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PubMed1982

Membranous obstruction of the inferior vena cava and hepatocellular carcinoma in South Africa.

This study was undertaken to establish the frequency of membranous obstruction of the inferior vena cava in South Africa, to characterize the pathology of the lesion and to define its relationship to hepatocellular carcinoma. Over a 9-yr period 101 cases of membranous obstruction of the inferior vena cava into the right atrium was occluded in all cases in which it was examined, and two basic patterns of the abnormality in the hepatic portion of the inferior vena cava have been described. The histologic picture in the liver was a chronic congestive fibrosis. In 44 cases of congestive fibrosis, diagnosed from liver biopsy specimens from black patients over a 5-yr period, vena caval membranes were demonstrated on cavography in 38 (86.4%). Hepatocellular carcinoma developed in 48 of the 101 cases (47.5%), indicating the importance of this defect in the pathogenesis of hepatocellular carcinoma in South Africa.

Adolescent↗

PubMed2002

Research that influences policy and practice - characteristics of operational research to improve malaria control in Mpumalanga Province, South Africa.

BACKGROUND: Much communicable disease control research has had little impact on local control programme policy and practice for want of an operational component. The operational research model - the systematic search for knowledge on interventions, tools or strategies that enhance programme effectiveness - is gaining recognition as an appropriate method for addressing perplexing questions within public health programmes. METHODS: A series of operational research studies were conducted to refine malaria diagnosis in Mpumalanga Province, South Africa between 1995 and 1999. The grounded theory approach was used with groups of experienced Masters of Public Health students in South Africa and Australia to analyse a compilation of these studies for determining positive and negative attributes of operational research that affect its ability to influence communicable disease control policy and practice. RESULTS: The principal positive attributes of the operational research studies were high local relevance, greater ability to convince local decision-makers, relatively short lag-time before implementation of findings, and the cost-effective nature of this form of research. Potential negative features elicited included opportunities forfeited by using scarce resources to conduct research and the need to adequately train local health staff in research methodology to ensure valid results and accurate interpretation of findings. CONCLUSIONS: Operational research effectively influenced disease control policy and practice in rural South Africa, by providing relevant answers to local questions and engaging policy-makers. This resulted in accelerated inclusion of appropriate measures into a local communicable disease control programme.

Adult↗

PubMed1998

Epidemic spread of subgroup III of Neisseria meningitidis serogroup A to South Africa in 1996.

A total of 111 strains of Neisseria meningitidis isolated during a meningitis outbreak in Johannesburg, South Africa, in 1996 were analyzed by serogrouping, arbitrarily primed polymerase chain reaction analysis, ribotyping, and multilocus enzyme electrophoresis. Nineteen different clusters were identified, and typing patterns for the three techniques were comparable. Of the 111 strains analyzed, 55 (49.5%) belonged to the serogroup A clone complex designated internationally as subgroup I-1. The second largest cluster included 15 isolates (13.5%) that were identified as belonging to the pandemic clone III-1. A number of unrelated strains were also encountered. Our study provides the first documented evidence of the presence of clone III-1 in South Africa and indicates the continued spread of this clone well outside the African meningitis belt.

Cluster Analysis↗

PubMed2001

Investigation of human papillomavirus in transitional cell carcinomas of the urinary bladder in South Africa.

AIM: To investigate the prevalence of human papillomavirus in transitional cell carcinoma of the urinary bladder in South Africa. METHODS: Ninety-one archival samples of bladder transitional cell carcinoma were subjected to polymerase chain reaction (PCR) and non-isotopic in situ hybridisation (NISH) for the detection of human papillomavirus 6, 11, 16, 18, 31, and 33 genotypes. RESULTS: HPV was detected in only one case with PCR. HPV was not detected in any of the cases subjected to the NISH system. CONCLUSION: This study shows that although HPV has been shown to be associated with uterine cervical and esophageal squamous cell carcinomas in South Africa, this virus is not present in the transitional cell carcinoma of the urinary bladder in this geographical location. It is suggested that other factors, including nitrosamine exposure, p53 mutation, and additional unknown chromosomal events, may play a role in the carcinogenesis of this neoplasm in the bladder.

Beta-Globulins↗

PubMed2001

Implementation of the ART approach in South Africa: an activity report.

The Atraumatic Restorative Treatment (ART) approach has been adopted in public dental services in South Africa as an appropriate and economical means to provide basic restorative care in communities where it was not possible before. The approach also offers a less-traumatic treatment concept for fearful patients and children in the private dental practice. In 2000, the Division of Community Dentistry, University of the Witwatersrand, implemented a training, research and service programme in the ART approach. The aim of these activities was the promotion of ART at various levels within the oral health care system in the Republic of South Africa. The objectives of the programme were to initiate and provide training of oral health workers in ART, to evaluate the outcome of training and service programmes and to disseminate results. This paper describes the Division's ART activities in 2000, regarding public, private and refugee health services.

Adult↗

PubMed2005

Epidemiology of pericardial effusions at a large academic hospital in South Africa.

The aim was to establish the prevalence of large pericardial effusions in the Western Cape Province of South Africa, and to determine the incidence of various types of effusions. A total of 233 patients presented with large pericardial effusions. Each patient underwent tests for HIV, sputum smear and culture, blood culture, blood biochemistry and serological testing. Tuberculous pericardial effusions were diagnosed according to pre-determined criteria. Eighty-four patients (36.1%) were found to be HIV positive; 81 of these (96.4 %) had tuberculous pericarditis. More than 65% of the study population was aged between 15 and 39 years. The prevalence of HIV amongst unemployed individuals was 49.0% compared to 30.0% amongst employed individuals. Tuberculous pericarditis was the most common cause of pericardial effusions (69.5%, n=162). It was concluded that tuberculosis (TB) is a leading cause of pericarditis in this province of South Africa. The prevalence of TB confounded by HIV co-infection is steadily increasing, burdening the health-care facilities.

Adolescent↗

PubMed2003

The human face of decentralisation and integration of health services: experience from South Africa.

This paper explores the processes of policy-making, budgeting and service implementation in three provinces of South Africa, drawing on interviews with health managers at different levels of government. It illustrates how the process of decentralisation creates disjunctures between the policy-making authority of higher levels of government and the implementation capacity of service provision levels. It also explores the complex dynamics between those responsible for specific policies, such as reproductive health policies, and those responsible for managing the integrated delivery of all policies, with their resultant contestations over authority and resources. The pace of change in South Africa and the enormous capacity it requires, both in relation to financial management and the technical skills needed for specific programmes, has created a sense of frustration and demoralisation. Whilst shortage of financial resources, particularly as reflected in shortage of staff, is frequently assumed to be the biggest constraint in this context, most managers identified other issues, particularly staff morale, as greater barriers to the delivery of high quality health services. The paper concludes that it is the complexity of experience and feelings described by health managers that may determine the extent and quality of service delivery. For this reason, both practice and research need to give greater attention to issues of power relations and personal experience of change.

Attitude of Health Personnel↗

PubMedDate not supplied

Sunscreen use and environmental awareness among beach-goers in Cape Town, South Africa.

BACKGROUND: The potential impact on health of increased exposure to sunlight has caused increased concern in recent years. In South Africa little is known of peoples' sunbathing habits, use of sunscreens, and factors influencing these practices. AIMS: The aims of the study were to determine sunscreen usage among the South African beach-going public, to determine sunbathing practices of beach-goers and to determine factors influencing peoples' sunbathing habits. METHODS: Cluster sampling at 3 popular Cape Peninsula beaches was used to select a sample of 231 white adult beach-goers. Questionnaires were administered to obtain information on the use of sunscreens, frequency of use, peoples' sunbathing activities, their susceptibility to sunburn and ability to tan, whether there was a history of severe sunburn, and knowledge and awareness of environmental issues. Information was also obtained on personal characteristics and sociodemographic factors. RESULTS: 50% of respondents were using a sunscreen on the day of the interview. More women than men, and people over 25 years of age relative to younger persons, made frequent use of sunscreen lotions. A sun protection factor (SPF) of 15 or more was being used by 5% of the population. With respect to peoples' knowledge and awareness of the environment, 90% of the population cited skin cancer as a potential consequence of over-exposure to sunlight, although, in general, knowledge of environmental issues was poor. CONCLUSIONS: A major effort is needed to improve attitudes and practices in South Africa with respect to sun-tanning activities.

Adult↗

PubMed1993

The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa.

OBJECTIVE: To determine the prevalence of NIDDM and associated risk factors in urban Africans in Cape Town, South Africa. RESEARCH DESIGN AND METHODS: With a three-stage, proportional, stratified, random cluster method, we sampled 1000 Africans, > 30 yr of age, living in African residential areas in Cape Town. We assessed glucose tolerance with a 75-g oral glucose tolerance test, according to World Health Organization criteria, and obtained anthropometric and demographic data. RESULTS: The response rate was 79%. The prevalence of NIDDM was 8.0% (confidence interval 5.8-10.3%), age-adjusted to world population figures and that of impaired glucose tolerance, 7.0% (confidence interval 4.9-9.1%). Multivariate analysis indicated that increased age (odds ratio 4.18), upper-segment fat distribution (odds ratio 2.94), proportion of life spent in an urban area (odds ratio 2.32), and obesity (odds ratio 2.31) were significant independent risk factors for NIDDM. In contrast, sex, family history, alcohol intake, and physical activity were not independent risk factors. Only increased age (odds ratio 4.06) was a significant risk factor for impaired glucose tolerance. CONCLUSIONS: The prevalence of NIDDM in urban Africans in Cape Town, South Africa, is moderately high, and considerably higher than previous reports from Africa. The association of NIDDM with urbanization has important implications in view of the large-scale urbanization occurring in southern Africa.

Adult↗

PubMed1993

Sex differences in primary cognitive abilities among blacks, Indians and whites in South Africa.

Sex differences are reported for samples of approximately 1000 16-year-old blacks, Indians and whites in South Africa on ten tests of cognitive ability. Males obtained significantly higher means on non-verbal reasoning, spatial and mechanical aptitude, and females obtained significantly higher means on perceptual speed and memory for meaning (except among the black sample). In general the sex differences in South Africa are consistent with those typically obtained in the United States.

Adolescent↗

PubMed2005

Health system constraints to optimal coverage of the prevention of mother-to-child HIV transmission programme in South Africa: lessons from the implementation of the national pilot programme.

BACKGROUND: It is three years since the government of South Africa began implementing a PMTCT programme. Over this period of time attempts have been made to scale up this programme across all provinces under routine health service conditions. OBJECTIVES: To report on the uptake and performance of South Africa's national pilot programme for preventing mother to child HIV transmission (PMTCT) and to identify health system constraints to optimal coverage. METHODS: Routine programme data were collected from antenatal records and delivery registers at the pilot sites and interviews were conducted with health workers on site and with provincial programme managers. RESULTS: Routine PMTCT programme data were collected from all 18 pilot sites for the period January to December 2002. During this period, of 84406 women attending the sites for first antenatal visits, 47267 (56%) agreed to an HIV test. 14340 (30%) of the women tested were HIV positive and of these 7853 (55%) were dispensed nevirapine. 7950 (99%) of infants born to women identified as being HIV positive received nevirapine syrup. 58% (4196/7237) of HIV positive women expressed an intention to exclusively formula feed, and 42% (3041/7237) intended to exclusively breastfeed. 1907 infants were due for 12 month HIV testing between January and December 2002, of these 949 (50%) infants were tested. CONCLUSION: Programme effectiveness was limited by the low rate of HIV test acceptance, poor delivery of nevirapine to mothers and inability to track mother-infant pairs postnatally for 12-month HIV testing of infants. Infant feeding intentions of mothers suggest inadequate counselling and possible negative effects of the provision of free formula milk. The poor performance of the main components of this programme will seriously reduce its operational effectiveness. There is a need for greater integration of VCT within antenatal care, a review of the current policy of providing free formula milk and an alternative model for mother-infant follow up.

Cross-Sectional Studies↗

PubMed1989

Characterization of Palyam serogroup orbiviruses isolated in South Africa and serologic evidence for their widespread distribution in the country.

The finding that there had been multiple isolations of Palyam serogroup orbiviruses from aborted cattle fetuses in neighbouring Zimbabwe, suggested that there was a need to investigate the possible occurrence of the viruses in South Africa. Unidentified viruses isolated in South Africa, which had been in storage, were examined. Four viruses which had been isolated from Culicoides midges collected at various sites in the years from 1969 to 1977, were identified as three strains of Gweru virus and one of the Nyabira virus (Palyam group serotypes originally described from Zimbabwe). A fifth virus, isolated in 1967 from the blood of a cow with mild fever, was found to be a distinct new member of the Vellore antigenic complex of the Palyam serogroup and was named Apies River virus. Sera from 476 cattle, 150 sheep, 24 goats and 78 humans from 10 farms were tested for neutralizing antibodies to the above three serotypes of virus plus Abadina and Marondera serotypes. Only 1 of 100 cattle sera from two farms in the southern coastal area had antibody, but elsewhere there was a high prevalence of antibody with 254 (53%) of all cattle exhibiting activity for one or more of the five serotypes of virus tested. Only 6 (4%) sheep, 3 (12.5%) goats and 11 (14%) humans had antibody.

Animals↗

PubMed1999

High prevalence of the Cys282Tyr HFE mutation facilitates an improved diagnostic service for hereditary haemochromatosis in South Africa.

OBJECTIVE: The aim of the study was to investigate the molecular basis of hereditary haemochromatosis (HH) in South Africa in order to establish a reliable, cost-effective molecular diagnostic service for this potentially lethal disorder. DESIGN: DNA samples of patient and control groups were screened for two common haemochromatosis (HFE) gene mutations. The local frequencies of mutations C282Y and H63D were determined and the DNA results correlated with biochemical parameters. SETTING: Patients were referred from private practitioners, health workers and pathologists for a molecular diagnosis of HH at the University of Stellenbosch Medical School. Twenty-two of the 244 referrals were clinically diagnosed with HH, while the remaining patients were family members of the probands or unrelated subjects referred solely on the basis of an abnormal iron profile. RESULTS: Seventeen of the 22 patient referrals (77%) diagnosed with HH were homozygous for the C282Y mutation, 3 (14%) were compound heterozygotes for mutations C282Y and H63D, and 2 patients (9%) did not exhibit either mutation. Screening of 458 control individuals from the general South African population demonstrated a carrier frequency of approximately 17% for the C282Y mutation among whites, implying that up to 1 out of every 115 South Africans of European descent may be homozygous for this founder-type mutation. Among 64 healthy blood donors of mixed ancestry, we detected 2 individuals heterozygous and 1 homozygous for the C282Y mutation. CONCLUSIONS: The detection of mutations C282Y and H63D at a high frequency in the majority of affected South African patients facilitates accurate pre-clinical and confirmatory diagnosis of HH in South Africa. Early detection by DNA screening and subsequent treatment by repeated phlebotomy can prevent disease onset in affected individuals. DNA diagnosis is particularly applicable to a common genetic disease such as HH, which is underdiagnosed and potentially lethal, but treatable.

Adult↗

PubMed1998

The socio-cultural contexts of sexually transmitted diseases in South Africa: implications for health education programmes.

Sexually transmitted diseases (STDs) are widespread in South Africa and contribute to the growing HIV epidemic. As an important step in curtailing the spread of STDs, this study explores STD patients' illness representations within its socio-cultural context, particularly gender relationships. In-depth interviews were conducted with Xhosa- and Zulu-speaking patients in clinics in Cape Town, Western Cape (N = 67) and in rural areas of Kabokweni, Mpumalanga (N = 21) The findings suggest that STD patients' illness representations are reflections of their socio-cultural understanding of disease and of culturally defined gender relations. This, in turn, impacts on their general perceptions of the cause of STDs, their perceptions of the risk of contracting STDs, them entering and using formal and traditional medical treatment and on their ideas of prevention. Thus, healthy behaviours need to be facilitated through multiple educational strategies focusing on an improved understanding of the cause of the STD in its context of gender relations, the development of interpersonal and technical skills, as well as focusing on cues for action.

Attitude to Health↗

PubMed1987

The status of dengue fever virus in South Africa--serological studies and diagnosis of a case of dengue fever.

To assess the possibility of a dengue epidemic occurring in South Africa 3 groups of survey sera and 2 groups of patients' sera, from a dengue high risk area of South Africa, were tested for antibodies to several flaviviruses. 3.8% (75/1951) of the survey sera and 9.2% (26/282) of the patients' sera had haemagglutination inhibition antibodies to one or more of the flaviviruses tested. One of 1951 survey sera had a spectrum of complement fixation antibody consistent with a primary dengue infection, and 5 of 282 patients' sera also had complement fixation antibodies to flavivirus antigens. These 5 positive patients had recently travelled to India but in only one was there an antibody spectrum unequivocably consistent with a primary dengue infection. Dengue virus type 1 was successfully isolated from this patient's acute serum. The susceptibility of the population to dengue virus infection, the presence of the main vector of dengue virus and the occurrence of imported cases of dengue fever emphasize the need for continuous vigilance.

Antibodies, Viral↗

PubMed1996

Cesarean deliveries and maternal-infant HIV transmission: results from a prospective study in South Africa.

Data from a prospective study undertaken at an urban hospital in Durban, South Africa, were used to investigate associations between maternal-infant HIV transmission, mode of delivery, and specific circumstances of cesarean deliveries. A total of 141 children of HIV-infected women were followed until the children were 15 months of age to determine their HIV status. supplementary data were collected from obstetric records, masked to the HIV status of the children. In this African and predominantly breast-fed population, infants delivered vaginally were more likely to be infected (39.8% infected) than were infants delivered by cesarean section [22.9% infected; odds ratio (OR), 0.45; 95% confidence interval (CI), 0.20-0.99]. There were no significant differences between cesarean deliveries undertaken following prior rupture of membranes and those undertaken with membranes intact, but numbers for this comparison were small. Singleton cesarean deliveries without concurrent obstetric complications had lower rates of transmission than did vaginal deliveries (OR, 0.20; 95% CI, 0.04-0.94). These results suggest that certain intrapartum events may modify the risk of HIV transmission and highlight the importance of collecting more detailed intrapartum information in order to clarify the route by which mode of delivery may be associated with maternal-infant HIV transmission.

Breast Feeding↗

PubMed1987

Malignant melanomas in the Eur-African-Malay population of South Africa.

Malignant melanoma is common among the whites of South Africa. In the black population, the tumor is much less frequent and occurs predominantly on the lower limb--particularly the sole of the foot. This study brings to light the anomalous situation that among the Eur-African-Malay population (those of mixed ancestry), malignant melanoma has probably the lowest incidence in the world.

Adult↗

PubMed2002

High incidence of HIV-1 in South Africa using a standardized algorithm for recent HIV seroconversion.

Southern Africa has among the highest rates of HIV-1 infection in the world as judged by cross-sectional HIV-1 prevalence surveys carried out among women attending antenatal clinics. Incidence rates, which provide information on the number of new cases of infection, are more informative of the current state of the epidemic than estimates of prevalence, which provide information on the rates averaged over some previous time. Cohort studies to measure incidence rates are expensive and difficult to carry out, however, and few have been done in Africa. A recently developed standardized algorithm for recent HIV-1 seroconversion (STARHS) based on a sensitive/less-sensitive enzyme-linked immunosorbent assay was used to determine the incidence of HIV-1 subtype C infection among women attending public sector antenatal clinics in Hlabisa, a rural district in KwaZulu-Natal, South Africa. The STAHRS results were confirmed by using a mathematic model to obtain an independent estimate of the age-specific incidence rates from the age-specific prevalence data. The data reveal extraordinarily high HIV-1 incidence rates in South Africa. In 1999, the annual incidence of HIV-1 among susceptible women aged 15 to 49 years standardized to the age distribution of adult women in Hlabisa was 17%. Incidence peaked among 22-year-old women at 24% per year. The HIV-1 incidence rates provide valuable additional information indicating that new infections are continuing unabated and that the HIV-1 epidemic is still growing in rural South Africa.

Adolescent↗