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PubMed1999

DNA profiling of Mycobacterium tuberculosis from the Eastern Cape Province of South Africa and the detection of a high level of genetic diversity.

The genetic diversity in 502 isolates of Mycobacterium tuberculosis from the Eastern Cape Province of South Africa was DNA-profiled using random amplified polymorphic DNA sequences generated by four primers, and analyzed using the Dice similarity coefficient and the Ward cluster algorithm. Three major cluster groups and ten clusters were detected and shown to be significant at the five percent level using analysis of molecular variance (AMOVA). It is proposed that the three major cluster groups may represent three different entries of M. tuberculosis into South Africa during colonial times. No significant genetic differences could be detected between the urban and rural populations, suggesting that migration may play an important role in the wide transmission of all strains of the organism found in this province. However, a genetic distinction (p = 0.10) could be detected between rural individuals from the southern, more prosperous, region and the northern, less prosperous, regions of the province, which may represent either a limited migration between distant rural communities or a difference in health treatment historically in the two areas. AMOVA indicates the existence of a higher degree of population structure between drug sensitive and drug-resistant individuals than between urban and rural individuals (p = 0.05). Two clusters, C1 and C3, contained a large proportion of the isolates resistant to between one and three first-line drugs. Isolates resistant to more than three antibiotics were genetically diverse, suggesting that they are as yet not being transmitted at a high rate between individuals.

Antitubercular Agents↗

PubMed1992

Planning health care in South Africa--is there a role for traditional healers?

Developing health policies for the 'post-apartheid' era has become an urgent task of the early 1990s in South Africa. A neglected policy issue thus far has been the question of whether traditional healers have a role to play in future health care, and if so what this should be. Rather than developing positions on these questions, this paper sets out the main debates which need the consideration of health care planners. Arguments for and against traditional healers in health care are presented, and alternatives which could be chosen are outlined. Options adopted by countries on South Africa's borders, Zimbabwe, Mozambique and Swaziland are briefly considered.

Health Planning↗

PubMed2001

Development of the programme Mental Disorders in Primary Care as Internet-based distance education in South Africa.

SETTING: This innovative educational programme was developed in the South African context for general practitioners (GPs). AIM: This short report describes the process of designing an Internet-based distance education programme Mental Disorders in Primary Care. LEARNING METHODS: The article discusses relevant educational principles and then describes four stages in the instructional design process: design, development, evaluation and revision. CONCLUSION: The design and development of an Internet-based distance education programme for GPs in South Africa was a potent learning experience for me as an academic family physician with no prior experience in this area. I hope that this short report will assist other people and contribute to an ongoing dialogue on this topic.

Computer-Aided Design↗

PubMed1996

Alcohol attributable fractions for trauma in South Africa.

The misuse and abuse of alcohol is widespread in South African society and is likely to have a large impact on the economy. A major burden is borne by the hospital care system, in particular the cost of alcohol-related trauma. The purpose of this study was to estimate the cost of alcohol misuse in terms of fatal and non-fatal trauma. The design of the study was a cross-sectional survey of key informants. Each key informant was mailed a list of 11 trauma categories found to be linked to alcohol in both the local and international literature. They were asked to make an estimate of the alcohol attributable fraction (AAF) for each trauma category, based on their clinical experience and knowledge of empirical research. The median estimates for each trauma category showed that alcohol misuse could be linked to a substantial amount of mortality and morbidity, particularly with respect to motor vehicle trauma and interpersonal violence. These AAF estimates were supported by the findings of other empirical research conducted in South Africa, as well as by the literature on mortality data in the U.S.A. This suggests that there is potential for a vast amount of injuries and deaths to be eliminated if alcohol misuse could be controlled or eliminated.

Adolescent↗

PubMed2005

''If they rape me, I can't blame them": reflections on gender in the social context of child rape in South Africa and Namibia.

The study was based on 77 semi-structured in-depth interviews and 3 small group discussions which were conducted with informants in Windhoek, Namibia and rural Mpumalanga province, South Africa. Children (abuse survivors and others), parents, men and women from the community and a range of key informants (such as police, social workers, health workers, NGO staff and teachers) were asked about their experiences and perceptions of child rape and child rearing. This study has its roots in the recent popular concern about the high prevalence of child rape in Southern Africa. Drawing on the data, we reflect on aspects of the social context of child rape in South Africa and Namibia that at least provide space for, without actually legitimating, these acts. We argue that children are rendered vulnerable to abuse because of a series of ideas which create opportunities, the most important of which is the dominant patriarchal ideology, compounded by the pronounced age hierarchies found in these societies. The high status of men, with respect to particularly girl children, leads to vulnerability through reducing girls' ability to refuse sexual advances and generating expectations in men that they should control women and children. Rape is often an act of punishment, used to demonstrate power over girl children and manufacture control. Rape is also used as an instrument of communication with oneself (the rapist) about masculinity and powerfulness. This ability to avoid being caught was important in some rapes. Some children are rendered vulnerable by coming from backgrounds where the likelihood of cases being pursued was low. Whilst it is often said that communities abhor child rape, responses to cases show that often strong action is not taken against perpetrators and the girls may be equally, or predominantly, blamed. In cases close to home, perpetrators are often protected. Thus the dominant message is that much as child rape is abhorred, responses are highly inadequate. Advances in gender equity are central to positive change.

Child↗

PubMed2000

Control of an outbreak of vancomycin-resistant Enterococcus faecium in an oncology ward in South Africa: effective use of limited resources.

An outbreak of vancomycin-resistant enterococci (VRE) occurred in an adult oncology ward of a large teaching hospital in Johannesburg, South Africa. The outbreak strain was identified as an Enterococcus faecium carrying the vanA resistance genotype. Macro-restriction analysis showed that the majority of strains were clonally related. Modified infection control interventions were implemented and control of the outbreak was achieved. Although the epidemiology of VRE is well documented in Europe, North America and Australia, this problem has only recently emerged in South Africa. The epidemiology of the outbreak appears similar to that described for outbreaks elsewhere.

Adult↗

PubMed2006

Nematode parasites of Clarias gariepinus (Burchell, 1822) from the Rietvlei Dam, South Africa.

Catfish, Clarias gariepinus, from the Rietvlei Dam near Pretoria, South Africa were examined for nematode parasites. Two species, Procamallanus laeviconchus in the stomach and Contracaecum spp. larvae in the abdominal cavity, were found. The morphology of these species, based on light and scanning electron microscopy, and how they compare with previously described specimens are discussed. Infection rates were mild compared to previous surveys although Contracaecum spp. had a high prevalence of 86%.

Animals↗

PubMed1979

Epidemiology and control of bovine babesiosis in South Africa.

Babesiosis is the cause of serious economic losses in South Africa and involves most areas with an annual rainfall of more than 400 mm. Both Babesia bigemina and Babesia bovis are present and both are considered to be important. The vectors, distribution and factors influencing enzootic stability of both species are discussed. Except in some areas only marginally suitable for ticks, and where tick control alone may be adequate, control by immunisation is recommended. Short term prevention can be achieved by chemoprophylaxis.

Animals↗

PubMed1994

Geographical distribution of dental operators in South Africa over the period 1972-1992.

Using data available on dentists for 1972, 1982 and 1992 and on dental therapists for 1992 the geographical distribution of dental operators (dentists/dental therapists) in South Africa was determined and the dental operator to population ratios were calculated. Over a period of 20 years the number of dentists in South Africa has increased by 135,6 per cent while the total population of the area has increased by 59,8 per cent. The lowest operator to population ratio was 1:4517 found in the PWV region, and the highest ratio was 1:48730, recorded in the Northern Transvaal. The greatest decrease in dental operator to population ratios occurred in Natal and Transvaal. The study shows that there is an imbalance in the geographic distribution of dental operators favouring large urban areas.

Dentists↗

PubMed1999

Pregnancy- and lactation-related folate deficiency in South Africa--a case for folate food fortification.

OBJECTIVE: Characterisation of patients presenting with megaloblastic anaemia according to clinical, sociological, haematological and aetiological aspects of their disease, and use of these findings to increase awareness among clinicians and to make recommendations regarding changes in national health policy. METHODS: This study included 104 patients presenting with megaloblastic anaemia to a large referral hospital over a 1-year period. Data were collected and analysed in terms of age, gender, parity, gravidity, duration of lactation, socio-economic status, geographical origins, diet, previous haematinic treatment, clinical presentation and haematological measurements. RESULTS: The most common cause of megaloblastic anaemia was pernicious anaemia or probable pernicious anaemia (50%), followed by pregnancy- and lactation-related folate deficiency (32%); of these patients, the majority (28) presented postpartum while lactating; 5 patients were in the immediate puerperal period of 6 weeks, and a further 16 were seen during the first year and 7 during the second year following delivery. Only 4 patients were pregnant, and it is noteworthy that 2 of these were still lactating at 34 weeks' gestation. CONCLUSION: Pregnancy- and lactation-related folate deficiency up to 2 years after delivery remains a common cause of megaloblastic anaemia in South Africa. Certain communities in rural South Africa have recently been shown to have high incidences of both neural tube defects and folate deficiency. The fortification of a staple food (e.g. maize or flour) with folic acid is feasible, inexpensive, safe and likely to be beneficial. This practice should reduce the prevalences of megaloblastic anaemia in fertile women, neural tube defects, other congenital abnormalities, intra-uterine growth retardation, prematurity and possibly cardiovascular disease. There is urgent need for a national policy in this regard.

Adolescent↗

PubMed2004

Nicotine delivery capabilities of smokeless tobacco products and implications for control of tobacco dependence in South Africa.

OBJECTIVES: Smokeless tobacco (SLT) use is popular among black South African women and children. The study sought to determine the nicotine delivery capability of popular industrialised and traditional SLT brands in South Africa, and to provide information for policy action by regulatory authorities. DESIGN: Laboratory chemical analysis of four industrialised and one traditional SLT products commercially available, using previously published analytical methods. Potential for dependence was inferred from nicotine delivery capabilities determined by the percentage free base nicotine. MEASUREMENTS: Moisture, pH, total nicotine, and percentage free base nicotine. RESULTS: Total nicotine content was between 6-16 mg/g. The pH varied between 7-10 and this correlated with percentage free base nicotine, which ranged between 10-99%. The nicotine delivery capability of the traditional product was lower than that of the industrialised products except for the recently introduced portion bag snus, which had comparable total nicotine but the lowest pH and percentage free base nicotine. The most popular SLT brands showed the highest percentage free base nicotine ever reported for any industrialised SLT or cigarette brands. Small cans contained higher nicotine than the large cans of the same brand tested. Findings from the study support a potential for limited "product graduation" by users. CONCLUSIONS: South African SLT users are mostly exposed to potentially very highly addictive levels of nicotine that may favour tobacco dependence and its consequent health risks. The increasing use of SLT by women of childbearing age support the need for intensified policy action to control its use.

Ganglionic Stimulants↗

PubMed2006

Traditional healers' perceptions of smokeless tobacco use and health in the Limpopo Province of South Africa.

Traditional healers (THs) exert a significant influence in indigenous South African communities, where smokeless tobacco (SLT) use and dependence is common among women. This study was conducted during 2002. It sought to explore THs' beliefs about SLT use and its health effects. In-depth interviews were conducted with 28--mostly female (68%)--registered THs, with a mean age of 55 years and with an average of 17 years of practice experience. These listed THs were randomly selected from two culturally diverse regions of the (largely rural) Limpopo Province in South Africa. The THs perceive the ritual (external) use of SLT as an absolute necessity in divination, but 32% have also prescribed its 'internal' use to their clients, usually following a "directive from the ancestors." Almost all the THs who themselves regularly consume SLT condemned the recreational use of SLT and believe that SLT is addictive. However, 39% of them claimed to be able to treat addiction resulting from tobacco use not sanctioned by the ancestors. This study has identified opportunities for enlisting THs' collaboration in future community-based tobacco dependence interventions.

Adult↗

PubMed1989

The sociologic context of occupational health in South Africa.

The early history of the occupational health system in South Africa is outlined up to the early 1970s which mark a political and social transition in the society. Relevant demographic and social data are provided, and the roles and mutual relations of capital, labor, state, and academic sectors are discussed. During the past 15 years there has been heightened occupational health activity. Major legislative activity has included several commissions, the promulgation of new laws and regulations governing the workplace, and deregulatory measures in a contradictory mix. Conflictual relations between social forces are illustrated by two examples involving the introduction of safety representatives in the workplace, and compensation for occupational lung disease. The implications of wider political and economic realities are analyzed, and current and probable future trends in the evolution of the occupational health system are identified.

Economics↗

PubMed2001

Employees' perceptions of the implementation of affirmative action in the health sector in the Standerton District in South Africa.

Since the inception of a fully democratic government in South Africa in 1994, government and trade unions have been placing increasing pressure on government departments and public institutions to introduce steps to correct racial discrimination through the implementation of affirmative action (AA). This study, which was carried out in the Standerton Health District, assesses employees' perceptions of and attitudes towards the implementation of AA. A quantitative design was used. Data was gathered from a total population of 360 employees by means of a questionnaire. The study revealed the following major themes: Respondents feel that if AA were effectively implemented, there would be an increase in productivity. There is strong support for the implementation of AA appointments. The implementation of AA will fail if the goals of AA are not properly and effectively communicated to all employees.

Adult↗

PubMed1990

ESR dating evidence for early modern humans at Border Cave in South Africa.

The archaeological and hominid site of Border Cave (KwaZulu, South Africa) has a stratigraphic sequence covering the Middle and Later Stone Ages (MSA and LSA). It has been proposed that four hominid specimens recovered there (BC1 and BC2 of uncertain provenance, and BC3 and BC5 recovered from MSA layers) represent very early examples of anatomically modern humans, supporting an early late-Pleistocene appearance of modern Homo sapiens in Africa. This early appearance, however, has been questioned, largely because of doubts about the stratigraphic positions associated with the specimens and because of the lack of a reliable chronology for the stratigraphic sequence. We now report on the first comprehensive radiometric dating analysis of Border Cave, using electron spin resonance (ESR) on teeth within sediment layers. BC3 is likely to be approximately 70-80 kyr old, and BC5, 50-65 kyr old. BC1 and BC2 are almost certainly less than 90 kyr old. These results, although younger than some age estimates, support the early occurrence of anatomically modern humans at Border Cave. In addition, our results suggest that the Howiesons Poort lithic industry (approximately 45-75 kyr) and the MSA-LSA transition (approximately 35 kyr) are younger than often believed.

Animals↗

PubMed2007

Perceptions of community HIV prevalence, own HIV infection, and condom use among teachers in KwaZulu-Natal, South Africa.

A total of 120 teachers from KwaZulu-Natal, South Africa, underwent HIV/AIDS training. As part of the study, the teachers were surveyed, before and after the training, about their perceptions of HIV prevalences among pupils, other teachers, and community members, and about their perceptions of their own HIV status. Before the training, the teachers estimated average HIV prevalences among pupils, other teachers, and other community members to be 36%, 48%, and 61%, respectively. One-third of the teachers believed that they had a 50% or greater chance of currently being infected with HIV. Male teachers and teachers with a university degree gave lower HIV prevalence estimates for other people but not for themselves. Frequency of condom use was positively related to teachers' HIV prevalence estimates for other people. Teachers' estimates of HIV prevalence and perceived risk of own HIV infection increased significantly after the HIV/AIDS training.

Adult↗

PubMed2002

Indigenous healing practices and self-medication amongst pregnant women in Cape Town, South Africa.

This study was conducted in and around Cape Town, South Africa, at two primary obstetric facilities and in the antenatal clinics of two secondary hospitals. Findings show that majority of the Xhosa speaking women follow indigenous healing practices for both themselves and their babies because of the need to "strengthen" the womb against sorcery, to prevent childhood illnesses, and to treat symptoms they perceive that biomedical services would not be able to treat. Self-medication with non-prescribed drugs, herbs and Dutch remedies was common practice amongst the Afrikaans speaking women for both themselves and their babies. Herbs and Dutch remedies were mainly used to treat indigenous illness (baarwind) while non-prescribed over-the-counter drugs were used to treat minor ailments associated with pregnancy. There is, therefore, an urgent need to bridge the gap between orthodox and indigenous medical systems through reciprocal learning and by acknowledging each other's roles.

Female↗

PubMed1975

The Griqua of Campbell, Cape Provice, South Africa.

The Griqua of Campbell in the Cape Province of South Africa are reputed to be descended from an amalgam of Khoi ("Hottentots") with various Caucasoid, Negroid and East Asian elements at the Cape of Good Hope. A stormy history of migration and deprivation has left this small residuum on the edge of the Kalahari Desert. It was hoped that a sero-genetic study of these people, who proudly preserve their identity, might provide further insights into the genetic consitution of their Khoi forebears. Despite the retention of the language of their own, an social mores distinct from of other Mixed populations, they have been shown, however, to have received an appreciable inflow of non-Khoisan genes. This has probably resulted from social factors such as the prestige attaching to Griqua membership and the willingness of the Griqua to assimilate outsiders, combined with the tendency of Campbell Griqua to migrate elsewhere. There are no significant differences between "Griqua" members of the population and those who are not recognized as "Griqua."

Black People↗