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PubMed2002

The use of a GIS-based malaria information system for malaria research and control in South Africa.

The paper aims to outline the innovative development and application of a Geographical Information System based Malaria Information System for malaria research and control in South Africa. This system is a product of collaboration between the Malaria Control Programmes and the Malaria Research Programme of the Medical Research Council of South Africa. The ability of such a system to process data timeously into a usable format is discussed, as well as its relevance to malaria research, appropriate malaria control measures, tourism, and social and economic development.

Communicable Disease Control↗
PubMed1985

Chloroquine-resistant Plasmodium falciparum malaria in South Africa. A case report.

Chloroquine-resistant plasmodium falciparum malaria has been described in many parts of the world, including Africa as far south as south-western Africa. We report a case of chloroquine-resistant P. falciparum cerebral malaria in the RSA. It seems likely that the infection was acquired in the Louis Trichardt district of the northern Transvaal. Despite the administration of an adequate course of chloroquine, the parasitaemia failed to clear and even increased (type III resistance). Eventually clinical and laboratory-proven cure was obtained only after combined quinine and tetracycline therapy. To our knowledge this is the first case of chloroquine-resistant P. falciparum malaria acquired in the RSA.

Adolescent↗
PubMed2000

Epidemiology of glycopeptide-resistant enterococci colonizing high-risk patients in hospitals in Johannesburg, Republic of South Africa.

Recent cases of infections caused by glycopeptide-resistant enterococci (GRE) have highlighted the emergence of these organisms in the Republic of South Africa. During May 1998 we conducted a prevalence study in four hospitals in Johannesburg and obtained 184 rectal swabs from patients identified as being at high risk for GRE colonization. Twenty enterococcal isolates showing various glycopeptide resistance genotypes were recovered: 3 Enterococcus faecium vanA isolates, 10 E. faecium vanB isolates, 6 E. gallinarum vanC1 isolates, and 1 E. avium vanA isolate. Macrorestriction analysis was used to demonstrate the clonal spread of GRE strains within hospitals. Evidence also demonstrated the likely persistence of the original E. faecium vanA isolate associated with the first confirmed death contributed to by GRE infection in South Africa in March 1997.

Adolescent↗
PubMed2005

Fumonisin mycotoxins in traditional Xhosa maize beer in South Africa.

The production and consumption of home-brewed Xhosa maize beer is a widespread traditional practice in the former Transkei region of South Africa. HPLC determination of fumonisins B1 (FB1), B2 (FB2), and B3 (FB3) in maize beer samples collected in two magisterial areas, Centane and Bizana, showed a wide range of levels. All samples were positive for FB(1), with a mean level of 281 +/- 262 ng/mL and a range from 38 to 1066 ng/mL. Total fumonisins (FB1 + FB2 + FB3) ranged from 43 to 1329 ng/mL, with a mean of 369 +/- 345 ng/mL. Data on the consumption of home-brewed beer are not available. On the basis of published data for the consumption of commercial beer in South Africa, the fumonisin exposure in these districts among the consumers of maize beer was found to be well above the provisional maximum tolerable daily intake of 2 mug/kg of body weight/day set by the Joint FAO/WHO Expert Committee on Food Additives.

Beer↗
PubMed1996

Trends in cervical cancer mortality in South Africa.

BACKGROUND: Cervical cancer is an important cause of death throughout the world, especially in less developed countries. Reports of trends in cervical cancer mortality from less developed countries have been limited by poor data quality and inaccurate population estimates. This paper examines trends in cervical cancer mortality in South Africa from 1949 to 1990 and discusses the impact of cytology screening on these trends. METHODS: Analysis of national mortality statistics and reconstructed population data. RESULTS: The age-standardized mortality rates for Whites declined after the mid 1960s, while that for Coloureds rose, particularly before the 1970s. These trends were affected predominantly by trends among women in the 35-64 age range. CONCLUSIONS: The pattern of mortality in successive birth cohorts for Whites is consistent with a reduction in age-specific mortality following the advent of cytological screening. The same pattern is not evident in trends for Coloureds, among whom screening has apparently had a minor impact if any at all. The apparent lack of impact of screening in those groups of women most at risk of cervical cancer lends weight to demands for the implementation of equitable and rational screening programmes for cervical cancer in South Africa and internationally.

Adult↗
PubMed1989

Survey of oral fluid therapy practices in South Africa.

The objectives of this study were to document the official oral fluid therapy (OFT) policies of all the ministries of health in South Africa and of the four provincial authorities, to determine what methods of OFT are used in hospitals providing paediatric care, to determine the OFT methods recommended by hospital staff for use at home, to establish the level of support for the idea of one national policy for OFT and to determine what senior academic paediatricians think about these issues. We conducted structured telephonic interviews of professional staff in charge of paediatric wards in 159 randomly selected hospitals providing general inpatient care. The hospitals were stratified as private, provincial and 'homeland'. We also interviewed the directors-general or the secretaries or their deputies in each ministry of health as well as directors of hospital services or their deputies in each one of the four provinces of the Republic. Lastly, we spoke to the academic heads of paediatric departments in each of the country's eight medical schools. The results show that the use of OFT for inpatient care of diarrhoeal disease is far from universal, and that the picture with regard to promotion of home OFT is even less favourable. We identified an unacceptable diversity in the OFT methods being promoted as well as a degree of resistance to the development of one national policy. We recommend that one policy, based on the recommendations of the South African Paediatric Association, be adopted by all health authorities in South Africa as a matter of urgency.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluid Therapy↗
PubMed2002

Disadvantaged black and coloured infants in two urban communities in the Western Cape, South Africa differ in micronutrient status.

OBJECTIVES: To determine the nutritional and health status of urban infants in two disadvantaged communities in the Western Cape, South Africa with special reference to micronutrient status. The results of this study will serve to plan an intervention study in these communities in the same age group. DESIGN: Cross-sectional study. SETTING: Two disadvantaged urban black and 'coloured' communities in the Western Cape, South Africa. SUBJECTS: Sixty infants aged 6-12 months from each community. OUTCOME MEASURES: Dietary intake, anthropometric measurements, micronutrient status and psychomotor development. RESULTS: Stunting and underweight were more prevalent in coloured infants (18% and 7%, respectively) than in black infants (8% and 2%, respectively). Anaemia (haemoglobin (Hb) < 11 g dl(-1) was prevalent in 64% of coloured and 83% of black infants. Iron-deficiency anaemia (Hb < 11 g dl(-1) and ferritin < 10 ng ml(-1) was found in 32% of coloured infants and in 46% of black infants. Zinc deficiency was prevalent in 35% and 33% of the coloured and black infants, respectively. Marginal vitamin A deficiency (serum retinol < 20 microg dl(-1) was observed in 23% of black infants compared with 2% of coloured infants. Of black infants, 43% and of coloured infants 6% were deficient in two or more micronutrients. Six per cent of coloured infants had C-reactive protein concentrations above 5 mg l(-1) compared with 38% of the black infants. The dietary intake of micronutrients was in general lower in black infants than in coloured infants. The overall psychomotor development, assessed by the Denver Developmental Screening Test, was different between the two groups. The coloured infants scored higher in three out of the four categories as well as in their overall score. CONCLUSIONS: This study shows that information on stunting and wasting only in urban disadvantaged infants is not sufficient to make recommendations about specific community intervention programmes. Information on the micronutrient status, independent of wasting and stunting, is necessary to design nutrition programmes for different communities. The study also showed a substantially higher prevalence of micronutrient deficiencies among black infants.

Black or African American↗
PubMed1992

Combinations of three different forms of alpha-thalassemia in a large Indian family from Durban, South Africa: hematological observations.

We have identified three types of alpha-thalassemia in 28 members of an Indian family from Durban, South Africa. The rare South African (SA) type of alpha-thalassemia-1, which is characterized by an approximately 23-kb deletion involving the psi zeta, psi alpha 2, psi alpha 1, alpha 2, alpha 1, and theta 1 genes, was present in 13 members [6 simple heterozygotes, 5 with Hb H disease of the --(SA)/-alpha(-3.7 kb) type, and 2 with Hb H disease of the --(SA)/-alpha(-4.2 kb) type]. Seven others were heterozygotes for alpha-thalassemia-2 (-3.7 kb), 1 was homozygous for this deletion, and 1 was a compound heterozygote [-alpha(-3.7 kb/-alpha(-4.2 kb)]. Hematological and hemoglobin composition data indicated a moderate anemia in all 7 patients with Hb H disease with severe microcytosis and hypochromia, no elevation of gamma-chain synthesis, low levels of Hb A2 (0.3-0.7%), and low levels of Hb H. The most severe disease was present in 2 teenagers with the --(SA)/-alpha(-4.2 kb) combination.

Adolescent↗
PubMed2001

Molecular epidemiology of serotype O foot-and-mouth disease virus with emphasis on West and South Africa.

Genetic relationships of serotype O foot-and-mouth disease (FMD) viruses recovered from outbreaks of the disease in the West African countries of Niger, Burkina Faso and, Ghana (1988-1993) and those from South Africa (2000) were determined by partial VP1 gene characterization. A 581-bp fragment, corresponding to the C-terminus half of the ID (VP1 gene) region was amplified and sequenced. An homologous region of 495 nucleotides was ultimately used to determine genetic relationships of serotype O viruses from the Middle East, Europe, South America, North Africa, East Africa, southern Africa and Asia. Seven distinct type O genotypes were identified by phylogenetic reconstruction, consisting of viruses from the following geographical regions: Genotype A: Asia, the Middle East, and South Africa, Genotype B: East Africa, Genotype C: West and North Africa, Genotype D: Taiwan and Russia, Genotype E: Angola and Venezuela, Genotype F: Western Europe, and Genotype G: Europe and South America. The genotypes constitute three different evolutionary lineages (I-III), which correspond to three discrete continental regions, some of which display inter-continental distributions due to introductions. Results further indicate that the outbreaks in Burkina Faso (1992) and Ghana (1993) are part of the same epizootic and that the strain involved in a recent outbreak of the disease in South Africa is most closely related (97% sequence identity) to a 1997 Bangladesh strain.

Africa, Western↗
PubMed2005

Prevalence of cardiovascular diseases and associated risk factors in a rural black population of South Africa.

BACKGROUND: To determine the prevalence and associated risk factors of cardiovascular diseases in a rural adult black population from Limpopo Province in South Africa. DESIGN: A cross-sectional study. METHODS: A sample of 1608 women and 498 men aged 30 years and above participated in the study. Sociodemographic data, anthropometric measures (body mass index, waist/hip ratio), blood pressure and biochemical risk factors were measured. A global cardiovascular disease (CVD) risk profile was developed. RESULTS: There was a high prevalence of tobacco use for men (57%) and women (35.4%), with women (28.1%) predominantly using smokeless tobacco. Alcohol use was very common in men (57.2%). Women weighed a great deal more than men, and 51.7% were either overweight or obese. Diabetes was diagnosed in 8.8 and 8.5% of women and men, respectively. High-density lipoprotein-cholesterol was relatively high, whereas 42.3% of women and 28.5% of men had low-density lipoprotein-cholesterol levels of 3 mmol/l or more. Hypertension (blood pressure > or =140/90 mmHg) was found in 25.5% of women and 21.6% of men. According to the Framingham formulae, 18.9% of women and 32.1% of men had a 20% or higher chance of having a CVD event in the next 10 years. CONCLUSIONS: There was a high prevalence of chronic disease risk factors in the rural, poor black community in Limpopo, South Africa. Consequently, the population had a higher than expected risk of developing a CVD event in the following 10 years when compared with similar studies in black Africans.

Adult↗
PubMed1996

Management of community-acquired pneumonia in adults. Working groups of the South African Pulmonology Society and the Antibiotic Study Group of South Africa.

OBJECTIVE: To recommend an initial choice of antibiotic therapy in immunocompetent patients with community-acquired pneumonia encompassing the following subgroups: (i) adults < 60 years without co-morbid illness; (ii) older patients > 60 years and/or cases with associated co-morbidity; and (iii) those with severe pneumonia. OPTIONS: Few studies exist worldwide comparing patient outcome with the various treatment regimens. The choice of antibiotic is based on the most commonly isolated pathogens with cost as consideration. OUTCOMES: The empiric antibiotic therapy covers all commonly encountered organisms in patients with community-acquired pneumonia and is thus likely to be associated with the best prognosis. EVIDENCE: Working groups of clinicians, pharmacologists and medical microbiologists, following detailed literature review, particularly of studies performed in South Africa Benefits, harms, costs. The guidelines pay particular attention to cost-effectiveness in South Africa. RECOMMENDATIONS: These include details of likely pathogens, an appropriate diagnostic approach, factors suggesting need for hospitalisation and severity of illness, and treatment options. VALIDATION: Developed by working groups of the South African Pulmonology Society and the Antibiotic Study Group of South Africa. Reference was made to recent international guidelines from the UK, Canada and the USA.

Adult↗
PubMed2003

Increasing relative prevalence of HSV-2 infection among men with genital ulcers from a mining community in South Africa.

OBJECTIVES: To determine the aetiology of genital ulcer disease (GUD) and its association with HIV infection in the mining community of Carletonville, South Africa, from two cross sectional surveys of consecutive men presenting with genital lesions during October 1993 to January 1994 and July to November 1998. METHODS: A multiplex polymerase chain reaction (M-PCR) assay combined with amplicon detection was used to identify DNA specific sequences of Treponema pallidum, herpes simplex virus (HSV), and Haemophilus ducreyi. A real time PCR assay was used to differentiate between HSV-1 and HSV-2. RESULTS: M-PCR detected T pallidum, HSV, and H ducreyi in 10.3%, 17.2%, and 69.4% of 232 GUD patients during 1993-4 and in 12.4%, 36.0%, and 50.5% of 186 GUD patients in 1998. The proportion of patients with more than one agent increased significantly from 7.3% (17/232) in 1993-4 to 16.7% (31/186) in 1998 (p <0.01). HSV-2 was detected in a higher proportion of ulcer specimens from HIV infected patients than in specimens from HIV uninfected patients during both time periods (1993-4: 26.2% v 6.7%, p <0.001; 1998: 42.1% v 29.6%, p >0.09). CONCLUSIONS: Based on two cross sectional surveys, 4 years apart, chancroid remained the leading cause of GUD in men who presented at the STD clinic with genital ulcers in the mining community of Carletonville, South Africa. The relative prevalence of primary syphilis has remained low. However, HSV-2 has emerged as a more significant cause of GUD and the proportion of GUD patients infected with more than one agent also increased significantly. HSV-2 DNA was detected in a significantly higher proportion of ulcer specimens from HIV positive patients than from HIV negative patients. No association was found between HIV infection status and the relative prevalence of chancroid or syphilis.

Adult↗
PubMed2003

Anthelmintic resistance of nematodes in communally grazed goats in a semi-arid area of South Africa.

A survey was conducted on the occurrence of anthelmintic resistance of nematodes in communally grazed goats in a semi-arid area in South Africa. In herds belonging to 10 small-holder goat farmers, the efficacies of fenbendazole, levamisole and rafoxanide were tested by faecal egg count reduction (FECR) tests. Efficacies of 80% were considered a threshold for anthelmintic resistance. The FECR tests showed that all drugs tested more than 80% effective in most instances, but there were notable exceptions. In 1 case, rafoxanide was only 31% effective and in another case fenbendazole was only 47% effective. The occurrence of anthelmintic resistance in this farming sector is of concern. Steps should be taken to prevent its further spread and to avoid the development of a situation as on numerous commercial sheep farms in South Africa where resistance is very common.

Albendazole↗
PubMed2004

Assessment of effectiveness of traditional herbal medicine in managing HIV/AIDS patients in South Africa.

BACKGROUND: Very few clinical studies have been conducted in South Africa to assess the value and efficacy of traditional herbal medicines that are commonly used by traditional healers for the treatment of HIV-positive patients. OBJECTIVE: To assess efficacy of a South African traditional herbal medicine in reducing viral load and increasing CD4+T cell counts of HIV/AIDS patients. DESIGN: A descriptive, prospective, follow-up study of 33 HIV-positive volunteers over a one year period. Viral load and CD4 counts were taken three times from each participant. SETTING: From November 2001 to October 2002, patients were treated at the Rustenburg Community Based Centre for traditional therapy. Clinical and paraclinical treatments and screening of patients were done at Pretoria Gynaecological Hospital. PARTICIPANTS: Seven men and 26 women aged between 22 and 43 years took part in a 12-month long follow-up study. HIV monitoring was done at the beginning and after 4 and 8 months in symptomatic and asymptomatic patients with CD4 counts below 200 cells/mm3 or viral load counts above 10,000 copies. INTERVENTION AND ASSESSMENT: ab mitio and after 4-months, viral load, CD4+T cell count, FBC, LFT, glycaemia, U/E, cholesterol, pap smear, clinical and subjective assessment, modern drugs plus hospitalisation for opportunistic infections and resuscitation where needed, powder or suspension of herbal medicine followed by meals. MAIN OUTCOME MEASURES: Improvement in overall health condition and immune system, increase in CD4+T cell count and decrease in viral load count. The two sample paired t-test was used to compare initial and final counts at the 5% level of significance and power of 80%. Ninety five per cent confidence intervals were obtained for differences between mean values. RESULTS: After four and/or eight months of therapy, significant health improvement was achieved: better physical appearance (80% of patients), increased appetite (65%), feeling of well-being (60%), disappearance of skin marks (70%) and urogenital lesions (100%), resumption of workplace duties (60%), weight gain (80%), significant reduction in viral loads (85.4%, p = 0.0015) and significant increase in CD4+ T cell counts (226%, p = 0.0000). CONCLUSION: Achievement of health improvement within eight months indicates that herbal medicine can be used as supplementary or alternative treatment for HIV/AIDS patients, and that it is an obvious immune system booster and probable "virus-cidal" factor. The apparent safety and efficacy of herbal medication warrants further research with a larger sample size of study.

Adult↗
PubMed1998

Community pharmacy in South Africa: a changing profession in a society in transition.

The analysis of community pharmacy as a profession in transition acquires an additional dimension in South Africa, since it is inextricably linked to its social characteristics as well as to the political transformation taking place. Using data collected by means of a documentary search, interviews with key informants and a survey of community pharmacists, the paper presents the relevant societal features and explores some of the complexities associated with the existing as well as the potential future role of community pharmacy in the context of changing health services in a society in transition. It concludes that the changes in community pharmacy and the role it can play in the provision of Primary Health Care to all the people of South Africa are linked to the greater transition in society and its future health care services.

Adolescent↗
PubMed1999

Safety and efficacy of atovaquone and proguanil hydrochloride for the prophylaxis of Plasmodium falciparum malaria in South Africa.

The objective of this study was to determine the safety and efficacy of atovaquone and proguanil hydrochloride combination therapy for the prophylaxis of Plasmodium falciparum malaria in at-risk nonimmune subjects in South Africa. This open-label trial was conducted at research sites in South Africa during the main malaria transmission season, February through July. The study volunteers were temporarily living in, or traveling to, a malaria-endemic area. They received I tablet of 250 mg atovaquone and 100 mg proguanil hydrochloride once daily for up to 10 weeks. Subjects were monitored using sequential clinical and laboratory assessments. Thick blood smears were stained and evaluated by a central laboratory. An immunochromatographic test for P. falciparum was also used for on-site patient management. Prophylactic success was summarized using a 95% confidence interval for the proportion of subjects who did not develop parasitemia or who withdrew due to a treatment-related adverse event. A total of 175 subjects (15% women) were enrolled in the trial. The mean duration of drug exposure was 8.9 weeks. The combination of atovaquone and proguanil hydrochloride was well tolerated. The most frequently reported adverse events considered possibly related to study treatment were headache (7%), abdominal pain (2%), increased cough (2%), and skin disorder (2%). No serious adverse events were reported, and no treatment-emergent effects were noted for any laboratory variables. One subject who was noncompliant with therapy developed parasitemia, and 3 subjects withdrew due to a treatment-related adverse event (2 subjects with headache and 1 with nausea and dizziness). The prophylaxis success rate was 97%. In this study, atovaquone and proguanil hydrochloride combination therapy had an excellent safety and efficacy profile for prophylaxis of P. falciparum malaria in nonimmune subjects.

Adult↗
PubMed2001

Changes in fatal and near-fatal asthma in an urban area of South Africa from 1980-1997.

Over the past two decades, changes in the health services designed to improve access to and quality of asthma care have occurred in South Africa. The aim of this study was to investigate the incidence of fatal and near-fatal asthma (NFA) from 1980-1997 in an urban part of South Africa. A retrospective analysis of fatal asthma and NFA in the Cape Town City Council area was performed. Mortality data were obtained from death notification records. Data on NFA were obtained from the records of patients admitted for asthma to intensive care units (ICUs) at major academic hospitals serving the area. There were 1,506 deaths (mean age 56 yrs) from asthma reported; 39 and 3% occurred in people under 55 and 15 yrs, respectively. Average annual asthma mortality rate (8.1 +/- 1.9 per 100,000 population) was highest amongst people of mixed race (10.1 +/- 2.0), followed by Blacks (6.8 +/- 3.1) and Whites (5.0 +/- 1.9, p<0.001). Asthma mortality declined by 0.28 deaths per 100,000 population per year; rates decreased in all ethnic groups. Most deaths (72.3%) were outside a health facility and a higher number of deaths occurred on weekends (223 deaths x day(-1)) than weekdays (207 deaths x day(-1), p=0.014). Paediatric asthma ICU admissions declined by 1.81 children yr(-1). The annual number of adults admitted to ICU for asthma, and the proportion requiring intermittent positive pressure ventilation did not change. These results indicate that the incidence of fatal and near-fatal asthma in this area has declined over the period and this may reflect improved asthma management. However, the relatively high asthma mortality rate in people of mixed race and the predominance of deaths outside health facilities and on weekends suggest problems with access to care.

Adolescent↗