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PubMed1988

The impact of political violence on health and health services in Cape Town, South Africa, 1986: methodological problems and preliminary results.

Cape Town, South Africa experienced an upsurge in the level of political violence from May to July of 1986. To determine the impact of the political violence on health and health services, selected routinely available information was analyzed, a community survey was conducted of 1,540 randomly selected households in high, medium, and low impact areas (defined using police and community reports), and a survey of 162 nurses (75 per cent response rate) working in clinic and maternity services in Cape Town's townships was undertaken. Methodological problems were encountered in relation to sampling, interviewer allocation to areas, and access to routinely available information. Nevertheless, a consistent picture emerged from the studies that: demonstrated the impact of political violence on attendance at routine health service facilities (for hypertension, tuberculosis, immunizations, antenatal and postnatal services); highlighted the disruptions caused to basic services in high impact areas (water, street lighting, sanitation and transport); documented the problems experienced by nurses in performing their usual services and by patients obtaining access to their services; showed that high impact areas had three times higher rates of gunshot wounds than low impact areas during the period.

Adolescent↗

PubMed1996

Selenium toxicosis with focal symmetrical poliomyelomalacia in postweaning pigs in South Africa.

An outbreak of paralysis in finisher pigs in South Africa after ingestion of feed containing 54,581 mg/kg of selenium is described. The main and entirely consistent lesion was bilaterally symmetrical focal poliomalacia of the ventral horns of the spinal cord, which was most severe and consistent in the lumbar intumescence. Acute and subacute lesions were characterized by malacia with large numbers of gitter cells. The main features of chronic lesions were loss of neurons and gliosis. Focal degeneration and necrosis of the myocardium and skeletal muscles were also consistent, but there were fewer specific changes. Endothelial swelling, mild fibrinoid degeneration and perivascular leukocytic infiltration were present in the acute stage. Dermatitis, coronitis and hoof sloughing, usually present in more chronic cases of intoxication, were not a feature of the present outbreak, although alopecia and crusting were evident on the backs of a few pigs several weeks after the episode of intoxication. Serum-and tissue-selenium levels were elevated in the early stages after intoxication. Serum levels were nearly normal in chronic cases two months after the episode, while liver and kidney levels were still higher than normal. Higher levels were found in liver, kidney and serum than in muscle, with the highest levels in the kidney. Less than 20% of affected pigs recovered sufficiently to be marketed.

Animal Feed↗

PubMed1999

Mycobacterium bovis as a zoonosis in the Kruger National Park, South Africa.

SETTING: The Kruger National Park (KNP), Mpumalanga Province, South Africa. OBJECTIVE: The prevalence of tuberculosis caused by Mycobacterium bovis exceeds 70% in African buffalo in the southern region of the KNP. Inter-species transmission (lion, cheetah, baboon, antelope) has also been confirmed. Regular culling of emaciated buffalo and processing of meat and hides constitute routine control policy. Following extensive media coverage of the problem, public health concerns about the transmission of M. bovis to humans, including visitors to the KNP, prompted this investigation. DESIGN: The study was designed to determine the prevalence of infection and/or active disease due to M. bovis among KNP employees selected from three defined risk groups based on occupation category. RESULTS: Of 206 persons screened for active disease by sputum bacteriology, two persons with disease due to M. tuberculosis were identified. No isolate of M. bovis was found. Differential skin testing using three antigens failed to show any degree of M. bovis infection risk, even among high risk occupations. Reasons for these results are discussed. CONCLUSIONS: Bovine tuberculosis was not indicated as an occupational zoonosis in the KNP, nor was aerosol transmission implicated as a mechanism for human infection. Concerns about the public health implications of tuberculosis in buffalo in the KNP have therefore not been validated.

Adult↗

PubMed1999

Tuberculosis patient care decentralised to district clinics with community-based directly observed treatment in a rural district of South Africa.

SETTING: A rural district of the Northern Province, South Africa. OBJECTIVES: To measure the effect of decentralisation of a tuberculosis service in a rural area on treatment outcomes. DESIGN: An intervention study that measured treatment outcomes of patients attending district clinics for tuberculosis treatment and compared these with outcomes of patients attending the district hospital. RESULTS: Over the 4-year period 1992-1995, 928 patients were admitted to the tuberculosis unit of the district hospital. In the initial pre-intervention phase, the best estimate of completed treatment for all 503 cases was 61%, and for 206 new smear-positive patients it was 67%. The intervention process established a tuberculosis control programme with directly observed treatment for all patients, and training and supervision of clinic staff. Ninety per cent of all patients had community-based supporters. For most patients, cure was not proven, but assuming success from completion of and proven adherence to treatment, successful outcomes for new smear-positive cases rose to 82% for decentralised (clinic) treatment, and 88% for those patients who lived in the district but attended the hospital for treatment. CONCLUSIONS: These findings suggest that district clinics can achieve the same good results as the hospital. It is recommended that tuberculosis control needs a dedicated co-ordinator at district level to manage the necessary infrastructural and staff resources.

Adolescent↗

PubMed1980

Rift Valley fever in humans in South Africa.

During an epizootic of Rift Valley fever in South Africa in 1974/1975, mainly affecting sheep and cattle, a large number of human cases occurred. The majority of the patients, mostly farmers, farm labourers and veterinary surgeons, acquired the infection while handling the carcasses of animals which had died of Rift Valley fever. Some gave no history of contact with infected animals and it is presumed that they were infected by mosquitoes. Complications were common. Retinitis clinically associated with defective vision occurred in about 20% of patients investigated. In others, meningo-encephalitis developed; 1 patient died and the brain showed perivascular cuffing and round-cell infiltration. In 110 cases the diagnosis was confirmed in the laboratory, in 17 by isolation of the virus and in 93 by the finding of an antibody response in serological tests. In 3 fatal cases the virus was isolated from the liver, and in a further 4 fatal cases in which virus isolation was not attempted, there was clinical and epidemiological evidence of the diagnosis; in each case a haemorrhagic state associated with hepatitis had developed. In 1978, follow-up studies showed that immune rates among residents on affected farms varied from 10% in children to 17,1% in adult males, with an overall immunity rate of 14,5%.

Adult↗

PubMed2005

Duodenal ulcer in South Africa: home-pounded versus milled maize.

BACKGROUND: In South Africa there is suggestive evidence that home-pounded maize protects against duodenal ulceration. Therefore the purpose of the present paper was to test, in an animal model, whether oil from home-pounded maize gives protection against ulceration and whether this effect is present in commercially prepared maize oil. METHODS: Gastric ulceration was induced in rats with topical ethanol 1 h after giving oil prepared either from fresh-pounded or from commercially treated maize. The lengths of the linear ulcers produced were measured with a planimeter and summed in each rat. Control observations were made using arachis oil (which is known not to be ulceroprotective) and horse gram lipid (which is known to be strongly ulceroprotective). Statistical comparisons were performed mainly with the Mann-Whitney U-test, but also with reference to the normal distribution. Thin-layer chromatography (TLC) was performed on the oil from fresh maize, and the fractions similarly investigated for ulceroprotective activity. RESULTS: Fresh maize oil was strongly ulceroprotective (P = 0.0039), commercial maize oil was not (P = 0.2864). The active ingredient in the fresh maize oil was located in the fraction near the solvent front. CONCLUSION: These findings support the hypothesis that home-pounded maize protects against duodenal ulceration.

Animal Feed↗

PubMed1998

Dietary iodine deficiency in South Africa. Surveys before the introduction of universal salt iodisation.

OBJECTIVE: To survey iodine nutritional status in several geographically separated communities in South Africa. DESIGN: In an initial study total goitre prevalence (TGP) was correlated with urinary iodine concentration (UIC) in some 300 primary school children in a single district. Thereafter only UIC was surveyed in children from 5 additional communities. RESULTS: In the initial survey in Mpumalanga TGP was 74.2% (23.4% visible) and the median UIC was 15.6 micrograms/l, both data indicating severe iodine deficiency in this district. Median UIC values indicated mild to severe iodine deficiency in districts in the Northern Province, moderate deficiency in the Eastern Cape, and mild deficiency in Soweto, Gauteng. Only non-black African children in Johannesburg were iodine-replete (UIC > 100.0 micrograms/l.) CONCLUSION: Before the introduction of compulsory iodisation of salt in December 1995, dietary iodine deficiency was widespread in South Africa.

Child↗

PubMed1998

AIDS control and the workplace: the role of occupational health services in South Africa.

AIDS interventions typically fail to address the disjuncture between private behaviors and the social determinants of HIV infection. Data from a telephone survey of manufacturing companies and a postal survey of occupational health nurses in the Western Cape, South Africa, were used to explore the possible role of occupational health services in prevention and control of AIDS. The author found limited evidence of worker involvement in AIDS programs, particularly in companies with occupational health professionals. The management of sexually transmitted diseases was incomplete. Mandatory pre-employment testing of workers for HIV was not widespread. Respondents' opinions on priorities for AIDS prevention and control reflected a preoccupation with knowledge transfer. To ensure their effectiveness, workplace AIDS programs must improve worker participation and integrate AIDS prevention in general workplace health and safety programs. In addition, education programs must develop objectives within a critical theoretical understanding of the behavioral issues relevant to AIDS prevention, and must emphasize the empowerment of women in the workplace. In the context of the present restructuring of health services in South Africa, occupational health services, using the strategies outlined, can make a major contribution to national AIDS prevention and control.

Acquired Immunodeficiency Syndrome↗

PubMed2002

Unpaid community volunteers--effective providers of directly observed therapy (DOT) in rural South Africa.

OBJECTIVE: To illustrate successes and difficulties for the South African National Tuberculosis Programme in a rural area. DESIGN: Prospective cohort study. SETTING: Sekhukhuneland, Provincial Health Service Southern Region, Northern Province, South Africa. SUBJECTS: All patients diagnosed with tuberculosis (TB) in the catchment area of four rural hospitals between January 1997 and June 1999. MAIN OUTCOME MEASURES: Standard outcomes for TB treatment as defined by the World Health Organisation. Treatment failure, treatment interruption and death were grouped as poor outcomes. RESULTS: One thousand four hundred and seventy-six people were diagnosed with TB. The majority (76%) had smear-positive pulmonary disease. Treatment was given by directly observed therapy (DOT) throughout in all but 15 instances. Excluding 10 subjects with known multidrug-resistant TB (MDRTB), 723 (66%) were cured, 68 (6%) completed treatment, 73 (7%) interrupted treatment, 37 (3%) failed treatment, 66 (6%) transferred out, and 134 (12%) died. Of the 920 initially smear-positive patients who survived the first 2 months to receive DOT in the community, 693 (75%) were supervised by unpaid community volunteers. Poor outcomes were no more common among patients supervised by these volunteers than among patients supervised by professional health care workers. Male gender (odds ratio 1.38, 95% confidence interval 1.02, 1.87) was significantly associated with a poor outcome. CONCLUSION: Although there were difficulties, the national programme was successfully applied with no additional funds or facilities. Explanations for the high death rate and poor outcomes for men need to be found. Great efforts will be required to preserve the quality of the TB programme if it is devolved to primary care level.

Adolescent↗

PubMed1999

Duinefontein 2: an Acheulean site in the Western Cape Province of South Africa.

Excavations at Duinefontein (DFT) 2 near Cape Town, South Africa have recovered numerous stone artefacts and animal bones on an ancient surface sealed within iron-stained eolian sands. U-series analysis of an overlying calcrete places the sands before 150 ka ago, while the large mammal taxa imply an age between 400 and 200 ka ago. The artefacts include a classic Acheulean handaxe and probable biface shaping flakes that support this age estimate. The principal mammalian species are long-horned buffalo, black wildebeest, greater kudu, Cape zebra, and grysbok/steenbok, which imply a grass-and-bush mosaic instead of the historic small-leafed shrubland. Hippopotamus and reedbuck indicate that water stood nearby, probably in dune swales. The large mammal bones are mostly vertebrae and other axial elements, often in near-anatomical order. Both proximal and distal appendicular elements are rare. Bones with carnivore damage are common, but ones with stone tool marks are scarce. The sum suggests a water-edge attritional death site where people played a minimal role and carcasses were disarticulated mainly by carnivore feeding and by trampling. Stone tool marks tend to be equally rare at other Acheulean attritional death sites, and the implication may be that Acheulean people rarely obtained large mammals, whether by hunting or scavenging. Human scavengers at DFT2 would not have encountered a disproportionate number of distal (versus proximal) limb elements, and it follows that the tendency for distal elements to dominate many archeological assemblages need not reflect scavenging versus hunting. Even if DFT2 was not itself a locus of intense human activity, it provides a useful baseline for evaluating bone damage, skeletal part representation, and other variables at sites where people were deeply involved.

Animals↗

PubMed1983

A 3-year cytogenetic survey of 9 661 patients in South Africa.

During the period 1 January 1977 - 31 December 1979, 9 661 patients underwent cytogenetic investigation at seven participating laboratories in South Africa. The chromosome data were coded using a standard protocol and the results tabulated, being listed according to the clinical signs which led to referral for investigation. Cytogenetic investigation was most commonly requested for prenatal studies, and 22% of the group's effort was directed towards this. One in 27 amniotic cell specimens was reported to have shown anomalous chromosomes, trisomy 21 being the most frequent abnormality. The majority of postnatal investigations were requested because congenital abnormalities suggested an underlying chromosomal defect. In 42,3% of 2 420 patients a chromosome defect was confirmed. Results of chromosome studies are tabulated by indication for referral and the findings summarized. This collaborative study gives an indication of the nature and frequency of chromosome disorders in South Africa.

Chromosome Aberrations↗

PubMed2006

Running before we walk: how can we maximise the benefits from community service dietitians in KwaZulu-Natal, South Africa?

INTRODUCTION AND AIM: The Department of Health in South Africa, instituted compulsory community service (CS) as one strategy to overcome the chronic shortage of health professionals in underserved and rural areas. A number of articles have listed the reasons for the lack of willingness of health professionals to practice in rural areas. Amongst others they listed the lack of career opportunities, the recruitment of students into health professions from incongruous backgrounds, inappropriate training, bureaucratic problems, poorly equipped hospitals and social isolation. The aim of this study was to examine and explore the factors affecting the professional development of dietitians during CS. METHODS: Thirteen of the 15 community service dietitians (CSDs) currently (2005) undertaking CS in KwaZulu-Natal participated in focus group discussions. Each member of the group was also required to answer a short written questionnaire before the discussions to establish whether there was congruence between the written answers and the verbal discussions. The large group was divided into two sub groups and each session lasted one and a half hours. A list of topics was discussed by each group. The sessions were taped and transcribed and further analysed using the qualitative analysis programme, "QSR NVivo". RESULTS: Analysis of the transcripts revealed a number of thematic areas and included the evaluation of the placement process, obstructions and constraints, the developmental progress of the CSD and means of enhancing professional development. The discussion on the placement process was not contentious, with only three CSDs having reservations about the process. Many obstructions and constraints to service delivery and professional development were revealed and included the lack of supervision and support, the lack of preparedness of the institutions receiving CSDs and the lack of clarity of the CSDs' perception of community service, unhappiness of some CSDs being placed a long way from home, work and role overload, not being part of a team, lack of understanding the CSDs role and the under utilisation of their services. Developmental progress of the CSDs was enhanced by some positive aspects which included the social interactions experienced in the community setting, learning new skills and support that they received from other community service professionals. DISCUSSIONS AND RECOMMENDATIONS: Comparison of the written answers with verbal discussions showed the same results. A number of issues raised in this study have been recorded by other authors. It is recommended that the issue of supervision and support be addressed so that the professional development of CSDs is enhanced. The lack of preparedness of the receiving institutions is a problem that is relatively easy to address and should be made a priority. The training institutions also need to be more proactive in preparing dietetic students for CS. CONCLUSIONS: Compulsory community service as a method of addressing the problems of underserved population has merit. To maximise the benefits the DOH would do well to heed the recommendations by ensuring that there are structures in place to provide adequate resources for and support and supervision of CSDs.

Allied Health Personnel↗

PubMed2003

Fetal alcohol syndrome--South Africa, 2001.

Fetal alcohol syndrome (FAS) is caused by maternal alcohol use during pregnancy and is one of the leading causes of preventable birth defects and developmental disabilities. The FAS phenotype is characterized by a combination of facial dysmorphic features, growth retardation, and central nervous system (CNS) abnormalities. State-based estimates of the prevalence of FAS in the United States vary from 0.3 to 1.5 per 1,000 live-born infants. Recently, the highest prevalence of FAS worldwide was reported among first-grade children in a wine-growing region in the Western Cape province of South Africa. Investigators for the National Institutes of Alcoholism and Alcohol Abuse (NIAAA) reported a FAS prevalence of 40.5 to 46.4 per 1,000 children aged 5-9 years in one community in Western Cape. To determine whether FAS was associated exclusively with the wine-growing region in Western Cape or was more endemic in other areas of the country, CDC, in collaboration with the University of Witwatersrand and the Foundation for Alcohol Related Research in Johannesburg, South Africa, conducted a prevalence study in Gauteng province and is developing ongoing surveillance and prevention activities. This report summarizes the findings of the study, which indicate a high prevalence of FAS among first-grade children in four nonwine-growing communities around Johannesburg. Because South Africa has limited resources and many competing health problems (e.g., human immunodeficiency virus/acquired immunodeficiency syndrome, tuberculosis, and sexually transmitted diseases), integrating prenatal alcohol-exposure prevention activities with existing prevention programs should be explored.

Child↗

PubMed1989

Health care in South Africa: the rights and responsibilities of the community.

Both community mobilisation and expert intervention are required for proper health care. All members of the South African Community have a right to justice, equity and participation in their health care system. Justice demands equal facilities for all, and in South Africa cannot be achieved without fundamental political change. Equity demands freedom from financial anxiety. Arguments for the further privatisation of health care in South Africa are immoral and unconvincing. Participation demands that a patient be actively involved in deciding the nature of health care rather than merely a 'consumer'. This requires both demythologising the medical profession and vesting power in the community. Practical steps towards these ends are suggested.

Delivery of Health Care↗

PubMed1990

Short-term predictions of the prevalence of human immunodeficiency virus infection among the black population in South Africa.

After a brief methodological review of acquired immunodeficiency syndrome/human immunodeficiency virus (AIDS/HIV) forecasting methods, some of these methods were applied to the South African situation and short-term predictions of the prevalence of HIV infection among the black population in South Africa were obtained. At present, the prevalence of HIV infection increases exponentially, with a doubling time of 8,5 months (95% confidence interval 7,6-9,6 months). By the end of 1989 the number of HIV-infected black South Africans aged 15-49 years was estimated to be between 45,000 and 63,000, and it is predicted that these numbers will rise to between 119,000 and 168,000 by the end of 1990, and to between 317,000 and 446,000 by the end of 1991. Because of the lack of basic data, these forecasts are tentative, but they nevertheless indicate the great seriousness of the HIV epidemic in South Africa.

Acquired Immunodeficiency Syndrome↗

PubMed2004

An evaluation of nine probiotics available in South Africa, August 2003.

BACKGROUND AND OBJECTIVE: Although probiotics are not new, 5 new commercially available products have been launched onto the South African market in the last 2 years. Evaluations of products in the USA and Europe shown poor correlation between label claims and actual contents. We undertook an evaluation of 9 products currently available on the shelves in South Africa. METHODS AND ANALYSIS: An independent laboratory was used. A culture method involving serial dilutions on selective media was used to obtain a colony count per gram for indicated organisma. A non-culture method, denaturing gradient gel electrophoresis (DGGE), was used to determined the organisms present in the products. RESULTS: Disturbingly, we found a relatively poor correlation between the advertised and determined bacterial content. Only 3 of the 9 products tested contained the bacteria indicated on the label and 5 products contained sufficient bacteria for a probiotic effect. The Enterococcus faecium, a potential pathogen and Saccharomyces cerevisiae found in 2 of the products are of concern. CONCLUSION: This evaluation confirms that the contents of several probiotics available in South Africa do not correspond to the label claims. This is of concern as clinical efficacy is dependent on strain specificity and organism numbers. Current regulatory requirements do not address this discrepancy. As such, we recommend that commercially available probiotic products be screened annually and the results of such quality control measures be made available to the Medicines Control Council (MCC).

Bacillus↗

PubMed2001

Alcohol dehydrogenase-2*2 allele is associated with decreased prevalence of fetal alcohol syndrome in the mixed-ancestry population of the Western Cape Province, South Africa.

BACKGROUND: Fetal alcohol syndrome (FAS) is particularly common among the mixed-ancestry population of the Western Cape Province of South Africa and occurs at a frequency of 0.0392-0.0429 (39.2-42.9 of 1000) among 5- to 9-year-old school entrants. While FAS is clearly caused by an environmental insult, studies in twins and mice support a significant genetic contribution to risk for FAS. It is likely that the development of FAS following excessive alcohol exposure is influenced by genetic factors in both the mother and the child. Known polymorphisms of the alcohol dehydrogenase-2 (ADH2) gene resulting in isozymes with different alcohol oxidizing capacities were investigated as possible candidates for influencing the risk for FAS. METHODS: Genotyping was undertaken for the ADH2 locus in 56 FAS-affected children, their 56 mothers, and 178 control individuals of mixed ancestry from the same geographic region. The ADH2 alleles were analyzed for the three groups and the allele frequencies of the mother and FAS-affected children were independently compared with the control group. RESULTS: The ADH2*2 allele was found to be significantly more common in the control group than in the mothers of FAS-affected children (p = 0.025 +/- 0.004) and in the FAS subjects (p = 0.025 +/- 0.004). The ADH2*3 allele frequency was low and was not significantly different between the groups. CONCLUSION: The ADH2*2 allele is significantly more common in control individuals, suggesting that it may either confer protection or be a marker for a protective effect against FAS among individuals of mixed ancestry in the Western Cape Province of South Africa.

Alcohol Dehydrogenase↗

PubMed2004

Tobacco attributable deaths in South Africa.

BACKGROUND: In mid 1998, a question "Was the deceased a smoker five years ago?" was introduced on the newly revised South African death notification form. DESIGN: A total of 16,230 new death notification forms from 1998 have been coded, and comparison of the prevalence of smoking among those who died of different causes was used to estimate, by case-control comparisons, tobacco attributed mortality in South Africa. Cases comprised deaths from causes known (from other studies) to be causally associated with smoking, and controls comprised deaths from medical conditions expected to be unrelated to smoking. Those who died from external causes, and from diseases strongly related to alcohol consumption, were excluded. SUBJECTS: Reports were available from 5340 deceased adults (age 25+), whose smoking status was given by a family member. RESULTS: Significantly increased risks were found for deaths from tuberculosis (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.23 to 2.11), chronic obstructive pulmonary disease (COPD) (OR 2.5, 95% CI 1.9 to 3.4), lung cancer (OR 4.8, 95% CI 2.9 to 8.0), other upper aerodigestive cancer (OR 3.0, 95% CI 1.9 to 4.9) and ischaemic heart disease (OR 1.7, 95% CI 1.2 to 2.3). CONCLUSION: If smokers had the same death rate as non-smokers, 58% of lung cancer deaths, 37% of COPD deaths, 20% of tuberculosis deaths, and 23% of vascular deaths would have been avoided. About 8% of all adult deaths in South Africa (more than 20 000 deaths a year) were caused by smoking.

Adult↗