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PubMed2001

Pedestrian road traffic collisions in South Africa.

Pedestrian road traffic collisions continue to account for a large number of the clients attending the accident & emergency units in South Africa. These victims include both adults and children, and can lead to serious lifelong consequences for the victims and their families. A pilot study was carried out in Durban, KwaZulu-Natal in order to investigate the injuries sustained by pedestrian paediatric clients who were involved in road traffic collisions in South Africa. The findings of the study reflecting the age, gender distribution and the injuries and their severity are discussed.

Accidents, Traffic↗

PubMed2005

The cost of a rapid-test VCT clinic in South Africa.

CONTEXT: Demand for HIV voluntary counselling and testing (VCT) will increase as HIV prevention and treatment scale up in South Africa. Understanding the cost of delivering VCT will inform funding decisions. OBJECTIVE: To determine the cost per client completing VCT (pretest counselling, testing and post-test counselling) in a non-research- based programme using rapid-test technology. DESIGN: One year of expenditure and output data were collected retrospectively as part of the PANCEA (Prevent AIDS: Network for Cost-Effectiveness Analysis) study. Market prices were determined for donated resources. SETTING: An urban, church-based, non-profit organisation that offers rapid-test VCT services in KwaZulu-Natal, South Africa. RESULTS: Financial expenditure for the 2002/2003 fiscal year was 39,761 dollars (calculated using an average conversion rate for July 2003, which was 0.133). Using market prices for donated resources, the economic cost for the year was estimated at 67,248 dollars. Six hundred and sixty-two clients completed VCT, resulting in financial expenditure of 60.06 dollars per client and an economic cost of 101.58 dollars per client. Financial expenditures and economic costs per client decreased over the year by 66% because expenses remained stable as more clients were served. CONCLUSIONS: The cost of providing VCT services was higher than previously reported, but declined with expanding scale.

AIDS Serodiagnosis↗

PubMed2005

Determinants of smoking cessation among adolescents in South Africa.

Data is required on the motivational determinants of smoking cessation among a multi-ethnic sample of adolescents in South Africa. The I-Change Model was used to explore the determinants of smoking cessation among a sample of 1267 Black African, Colored and White Grade 9-11 monthly smokers and former smokers in the Southern Cape-Karoo region. Across the ethnic groups, former smokers displayed a more positive attitude toward non-smoking, were surrounded by a social environment that was more supportive of non-smoking, displayed higher self-efficacy not to smoke in stressful, routine and social situations, and were more positive about their intention not to smoke in the next year. The I-Change Model can be used to address the cognitions of smoking in a multi-ethnic society like South Africa. However, some ethnic tailoring will be required. Black African students will benefit from a focus on attitudinal cognitions and cultural factors that motivate smoking. Colored students require the involvement of their social environment, while White students will benefit from the development of refusal skills in social situations.

Adolescent↗

PubMed2003

Understanding high school students' risk behaviors to help reduce the HIV/AIDS epidemic in KwaZulu-Natal, South Africa.

Of 901 rural learners (X age 16.1, SD = 2.4) at 10 randomly selected high schools in KwaZulu-Natal, South Africa, those living with a parent were less likely to drink alcohol (P < 0.0001) or use drugs (P = 0.006). Thirty percent (95% CI 26.9, 33.1) were sexually active, and 53.1% used a condom in the past 30 days. The odds of males being sexually active was 7.27 the likelihood of females (95% CI 5.2, 10.1). Only one-third of male respondents always used condoms. Of sexually active respondents, 46.5% had experienced coercive sex. More males (14.1%) than females (3.6%) smoked cigarettes (P < 0.0001). The odds of males drinking alcohol was 4.5 times that of females (P < 0.0001). Smoking, (OR 2.42, 95% CI 1.32, 4.44) and drinking, (OR 2.67, 95% CI 1.71, 4.19) among learners increased the likelihood of sexual activity. With youth at increasing risk of HIV/AIDS in KwaZulu-Natal, South Africa, interventions to reduce learners' risk behaviors are required.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Cost-effectiveness of highly active antiretroviral therapy in South Africa.

BACKGROUND: Little information exists on the impact of highly active antiretroviral therapy (HAART) on health-care provision in South Africa despite increasing scale-up of access to HAART and gradual reduction in HAART prices. METHODS AND FINDINGS: Use and cost of services for 265 HIV-infected adults without AIDS (World Health Organization [WHO] stage 1, 2, or 3) and 27 with AIDS (WHO stage 4) receiving HAART between 1995 and 2000 in Cape Town were compared with HIV-infected controls matched for baseline WHO stage, CD4 count, age, and socioeconomic status, who did not receive antiretroviral therapy (ART; No-ART group). Costs of service provision (January 2004 prices, USD 1 = 7.6 Rand) included local unit costs, and two scenarios for HAART prices for WHO recommended first-line regimens: scenario 1 used current South African public-sector ART drug prices of $730 per patient-year (PPY), whereas scenario 2 was based on the anticipated public-sector price for locally manufactured drug of $181 PPY. All analyses are presented in terms of patients without AIDS and patients with AIDS. For patients without AIDS, the mean number of inpatient days PPY was 1.08 (95% confidence interval [CI]: 0.97-1.19) for the HAART group versus 3.73 (95% CI: 3.55-3.97) for the No-ART group, and 8.71 (95% CI: 8.40-9.03) versus 4.35 (95% CI: 4.12-5.61), respectively, for mean number of outpatient visits PPY. Average service provision PPY was $950 for the No-ART group versus $1,342 and $793 PPY for the HAART group for scenario 1 and 2, respectively, whereas the incremental cost per life-year gained (LYG) was $1,622 for scenario 1 and $675 for scenario 2. For patients with AIDS, mean inpatients days PPY was 2.04 (95% CI: 1.63-2.52) for the HAART versus 15.36 (95% CI: 13.97-16.85) for the No-ART group. Mean outpatient visits PPY was 7.62 (95% CI: 6.81-8.49) compared with 6.60 (95% CI: 5.69-7.62) respectively. Average service provision PPY was $3,520 for the No-ART group versus $1,513 and $964 for the HAART group for scenario 1 and 2, respectively, whereas the incremental cost per LYG was cost saving for both scenarios. In a sensitivity analysis based on the lower (25%) and upper (75%) interquartile range survival percentiles, the incremental cost per LYG ranged from $1,557 to $1,772 for the group without AIDS and from cost saving to $111 for patients with AIDS. CONCLUSION: HAART is a cost-effective intervention in South Africa, and cost saving when HAART prices are further reduced. Our estimates, however, were based on direct costs, and as such the actual cost saving might have been underestimated if indirect costs were also included.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Different approaches to the vaccination of free ranging village chickens against Newcastle disease in Qwa-Qwa, South Africa.

The aim of this study was to develop a strategy to control Newcastle disease (ND) in free ranging village chickens using the Nobilis ND Inkukhu vaccine (Intervet South Africa). The study was conducted at Thibella village in Qwa-Qwa, South Africa from April 2001 to October 2002. Three different routes of vaccination (administration via eye-drop, drinking water and feed) were investigated. The haemagglutination inhibition (HI) test was conducted monthly in order to measure the antibody response of village chickens after immunization against Newcastle disease. Using a South African isolate of velogenic ND virus, challenge trials were conducted to determine the efficacy of the vaccine. A questionnaire was provided to evaluate perceptions of farmers on vaccinations. The eye-drop vaccination route produced the highest HI titres ranging between 2.7 and 4.4, followed by the drinking water vaccination route with titres ranging between 2.3 and 4.0. The lowest titres were from the feed vaccination route which ranged between 1.6 and 3.0. Following the challenge, the entire control group died on the third and fourth day after infection. However, 70% of the chickens immunized by using either the eye-drop or drinking water route survived the challenge. Only 20% of the chickens from the group immunized through the feed route survived. Evidently both the eye-drop and drinking water routes were efficient in preventing disease. Necropsies showed that vaccinated chickens had mild lesions whilst control chickens had severe lesions compatible with Newcastle disease. The efficacy of the vaccine using either of the routes can be enhanced by administration of booster vaccinations at 3-month intervals during the first year of a vaccination campaign and then at 6-month intervals from the second year onwards. The majority of the owners indicated that they would prefer to vaccinate their flocks using the drinking water route.

Animals↗

PubMed1997

The increasing burden of tuberculosis in rural South Africa--impact of the HIV epidemic.

OBJECTIVE: To determine the impact of the HIV epidemic on tuberculosis caseload in rural South Africa. SETTING: Hlabisa health district, KwaZulu-Natal. METHODS: Demographic and clinical data were extracted from the tuberculosis database for the period, May 1991-June 1995. The attributable fraction of HIV-infected tuberculosis cases was estimated from the prevalence of HIV infection in tuberculosis cases and the prevalence of HIV infection in women attending antenatal clinics. RESULTS: Between 1991 and 1995, the annual tuberculosis caseload increased from 301 to 839 cases. Tuberculosis accounted for 4.7% of all admissions in 1989 and 8.3% in 1995 (P < 0.0001). The incidence of tuberculosis increased from 154/100,000 in 1991, to 413/100,000 in 1995. The proportion with smear-positive pulmonary disease fell from 65% to 56% (P = 0.04), and pleural tuberculosis accounted for 7.5% of disease in 1991 and 18% in 1995 (P = 0.002). The minimum HIV prevalence in patients with tuberculosis increased from 8.7% in 1991 to 28.3% in 1995, and the proportion of tuberculosis cases attributable to HIV infection was estimated to be at least 44% in 1995. CONCLUSION: The burden of HIV-related tuberculosis is increasing rapidly in rural South Africa and is exerting a negative impact. Innovative approaches to control will be needed to cope with it effectively.

AIDS-Related Opportunistic Infections↗

PubMed1977

Focal epithelial hyperplasia of the mouth: recently discovered in South Africa.

Seventy-six cases of focal epithelial hyperplasia are encountered during an epidemiological survey in the Western Cape Province of South Africa. They affected only Cape Coloureds and were confined to pupils of reform schools and residents of a secluded community. This pattern of distribution, coupled with its typical clinical and histological features and the fact that viral particles were observed in lesions, indicates a communicable disease of viral origin, possibly a virus of the papova group. The recent discovery of its presence in South Africa indicates that it may be newly introduced into the country or that it is a new or hitheto undetected manifestation of an existing viral disease.

Adolescent↗

PubMedDate not supplied

Concomitant Ornithobacterium rhinotracheale and Newcastle disease infection in broilers in South Africa.

Ornithobacterium rhinotracheale was first isolated from broilers in South Africa in 1991. The importance of O. rhinotracheale infections has been established, with growth suppression, respiratory symptoms, and arthritis commonly seen as complications. Dual infection with Newcastle disease and O. rhinotracheale in 28-day-old broilers led to more severe respiratory lesions and higher mortality rates than in birds with only Newcastle disease. It was concluded that the pathogenicity of Newcastle disease virus was enhanced when occurring in combination with O. rhinotracheale. Also of interest was the first isolation of O. rhinotracheale from the liver.

Animals↗

PubMed2006

The cost-effectiveness of antiretroviral treatment in Khayelitsha, South Africa--a primary data analysis.

BACKGROUND: Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART) represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY) and quality adjusted life year (QALY) gained of HIV treatment interventions from a provider's perspective. METHODS: Data on service utilisation, outcomes and costs were collected in the Western Cape Province of South Africa. Utilisation of a full range of HIV healthcare services was estimated from 1,729 patients in the Khayelitsha cohort (1,146 No-ART patient-years, 2,229 ART patient-years) using a before and after study design. Full economic costs of HIV-related services were calculated and were complemented by appropriate secondary data. ART effects (deaths, therapy discontinuation and switching to second-line) were from the same 1,729 patients followed for a maximum of 4 years on ART. No-ART outcomes were estimated from a local natural history cohort. Health-related quality of life was assessed on a sub-sample of 95 patients. Markov modelling was used to calculate lifetime costs, LYs and QALYs and uncertainty was assessed through probabilistic sensitivity analysis on all utilisation and outcome variables. An alternative scenario was constructed to enhance generalizability. RESULTS: Discounted lifetime costs for No-ART and ART were US$2,743 and US$9,435 over 2 and 8 QALYs respectively. The incremental cost-effectiveness ratio through the use of ART versus No-ART was US$1,102 (95% CI 1,043-1,210) per QALY and US$984 (95% CI 913-1,078) per life year gained. In an alternative scenario where adjustments were made across cost, outcome and utilisation parameters, costs and outcomes were lower, but the ICER was similar. CONCLUSION: Decisions to scale-up ART across sub-Saharan Africa have been made in the absence of incremental lifetime cost and cost-effectiveness data which seriously limits attempts to secure funds at the global level for HIV treatment or to set priorities at the country level. This article presents baseline cost-effectiveness data from one of the longest running public healthcare antiretroviral treatment programmes in Africa that could assist in enhancing efficient resource allocation and equitable access to HIV treatment.

Journal Article↗

PubMed1979

Scaling sex attitudes and behavior in South Africa.

Sex attitudes and behavior were scaled according to Guttman scale criteria among 300 members of the public, students, and nurses in Johannesburg, South Africa, replicating the central features of earlier studies conducted in the United States. The study presents an initial attempt to establish norms of sex attitudes and behavior in South Africa. The scales are shown to provide reliable tools for sex research and clinical practice.

Attitude↗

PubMed1997

A unique segment of the hepatitis B virus group A genotype identified in isolates from South Africa.

The preS2/S genes of hepatitis B virus isolated from 29 acutely or chronically infected individuals in the Gauteng province of South Africa were sequenced. Phylogenetic analysis of these sequences in comparison with global isolates from the GenBank database showed that 24 sequences clustered with genotypic group A, three with genotypic group D and one each with genotypic groups B and C. Group A isolates had greater identity with groups D (variation of 6.6%) and E (6.8%) than with the Eastern groups B (7.4%) and C (8.1%) and were most different from group F (11.0%). Of the South African group A specimens, 59.1% clustered with two global sequences to form a discrete segment which we have called subgroup A. The amino acid differences that set these isolates apart from the rest of group A tended to cluster in the preS2 region (amino acids 7, 10, 32, 35, 47, 48, 53 and 54), with a few changes occurring in the major surface antigen (amino acid sites 207 and 209). Analysis of isolates showed that there was a 9-fold higher prevalence of the ay determinant in South Africa than previously reported.

Amino Acid Sequence↗

PubMed2004

Ad/dressing the nation: drag and authenticity in post-apartheid South Africa.

This paper examines a style of drag in South Africa that features "traditional African" clothing. In a region in which homosexuality is denigrated as a colonial, European import and "unAfrican," the meaning of "traditional drag" is deeply inflected by the question of cultural authenticity. This dragging practice fits within a distinctly post-colonial production of tradition and its self-conscious display--in the form of attire--of a decidedly "gay" one. Traditional drag also responds to ongoing politics within and between lesbian and gay communities about racial "representivity" and "transformation." The paper focuses on displays of traditional drag at Johannesburg's Gay and Lesbian Pride Parade but also explores the complex politics of publicity and address suggested by varying contexts in which traditional dress and drag are mobilized.

Clothing↗

PubMed1988

Infant mortality rates in urban areas of South Africa, 1981-1985.

National infant mortality rates (IMRs) for South Africa are at present based on guestimates. There is no reliable national black IMR estimate. A study was undertaken to determine the IMR for 10 large urban areas (where records are available) for 1981-1985 and to use these to estimate a national black IMR. Considerable variability in the IMR was found for blacks both between cities and years. An overall national IMR estimate for blacks of between 94 and 124 deaths per thousand live births was obtained. This is about twice as high as the national figure of 51.9 for coloureds. The coloured non-urban rate was 2.6 times the urban rate of 25.9 while the Asian and white rates were similar in urban and non-urban areas (17.9 and 12.3 respectively).

Black or African American↗

PubMed1989

High prevalence of hepatitis B virus infection in rural black adults in Mseleni, South Africa.

A community-based study in northern Natal/KwaZulu, South Africa, assessed the prevalence of hepatitis B virus (HBV) infection in rural Black adults. The prevalence of HBV carriers was 4.4 percent in women (N = 342) and 7.1 percent in men (N = 99). At least one marker of HBV infection was present in 81 percent of women and 86 percent of men. The relative risk (RR) of HBV marker positivity in women due to scarification, adjusted for the presence of pierced ears, was 1.37 (95% CI = 0.9, 2.1). Risk factors such as scarification and pierced earlobes need to be further investigated to assess their role in the transmission of the HBV.

Adolescent↗

PubMed2003

Occupational health nursing in South Africa. Enhancing international perspectives.

1. Occupational health care in South Africa has lagged behind that of other countries because it was developed within the context of a fragmented, racist, and conservative legislative framework. This legislation has been improved in recent years. 2. Complex legislation, the demographic profile of workers, mortality and morbidity profiles, occupational injuries and diseases, changes in technology, and poor working conditions are present challenges for occupational health nursing practitioners to provide a comprehensive program for the protection of worker health and safety. 3. Most occupational health services are provided by private sector companies. There is a lack of occupational team members, especially physicians, occupational hygienists, and rehabilitation workers. Occupational health nurses provide primary health care, as well as occupational health care in their clinics. 4. Occupational health nursing has developed into a formally recognized post-graduate specialization, with a strong national professional society and the promotion of research.

Humans↗

PubMed2001

National policy on testing for HIV in South Africa: an urgent need.

No National Policy exists in South Africa for the testing of persons who may be infected by HIV/AIDS. A Draft National Policy on Testing for HIV was published in the Government Gazette by the Minister of Health for commentary in December 1999. The policy provides for the following: circumstances under which HIV testing may be conducted; informed consent, pre-test and post-test counselling; and the interpretation of the policy. This policy will apply to persons who are able to give consent as well as to those who are legally entitled to give proxy consent to HIV testing. Testing with informed consent means that the individual has been made aware of, and understands, the implications of the test. "The vision which fueled our struggle for freedom; the deployment of energies and resources; the unity and commitment to common goals--all these are needed if we are to bring AIDS under control. Future generations will judge us on the adequacy of our response." President Nelson Mandela. DAVOS, 1996.

AIDS Serodiagnosis↗

PubMed1991

The role of health professional at worksite health services in South Africa.

The goal of this study was to describe the roles of health care professionals at small and large worksites in South Africa and to compare them with those of similar professionals in other countries. Questionnaires were mailed to 981 individuals listed as responsible for worksites. Respondents were asked to record number of employees at the worksite and indicate what proportion of time was spent by registered nurses and medical practitioners on each of the specified duties. Medical practitioners spent much less time at worksite health services than nurses. Nurses in small worksites worked a 33.6 hour week, while nurses in large worksites worked a 45.4 hour week. Nurses spent more time on administration, particularly in small worksites. This study showed that the nurse may be better suited to the role of administrator of the worksite health service in South Africa because of the longer work week and greater employee contact than the medical practitioner.

Allied Health Personnel↗