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PubMed2003

A step too far? Making health equity interventions in Namibia more sufficient.

BACKGROUND: Equality of health status is the health equity goal being pursued in developed countries and advocated by development agencies such as WHO and The Rockefeller Foundation for developing countries also. Other concepts of fair distribution of health such as equity of access to medical care may not be sufficient to equalise health outcomes but, nevertheless, they may be more practical and effective in advancing health equity in developing countries. METHODS: A framework for relating health equity goals to development strategies allowing progressive redistribution of primary health care resources towards the more deprived communities is formulated. The framework is applied to the development of primary health care in post-independence Namibia. RESULTS: In Namibia health equity has been advanced through the progressive application of health equity goals of equal distribution of primary care resources per head, equality of access for equal met need and equality of utilisation for equal need. For practical and efficiency reasons it is unlikely that health equity would have been advanced further or more effectively by attempting to implement the goal of equality of health status. CONCLUSION: The goal of equality of health status may not be appropriate in many developing country situations. A stepwise approach based on progressive redistribution of medical services and resources may be more appropriate. This conclusion challenges the views of health economists who emphasise the need to select a single health equality goal and of development agencies which stress that equality of health status is the most important dimension of health equity.

Journal Article↗

PubMed1996

Brief communication: new primate remains from the Miocene of Namibia, southern Africa.

Miocene primates from southern Africa are extremely rare. For this reason we wish to place on record several interesting new fossil primate specimens recently recovered from the Miocene sites of Berg Aukas and Harasib in the Otavi Mountain region of northern Namibia. The new finds consist of a virtually complete atlas vertebra from Berg Aukas attributable to the hominoid Otavipithecus namibiensis and two teeth and four postcranial fragments from Harasib referrable to Cercopithecoidea. The atlas vertebra exhibits anatomical characteristics intermediate between those of modern cercopithecoids and hominoids which may be indicative of a transition from pronograde to orthograde postures. The cercopithecoid remains show that the earliest Old World monkeys known from southern Africa were small, approximately the size of vervet monkeys. These new specimens are important because they provide the first evidence relating to possible positional behaviors of Otavipithecus and the earliest fossil record of cercopithecoids from southern Africa.

Animals↗

PubMed1996

Outcome of children treated for cancer in the Republic of Namibia.

The data of a survey undertaken to record all cases of childhood cancer in Namibia from 1983 to 1988 were analyzed to estimate 5-year survival rates. The projected survival rate for 150 children with cancer was 37% with no difference between boys and girls. The calculated survival rates for most of the tumor groups were poor with the exception of Wilms' tumor which had a 5-year survival rate of 76%. The zero survival rate of children with malignant bone disease may have been due to inadequate treatment. Neuroblastoma and retinoblastoma presented with advanced disease which contributed to the poor survival rates of 13% and 46%, respectively. The overall survival rate for lymphoma of 53% and 39% for all leukemias compares poorly with the rates obtained in industrialized countries. The relatively poor 25% survival rate in tumors of the central nervous system (CNS) may partly be due to the long delay between the initial diagnosis and the institution of appropriate treatment for raised intracranial pressure and for the tumor. Both cure and long-term follow-up are difficult to achieve in a developing country. Improved early diagnosis and appropriate treatment are necessary to improve survival rates.

Child↗

PubMed1980

Brachymesophalangia V in Hottentot and "Cape Colored" children in Namibia (South West Africa) and South Africa.

In order to determine the incidence of Brachymesophalangia V, an inspectional and metrical analysis was made of radiographs of 67 Nama-speaking Hottentots aged 2 to 17.5 years, and 210 Rehoboth Basters (in Namibia) and Cape Colored children (near Cape Town) aged 1.5 to 21 years. None of the children displayed cone-shaped epiphysis or early union, and none showed Brachymesophalangia V. It was confirmed that the incidence of Brachymesophalangia V is considerably higher in Mongoloid populations than in Caucasoid or Negroid groups, including Hottentots.

Adolescent↗

PubMed1995

Fossil Homo femur from Berg Aukas, northern Namibia.

The proximal half of a hominid femur was recovered from deep within a paleokarst feature at the Berg Aukas mine, northern Namibia. The femur is fully mineralized, but it is not possible to place it in geochronological context. It has a very large head, an exceptionally thick diaphyseal cortex, and a very low collodiaphyseal angle, which serve to differentiate it from Holocene homologues. The femur is not attributable to Australopithecus, Paranthropus, or early Homo (i.e., H. habilis sensu lato). Homo erectus femora have a relatively longer and AP flatter neck, and a shaft that exhibits less pilaster than the Berg Aukas specimen. Berg Aukas also differs from early modern femora in several features, including diaphyseal cortical thickness and the degree of subtrochanteric AP flattening. The massive diaphyseal cortex of Berg Aukas finds its closest similarity within archaic H. sapiens (e.g., Castel di Guido) and H. erectus (e.g., KNM-ER 736) samples. It has more cortical bone at midshaft than any other specimen, although relative cortical thickness and the asymmetry of its cross-sectional disposition at this level are comparable with those of other Pleistocene femora. The closest morphological comparisons with Berg Aukas are in archaic (i.e., Middle Pleistocene) H. sapiens and Neandertal samples.

Adult↗

PubMed2006

["Ear camp" for children in Namibia. A field report].

BACKGROUND: Ear surgery is urgently needed in northern Namibia as many children cannot even be provided with hearing aids due to chronically discharging ears, not to forget possible complications of untreated cholesteatoma. METHODS: During the two "ear camps" in 2003 and 2004, 61 children (median age 12 years) and one adult were operated, mainly for (sub)total defects of the tympanic membrane (81 tympanoplasties). PATIENTS AND RESULTS: We performed tympanoplasty type I in 33 cases and type III in 48 cases, mostly using autogenous ossicles and titanium prostheses. In 39 cases, an antrotomy or mastoidectomy was also performed, while in six cases an open cavity had to be created because of a cholesteatoma. The tympanic membrane was reconstructed using tragal cartilage with overlapping perichondrium in an "underlay-technique". The closure rate after 6 months was about 80%, the average improvement in air conduction thresholds in the frequencies between 250 and 4,000 Hz was 13 dB. CONCLUSIONS: An "ear camp" can only be realised with the financial and material help of companies and private supporters. Therapy must be adapted to the limited local possibilities. The use of tragal cartilage with overlapping perichondrium is a safe technique for the reconstruction of a stable tympanic membrane. We have started to instruct local doctors in pre- and postoperative care in ear surgery in order to develop local competence. This will be continued in the next "ear camp".

Child↗

PubMed2005

Prevalence of theileriosis in Red Hartebeest (Alcelaphus buselaphus caama) in Namibia.

A total of 23 blood samples from Red Hartebeest and 28 ticks of the subspecies Rhipicephalus evertsi were collected in Namibia during the summer 2003. For a Piroplasmida species, Theileria sp 95.7% of blood and 50.0% of tick samples (all R. e. mimeticus, none of R. e. evertsi were carrying the pathogen) were PCR positive. Sequencing showed infection from a re-emerging mild species of Theileria phylogenetically different from other African Theileria species such as Theileria parva, T. buffeli, T. annulata, T. taurotragi or T. mutans.

Animals↗

PubMed2004

Land degradation monitoring in Namibia: a first approximation.

This paper presents development of a first approximation of a Namibian, national level, land degradation monitoring system. The process involved a large number of stakeholders and led to the definition of four primary indicators that were regarded as related to land degradation in Namibia: population pressure, livestock pressure, seasonal rainfall and erosion hazards. These indicators were calculated annually for the period 1971-1997. Annual land degradation risk maps were produced for the same period by combining the indicators. A time series analysis of results generated by indicators was undertaken at two sites. The analysis revealed a general trend towards an increased land degradation risk over the period 1971-1997. A decrease in annual rainfall and an increase in livestock numbers caused this negative trend at one site, while decreased annual rainfall and increased human population were the causes at a second site. Evaluation of resulting maps through direct field observations and long-term monitoring at selected study sites with different conditions relevant for the indicators defined, is an essential next step.

Animals↗

PubMed2006

Long term fire scar monitoring with remote sensing in Northern Namibia: relations between fire frequency, rainfall, land cover, fire management and trees.

A cost-effective method was developed to map fire scars on Quicklooks of Landat TM imagery. The method was compared with a full resolution Landsat image using visual interpretation and supervised classification using the Maximum Likelihood procedure, resulting in a high degree of agreement between methods. A long time series of fire scars was developed using all available Landsat Quicklooks between 1989 and 2001 for an area of 63000 sq km in north-east Namibia. Between 27 and 51% of the study area burned annually, while only 10% of the area did not burn between 1989 and 2001. Not-burned areas were mainly settled areas and permanent wetlands. 33% of the area burned between 5 and 7 times during the 13 years indicating a high frequency overall. Rainfall and livestock had little influence on burned areas. In 1996 formal fire management started in a portion of the study area consisting of building firebreaks and holding awareness programs. A comparison of burned areas before and after the intervention started allowed evaluating its effectiveness. The area where the formal fire management program was undertaken showed a significant decrease in burned area. It is suggested that awareness campaigns rather than firebreaks contributed to this decrease. Selected tree population data were compared with fire frequencies. Differences in tree occurrence, regeneration, and stem diameter distributions between low and high fire frequencies could be detected and explained with known responses of the species to fire. This suggests that the observed time series is representative of a long-term fire regime in the area.

Biomass↗

PubMed1987

Onyalai in Namibia. Clinical manifestations, haematological findings, course and management of 103 patients in the Kavango territory.

A series of 103 patients with onyalai, from the Kavango territory in Namibia, is recorded. In addition to haemorrhagic bullae in every patient, epistaxis was present in 53, petechiae and ecchymoses in 23, subconjunctival or scleral bleeds in 17, melaena and haematemesis in 16, haematuria in 12 and menorrhagia in 9 patients. The male:female ratio was 43:60. The ages varied from 6 months to 70 years with a peak incidence between 11 and 20 years. The mean platelet count was 22 X 10(9)/l and the mean haemoglobin 10.3 g/dl on admission. The management consisted of the correction of blood loss. A splenectomy in 2 patients with uncontrollable haemorrhage caused a rise in the platelet count. Prednisolone and intravenous gammaglobulin had the same effect on the platelet count as ascorbic acid (placebo). Vincristine sulphate appeared to benefit some patients. One year's observation of 21 patients demonstrated that 80% of cases will have chronic thrombocytopenia with a risk of intermittent attacks of acute haemorrhage. Six patients died, 4 of cerebral haemorrhage and 2 of haemorrhagic shock. Four infants born to mothers with onyalai were normal at birth. Onyalai should be clearly distinguished from classical idiopathic thrombocytopenic purpura, a disease also encountered in Africa.

Adolescent↗

PubMedDate not supplied

Intestinal helminths of hospital patients in Kavango territory, Namibia.

In-patient and out-patient faeces examination reports from the State Hospital in Rundu, Kavango territory, Namibia, gave some idea of the prevalence of helminthic infections. 4174 specimens were examined over a 29-month period. Hookworm (6.8%) and Strongyloides (2.7%) were the most common infections, followed by Hymenolepis nana (1%), Schistosoma mansoni (1%) and Taenia sp. (0.9%). S. mansoni was more common in males than females, hookworm more common in females than males, and H. nana was most common in the pre-school group. Promiscuous defaecation on the banks of the Okavango river provides ideal situations for the development and transmission of hookworm and Strongyloides, while fishing and other activities enhance the transmission of S. mansoni infections. Larva migrans, probably due to Ancyclostoma braziliense or A. caninum, is common in the area. Studies involving schoolchildren would provide more accurate assessment of the prevalences of the various helminths.

Adolescent↗

PubMedDate not supplied

Onyalai at Rundu, Namibia 1981-1988: age, sex, morbidity, mortality and seasonal variation of 612 hospitalized patients.

Of 51,263 admissions to Rundu State Hospital in Namibia between 1981 and 1988, 612 (1.19%) were diagnosed as onyalai. The annual incidence varied between 0.96% and 1.66% of all admissions. The female to male ratio was 3:2. The mean age at presentation was 24.8 years (range 6 months to 80 years) and the mean hospital stay (and duration of clinical bleeding) for the years 1981 to 1982 and 1985 to 1988 was 7.68 d (range 1-38 d). Although the highest number of cases occurred during the months March, April and May a statistically significant monthly variation was not found. The treatment policy of commencing intravenous fluid on admission and a blood transfusion whenever the haemoglobin dropped below 10 g/dl in patients with active bleeding was associated with a mortality rate of 2.78% compared to 9.8% in cases recorded up to 1981.

Adolescent↗

PubMedDate not supplied

Serological markers of hepatitis B virus and certain other viruses in the population of eastern Caprivi, Namibia.

Serum samples from 475 male and 420 female subjects from the population of eastern Caprivi, the north-easternmost territory in northern Namibia, were examined for the presence of hepatitis B surface antigen (HBsAg), antibodies to HBsAg (anti-HBs) and hepatitis B core antigen (anti-HBc). There appeared to be a rapid acquisition of antibodies to the different markers in childhood, reaching maximum values in the 20-24 year age group. The prevalence rate for all markers was lower in eastern Caprivi than in Kavango, an area 180 km to the west. The reason for these differences is unclear. It is postulated that the hut tampan tick (Ornithodoros moubata), which has previously been shown to be implicated in the transmission of hepatitis B virus in Kavango, is more common in the latter territory than in eastern Caprivi. Huts in eastern Caprivi are usually better constructed than in Kavango, where reeds are commonly used as building material. Tampans lodge between the reeds and are more difficult to eradicate. West Nile virus was the most common of the arboviruses found in our sero-prevalence studies.

Antibodies, Viral↗

PubMed1988

The political economy of health care: colonial Namibia 1915-1961.

The political economy of health care services in colonial Namibia during 1915-1961 closely reflected the extreme racial and class imbalance of power in a conquest state. The colonial power allocated to the indigent nine-tenths, the poorest nine-tenths of the people, an average 43% of the health care budget between 1922 and 1954. The League of Nations mandate proved toothless in pressuring the Mandatory power to rectify this or other inequalities.

Black or African American↗

PubMed2005

Management of an "Ear Camp" for children in Namibia.

OBJECTIVE: In this publication, we present our experiences with managing an "Ear Camp" in northern Namibia, where the population is predominantly black. Medical coverage for ear problems is poor in this part of the country. METHODS: Within 10 days, 38 children (median age 12 years) were operated mainly for (sub) total defects of the tympanic membrane. In two cases, an open cavity had to be created because of a cholesteatoma. We performed a tympanoplasty type I in 18 cases and a tympanoplasty type III in 20 cases. Additionally, in 8 cases an antrotomy and in another 8 cases a mastoidectomy was performed. The ossicular chain was reconstructed with a titanium-PORP (14 cases), a titanium-TORP, interposition of the head of the malleus or a cartilage columella (one case each) or by placing the reconstructed tympanic membrane directly onto the head of the stapes (three cases). The tympanic membrane was reconstructed by the use of tragal cartilage with overlapping perichondrium in underlay-technique. RESULTS: Thirty-one children could be followed up. A defect of the tympanic membrane was found in five cases because of continuous purulent discharge. The average improvement of air conduction thresholds in the frequencies between 250 and 4000 Hz was 15 dB. CONCLUSIONS: Surgical techniques, antibiotic treatment and perioperative management have to be adapted to limited possibilities of pre-treatment and aftercare. As development aid should support people to look after themselves, we started to instruct local doctors with regard to pre- and postoperative care in ear surgery. Training of the local doctors will be continued in our next "Ear Camp" in 2004.

Adenoidectomy↗

PubMed2006

Stigma, fatigue and social breakdown: exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia.

It is generally assumed that caring is a substantial burden upon households afflicted by HIV/AIDS. However, as a 'private' household responsibility, little is known about the experiences of either those who provide the care, or those receiving care, despite the fact that the process may extend over several years and may have a greater impact upon the livelihood security and well-being of the household than the actual death of the ill person. Drawing upon data collected through solicited diaries, this paper explores how illness and the daily and long-term duties of caring amongst a sample of households in the Caprivi Region of Namibia impacts upon the physical and psychological well-being of ill people and their carers. While optimism and enhanced well-being were recorded during periods of illness remission, AIDS-related illnesses invariably result in periods of sickness and dependency. This results in disempowerment and lowered self-esteem, and decreased well-being amongst ill people. This paper argues that the increasing dependency of the ill person, widespread pressure to maintain household integrity through 'seeing for yourself', i.e. being self-sufficient, or at least contributing to reciprocal support networks, and the stigma attached to HIV/AIDS can result in considerable intra-household tension and breakdown of key social support networks.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Outbreak of paralytic poliomyelitis in Namibia.

The last confirmed case of poliomyelitis in Namibia had been reported in 1988. However, between Nov 8, 1993, and Jan 7, 1994, 27 cases of paralytic poliomyelitis were confirmed in the country. The outbreak was limited to the south health region; at least 80% of infants in this region have received four doses of oral poliovaccine (OPV) by the age of 1 year. Acute flaccid paralysis (AFP) was the predominant clinical presentation during the outbreak. The patients' ages ranged from 13 months to 12 years; 24 were younger than 5 years. Of the 26 patients whose vaccine status was known, 14 had received four doses of OPV, 6 had one or two doses, and 6 no vaccine. Genotypic analysis showed 86% homology of outbreak isolates with a 1982 Namibian isolate and west African isolates. Factors that may have had a role in the outbreak include establishment of a pool of susceptible people, rapid urbanisation, inadequate sanitation, poor water supply, and possible endemicity of poliovirus in neighbouring areas. Epidemics can occur in areas of high vaccine coverage. Our findings emphasise the need to improve AFP surveillance activities and the estimation of vaccine coverage to identify areas of potential susceptibility for outbreaks.

Antibodies, Viral↗

PubMed1996

Analysis of lymphocytes from uranium mineworkers in Namibia for chromosomal damage using fluorescence in situ hybridization (FISH).

Workers in the open pit uranium mine in Namibia appear to suffer from health problems including malignant diseases at a much higher prevalence when compared with the general population. The objective of the present study was to determine whether long-term exposure to low-dose uranium increases the risk of biological radiation damage which could lead to malignant diseases. In order to investigate this risk, we measured the relative frequency of chromosome alterations using Fluorescence in situ hybridization (FISH). A representative cohort of 11 non-smoking miners, were compared to a control group of 9 individuals with no occupational history in mining. We determined a significant increase in chromosome aberrations in the circulating lymphocytes of miners versus the non-smoking controls (p = 0.0000096). Therefore, we concluded that these uranium exposed miners are at an increased risk to acquire genetic damage, which may be associated with an increased risk for malignant transformation.

Adult↗