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PubMed2005

Sexual risk behaviour among the youth in the era of HIV/AIDS in South Africa.

The paper discusses factors associated with sexual risk behaviour, i.e. failure to use condoms consistently during sexual intercourse, among unmarried sexually experienced youths in South Africa. Data from the 'Transitions to Adulthood in the Context of AIDS in South Africa' surveys of 1999 and 2001 were analysed to identify factors associated with high sexual risk behaviour among the youth. The multinomial regression models for male and female youths were fitted separately for the 1999 and 2001 data sets. The results show increasingly consistent use of condoms during sexual intercourse and that high sexual risk behaviour among youths is predominantly determined by social factors such as 'ever-pregnant' or 'ever made pregnant', 'ever given something for sex', age of sexual partner, currently in school, pressured by friends to have sex, peer influence on safe sex and education level for males. There is evidence that availability of contraception information is important in strategic interventions that seek to change the sexual behaviour of the youth in South Africa.

Adolescent↗

PubMed1989

Economics of health in South Africa: past, present and future.

Some of the background to the present structure of medicine in South Africa, an outline of some economic aspects of our current (inadequate) health care service and tentative suggestions regarding the directions in which our health services should be moving to facilitate the legitimization (political) and accumulation (economic) processes required to meet the needs and demands of all the people of an internationally recognized, just and free South Africa are presented.

Community Health Services↗

PubMed1997

The causes of childhood blindness in South Africa.

OBJECTIVES: 1. To ascertain the causes of severe visual impairment and blindness in children in schools for the blind in South Africa. 2. To determine the major avoidable causes. 3. To determine causation by ethnic group. DESIGN: A cross-sectional survey, undertaken at 15 of the 16 schools for the blind in South Africa, during May-September 1996, using standard WHO methodology. SUBJECTS: Children less than 16 years of age on May 1996. RESULTS: Of 1,615 eligible children, 1,311 were examined. According to WHO categories of visual impairment, using the corrected visual acuity in the better eye, 30.4% of children were blind (< 3/60, BL), 12.6% had severe visual impairment (< 6/60-3/60, SVI), 42.3% were visually impaired (< 6/18-6/60), and 12.0% had no impairment (6/18 or better). The anatomical sites of SVI/BL in 564 children were: retina 38.5%; optic nerve 15.2%; cornea/phthisis bulbi 11.0% and glaucoma 6.7%. Aetiological categories of SVI/BL were: hereditary diseases 33.0%; intra-uterine factors 0.9%; perinatal conditions 13.1%; acquired conditions of childhood 11.5%. In 41.5% the underlying cause could not be determined. In 38.8% of children with SVI/BL the cause was avoidable, i.e. preventable or treatable. The main causes varied between ethnic groups, the major difference being the higher proportion of retinopathy of prematurity in white and Indian children. CONCLUSIONS: The study suggests that 38.8% of causes of SVI or blindness in children in schools for the blind in South Africa are avoidable, and that specific control measures need to be targeted at different ethnic groups.

Animals↗

PubMed2026

The impact of alcohol sale restrictions on unnatural deaths during the COVID-19 pandemic in Johannesburg, South Africa.

The COVID-19-related restrictions on the sale of alcohol in South Africa presented a unique opportunity to examine the association between alcohol availability and the prevalence of unnatural deaths. The study sample included all unnatural deaths investigated by the Johannesburg Forensic Pathology Services Medico-Legal Laboratory during the four COVID-19 alcohol restriction periods compared to the same time periods in the previous year when there were no restrictions. When alcohol sales were initially prohibited, there was a 54.2% decrease in cases of unnatural deaths (p < 0.05), suggesting a link between alcohol use and the occurrence of such deaths. Over all four periods of alcohol sale bans, there was a total reduction of unnatural deaths by 26.4% with declining frequencies in all demographics. There were significant decreases (p < 0.05) in the frequency of deaths in males, Black and Coloured individuals, and the 21-40 years age group. Deaths whose circumstances were a result of motor vehicle accidents, pedestrian vehicle accidents, and firearm discharges decreased significantly (p < 0.05). The cause of death due to blunt forces trauma and gunshot wounds also significantly decreased (p < 0.05). This study highlights the significant impact alcohol consumption has on mortality in South Africa.

Humans↗

PubMed2003

Trauma care systems in South Africa.

AIM: To provide an overview of the provision of trauma care in South Africa, a middle income country emerging into a democratic state. METHODS: Literature review. CONCLUSIONS: South Africa is gripped by an almost hidden epidemic of intentional and non-intentional injury, largely driven by alcohol and substance abuse, against a background of poverty and rapid urbanisation. Gross inequities exist in the provision of trauma care. Access to pre-hospital care and overloading of tertiary facilities are the major inefficiencies to be addressed. The burden of disease due to trauma presents unique opportunities for reconstruction and clinical research.

Accidents↗

PubMed1997

Prevalence, epidemiology and geographical distribution of Sporothrix schenckii infections in Gauteng, South Africa.

Sporotrichosis is a subcutaneous fungal infection caused by the traumatic implantation of the dimorphic, pathogenic fungus, Sporothrix schenkii. It constitutes the most common subcutaneous fungal infection in the general population in South Africa. Sporotrichosis in South Africa dates back to 1914, when the disease was first diagnosed in the gold mines. Occupational and recreational circumstances of infection are well established, and the environmental requirements for contracting the disease are better understood. Sporotrichosis cases were recorded from 42 suburbs in the greater Pretoria area as well as from 23 towns outside the Pretoria municipal boundary. It occurred in 154 patients with ages ranging from less than 1 year to 90 years old, with males predominating. Females in the area seemed to be at lesser risk, mainly becoming infected through gardening injuries, insect bites or other minor injuries due to outdoor activities. Exposure to possible sources of the fungus, either from recreational or occupational activities in males, was the main determining factor in acquiring the disease. The lymphocutaneous and localized forms of the disease were most often recorded. Our study indicates that, while there is no pronounced seasonal variation, the onset of the disease seemed to be mainly in the cooler and dryer months of the year.

Adolescent↗

PubMed2003

Temperature-suitability maps for schistosomiasis in South Africa.

The results of parasitological surveys have shown that both urinary and intestinal schistosomiasis occur widely among the human residents of South Africa. The national data on both diseases have now been incorporated into a geographical information system, to develop new maps based on defined temperature constraints. The disease data, obtained from a 'hard-copy' atlas of schistosomiasis, were used as a template to select temperature regimes that were (1) suitable and (2) unsuitable for the transmission of schistosomes to humans in South Africa. The regimes were derived from the published results of investigations in which the biology of larval schistosomes (i.e. schistosome transmission) was related to temperature in South Africa. Those regimes that were based on the estimated temperature minima for transmission corresponded more closely to the disease-distribution data than those based on the corresponding maxima. An estimate of the number of children living in the climate-suitable areas was made but, within the context of the spatial methodology used and the limitations of the available disease data, it was not possible to predict the prevalences of schistosomiasis.

Adolescent↗

PubMed1997

The epidemiology of incomplete abortion in South Africa. National Incomplete Abortion Reference Group.

OBJECTIVE: To describe the epidemiology of incomplete abortion (spontaneous miscarriage and illegally induced) in South Africa. DESIGN: Multicentre, prospective, descriptive study. SETTING: Fifty-six public hospitals in nine provinces (a stratified, random sample of all hospitals treating gynaecological emergencies). PATIENTS: All women of gestation under 22 weeks who presented with incomplete abortion during the 2-week study period. MAIN OUTCOME MEASURES: Incidence of, morbidity associated with and mortality from incomplete abortion. MAIN RESULTS: An estimated 44686 (95% CI 35633-53709) women per year were admitted to South Africa's public hospitals with incomplete abortion. An estimated 425 (95% CI 78-735) women die in public hospitals from complications of abortion. Fifteen per cent (95% CI 13-18) of patients have severe morbidity while a further 19% (95% CI 16-22) have moderate morbidity, as assessed by categories designed for the study which largely reflect infection. There were marked inter-provincial differences and inter-age group differences in trimester of presentation and proportion of patients with appreciable morbidity. CONCLUSIONS: Incomplete abortions and, in particular, unsafe abortions are an important cause of mortality and morbidity in South Africa. The methods used in this study underestimate the true incidence for reasons that are discussed. A high priority should be given to the prevention of unsafe abortion.

Abortion, Incomplete↗

PubMed2006

A brain-behaviour initiative for South Africa: the time is right.

BACKGROUND: Many have advocated for science and health research in developing world settings. However, there has been less focus on the value of basic and clinical neuroscience research in this context. The current paper focuses on the relevance of a brain-behaviour research initiative in South Africa. METHODS: Workshops sponsored by the University of Cape Town Research Office and by the National Research Foundation have recently focused on the state of South African basic and clinical neuroscience, and on how to strengthen research in these areas. The context of the discussion included national science and health priorities, as well as local research opportunities. RESULTS: Neuropsychiatric disorders account for the second largest proportion of the burden of disease in South Africa, but receive relatively little research funding. There is a critical need for research, and there are unique research opportunities, in areas such as trauma and resilience, impulsive behaviour (eg violence, sexual risk taking, and substance abuse), and neuroAIDS. Basic, clinical, and systems research can all make important contributions. CONCLUSION: There is a need to apprise policy-makers in developing world countries such as South Africa of the need for increased expenditure on basic and clinical neuroscience research. Local and international collaboration may be useful in increasing research capacity in South Africa, and ultimately in improving mental health services.

Mental Health↗

PubMed1980

Medical informatics: developments in West Germany and South Africa.

Comparisons are made between medical information systems in West Germany and South Africa. In both countries the costs and importance of medical information systems dictate that a methodological approach is essential in order to obtain a solution for a particular environment. The special implications for South Africa are (i) to work from user requirements to computer system, rather than the reverse; (ii) to institute training programmes for the professionals required to organize and staff such systems; and (iii) to prepare the groundwork for medical information systems by scrutinizing the existing types, amounts, flows and uses of medical information.

Computers↗

PubMed2005

The impact of the HIV/AIDS epidemic on hospital nurses in KwaZulu Natal, South Africa: nurses' perspectives and implications for health policy.

During a stay in South Africa in 2002-2003, we learned that public sector nurses dealt with serious community and workplace impacts from the HIV/AIDS epidemic; and were reluctant to report occupational exposures to HIV or take a short-course of antiretroviral post-exposure prophylaxis to prevent HIV infection. In May 2003, in South Africa's KwaZulu Natal province, we explored perspectives of 34 public hospital nurses in nine group interviews on workplace safety; the impact of HIV/AIDS on nurses' work environments; and, hospital and government policy. The information they provided illustrates that the views of nurses are vitally important to policy-making. We conclude that seeking nurses' views and involving them in policy processes could contribute to worker health, to addressing the dramatic shortage of nurses, recently identified as the largest threat to providing HIV/AIDS treatment in sub-Saharan Africa, and to improving quality of care.

Government Regulation↗

PubMed1997

Ethnolinguistic vitality under a new political dispensation in South Africa.

The dimensions and group expectations of ethnolinguistic vitality in the new South Africa were investigated in random samples of 460 Whites (347 Afrikaans-speaking; 113 English-speaking) and 466 Blacks. By means of a factor analysis, 5 factors were distinguished: Institutional Support, Group Status and Power, Maintenance of Identity, Maintenance of Symbols, and Threat to Identity. The expectations of groups differed significantly in regard to the dimensions of ethnolinguistic vitality. Relationships between these dimensions and other variables and the implications of the findings were discussed against the background of sociopolitical and economic changes in South Africa.

Adolescent↗

PubMed1993

African urbanization in metropolitan South Africa--differential urbanization perspectives.

"As a potentially important urban development policy consideration, attention is focused in this paper on differential urbanization trends in South Africa at the metropolitan level. Recent informal urban settlement patterns of the African population within the major metropolitan areas are contrasted against these differential urbanization trends to determine the implications of both for residential development in the metropolitan areas during the post-apartheid era."

Africa↗

PubMed1994

[The midwife in South Africa. Part I--The practice of the midwife].

Part 1, of a two part series on the dilemma of the midwife in South Africa, deals with the practice of the midwife. It is difficult to estimate the number of practicing midwives, as they form part of the general nursing register. Also midwifery is part of the basic nurse training and is not taught as a separate entity. The midwife in South Africa practices in the areas of primary health care, hospitals, clinics, mobile clinics, homes and MOU's. The governments commitment to PHC will likely result in most midwives practicing in this area. Problems are high maternal deaths, shortages and maldistribution of midwives in an urban/rural context and the fragmentation and poor coordination of the health services. The safe motherhood initiative of the WHO has been adopted, there are recommendations that midwifery education be separated from general nurse education, and that clinical skills be strengthened. Midwifery services in South Africa do not fulfill the basic criteria for a PHC service.

Humans↗

PubMed2006

Suicide mortality in South Africa: a city-level comparison across socio-demographic groups.

BACKGROUND: South Africa offers a valuable study environment to assess the impact of political and social changes on health. Increasing urbanisation has led to a focus on city development and its effect on its residents. The study assesses whether sex- and race-specific suicide rates differ across six of South Africa's major cities. Regional differences may reflect varying contextual and individual underlying mechanisms. Those need to be understood for appropriately targeted prevention efforts. METHODS: Suicide mortality data (n=4,946) for the six cities between 2001 and 2003 were used to assess whether there are differences in rates for age-standardised race and sex groups across cities and whether these differences are constant across cities. The overall age-standardised rates for the six cities was 25.3/100,000 for men and 5.6/100,000 for women. RESULTS: Suicide rates are most often highest among whites and men, but both the magnitude and distribution of suicide vary considerably for different race and sex groups within and across cities. There is a strong association between the method of suicide used and the city. CONCLUSIONS: Despite some common trends in the suicide profile across South African cities, city does matter for the magnitude and distribution of suicide mortality across race and sex groups and for the method of suicide used. The need for locally based suicide research investigating possible reasons for these differences is highlighted.

Adult↗

PubMed2006

Cultural similarities and differences between a sample of Black/African and colored women in South Africa: convergence of risk related to substance use, sexual behavior, and violence.

South Africa is one of the six southern African countries where the HIV levels for childbearing women are 20% or higher. We conducted two focus groups aimed at developing an understanding of the intersections of substance abuse, sexual behavior, and violence affecting the lives of women of color in Cape Town, South Africa. Both Colored and Black/African participants reported using cannabis, methaqualone, and alcohol, although they differed on other drugs used. Black/African women also used heroin, and crack cocaine, whereas Colored women used methamphetamines. For participants in both groups, relationships with men affected sexual and substance use risk behaviors. Although the Black/African women did not trust men to use condoms, the Colored women in the study believed that almost all men use condoms. Both groups of women reported high rates of violence, with Colored participants reporting more gang violence and woman-on-woman violence compared with Black/African participants. The paper discusses these issues, as well as the implications for adapting a culturally specific, brief woman-focused HIV prevention intervention for the South African context.

Adult↗

PubMed1979

Gaucher's disease in South Africa.

The adult non-neuropathic form of Gaucher's disease has been identified in 32 patients in 25 Ashkenazi Jewish kindreds in South Africa. The minimum prevalence in this population is 1 in 5000, with a gene frequency of 0.014 and a carrier rate of 1 in 36. On correction for bias resulting from possible under-ascertainment, these minimum figures become 1 in 4000, 0.0166, and 1 in 30, respectively. Confirmation of autosomal recessive inheritance was obtained by segregation analysis by the 'a priori' and 'simple sib' methods. The Ashkenazin of South Africa have their origins in Lithuania and it is evident that the high gene frequency in South Africa is a reflection of the genetic constitution of the immigrant population. The localisation of the Gaucher gene to Lithuania represents a further step in the determination of the early geographic distribution of the genetic disorders of the Jewish race.

Gaucher Disease↗

PubMed2004

'White liquor hits black livers': meanings of excessive liquor consumption in South Africa in the second half of the twentieth century.

Four years into South Africa's first democracy, the African National Congress Youth League, with the help of the liquor industry's Social Aspects of Alcohol Committee drafted a policy to prevent substance abuse in black communities. They declared that alcohol was 'often not used in a socially acceptable way'. Concerned not so much with post-apartheid policy as with making sense of what socially acceptable alcohol usage might mean, this article explores narratives of alcohol use and abuse in South Africa in the second half of the twentieth century. It demonstrates that while multiple understandings of excess in alcohol consumption were articulated, those notions tied to particular constructions of racial difference prevailed. Ideas pairing drinking habits with race were given effect by state institutions. By tying drinking habits to 'race' and by locating 'race' in a social hierarchy, state institutions determined access to liquor and welfare services. By naturalising Africans as heavy drinkers, the state justified its sale of liquor to African men while denying the need for rehabilitation in the event of alcoholic dependence. By placing 'coloured' closer to 'white' in its racial order, the apartheid state found cause to extend limited rehabilitation services to those designated 'coloured'. By tying liquor revenues to apartheid administration, the ruling regime exonerated its policy of excluding blacks from the retail liquor trade even after lifting prohibition in 1962. This policy encouraged rampant illicit liquor dealing, created a social environment in which alcoholic excess, particularly after 1976, reached new proportions and generated new and dangerous meanings of socially acceptable drinking. Against the grain of these dominant discourses of racially designated meanings of drinking, African people forged a more complex set of practices and meanings not rendered any clearer by the ANC Youth League's discourse of acceptable and unacceptable usage.

Alcohol Drinking↗