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PubMed2006

Modeling the impact of a partially effective HIV vaccine on HIV infection and death among women and infants in South Africa.

OBJECTIVE: To assess the potential impact over 10 years of a partially effective HIV vaccine in a cohort of 15-year-old adolescent girls in South Africa in terms of HIV infections and deaths prevented in mothers and infants. METHODS: A computer simulation was constructed using a population of all 15-year-old adolescent girls in South Africa followed for 10 years. A partially effective vaccine is introduced into this population with the ability to reduce the HIV incidence rates of the adolescents and vertical transmission to their infants through birth and breast-feeding. At the end of this 10 year period, the number of HIV infections and death prevented in adolescents and infants is analyzed. RESULTS: Using a 5% HIV incidence rate, a 50% effective vaccine decreases the number of HIV cases among adolescents by 57,653 (28.7%) and the number of cases among infants by 13,765 (28.9%) over 10 years. In addition, assuming a vaccine cost of $20 per dose, the vaccination program can save approximately $120 million for the South African government over 10 years. CONCLUSION: A partially effective HIV vaccine has an important role in HIV prevention in adolescents and infants in South Africa irrespective of other public policy implementations.

AIDS Vaccines↗

PubMed2001

HIV infection in general surgical patients at the Ga-Rankuwa/MEDUNSA complex South Africa.

OBJECTIVE: To assess the possible impact of HIV infection on the management of general surgical patients at the Ga-Rankuwa Hospital. DESIGN: A prospective study. SETTING: Ga-Rankuwa Hospital/Medical University of Southern Africa (MEDUNSA) Academic Complex, Pretoria, South Africa. SUBJECTS: Nine hundred and forty one patients admitted to general surgical wards. MAIN OUTCOME MEASURES: HIV infection and CD4 counts. RESULTS: Nine hundred and forty one patients admitted to general surgical wards from January 1966 to December 1997 were tested for HIV infection. Twelve per cent tested positive. HIV positive patients were significantly younger [33 +/- 10 versus 41 +/- 7 (men +/- SD) years, Chi-square = 51, p < 0.0001]. There was no correlation of HIV positivity to the patient's sex (p = 0.7). In forty three HIV positive patients treated surgically, mortality was attributed to HIV/AIDS in only one patient with a CD4 count of 47/ul who died following laparotomy for peritonitis. CD4 counts done during follow up in thirty one HIV positive patients revealed a count of < 500/ul in eleven patients. CONCLUSION: It is predicted that an increasing number of patients with HIV/AIDS will be admitted to general surgery wards of the Ga-Rankuwa Hospital. Surgeons are advised to take universal precautions to prevent HIV infection.

Adolescent↗

PubMed2005

Ulcerative balanitis and vulvitis of Dorper sheep in South Africa: a study on its aetiology and clinical features.

Ovine ulcerative balanitis and vulvitis in sheep of the Dorper breed has been observed in South Africa since 1979. Its aetiology has not been conclusively resolved, and there is some discrepancy in descriptions of its clinical features. In order to identify the pathogenic micro-organism/s that contribute to the occurrence of the disease, the microflora in the genital tracts of both clinically healthy and affected sheep were isolated and compared. Bacteriological examination of materials from affected and unaffected sheep resulted in the isolation of Arcanobacterium pyogenes from 44.2% and 17.2% of them respectively. This difference is statistically significant (P < 0.01). Seventy-four per cent of the isolates originated from severe clinical cases. Mycoplasmas were isolated from 49.3% of 116 clinically normal sheep and 78.2% of 104 affected sheep. There were significant differences in their rates of isolation in clinical groups (P < 0.05). Of all the mycoplasma isolates, Mycoplasma mycoides mycoides large colony variant (MmmLC) was isolated from 61.5% of clinically diseased sheep while 6.0% of the isolates were from apparently healthy animals (P < 0.05). The study threw light on the prevalence of mycoplasmas in the genital tract of apparently healthy sheep and, at the same time the identity of the mycoplasma pathogen associated with ulcerative balanitis and vulvitis was revealed. The findings of this investigation therefore confirmed the involvement of mycoplasma, particularly that of MmmLC large colony, in the disease in Dorper sheep in South Africa, and it was concluded that this microorganism is an important pathogen of balanitis and vulvitis in them. The study furthermore demonstrated a probable synergism between A. pyogenes and MmmLC. Finding these 2 organisms together occurred 53.4 times more frequently in the affected sheep than in the unaffected, which emphasises the probable multifactorial nature of the disease. The association between age and the presence of clinical signs was statistically significant. It was found that young sheep were more likely to have lesions than adult sheep. Clinical observations showed that the typical ulceration appears to be confined to the glans penis and lips of the vulva; no ulceration was observed on the shaft of the penis and prepuce or vaginal vestibule. In uncomplicated cases inflammation of the prepuce and vaginal vestibule is not a regular feature of the disease. Therefore the names ulcerative balanitis and vulvitis most accurately describe the nature of the disease in South Africa.

Age Factors↗

PubMed1998

The African monogenean gyrodactylid genus Macrogyrodactylus Malmberg, 1957, and the reporting of three species of the genus of Clarias gariepinus in South Africa.

Three different species of the genus Macrogyrodactylus Malmberg, 1957, collected from the gills and skin of Clarias gariepinus (Burchell, 1822) from the Middle Letaba Dam and Mokgoma-Matlala Dam in South Africa were examined and identified. This is the first record of a species of the genus in South Africa. The three species are M. congolensis (Prudhoe, 1957)--found on the skin, M. clarii Gussev, 1961 and M. karibae Douellou & Chishawa, 1995--found on the gills. The last species is elevated to the status of a species having been described previously as a subspecies of M. congolensis. The present study presents and discusses the value of some of the taxonomic characters which can be used to differentiate the species of the genus. The shape and size of the sclerites of the haptor are found to be the most reliable characters. Only four species of the genus, namely M. polypteri and the three above-named species are regarded to be valid. Three species, namely M. latesi Paperna, 1969, M. anabantii Paperna, 1973 and M. ctenopomii Paperna, 1973 are regarded as species inquirenda. Generic diagnoses, measurements and illustrations of the sclerites of the four valid species are presented and a key for their differentiation is provided. The development of the gyrodactylid population on C. gariepinus during the filling of the Middle Letaba Dam in South Africa is discussed.

Animals↗

PubMed2005

Veterinary immunology as colonial science: method and quantification in the investigation of horsesickness in South Africa, C. 1905-1945.

This article examines the practice of veterinary immunology in South Africa during the first half of the twentieth century through an analysis of research into a horsesickness vaccine at the Onderstepoort Veterinary Institute. From the early 1900s, Arnold Theiler prioritized research into horsesickness, by then defined as an insect-borne disease caused by an ultravisible virus. He succeeded in devising a means of prophylaxis using a simultaneous injection of infective blood and immune serum, but he discovered antigenically different strains of the virus, which could overcome the immunity produced by his treatment. The practical value of Theiler's methods was further limited by difficulties in standardizing the biological material used in immunization, the results of which remained too erratic for application on a large scale. No further advances were made until the 1930s, by which time Onderstepoort had been drawn more closely into international scientific networks. Using techniques derived from research into yellow fever in America and canine distemper in Britain, the Onderstepoort scientist Raymond Alexander invented a method of immunization that utilized the propagation of the horsesickness virus in the brains of mice. Alexander's methods, which were characterized by successful technical adaptation and innovation, depended upon methods of quantification first developed by Paul Ehrlich to standardize diphtheria antitoxin during the 1890s. During the 1940s, vaccination expanded rapidly in South Africa, and Onderstepoort later exported the vaccine and associated technology to other countries affected by horsesickness.

Academies and Institutes↗

PubMed1996

The defined daily dose as a measure of drug consumption in South Africa. A preliminary study.

OBJECTIVE: To perform a preliminary investigation into the us e of the defined daily dose (DDD) as a unit to measure drug utilisation in South Africa. The DDD methodology has been applied in many countries in Western Europe and in other parts of the world. However, research using the DDD method is still lacking in South Africa despite the important role that it can play in economic planning and the improvement of prescribing practices. DESIGN: A retrospective drug utilisation study using da ta from a medical aid. Consumption of selected central nervous system drugs in a formulary system was determined. SETTING: Doctors and patients located in an area of Port Elizabeth. PARTICIPANTS: The prescribing behavior of 50 dispensing doctors serving a homogeneous demographic and socioeconomic patient population was analysed. OUTCOME MEASUREMENTS: The DDD/1,000 registered patients/day, the cost per DDD and the relationship between the two units. RESULTS: Values for the DDD/1,000 registered patients/day were on average lower than international values, but similar trends were observed. The cost per DDD for antipsychotic and antidepressant drugs was on average higher than for hypnotic and anxiolytic drugs. There was an inverse relationship between the DDD/1,000 registered patients/day and the cost per DDD. CONCLUSIONS: The DDD methodology is a useful technique to enable drug consumption data to be measured and compared both nationally and internationally. It can be regarded as a valuable tool for the promotion of rational and cost-effective use of medicine in a future health care system for South Africa.

Central Nervous System Depressants↗

PubMed2000

Redressing dis-advantage: promoting vertical equity within South Africa.

This paper represents the first attempt to apply vertical equity principles to the South African health sector. A vertical equity approach, which recognises that different groups have different starting points and therefore require differential treatment, appears to offer an appropriate basis for considering how best to redress the vast inequities which exist in post-Apartheid South Africa. Vertical equity principles are applied in critically analysing two areas of recent policy action which are particularly relevant to health sector equity in South Africa, namely public-private sector cross-subsidies and the allocation of government resources between provinces. Despite a strong political commitment to redressing historical inequities, recent government policy actions in these two areas appear to fall short of desirable goals when viewed through a vertical equity lens. In particular, policies since the first democratic elections in 1994 have done little to reduce the extent of government subsidies to the private health sector, which serves a minority of the population. In addition, recent proposals for a Social Health Insurance will allow minimal cross-subsidies between high- and low-income earners and would not adequately redress the currently inequitable public-private cross-subsidies. With respect to the allocation of government resources between provinces, a vertical equity approach would suggest that the most historically dis-advantaged provinces have an even greater claim on government resources than reflected in the current formula, as developed by the Department of Finance. This paper also considers the potential benefits of engaging with societal views in determining what constitutes dis-advantage in the South African context, in order to identify those who should receive priority in resource allocation decisions. It concludes with a review of a number of practical steps that can be taken to draw vertical equity principles into policy action.

Black or African American↗

PubMed2006

Community attitudes towards sexual activity and childbearing by HIV-positive people in South Africa.

While the ability to lead a healthy sexual life and to choose whether and when to have children are well-established features of reproductive health and human rights, issues surrounding sexual activity and childbearing among HIV-infected women and men have received little attention in sub-Saharan Africa. We conducted a semi-structured, cross-sectional survey at 26 primary health care clinics in South Africa to investigate community attitudes towards sexual activity and reproduction by HIV-infected individuals. Of the 843 women interviewed, slightly less than half (43%, n = 361) thought that people living with HIV/AIDS should remain sexually active if they choose, while 13% (n = 113) said they thought that people living with HIV/AIDS should have children if they wished to do so. In multivariate analysis, negative attitudes towards both sexuality and childbearing were persistently associated with not knowing someone infected with HIV (p = 0.001 and 0.043, respectively). These findings suggest that the sexual and reproductive health rights of HIV-infected women and men may be an important target as part of efforts to reduce HIV/AIDS-related stigma. Health policies and services are required to reinforce the reproductive rights of HIV-infected individuals in South Africa and other countries in sub-Saharan Africa where HIV is most prevalent.

Adult↗

PubMed2001

The first five years of universal hepatitis B vaccination in South Africa: evidence for elimination of HBsAg carriage in under 5-year-olds.

South Africa implemented a vaccine against hepatitis B virus (HBV) into the Expanded Programme on Immunisation (EPI) in April 1995. The HBV vaccine is given at 6, 10, and 14 weeks, in parallel with OPV, DTP and Hib vaccines. This study assessed the impact of universal childhood HBV vaccination programme in reducing HBsAg carriage, in the first five years (1995--1999) since its implementation. In parallel, we investigated the current burden of HBV infection in mothers of vaccinees and the adult general population. A total of 598 babies (mean age=23.3 months) who received 3 doses of 1.5 microg/0.5 ml Hepaccine-B (Cheil) were recruited from the Northern Province (one of the nine provinces in South Africa). HBsAg, anti-HBs, anti-HBc, HBeAg and anti-HBe were tested using the IMx or Axsym kits (Abbott Laboratories). PCR assays were performed following established protocols. The overall seroprotection rate (i.e. anti-HBs titre> or =10 mIU/ml) was 86.8% (519/598) in vaccinated babies, while 13.2% had anti-HBs levels<10 mIU/ml. Seroprotection rates and geometric mean titres (GMT) decreased significantly with increasing age, possibly reflecting waning anti-HBs titre over time. Total HBV exposure (positive for either HBsAg, anti-HBs, or anti-HBc) was 31.0% (58/187) in mothers of vaccinees and 40% (72/180) in the adult general population. HBsAg carrier rate was virtually similar in both groups (3.2% in mothers of vaccinees vs. 3.3% in the general population). Against this background, no vaccine failures resulting in HBsAg and HBV DNA positivity were seen in vaccinated babies, including 6 babies born to HBsAg positive carrier mothers (one carrier mother was positive for HBeAg and HBV DNA). However, 0.9% (5/582) babies, aged between 8--11 months, tested positive for anti-HBc, all of whom had anti-HBs titres>10 mIU/ml and were negative for HBV DNA. Anti-HBc positivity was probably maternal in origin, or may represent sub-clinical averted HBV infections. It can be concluded that the HBV vaccine is highly effective within the framework of the South African EPI and already shows a positive impact in the elimination of HBsAg carrier rate in children<5 years.

Adult↗

PubMedDate not supplied

Successful public/private donation programs: a review of the Diflucan Partnership Program in South Africa.

A review of the partnership between Pfizer Inc. and the South African Ministry of Health to distribute free Diflucan (fluconazole) in the Diflucan Partnership Program (DPP) demonstrates that product donations may be a useful response to AIDS if they are coupled with efforts to build means of drug distribution and enhance professional healthcare capacity to treat patients. Equally important is the creation of a new set of productive working relationships between stakeholders who came to the project with different backgrounds and perspectives, as well as a frankly disparate set of objectives. A decision tree illustrates how these relationships were built into the DPP. This review concludes with a few lessons learned in providing medicines not only to South Africa, but also to the 77 other African countries now participating in the DPP. As the search for new treatments and vaccines continues, increasing access to existing medicines through targeted donations--including training and infrastructure support--is the most practical way for the health community to address the problem of ill health among the poor. In addition to a detailed analysis of the DPP, there is also a discussion of the benefits of a donation program that addresses the AIDS crises on a global scale. This review may serve as a blueprint for establishing programs that are successful in fighting AIDS and improving the lives of millions of people.

AIDS-Related Opportunistic Infections↗

PubMed2001

Implementing AIDS policy in post-apartheid South Africa.

In common with the rest of the Southern African sub-continent. South Africa is currently experiencing a serious HIV epidemic. When it came into power in 1994, the new, Mandela-led government immediately mobilised funds and adopted a far-reaching AIDS Plan for the country. However, the implementation of AIDS policy in the first four years after 1994 has been characterised by a lack of progress and a breakdown of trust and co-operation, both within government and between government and NGOs. This paper outlines the political context which shaped the development of the AIDS Policy, then examines the difficulties of implementing a comprehensive response to AIDS in a country undergoing restructuring at every level. It questions the notion of "inadequate political will" as an explanation for lack of progress. Involvement by politicians has, in fact, been experienced as a double-edged sword in South Africa, with inappropriate, "quick-fix" actions creating conflict and hampering a more longer-term, effective response. The paper also highlights the importance of groupings outside of government in promoting effective policy actions, and the types of leadership required to mobilise a broad range of actors around a common vision. It concludes by emphasising the need to develop approaches to policy implementation rooted in the possibilities and constraints of the local situation, rather than relying on universal blue-prints developed out of context.

Communicable Disease Control↗

PubMed2005

Refugia, dispersal and divergence in a forest archipelago: a study of Streptocarpus in eastern South Africa.

We describe a scenario of plant speciation across a relict forest archipelago in South Africa involving Pleistocene habitat expansion-contraction cycles, dispersal and adaptation to lower temperatures. This is the first population level study using molecular data in South African forests and has significant implications for conservation efforts in this area. Populations of the mesophytic forest floor herbs Streptocarpus primulifolius sensu lato and Streptocarpus rexii were sampled throughout their range in the naturally fragmented forests of eastern South Africa in order to investigate population genetic and phylogenetic patterns within the species complex, using nuclear microsatellites, nuclear ribosomal ITS (internal transcribed spacer) sequences and chloroplast genome sequences. S. primulifolius harbours high levels of genetic diversity at both the nuclear (mean HE = 0.50) and the chloroplast level (each population fixed for a unique haplotype). This is consistent with populations of these coastal species being Pleistocene relicts. In contrast, populations of S. rexii in cooler habitats at higher altitudes and lower latitudes harbour little or no nuclear genetic diversity (mean HE = 0.09) and most share a common chloroplast haplotype. The split of S. rexii from populations intermediate between the two species (S. cf. primulifolius) occurred between 0 and 0.44 million years ago according to the calibrated ITS phylogeny of the taxa. The low genetic diversity and homogeneity of S. rexii is congruent with this species having reached its current range during the Holocene. We found no evidence of monophyly of any of the taxa in this study, which we consider a consequence of recent evolution in a fragmented habitat.

Conservation of Natural Resources↗

PubMed2004

Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa.

Gender-based violence is a key health risk for women globally and in South Africa. The authors analyzed data from 1,395 interviews with women attending antenatal clinics in Soweto, South Africa, between November 2001 and April 2002 to estimate the prevalence of physical/sexual partner violence (55.5%), adult sexual assault by nonpartners (7.9%), child sexual assault (8.0%), and forced first intercourse (7.3%). Age at first experience of each type of violence was modeled by the Kaplan-Meier method, and Cox hazard models with time-varying covariates were used to explore whether child sexual assault and forced first intercourse were associated with risk of violent revictimization in adulthood. Child sexual assault was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.43, 95% confidence interval: 1.93, 3.06) and with adult sexual assault by a nonpartner (risk ratio = 2.33, 95% confidence interval: 1.40, 3.89). Forced first intercourse was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.64, 95% confidence interval: 2.07, 3.38) and nonsignificantly with adult sexual assault by a nonpartner (risk ratio = 2.14, 95% confidence interval: 0.92, 4.98). This study confirms the need for increased attention by the public health community to primary and secondary prevention of gender-based violence, with a specific need to reduce risk among South African adolescents.

Adolescent↗

PubMed1978

The future of veterinary services in the Republic of South Africa.

Future developments will depend mainly on new information generated by research and on effective application of preventive medicine. In the latter case, the various diagnostic centres in South Africa will have to be developed to their full extent, leading to the drawing up of computerised disease profiles and monitoring of the incidence of scheduled diseases. Dealing with these problems will require further knowledge to be generated by research. Problems of increasing drug, insecticide and acaricide resistance and problems of virus bionomics will call for attack at the molecular, biochemical, biophysical and immunological levels. This will demand adjustment of post-graduate veterinary education and of ever closer collaboration with scientists well-versed in the basic disciplines. Despite the argument that animal production will be ousted by crop production, the former, particularly in South Africa, is bound to develop and will call for more attention to the physiology of digestion and metabolism and to diseases of metabolism of ruminants. Concern is expressed that so few young veterinarians take up research as a career, as South Africa has many veterinary problems peculiar to itself.

Animals↗

PubMed1994

Monogenic primary hypercholesterolaemia in South Africa.

Familial hypercholesterolaemia (FH) and familial defective apolipoprotein B-100 (FDB) are the two major causes of monogenic primary hypercholesterolaemia. In this review, FH and FDB are defined in relation to normal lipoprotein metabolism. In South Africa FH affects about 1% of Afrikaners, Jews and Indians, while FDB is probably a much rarer disorder. In Afrikaners, three 'founder' mutations are responsible for more than 80% of FH. The population genetics that created the exceptionally high frequency of FH and comparatively low frequency of FDB in various South African populations are described. The genetic organisation and itinerary of the normal low-density lipoprotein (LDL) receptor are reviewed, with particular emphasis on the structure-function relationships in the LDL receptor that have been clarified by the mutations found in South Africa. Finally, the clinical relevance of research into FH in South Africa is discussed.

Apolipoprotein B-100↗

PubMed1989

Commodity relations and nutrition under apartheid: a note on South Africa.

The influence of commodity relations upon human nutritional status has recently received a good deal of attention in the context of sub-Saharan Africa. This paper takes up the question for the case of contemporary South Africa. It is argued that the structure of racial capitalism in South Africa exaggerates the negative influences of commodity relations on nutrition. In the extreme physical and social environments artificially created by apartheid in both Bantustan and urban township, the survival strategies employed by parents elsewhere in Africa fail to safeguard the nutritional well being of their children. Whereas elsewhere in this Special Issue Bryceson shows that commodity relations can have both positive and negative impacts on nutrition, the South African case reveals only the negative.

Agriculture↗

PubMedDate not supplied

Why do women seek antenatal care late? Perspectives from rural South Africa.

Despite the widespread availability of free antenatal care services, most women in rural South Africa attend their first antenatal clinic late in pregnancy and fail to return for any followup care, potentially leading to avoidable perinatal and maternal complications. Using interviews with pregnant women from the rural Hlabisa district of South Africa, we documented perceptions of health and health care during pregnancy and investigated factors shaping the utilization of antenatal care. Our findings indicate that most women in this setting do not perceive significant health threats during pregnancy, and in turn view more than one antenatal care visit as unnecessary. In contrast, women perceive labour and delivery as a time of significant health risks that require biomedical attention, and most women prefer to give birth in a health facility. This paradox, in which health care is important for childbirth but not during pregnancy, is embodied in most women's primary reason for seeking antenatal care in this setting: to receive an antenatal attendance card that is required to deliver at a health facility. Health education programs promoting antenatal care are required to explain the importance of effective antenatal care toward maternal and child health.

Adolescent↗

PubMed2004

Characterization of a pigeon paramyxovirus (PPMV-1) isolated from chickens in South Africa.

A paramyxovirus with a thermostability of 60 min (typical of velogenic viruses) and a mean death time of > 90 h (typical of lentogenic viruses) was isolated from layers near Mooi River, South Africa. Our results, based on comparative nucleotide sequence data indicated that the virus is pigeon paramyxovirus 1 (PPMV-1), a variant of Newcastle disease virus. The F0 cleavage site contains a 112RRKKRF117 motif, and the virus had 98% sequence identity with PPMV-1 strains from the Far East. PPMV-1 was last reported in South Africa during the 1980s, with this being the first report of PPMV-1 isolated from chickens in South Africa.

Animals↗