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PubMed2006

Guideline for the management of nosocomial infections in South Africa.

OBJECTIVE: To write a guideline for the management and prevention of nosocomial infections in South Africa in view of the following: Nosocomial infections are a common and increasing problem globally, including South Africa. Widely varying standards of prevention and management of these important infections. Increasing and emerging antimicrobial resistance among commonly isolated pathogens. The significant economic burden of these infections on the health care system as well as their impact on patient morbidity and mortality. The main aims of the guideline are to provide recommendations for the initial choice of antimicrobial agents and the appropriate management of these infections encompassing the following conditions: (i) nosocomial pneumonia, health care-associated pneumonia and ventilator-associated pneumonia; (ii) nosocomial bloodstream infections; (iii) nosocomial intravascular infections; (iv) nosocomial urinary tract infections; (v) nosocomial intra-abdominal infections; and (vi) nosocomial surgical skin and soft-tissue infections. EVIDENCE: Working group of clinicians from relevant disciplines, following detailed literature review. RECOMMENDATIONS: These include details of the likely pathogens, an appropriate diagnostic approach, antibiotic treatment options and appropriate preventive strategies. ENDORSEMENT: The guideline document was endorsed by the South African Thoracic Society, the Critical Care Society of Southern Africa and the Federation of Infectious Diseases Societies of Southern Africa.

Anti-Infective Agents↗
PubMed2006

Prevalence and incidence of Entamoeba histolytica infection in South Africa and Egypt.

There are little data on the true prevalence and incidence of Entamoeba histolytica infection in Africa. This is due to the inability, historically, to differentiate Entamoeba histolytica from the more common, but non-pathogenic, Entamoeba dispar. In addition, newer studies have demonstrated that the previous gold standard, culture with zymodeme analysis, is insensitive in detecting the presence of infection, especially when compared to PCR. Recent published articles as well as data from the authors' previous work are reviewed and summarized to elucidate what is known about prevalence and incidence of Entamoeba histolytica in Africa. The majority of data on asymptomatic infection are published from South Africa, Egypt and Cote d'Ivoire. Egypt has high rates of asymptomatic infection detected in the stool (>21%), whereas South Africa and Cote d'Ivoire rates range between 0 and 2%. Seroprevalence estimates the rate of recent infection, because anti-amebic antibodies generally persist for <5 years. Seropositivity rates (IgG, IgA) range from approximately 10 to 20%, indicating recent infection in this proportion of the population. Entamoeba histolytica infects a significant proportion of many populations of Africa; however, little data are currently available to indicate true prevalence and incidence. Further studies are needed to determine the burden of infection and disease in Africa.

Animals↗
PubMed2003

Protection of human participants from risks in biomedical research: an analysis of the law of South Africa and international ethical guidelines.

In order to enhance the quality of lives of South Africans who are afflicted by many diseases, medical researchers have been engaged in biomedical research with the aim of testing, evaluating newly developed prophylactic and therapeutic methods. However, during the testing of newly developed therapeutic methods, participants are sometimes exposed to harm which may ruin the remainder of their lives or even lead to their deaths. Despite the seriousness of harm which may result from research, South Africa does not regard social and economic harms as a threat to the welfare and health of participants. Though they utilize the risk-benefit analysis as outlined by international ethical guidelines to minimize harm, this developed criterion has been shown to be an inadequate safeguard for the welfare and health of participants as it fails to cover the occurrence of scientifically unforeseen risk. To ensure protection of participants, this paper suggests the introduction of a precautionary approach in research and also, specific reference to South Africa, the recognition of all categories of harm.

Biomedical Research↗
PubMed2006

Notification of rheumatic fever in South Africa -- evidence for underreporting by health care professionals and administrators.

OBJECTIVE: To determine whether under-reporting of rheumatic fever occurs at hospital, municipal, provincial and national levels of the South African health system. BACKGROUND: Information on the incidence of rheumatic fever (RF) and the prevalence of rheumatic heart disease (RHD) is required for the prevention of valvular heart disease in developing countries. In South Africa, RF was made a notifiable condition in 1989. It has recently been suggested that the reporting of RF cases may be incomplete, possibly because of underreporting by health care professionals and deficient administration of the disease notification system in South Africa. METHOD AND RESULTS: We assessed whether underreporting of RF cases occurs by comparing the numbers of RF cases reported per year at hospital, municipal, provincial and national levels from 1990 to 2004. There was a fall in the number of RF cases reported per year at national and provincial level over the 15 years of observation. A detailed analysis of the number of RF cases reported at hospital, municipal and provincial level for a 5-year period showed that more cases were diagnosed in one hospital (serving a smaller population) than were captured at municipal and provincial level (serving a larger population), suggesting underreporting by health care professionals. There were discrepancies in the number of cases reported at municipal, provincial and national level, suggesting poor administration of the notification system. CONCLUSION: There appears to be underreporting of RF cases by health care professionals, and poor administration of the RF notification system. Health care professionals need to be educated about the statutory requirement to notify all RF cases in South Africa. An effective national disease notification system is required.

Data Collection↗
PubMed2000

Reconciliation and Revenge in Post-Apartheid South Africa. Rethinking Legal Pluralism and Human Rights.

Human rights are a central element in the new governmental project in the new South Africa, and this article traces some of the specific forms of connection and disconnection between notions of justice found in townships of the Vaal and rights discourses as articulated by the Truth and Reconciliation Commission. The introduction of human rights in post-apartheid South Africa has had varied social effects. Religious values and human rights discourse have converged on the notion of reconciliation on the basis of shared value orientations and institutional structures. There are clear divergences, however, between human rights ideas and the notions of justice expressed in local lekgotla, or township courts, which emphasize punishment and retribution. The article concludes that the plurality of legal orders in South Africa results not from systemic relations between law and society but from multiple forms of social action seeking to alter the direction of social change in the area of justice within the context of the nation-building project of the post-apartheid state.

Journal Article↗
PubMedDate not supplied

HIV/AIDS in South Africa: an overview.

This paper presents an overview of the development of HIV/AIDS in South Africa, taking into consideration the social context and analyzing the factors most likely to have influenced its spread as well as the societal response to it. The authors argue that macro factors such as social and political structures, in addition to behavioral ones, have combined to shape the course of the epidemic. Since various factors linked to social inequalities have combined to shape the pattern and growth of the HIV/AIDS epidemic in South Africa, it is inappropriate to focus on only one dimension in an attempt to combat the epidemic. Following the psycho-socio- environmental model, all potential contributing elements need to be addressed simultaneously. This calls for a true interdisciplinary and multi-sectorial approach. It also requires great commitment as well as strong political will.

Acquired Immunodeficiency Syndrome↗
PubMed2000

New cases of Mokola virus infection in South Africa: a genotypic comparison of Southern African virus isolates.

Mokola virus, one of the six genotypes within the Lyssavirus genus of the Rhabdoviridae family, is believed to be exclusive to the African continent, where infections in various mammal species have been reported. After an isolation of Mokola virus at Umhlanga on the east coast of South Africa in 1970, the virus was not reported in South Africa until its reappearance in 1995. Since then a total of six new isolates of the virus were made, three from the East London region in 1995 and 1996, two near Pinetown in 1997 and a further isolate in a residential suburb of the city of Pietermaritzburg, in 1998. These isolation sites are respectively about 500 km (East London region) and 23 to 60 km from the site of the 1970 isolation Phylogenetically the three isolates from the East London area were similar and could be distinguished from the four KwaZulu-Natal isolates, which formed a defined group of their own. The viruses comprising these two clusters were also found to be distant from another southern African isolate, made in 1982 in Zimbabwe, Mokola virus isolates thus conforms to a pattern of virus evolution strongly influenced by geographical determinants. In comparison to Rabies virus, of which at least two different biotypes are known and a vast array of different wildlife species contribute to its complex epidemiology on the sub-continent, Mokola viruses have only been isolated form one species, i.e. domestic cats, in South Africa. Nevertheless, the heterogeneity among the Mokola virus isolates is far greater than the degree of variation among the Rabies virus populations of the region.

Animals↗
PubMed2001

Psychiatric research in South Africa: a systematic review of Medline publications.

BACKGROUND: There is debate about the future path that medical and psychiatric research in South Africa should take. In particular, there have been calls to make research more relevant to the needs of the population. There is, however, little systematically collected data on the nature, strengths, and flaws of past psychiatric research in this country. METHODS: We undertook a MEDLINE search to gather all manuscripts that fell under the umbrella of psychiatric research and published by South Africa-based authors during the years 1966-1997. Several kinds of data were collated from each of the articles, including information about the authors and the journal, as well as information on the focus and type of article. RESULTS: While publications from South Africa continue to grow in number, relatively few involve collaborative research groups and few authors write more than one paper. Many papers relevant to psychiatry were published in general medical journals and many were from general medical departments. While blacks and females have been included in research, a number of important areas have received little attention. CONCLUSIONS: Psychiatry research in South Africa requires additional fostering, including additional resources for research training and arguably additional development of subspecialty focuses. Given the limited resources, and the nature of modern research, increased emphasis on collaboration seems advisable. A number of areas in psychiatry deserve particular attention from future researchers.

Humans↗
PubMed1999

Use of Ammophila arenaria for Dune Stabilization in South Africa and Its Current Distribution-Perceptions and Problems.

/ This paper examines the use of the European dune pioneer plant Ammophila arenaria (marram or European beach grass) for dune stabilization in South Africa in the past and present, its present distribution in South Africa, and the perceptions of coastal management agencies and the public about its further use. The planting of A. arenaria became the most important means of dune stabilization, by human intervention, along the South African Cape coast in this century. Its modern distribution from the semiarid west coast to the subtropical shores of the Eastern Cape extends through various climatic zones. Although historical data are missing for some areas, there is no indication of its unaided spread. A. arenaria occurs at most sites because of its prior planting. The South African climate appears to affect its vigor. However, concern about the use of the alien grass has been raised since it has proved to be a highly invasive species in other parts of the world, particularly along the North American west coast and in Tasmania. While the CSIR (Council of Scientific and Industrial Research) promotes its use, CNC (Cape Nature Conservation) follows a policy that restricts the use of any alien plant, including A. arenaria, and requests further research on its invasive properties. Although a questionnaire survey shows that stabilization sites featuring large areas of A. arenaria are accepted by the South African public, current coastal management practices need to be analyzed critically. A thorough investigation of the potential invasiveness of A. arenaria on South African coastal dunes will be essential and shed new light on the American A. arenaria problem.KEY WORDS: Ammophila arenaria; Marram; European beach grass; Dune stabilization; South Africa; Coastal managementhttp://link.springer-ny.com/link/service/journals/00267/bibs/24n4p467.html</HEA

Journal Article↗
PubMed1997

Smoking in urban pregnant women in South Africa.

AIM: To estimate the exposure to active and passive smoking of pregnant women in South Africa and to determine their knowledge and behaviour with regard to smoking during pregnancy. METHODS: A questionnaire was completed by pregnant women attending antenatal services in four South African cities. Questions were asked about smoking status, beliefs on the health effects of tobacco smoke during pregnancy, exposure to passive smoking and behavioural changes with regard to smoking during pregnancy. Women from different ethnic groups and social classes participated. RESULTS: The study population was 394 pregnant women. Of these 42% were black, 29% coloured and 10% Indian women, who used public antenatal services, and 19% were pregnant women (ethnicity unspecified) who attended private obstetric practices. Of the coloured women, 47% smoked; for the black and Indian women and those who attended a private practice, the smoking rates were 4%, 3% and 28%, respectively. Approximately 90% of the pregnant women knew it was unhealthy to smoke during pregnancy. Most women who smoked stopped or reduced tobacco use during their pregnancy. Of the pregnant women, 70% lived with at least one smoker in the house. CONCLUSIONS: Few black and Indian pregnant women in South Africa smoke, while coloured pregnant women smoke heavily. Quitting programmes should be targeted at them when they attend antenatal services. Pregnant women and their families should be alerted to the impact of environmental tobacco smoke, since so many are passive smokers during pregnancy.

Adult↗
PubMed1983

Crimean-congo hemorrhagic fever in South Africa.

Crimean-Congo hemorrhagic fever virus was isolated for the first time in South Africa in February 1981, from the blood of a 13-year-old boy who died in Johannesburg after attending a camp in a nature reserve in the western Transvaal. Virus was isolated from 21/120 pools of questing ticks from the nature reserve, the infected species being Hyalomma marginatum rufipes and H. truncatum. Virus was also isolated from 4/38 pools of partially engorged ticks and other ectoparasites collected off hosts, the infected species being H.m. rufipes, H. truncatum and Rhipicephalus evertsi. Antibodies were found in the sera of 5/74 humans, 8/26 wild vertebrates, 74/270 sheep, and 109/170 cattle from the reserve and surrounding farms. Antibodies were also found in 28/200 hares from various locations in the country. It was concluded that the virus is widely prevalent in South Africa, but the full medical and veterinary significance of its presence has yet to be determined.

Adolescent↗
PubMedDate not supplied

Granuloma inguinale (donovanosis) in women. An analysis of 61 cases from Durban, South Africa.

BACKGROUND AND OBJECTIVES: Granuloma inguinale (GI) appears to be making a resurgence in South Africa. Local cases were reviewed in order to determine an increasing prevalence and whether differences appeared between pregnant and non-pregnant women. STUDY DESIGN: Retrospective analysis of clinical records of patients attending a large tertiary teaching hospital, serving an underprivileged population. RESULTS: Sixty-one women with GI were diagnosed over a 3-year period. The most common clinical presentation was genital ulceration in both pregnant (88.5%) and nonpregnant (45.7%) patients. The next most common presentation was genital tract bleeding (19.7%), which occurred mainly among nonpregnant women. The vulva was the most frequent anatomical site involved (54.1%), in both pregnant (88.5%) and nonpregnant (28.6%) women. Multiple sites of infection (vulva, vagina, cervix) occurred only among nonpregnant women. Fourteen of 33 (42.4%) patients whose syphilis serology results were available had reactive tests. Erythromycin and tetracycline were the most common single antimicrobial agents used for therapy and response varied according to site and size of lesion. CONCLUSIONS: This study confirms our clinical impression of the increasing prevalence of GI, especially among women in Durban, South Africa. The protean manifestations of the disease are demonstrated with sharp distinctions between pregnant and nonpregnant women and there was a high prevalence of concomitant syphilis.

Adolescent↗
PubMed1992

Workmens' compensation and byssinosis in South Africa: a review of 32 cases.

Byssinosis has been compensable in the Republic of South Africa (RSA) since 1973. The legal and administrative provisions for byssinosis compensation are reviewed. A series of 32 cases of presumed byssinosis was submitted to the compensation authorities by the authors. Identical reports were submitted to an independent medical panel. The findings and outcomes in these cases are presented and compared. Seventeen of the 32 claims initially received compensation and four were subsequently accepted following appeals. Analysis of the medical basis of decision making indicated that seven claims were refused and at least four had their awards reduced as a consequence of inconsistent decisions. Arguable decisions resulted in five claims being refused and one award being reduced. Our experience illustrates problems inherent in the compensation system in South Africa. Initiation of a claim is expensive relative to wages in the industry, and awards are low since they are linked to wages (mean $60.47 per week). Processing of a claim took a mean of 13.8 months, while appeals for refusal to compensate took a further 29.8 months. It is argued that consensus medical definitions of compensable occupational disease should be used routinely and that provision must be made to facilitate entry of claimants into the compensation system.

Adult↗
PubMed2005

Sentinel surveillance of sexually transmitted infections in South Africa: a review.

OBJECTIVES: To review studies of sexually transmitted infection (STI) prevalence in South Africa between 1985 and 2003 in selected sentinel populations. To examine how STI prevalence varies between populations and to identify the limitations of the existing data. METHODS: Studies of the prevalence of syphilis, chancroid, granuloma inguinale, lymphogranuloma venereum, gonorrhoea, chlamydia, trichomoniasis, bacterial vaginosis, candidiasis, and herpes simplex virus type 2 (HSV-2) were considered. Results were included if they related to women attending antenatal clinics or family planning clinics, commercial sex workers, individuals in the general population (household surveys), patients with STIs, patients with genital ulcer disease (GUD), or men with urethritis. RESULTS: High STI prevalence rates have been measured, particularly in the case of HSV-2, trichomoniasis, bacterial vaginosis and candidiasis. The aetiological profile of GUD appears to be changing, with more GUD caused by HSV-2 and less caused by chancroid. The prevalence of gonorrhoea and syphilis is highest in "high risk" groups such as sex workers and attenders of STI clinics, but chlamydia and trichomoniasis prevalence levels are not significantly higher in these groups than in women attending antenatal clinics. CONCLUSIONS: The prevalence of STIs in South Africa is high, although there is extensive variability between regions. There is a need for STI prevalence data that are more nationally representative and that can be used to monitor prevalence trends more reliably.

Adolescent↗
PubMed2001

Directly observed treatment for multidrug-resistant tuberculosis: an economic evaluation in the United States of America and South Africa.

OBJECTIVE: To estimate the cost-effectiveness of directly observed treatment compared to conventional therapy in reducing the spread of multidrug-resistant tuberculosis, for an industrialised country (represented by the United States of America) and a developing country (South Africa). METHODS: Monte Carlo analysis using published data on probability, cost and health impact. RESULTS: In both countries, directly observed treatment is the dominant strategy, yielding cost savings and improved health outcomes. Cost savings for directly observed treatment relative to conventional therapy become more significant as more expensive second-line drugs are used in treatments. CONCLUSIONS: The cost-effectiveness of directly observed treatment relative to conventional therapy is demonstrated for both the USA and South Africa. Cost savings are more pronounced (especially for South Africa) as the likelihood of multidrug-resistant tuberculosis increases and more expensive second-line therapies are used. Given that health care resources are more severely constrained in developing countries, the data contained in this study are useful in guiding the design of policies for the effective management of multidrug-resistant tuberculosis in settings with limited resources.

Antitubercular Agents↗
PubMed2005

Identifying deaths from AIDS in South Africa.

OBJECTIVE: To quantify the HIV/AIDS deaths misclassified to AIDS-related conditions in South Africa. DESIGN: Retrospective analysis of vital registration data. METHODS: Cause-specific death rates for 1996 and 2000-2001 were calculated using vital registration cause-of-death profiles applied to a model (ASSA2000) estimate of total mortality rates by age and sex. The difference in the age-specific death rates for these two periods was examined to identify conditions where there was a noticeable increase in mortality following the same age pattern as the HIV deaths, thus likely to be misclassified AIDS deaths. RESULTS: The increase in the age-specific death rates for HIV-related deaths showed a distinct age pattern, which has been observed elsewhere. Out of the 22 potential causes of death investigated, there were nine that increased in the same distinct age pattern (tuberculosis, pneumonia, diarrhoea, meningitis, other respiratory disease, non-infective gastroenteritis, other infectious and parasitic diseases, deficiency anaemias and protein energy malnutrition) and could be considered AIDS-related conditions. The increase in these conditions accounted for 61% of the total deaths related to HIV/AIDS. When added to the deaths classified as HIV-related on the death certificate, the total accounts for 93% of the ASSA2000 model estimates of the number of AIDS deaths in 2000. CONCLUSION: As a large proportion of AIDS deaths appear to be classified to AIDS-related conditions, without reference to HIV, interpretation of death statistics in South Africa cannot be made on face value as a large proportion of deaths caused by HIV infection are misclassified.

AIDS-Related Opportunistic Infections↗