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PubMed1982

Hypertension and ischaemic heart disease in Indian people living in South Africa and in India.

In a random house-to-house study of 1 000 Indians in Durban the prevalence of primary hypertension according to World Health Organization criteria was found to be 19% (females 22%, males 15%). This prevalence was higher than that in published data from India. Hypertension among Indians in South Africa was found to be closely associated with diabetes mellitus and obesity and to be more common in widows or separated people, in those from the lower socio-economic groups and in those with poor education. Hindu males were more commonly affected than Muslim males. Ischaemic heart disease was also found to be more common in Indians in South Africa than in those in India. Cardiovascular diseases are just as much an 'epidemic' among the Indians of South Africa as among the the Whites, and the 'epidemic' of ischaemic heart disease, cerebrovascular disease and hypertensive disease is of more serious proportions in Indians than in Whites. It appears that emigrant Indian populations have a higher incidence of vascular disease than Indians in India. This is because of the combination of hypertension and diabetes mellitus.

Adolescent↗

PubMed2001

Utilization and practical aspects of tele-ophthalmology between South Africa and the UK.

A tele-ophthalmology service was established between a regional hospital in South Africa and a specialist eye hospital in the UK. The aim of the service was to provide secondary specialist advice in the diagnosis and treatment of difficult ophthalmology cases in South Africa. Over 12 months, the South African medical officers saw 16,458 ophthalmology patients and would have liked a second opinion in 5.7% of these cases. Case discussions conducted by videoconferencing at 384 kbit/s were carried out in 0.5% of cases. No significant connection problems were experienced during the 12-month study period. On 4% of occasions, the case discussions were conducted at a bandwidth of 256 kbit/s, but this did not affect the quality of the still images. The South African medical officers valued the educational benefits gained from the case discussions with the UK specialists.

Diagnostic Techniques, Ophthalmological↗

PubMed1998

Iodine deficiency disorders in South Africa.

Iodine is an essential micronutrient, but iodine deficiency remains common worldwide, including many African countries. In South Africa endemic goitre was first noted in the 1920s. Several subsequent surveys have indicated its widespread persistence, despite the limited availability of iodised salt. The significance of nutritional iodine deficiency lies in the associated iodine deficiency disorders, which follow from maternal and fetal hypothyroidism. The extreme consequence is endemic cretinism, but much more prevalent are lesser degrees of intellectual and neurological deficits, with a potential reduction of intelligence scores in affected communities of more than 10%. Such severe consequences of iodine deficiency probably affect a significant proportion of South Africans. The control of iodine deficiency should be easy and inexpensive. Since the December 1995 legislation, all salt manufactured in South Africa must contain potassium iodate. Such supplementation is likely to cause a small increase in auto-immune thyroid disorders. This negative effect is slight in comparison with the potential benefit to millions.

Adult↗

PubMed2003

Lateral transmission of equine arteritis virus among Lipizzaner stallions in South Africa.

REASONS FOR PERFORMING STUDY: A serological study conducted in 1995 revealed that 7 stallions at the Lipizzaner Centre, Gauteng, South Africa, were seropositive for antibody to equine arteritis virus (EAV). A Lipizzaner stallion imported into South Africa from Yugoslavia in 1981 had previously (1988) been confirmed to be an EAV carrier. Despite being placed under life-long breeding quarantine, EAV had been transmitted between stallions at the Lipizzaner Centre. OBJECTIVES: To investigate the phylogenetic relationships between the strain of EAV shed in the semen of the original carrier stallion and strains recovered from the semen of 5 other stallions; and to investigate the means whereby lateral transmission of EAV occurred among 7 in-contact, nonbreeding stallions at the Centre. METHODS: EAV was isolated from semen collected from the seropositive stallions using RK-13 cells. Viral RNA was reverse transcribed and amplified by polymerase chain reaction using ORF 5-specific primers, subjected to sequence and phylogenetic analysis. RESULTS: Phylogenetic analysis of strains of EAV recovered from the semen of 6 persistently infected stallions confirmed that all viruses were closely related and probably derived from a common ancestor, i.e. the stallion imported from Yugoslavia. Lateral transmission subsequently occurred among 7 in-contact, nonbreeding stallions at the Centre. It is speculated that these stallions may have been exposed to virus from bedding or fomites contaminated with semen. CONCLUSIONS: These data confirm that lateral transmission of EAV can occur from shedding stallions to susceptible, in-contact horses, including other stallions, which may become persistently infected with the virus. POTENTIAL RELEVANCE: The findings are consistent with lateral spread of a single, unique strain of EAV among a group; and suggest that transmission of EAV may be initiated by infection of one or more stallions with virus on bedding or other fomites contaminated with EAV- infected semen.

Animals↗

PubMed2004

Sexual exposure to blood and increased risks for heterosexual HIV transmission in Cape Town, South Africa.

A total of 224 men and 276 women living in a Black township in Cape Town, South Africa, were interviewed using a structured questionnaire. Information was elicited on demographic characteristics and sexual behaviours over the three months preceding the interview including engaging in sexual contact that involved blood, lifetime history of STI diagnoses and STI symptoms, and HIV prevention knowledge. Thirty six per cent of the men and 28% of women experienced sexual contact involving blood in the past three months Sexual blood contact was associated with the number of sex partners, unprotected intercourse and sexually transmitted infections. Sexual exposure to blood is prevalent and may be a facilitating factor for HIV transmission in South Africa. Modern medical care providers as well as traditional healers should be encouraged to advise their clients to refrain from sexual intercourse during menstruation and other types of genital bleeding.

Adult↗

PubMed2006

Rates of complication in first-trimester manual vacuum aspiration abortion done by doctors and mid-level providers in South Africa and Vietnam: a randomised controlled equivalence trial.

BACKGROUND: We assessed whether the safety of first-trimester manual vacuum aspiration abortion done by health-care providers who are not doctors (mid-level providers) is equivalent to that of procedures done by doctors in South Africa and Vietnam, where mid-level providers are government trained and accredited to do first-trimester abortions. METHODS: We did a randomised, two-sided controlled equivalence trial to compare rates of complication in abortions done by the two groups of providers. An a-priori margin of equivalence of 4.5% with 80% power and 95% CI (alpha=0.05) was used. 1160 women participated in South Africa and 1734 in Vietnam. Women presenting for an induced abortion at up to 12 weeks' gestation were randomly assigned to a doctor or a mid-level provider for manual vacuum aspiration and followed-up 10-14 days later. The primary outcome was complication of abortion. Complications were recorded during the abortion procedure, before discharge from the clinic, and at follow-up. Per-protocol and intention-to-treat analyses were done. This trial is registered at with the identifier . FINDINGS: In both countries, rates of complication satisfied the predetermined statistical criteria for equivalence: rates per 100 patients in South Africa were 1.4 (eight of 576) for mid-level providers and 0 for doctors (difference 1.4, 95% CI 0.4 to 2.7); in Vietnam, rates were 1.2 (ten of 824) for mid-level providers and 1.2 (ten of 812) for doctors (difference 0.0, 95% CI -1.2 to 1.1). There was one immediate complication related to analgesics. Delayed complications were caused by retained products and infection. INTERPRETATION: With appropriate government training, mid-level health-care providers can provide first trimester manual vacuum aspiration abortions as safely as doctors can.

Abortion, Induced↗

PubMed1998

The learning curve: health education in STI clinics in South Africa.

This qualitative study aims to assess health education practice in sexually transmitted infection (STI) clinics in South Africa with a view to develop improved health education programs in such clinics. Health workers' knowledge of and attitudes towards health education practice, their perceived health education skills, the content of health education in STI clinics and the organizational structure as context for health education were investigated. In-depth interviews were conducted with 18 health care workers practicing in the area of STI control. A lack in knowledge and skills required for effective health education practice was reported. The constraints posed by health workers' current knowledge and skills around health education and the organizational structure in terms of the absence of policy and protocols to govern health education, limited time, space and resources, impede on the actual practice of health education. It seems that these obstacles to health education facilitate a biomedical approach to STI management. This approach is further portrayed in the power dynamics between the health workers as well as between health workers and patients. The data suggest that a health education intervention needs to be directed at an individual level namely at health workers and at the organizational level, i.e. the clinic that provides the context for health education. The newly adopted district health system which equally embraces medical care and health promotion augers well for a holistic management of STIs in South Africa. This would ensure the recognition of all categories of health workers' contributions to health education within their own functions, strengths and time limitations.

Community Health Services↗

PubMed2000

Nocardial infection as a complication of HIV in South Africa.

OBJECTIVES: To assess the occurrence, clinical and microbiological features of nocardial infections complicating HIV in Soweto, South Africa. METHODS: A prospective study was carried out over a 2-year period. Patients were identified after isolation of Nocardia spp. from a clinical specimen. Clinical details were recorded. The nocardial isolates were identified to species level and susceptibility tests performed. RESULTS: Ten patients were identified as having nocardial disease complicating HIV. Clinical presentations were pulmonary (five patients), pulmonary and cerebral (one patient), cerebral (one patient) and skin and soft tissue infection of the lower limb (three patients). Three infections were fatal. The isolates were Nocardia asteroides (seven patients), N. farcinica (two patients) and Nocardia spp. (one). Isolates of N. farcinica demonstrated opacification of Middlebrook agar. All isolates were sensitive to amikacin and minocycline. Most nocardial isolates were susceptible to cefotaxime, imipenem and coamoxiclav. In vitro resistance to cotrimoxazole was present in five. CONCLUSIONS: Nocardial infection occurs as a complication of HIV infection in the Republic of South Africa. Pulmonary cases may be difficult to distinguish from tuberculosis. Nocardia asteroides is the most common species isolated. Nocardia farcinica has resistance to multiple antibacterial agents and demonstrates opacification of Middlebrook agar, a useful screening test for this species. Agents with good in vitro antinocardial activity were amikacin, minocycline, cefotaxime, imipenem and coamoxiclav. There was a high level of resistance in vitro to cotrimoxazole.

AIDS-Related Opportunistic Infections↗

PubMed2006

Population data on the AmpF/STR Identifiler loci in Africans and Europeans from South Africa.

Allele frequencies of 15 short tandem repeat (STR) loci, D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA, were determined for 98 unrelated Africans from South Africa and 98 unrelated Europeans from South Africa using the AmpFlSTR Identifiler PCR amplification kit. The genotype frequency distributions of the 15 STR loci were in the Hardy-Weinberg equilibrium for both populations.

Black People↗

PubMed1976

Ixodes (Afrixodes) Bakeri Arthur & Clifford, 1961 (Acarina: Ixodidae): description of the male and immature stages from rodents and insectivores and notes on its biology in South Africa.

The male, nymph and larva of Ixodes (A), bakeri are described and illustrated with line drawings and scanning electron microscope photographs. This species was originally described from 1 female from Otomys sp., Nyika Plateau, Malawi. The present material consists of 28 collections from insectivores and 19 collections from rodents, Van Riebeeck Nature Reserve, Transvaal, plus 1 collection from a rodent in the Jonkershoek Valley, Cape Province, Republic of South Africa. Its biology in South Africa is also discussed.

Animals↗

PubMed1998

Some epidemiological and economic aspects of a bluetongue-like disease in cattle in South Africa--1995/96 and 1997.

In December 1995 to March 1996 and the early summer of 1997 South Africa experienced above average rainfall which favoured the occurrence of Culicoides transmitted diseases. During this period several outbreaks of an uncommon disease of cattle occurred over a large part of the country. The clinical signs were similar to those of infection with the viruses of bluetongue (BT) and epizootic haemorrhagic disease of deer (EHD). Virus isolation from cattle and Culicoides yielded both viruses. Dual infections occurred on several farms. Typing of BT isolates yielded types 2, 3, 6 and 8. On at least two farms more than one BT virus serotype was involved. On one farm only EHD virus could be isolated from cattle and Culicoides. Serological tests confirmed that on this farm the disease was caused by EHD. In 1932/33, when a similar disease was reported conditions were vastly different. Rainfall figures show that the 1932/33 season was exceptionally dry. Techniques available at that time could not identify EHD and the cause was reported to be BT. The occurrence of BT in a dry season and over a much wider area than the distribution in South Africa of Culicoides imicola, the only proven vector for BT, is a clear indication that other species less dependent on high rainfall are involved. The present isolation of BT virus from three of five pools of parous C. bolitinos is evidence that this species, which breeds in cattle dung, may be an additional vector for BT.

Animals↗

PubMed1996

Desegregating health statistics and health research in South Africa.

OBJECTIVE: This article aims: (i) to re-examine the use and usefulness of categorisation based on 'race', ethnicity and 'population group' membership in public health research; and (ii) to assess the consequences of using these categories for describing, analysing and redressing disparities in health within South Africa. The utility of categorisation based on 'race', ethnicity and 'population group'. Categorising populations and comparing patterns of disease between different groups of people can be a useful technique for identifying potential causes of disease. In this context, ethnicity is a valid social concept that could be used to investigate the consequences of self-ascribed identity on health. Likewise, 'population group', as defined during apartheid in South Africa, represents a valid political concept that could be used for assessing the impact of social discrimination on health. However, both these concepts are often seen, and used, as euphemisms for 'race', even though there are no genetically distinct human subspecies that can be identified and categorised as discrete 'races'. Indeed, 'race' as a biological concept has no validity in human biology. Nevertheless, categories based on 'race', ethnicity and 'population group; continue to be used in health research, and reinforce the perception that differences in disease between different 'racial', ethnic and 'population' groups are the result of heritable biological characteristics. In so doing, they undermine support for health interventions that would otherwise address the social and political origins of 'racial' and ethnic disparities in health. The utility of 'population group' for redressing the consequences of apartheid. Despite these problems, 'population group' classification provides important information for assessing the impact of apartheid on disparities in health within South Africa. Yet, the abolition of apartheid legislation is likely to result in extensive socio-economic and geographical migration that will weaken the sensitivity and specificity of 'population group' as an indicator for identifying inequalities in health. For this reason, targeting corrective action at specific population groups in order to tackle disparities in health, runs the risk of ignoring alternative social causes of inequalities in health, and ignoring disadvantaged individuals from elsewhere in the population. The continued use of 'population group' classification might also perpetuate the root cause of disparities in health, by maintaining the process used to formalise discrimination. CONCLUSION: If the purpose of health research is to monitor inequalities in health and to help target resources aimed at reducing these inequalities, then it should seek, in its language, concepts and methods to undermine the root cause of disadvantage. Health research aimed at monitoring and redressing the consequences of social disadvantage on health should therefore focus on non-biological determinants of social disparities in health. As a general rule, health researchers should avoid using categories based on 'race', ethnicity and 'population group' when collecting and analysing health data; journal editors should not accept articles that use these categories without justification; and health authorities should not collect data routinely segregated by 'race', ethnicity or 'population group'.

Bias↗

PubMedDate not supplied

The Martin-Bell syndrome in South Africa.

A national screening programme was introduced in 1980 when the first cases with the Martin-Bell syndrome were diagnosed in South Africa. This survey includes patients from all the major population groups in South Africa. One thousand patients, who include 354 relatives of 21 index cases, were investigated cytogenetically. About 75% of the 354 relatives were either affected males or obligate or possible carriers. The segregation pattern of the fragile site was investigated in 271 offspring of 58 carrier women. At least 30% of the carriers were mildly mentally retarded with most expressing the fragile site. Various other investigations, such as measurements of testes, speech, verbal and IQ evaluations and hormone studies were done on several affected males. No fragile site could be demonstrated in 57 unselected autistic children. The results of this programme show that this syndrome is a common cause of mental retardation and that prevention of mental retardation is possible if all the involved families could be identified.

Adolescent↗

PubMed2001

A proposed vitamin A supplementation programme for South Africa--design, coverage and cost.

BACKGROUND: A national survey of the micronutrient status of preschool children in South Africa established that vitamin A deficiency is a significant public health problem, requiring urgent attention. A number of immediate and long-term interventions were recommended, including the introduction of a vitamin A supplementation programme and a food fortification programme. OBJECTIVES: The aim of the study was to assist in the development and implementation of a national vitamin A supplementation programme at primary health care facilities for mothers and children. This was achieved by determining the design, coverage and cost of a national primary health care facility vitamin A supplementation programme. METHODS: Based on an extensive review of the literature, the main components of a primary health care facility vitamin A supplementation programme were identified. The annual, recurrent costs of each of the programme components were estimated for the nine provinces in South Africa. Immunisation coverage rates were used as a proxy for estimating the coverage of the programme. RESULTS: The main components of the programme were identified as: promotion, training, purchase of vitamin A capsules, distribution of vitamin A capsules to primary health care facilities, distribution of capsules to the programme beneficiaries, and monitoring and evaluation. The programme would operate from primary health care facilities and would target all children between 6 and 24 months of age and newly delivered mothers. It was estimated that the programme would cover 74% of children and 95% of postpartum women nationally. The total annual, recurrent cost of the national programme was estimated at R16.4 million. The bulk of the costs would include personnel costs, comprising 68% of the total costs. Other costs included promotion (27%), vitamin A capsules (4%) and training (1%). The cost of the programme would vary significantly by province, but the provinces' average total cost per beneficiary would be similar. CONCLUSION: A primary health care facility vitamin A supplementation programme has been designed and accompanied by an estimated overall cost and coverage for implementation. The findings of the study showed that the programme would be financially feasible and would reach the majority of children under 24 months of age. It is recommended that further research be undertaken to extend the programme to the more 'hard to reach' population using other strategies such as mass immunisation campaigns.

Adolescent↗

PubMed2006

Serotyping and genotyping of HIV-1 infection in residents of Khayelitsha, Cape Town, South Africa.

It is estimated that between 5.5 and 6.1 million people are infected with HIV/acquired immunodeficiency syndrome (AIDS) in South Africa, with subtype C responsible for the majority of these infections. The Khayelitsha suburb of Cape Town has one of the highest HIV prevalence rates in South Africa. Overcrowding combined with unemployment and crime in parts of the area perpetuates high-risk sexual behavior, which increases exposure to infection by HIV. Against this background, the objective of this study was to characterize HIV-1 in residents confirmed to be seropositive. Serotyping was performed through a competitive enzyme-linked immunosorbent assay (cPEIA). Genotyping methods included RNA isolation followed by RT-PCR and sequencing of the gag p24, env gp41 immunodominant region (IDR), and env gp120 V3 genome regions of HIV-1. With the exception of a possible C/D recombinant strain, all HIV-1 strains were characterized as HIV-1 group M subtype C. One individual was shown to harbor multiple strains of HIV-1 subtype C. In Southern Africa, the focus has been to develop a subtype C candidate vaccine, as this is the major subtype found in this geographical area. Therefore, the spread of HIV-1 and its recombinant strains needs to be monitored closely.

Adult↗

PubMed1994

Violent oppression: implications for mental health priorities in South Africa.

This study explores the complex nature of mental health challenges and priorities in a post-apartheid South Africa. Special reference is made to indigenous people's experiences of poverty, racism, sexism and the machinery of political repression as critical bases for determining the priorities in mental health services. Whilst the provision of mental health services for all is sought by mental health professionals and legal systems in Western countries and other African states, South Africa has not developed a coherent sociolegal policy which aims at preventing, alleviating and healing mental health problems for all its citizens. Research gathered through a phenomenological approach amongst the oppressed seeks to define the terrain of people's psychological problems. Although data used are deduced mainly from the 'oppressed' on one white owned farm, questions raised and conclusions drawn address national as opposed to regional solutions, and also facilitate thinking about mental health priorities for all South Africans living under similar conditions. Commonly experienced problems are the effects of organized violence, child and adolescent problems, the prevalence of alcohol and drug use, depression, lack of facilities for the disabled and psychological care for homeless children, families and the youth. Participants were ignorant about mental health services, they experienced them as inaccessible and they were generally suspicious of an lacked faith in mental health workers. The author proposes broad future mental health options, like the restoration of family life in oppressed communities, the training of lay counsellors and the introduction of community mental health programmes. A suggestion is made that health workers in community mental health centres should adopt an advocacy position against all forms of unfair practices and violence and lobby for the protection of human rights.

Adolescent↗

PubMed1975

Comparative epidemiological studies of multiple sclerosis in South Africa and Japan.

Evidence is presented pointing to an increased incidence of multiple sclerosis having taken place in South Africa during the period 1964 to 1970 and in Tokyo, Japan, during the period 1966 to 1972. There is a possibility that these changes in incidence point to the introduction during the years immediately after the second world war, of an infective element-probably from a high-risk area-to Tokyo and South Africa. If this is so, it lends support to the theory of an infective basis for multiple sclerosis and that the suspected infection in prepubertal susceptibles may produce the symptoms of multiple sclerosis years later. Other factors relevant to multiple sclerosis such as environmental changes, improved diagnostic techniques, and susceptibility are discussed.

Adolescent↗

PubMed2006

The incidence of fungi and mycotoxins in South Africa wheat and wheat-based products.

This investigation was undertaken to survey the fungal and mycotoxin contamination of South African wheat ranging from that growing in the field to processed wheat products. Samples of wheat were taken from various growing areas in South Africa and screened for fungi and mycotoxins, using a range of methodologies, including chromatography, immunoaffinity/fluorimetry, and cytotoxicity testing. Similar samples were taken from supermarkets and retail outlets in South Africa and analyzed in a similar manner. The result showed that a range of fungi and mycotoxins could be detected in wheat in all these sample types. The major fungal contaminants were Fusarium spp. and their attendant mycotoxins, in particular deoxynivalenol, which is in keeping with the observations made in the rest of the world. An interesting observation was that samples of wheat taken from the field with heavy Fusarium contamination were contaminated with fumonisin B1, which is not normally associated with this crop. Of more concern were the low but persistent levels of mycotoxins and fungi in wheat-based products sold directly to the public.

Consumer Product Safety↗