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PubMed2006

Quality of tuberculosis care provided in different models of public-private partnerships in South Africa.

SETTING: Free State, North West and Western Cape provinces, South Africa. OBJECTIVE: To evaluate quality of care for the treatment of tuberculosis (TB) provided in different public-private partnerships. DESIGN: Quality of care analysis comparing three different models of directly observed treatment (DOT) provision: purely public, public-private workplace partnership (PWP), and public non-governmental organisation (NGO) partnership (PNP). For each type of provision model, two sites were selected. Three dimensions of quality of TB care--structure, process and outcome--were assessed. RESULTS: The PWP sites had the highest score in all three aspects of quality of care. In terms of process quality, the sites achieved similar scores, reflecting a very good knowledge of the treatment guidelines for both private and public providers. Patients supervised in the public clinics generally had lower treatment completion rates than those supervised in the occupational health clinics in the workplace and in the community. CONCLUSION: Partnerships with community-based NGOs and employer-based medical services should be established when the government does not have the capacity to provide services. The capacity of the public sector to monitor the quality of care provided in the partnerships is therefore crucial.

Cooperative Behavior↗

PubMed2003

Abortion service provision in South Africa three years after liberalization of the law.

In 1996, South Africa introduced legislation that liberalized women's access to termination of pregnancy. This study presents the findings of a survey undertaken to describe the availability and accessibility of abortion services in 1999, three years after the law was passed. All facilities that had been officially designated to perform these services were contacted by telephone to determine whether they were providing the services, their capacity, whether they were performing second-trimester as well as first-trimester terminations, and how long women had to wait for these services. Nationally, 292 facilities had been designated, but in 1999 only 32 percent were functioning. Of the functioning facilities, 27 percent were in the private sector. Mapping of available services indicated that substantial parts of the country were entirely without such services. Half of the country's induced abortions were being performed in Gauteng province, although only 19 percent of women of reproductive age were living there. This finding indicates that service provision in other provinces was inadequate or lacking. Although in the first years following the new legislation efforts were made to establish abortion services, this study reveals gross inequality in service availability. Strategies for improving coverage are suggested.

Abortion, Legal↗

PubMed2006

The impact of meaning in life and life goals on adherence to a tuberculosis medication regimen in South Africa.

SETTING: Out-patient tuberculosis (TB) clinics in Durban, South Africa. OBJECTIVE: Health care provider concerns about persons with active TB defaulting on medications led to a study of adherence among persons receiving anti-tuberculosis therapy and, specifically, the relationships between meaning in life, life goals, sense of coherence, social support, symptom presence and intensity, and adherence in individuals diagnosed with TB. DESIGN: A cross-sectional, descriptive design was used to gather self-reported data from TB-infected individuals who were enrolled in out-patient clinics. Data were collected from 159 Zulu and/or English-speaking persons who agreed to participate in the study. RESULTS: A significant relationship was found between higher life goals and adherence to TB treatment (P = 0.027). Analysis of variance revealed that higher meaning in life ratings were significantly associated with older age (P = 0.007). Having children and children living in the same household were significantly associated with low meaning in life ratings (P = 0.006 and P < or = 0.001, respectively), indicating that these individuals were more concerned about basic matters of home and sustenance. CONCLUSIONS: The results of this study indicate that meaning in life and life goals may be useful for identifying individuals who will require additional support in adhering to anti-tuberculosis treatment.

Adolescent↗

PubMed1988

The consequences of health service privatisation for equality and equity in health care in South Africa.

The trend towards the privatisation of health services in South Africa reflects a growing use of private sources of finance and the growing proportion of privately owned fee-for-service providers and facilities. Fee-for-service methods of reimbursement aggravate the geographical maldistribution of personnel and facilities, and the competition for scarce personnel resources aggravates the difference in the quality of the public and private services. Thus the growth in demand for these types of providers may be expected to increase inequality of access in these two respects. The potential expansion of medical scheme coverage is shown to be limited to well under 50% of the population, leaving the majority of the population without access to private sector health care. Even for members of the medical schemes, benefits are linked to income, thus clashing with the principle of equal care for equal need. The public funds needed to overcome financial obstacles to access to private providers could be more efficiently deployed by financing publicly owned and controlled health services directly. Taxation also offers the most equitable method of financing health services. Finally, attention is drawn to the dilemma resulting from the strengthening of the private health sector; while in the short term this can offer better care to more people on a racially non-discriminatory basis, in the long term, health care for the population as a whole may become more unequal and for those dependent on the public sector it may even deteriorate.

Black People↗

PubMed2005

A community-based study to examine the effect of a youth HIV prevention intervention on young people aged 15-24 in South Africa: results of the baseline survey.

OBJECTIVES: To determine whether South African youths living in communities that had either of two youth human immunodeficiency virus (HIV) prevention interventions [(a) loveLife Youth Centre or (b) loveLife National Adolescent Friendly Clinic Initiative] would have a lower prevalence of HIV, sexually transmitted infections (STIs), and high risk sexual behaviours than communities without either of these interventions. METHODS: In 2002 the baseline survey of a quasi-experimental, community-based study was conducted in South Africa. In total 33 communities were included in three study arms (11 communities per study arm). The final sample included 8735 youths aged 15-24 years. All participants took part in a behavioural interview and were tested for HIV, gonorrhoea (Neisseria gonorrhoeae) and Chlamydia (Chlamydia trachomatis). RESULTS: HIV prevalence was 20.0% among females and 7.5% among males (OR 3.93 95% CI 2.51-6.15). There were no significant differences between study arms for HIV, NG or CT prevalence at baseline. In multiple regression analyses, HIV was significantly associated with NG infection (OR 1.96 95% CI 1.24-3.12) but not with CT infection. Youths who reported >1 lifetime partner were also significantly more likely to be infected with HIV (OR 1.98 95% CI 1.55-2.52), as were those who reported ever having engaged in transactional sex (OR 1.86 P = 0.02) or having had genital ulcers in the past 12 months (OR 1.71 P < or = 0.001). CONCLUSIONS: HIV prevention programmes must ensure that gender inequities that place young women at greater risk for HIV infection are urgently addressed and they must continue to emphasize the importance of reducing the number of sexual partners and STI treatment.

AIDS-Related Opportunistic Infections↗

PubMed2001

Working with public sector clinics to provide adolescent-friendly services in South Africa.

Health care facilities can play an important role for adolescents in preventing health problems, in promoting sexual and reproductive health and in shaping positive behaviours. Extensive research has established that South African public health facilities are failing to provide adolescent-friendly health services. The National Adolescent-Friendly Clinic Initiative (NAFCI) is an accreditation programme designed to improve the quality of adolescent health services at the primary care level and strengthen the public sector's ability to respond to adolescent health needs. The key objectives of the programme are to make health services more accessible and acceptable to adolescents, establish national standards and criteria for adolescent health care in clinics throughout the country, and build the capacity of health care workers to provide quality services. One of the indicators for success of NAFCI will be increased utilisation of public sector clinics by adolescents. NAFCI is an integral component of the largest, most innovative, public health programme ever launched in South Africa, loveLife. Achieving NAFCI accreditation involves clinic self-appraisals, quality improvements, external assessments and award of achievement stars. NAFCI is currently being piloted in ten government clinics in South Africa.

Adolescent↗

PubMed1998

Impact of the human immunodeficiency virus epidemic on mortality among adults with tuberculosis in rural South Africa, 1991-1995.

SETTING: In the Hlabisa district tuberculosis programme, South Africa, the prevalence of human immunodeficiency virus (HIV) infection among adults with tuberculosis increased from 36.0% in 1993 to 65.9% in 1997, and the annual tuberculosis caseload increased from 321 in 1991 to 1250 in 1996. OBJECTIVE: To examine the impact of the HIV epidemic on mortality among adults with tuberculosis from 1991 to 1995. METHODS: Data were extracted from the control programme database. As the programme started in July 1991, data for this year were combined with those for 1992. RESULTS: All-cause mortality among all those diagnosed with tuberculosis increased by 45.6%, from 9.2% (55/599) in 1991/92 to 13.4% (96/714) in 1995 (P = 0.02). Among smear-positive patients only, mortality increased by 134%, from 4.4% to 10.3% (P = 0.003). The case-fatality rate (CFR) increased in most age groups of both sexes, the largest increase (157.5%) being among women aged 15-34 years. CFR was highest among those with smear-negative disease (24.7% in 1995). In multifactorial analysis, independent risk factors for mortality were increasing age (P = 0.0001), HIV infection (odds ratio [OR] 3.5, 95 % confidence interval [CI] 2.3-5.4), smear-negative disease (OR 2.5, 95%CI 1.8-3.5), and diagnosis in 1995 vs 1991/92 (OR 1.8, 95%CI 1.2-2.7). Mortality among the HIV infected continued to accrue throughout treatment, whereas non-HIV-infected patients that died did so early in treatment. CONCLUSION: The HIV epidemic is increasing tuberculosis all-cause mortality. As well as having a direct effect on individuals, increased caseloads due to HIV may also contribute to increased mortality by reducing the health system's ability to provide adequate care.

Adolescent↗

PubMed1998

Prevalence of minor psychiatric disorders in an adult African rural community in South Africa.

BACKGROUND: This paper reports on a two-stage community-based epidemiological study of selected minor psychiatric disorders conducted on an adult African population in South Africa. METHODS: Using a modified random cluster sampling method, 354 adults were identified as the first-stage sample, with the SRQ-20 being used as a first-stage screen. Clinical interviews based on DSM-IV checklists for generalized anxiety disorder, major depression and dysthymia were administered as the second-stage criterion to 81 subjects from the sample. RESULTS: The weighted prevalence for generalised anxiety and depressive disorders was 23.9% (95% CI 15.1%-32.7%), comprising: generalized anxiety 3.7%, major depression 4.8%, dysthymia 7.3%, and major depression and dysthymia 8.2%. Statistically significant associations were found between caseness and age, marital status, employment, income and educational level. CONCLUSIONS: The results are discussed in relation to comparative local and international data as well as in the context of the current restructuring of the mental-health care system in South Africa from tertiary curative care to integrated primary mental-health care.

Adolescent↗

PubMed2000

Premarital fertility in rural South Africa: a challenge to existing population policy.

The age pattern of fertility in a rural area of South Africa under demographic surveillance (Agincourt subdistrict) was investigated over the 1992-97 period. The total fertility rate (TFR) averaged 3.3 births per woman of reproductive age over the period, a major drop from earlier estimates in the same area (6.0 births in 1970-74). Age-specific fertility rates showed an atypical bimodal pattern. They were decomposed into two components of similar magnitude: premarital fertility (among women aged 12-26) and marital fertility (among women aged 15-49). The decomposition revealed the two underlying modes: a mode of premarital fertility (among women aged 18-20) and a mode of marital fertility (among women aged 28-30). Premarital fertility accounted for 21 percent of all births and for 47 percent of births among women aged 12-26. This pattern of high premarital fertility appears to reflect a low incidence of contraceptive use before the first birth, especially among adolescents, a low prevalence of abortion, and a high contraceptive prevalence thereafter. This finding calls for a reorientation of the family planning policy, which until now has targeted married women and women who have been pregnant once, but has failed to address the contraceptive needs of young women before their first pregnancy, especially adolescents.

Adolescent↗

PubMedDate not supplied

Changes in the relative frequency of occurrence of infestations of two sympatric species of bedbug in northern Natal and KwaZulu, South Africa.

Between 1983 and 1988 the frequency of Cimex hemipterus infestations relative to C. lectularius increased near the Mozambique border and around main roads in the Nkundusi-Mfekayi area of South Africa (28 degrees 15'S; 30 degrees 23' E). In areas where both species were common, the observed number of doubly-infested huts equalled the expected. A hut infested by both bedbug species showed a significant change to a higher proportion of C. hemipterus in the adult population over 2 months. The general increase in C. hemipterus is thought to be due to the large influx of migrants into South Africa in recent years.

Animals↗

PubMed2005

Determinants of unprotected sex among HIV-positive patients in South Africa.

This study examined the prevalence of unprotected sex, other sexual risk behaviours, and factors associated with unprotected sex among men and women recently diagnosed with HIV in South Africa. One hundred and forty-nine outpatients (44 males and 105 females) were assessed, of whom 101 were sexually active at least 6 months prior to study entry. Subjects were asked about sexual risk behaviours with reference to their most recent sexual encounter. Logistic regression analysis was employed to determine the predictors of condom use, with independent variables selected from five general categories: (1) sociodemographic characteristics; (2) situational characteristics regarding sexual intercourse (i.e. alcohol or drugs used before intercourse); (3) clinical diagnoses; (4) negative life events; and (5) coping styles. Fifty-five patients (19 males and 36 females), representing 54.4% of those sexually active in the 6 months preceding the study, had not used a condom during the most recent intercourse. Compared with those who used condoms, participants who did not significantly reported shorter duration of HIV infection (t = -2.7, p < 0.001), have a current partner (chi2 = 3.98, p = 0.005), and lack knowledge of their partner's HIV status (chi2 = 4.78, p = 0.004). Also they were significantly more likely to engage in denial (t = 3.2, p < 0.002) and to use substances (t = 1.98, p < 0.05) as a means of coping. Logistic regression showed that shorter duration of illness (odds ratio (OR) = 1.2, 95% confidence interval (CI) = 1.01-1.41) and coping styles characterized by denial (OR = 0.6, 95% CI = 0.45-0.96) were significantly associated with unprotected sex. These data suggest the need for interventions to further reduce sexual risk behaviours in HIV-positive patients in South Africa.

Adult↗

PubMed1991

Birth to ten: child health in South Africa in the 1990s. Rationale and methods of a birth cohort study.

Birth to Ten is a longitudinal birth cohort study which began in April 1990 in the Johannesburg/Soweto area of Transvaal, South Africa. In this paper, the reason for the initiation of the study and its location in the current sociopolitical context is discussed. The health status of South Africa children in terms of infant mortality, morbidity (notifiable diseases) and nutritional status is described and mention is made of measures of psychological health and the importance of environmental pollution on health. The existing health service infrastructure in the study area is described and the fragmentation of health services between races, between preventive and curative services and on a geographical basis is highlighted. The study objectives, design, population, inclusion and exclusion criteria, methods of measurement and logistics are described.

Child↗

PubMed2004

Maternal and congenital syphilis programmes: case studies in Bolivia, Kenya and South Africa.

Preventing congenital syphilis is not technically difficult, however operational difficulties limit the effectiveness of programmes in many settings. This paper reports on programmes in Bolivia, Kenya, and South Africa. All three countries have established antenatal syphilis control programmes. Early antenatal syphilis screening and management of positive cases were difficult to implement since most women presented for their first antenatal clinic visit after 6 months of pregnancy. Most women had rapid plasma reagin (RPR) testing; results were available on the same day in some clinics but took up to 4 weeks in others. No clinic had a system for tracking RPR-reactive women who did not return for their results. There were no guidelines for providers in Kenya and Bolivia. In all countries, supplies, drugs, notification cards, and other consumables were often unavailable. Health-care providers were unmotivated in Kenya and reported an excessive client load. In South Africa and Kenya some clients reported at their exit interview that they had never heard of syphilis nor had they been informed why blood was collected. Several prevention strategies could be implemented at the clinic level. These include encouraging women to attend for antenatal care before the fourth month of pregnancy, providing point-of-care testing so that results are available immediately and women who test positive can be treated, implementing presumptive treatment of sexual partners of women who test positive, adding a second test later in pregnancy so that incident cases can be managed, and improving the quality of syphilis care during pregnancy, delivery, and the neonatal period.

Bolivia↗

PubMed2000

National and provincial estimated costs and cost effectiveness of a programme to reduce mother-to-child HIV transmission in South Africa.

OBJECTIVE: To estimate the cost and cost effectiveness nationally and for each province of a programme to reduce mother-to-child transmission (MTCT) of HIV in South Africa. METHODS: A model developed to estimate cost and cost effectiveness of interventions in Hlabisa, KwaZulu-Natal, was modified and applied to each province. This model predicts a 37% reduction in paediatric HIV infections if short-course oral zidovudine (ZDV) plus infant formula feed for 4 months is provided within a strengthened health system. Estimates of the number of pregnancies and HIV prevalence among pregnant women per province in 1997 were combined with an estimated 30% MTCT rate. Costs were calculated from a health system perspective, and effectiveness was estimated as cost per infection averted and cost per disability-adjusted life year (DALY) gained. RESULTS: In 1997, 63,397 paediatric HIV infections were estimated to have occurred in South Africa, mainly in KwaZulu-Natal (18,513, 29%) and Gauteng (10,417, 16%). The cost of a national programme is estimated at R155.9 million (1997 rand costs, 0.94% of the national health budget). Major cost items are drugs (R46.4 m, 30%), staff salaries (R45.8 m, 29%), and formula feed (R37.1 m, 24%). Most money would need to be spent in KwaZulu-Natal (R37.6 m, 24% of national cost), Gauteng (R25.2 m, 16%) and the Eastern Cape (R24 m, 15%). National cost per infection averted is R6,724, and R213 per DALY gained. Provincial DALY costs range from R176 to R369. CONCLUSIONS: A national programme preventing 37% of expected paediatric HIV infections would cost a small fraction of the national health budget, at a cost equivalent to R3.89 per capita total population. The cost per DALY gained compares well with established public health and clinical interventions in middle-income countries, even without factoring in the care costs that would be saved through a successful programme. Cost effectiveness is greatest where HIV prevalence is highest.

AIDS Serodiagnosis↗

PubMed2004

Oxytocin use in South Africa--a review.

OBJECTIVE: Oxytocin is one of the most frequently used drugs in labour and there are many different dosage regimens. The aim of this study was to examine the use of oxytocin by obstetricians in South Africa. METHODS: A specially designed questionnaire was drawn up and distributed to specialists according to an address list obtained from the South African Society of Obstetricians and Gynaecologists. RESULTS: Three hundred and fifty questionnaires were distributed, with 174 processed for analysis. The majority of obstetricians (70.3%) reported that they would not use oxytocin for induction of labour in a patient with a previous lower-segment caesarean section, and 63.7% said that they would not consider the use of oxytocin in a patient with a multifetal pregnancy. Most respondents used oxytocin for induction of labour in multigravid patients and 91.9% also used oxytocin for augmentation in these patients. However, clinicians would not use oxytocin if the patient was a grand multipara. CONCLUSIONS: Most clinicians adhere to accepted protocols practised internationally, with a few exceptions. The use of oxytocin for both induction and augmentation of labour in women with one previous caesarean section is not practised in South Africa, despite evidence suggesting its safety.

Cesarean Section↗

PubMed2002

Prevalence of HIV among truck drivers visiting sex workers in KwaZulu-Natal, South Africa.

BACKGROUND: Although the role of mobile populations in the spread of HIV has been documented in several countries, there are few data on HIV among truck drivers in South Africa and the sex workers with whom they interact. GOAL: To determine HIV prevalence and risk behavior in a sample of truck drivers visiting commercial sex workers at truck stops. STUDY DESIGN: Two sex workers from each of five truck stops were trained to obtain informed consent, administer questionnaires to obtain data on demographic and migration patterns, and collect saliva samples for HIV testing from their clients. Data on HIV prevalence and demographic characteristics of sex workers operating at the truck stops were obtained from an ongoing vaginal microbicide trial. RESULTS: The mean age of the truck drivers (all men) was 37 years (range, 18-71 years), and that of the sex workers (all females) was 25 years (range, 15-49 years). Sixty-six percent of the men reported having a sexually transmitted infection in the previous six months, and 37% always stopped for sex along the route. Twenty-nine percent reported never using condoms with sex workers, whereas 13% had used condoms with their wives. All men traveled to more than one province in South Africa, and 65% traveled to neighboring countries. Anal sex was practiced by 42% of the men. The overall HIV prevalence (in the two groups combined) was 56%. CONCLUSION: Truck drivers may have facilitated the spread of HIV infection throughout southern Africa.

Adolescent↗

PubMed2001

The epidemic of obesity in South Africa: a study in a disadvantaged community.

OBJECTIVE: The objective of this study was: 1) to determine the anthropometric profile of adults in Mamre, a small town in South Africa, which has a population of mixed ancestry ("colored" people of Afro-Euro-Malay-Khoisan ancestry); and 2) to determine the change in this profile between 1989 and 1996. DESIGN: Cross-sectional surveys conducted in random samples of adults in 1989 and 1996. PARTICIPANTS: The subjects were 684 women and 529 men in 1989, and 546 women and 430 men in 1996, aged 15 and older. MAIN OUTCOME MEASURES: The following measurements were recorded: height, weight, and circumference of waist, hips, and mid-upper arm. RESULTS: Based on data from the 1996 survey, 32% of women are obese (body mass index [BMI] > or = 30) at ages 25-44 years, rising to 49% at ages 45-64 years. A much lower prevalence of obesity is seen in men: 14% at ages 35-64 years. Obesity levels significantly increased in women between the two surveys (P=.015): up from 44% in 1989 to 49% in 1996 at ages 45-64 years. There was an increase in the prevalence of overweight (BMI 25-29.9) in men, though not in obesity. Mean BMI increased by about 3% in women and 2% in men between 1989 and 1996. CONCLUSIONS: This study conducted among people of mixed ancestry living in a disadvantaged community in South Africa shows that half of middle-aged women are obese. A rising trend in BMI was seen in adults of both sexes between 1989 and 1996. This trend may be explained by factors associated with rural-urban transition, including electrification, reduced physical activity, and increasing availability of energy-dense food.

Adolescent↗

PubMedDate not supplied

Mycobacterium avium-intracellulare complex serovars isolated in South Africa from humans, swine, and the environment.

From 1968 to 1978 a total of 792 strains of the Mycobacterium avium-intracellulare complex were isolated from various sources in South Africa and serotyped according to Schaefer's seroagglutination test' 569 strains were from healthy rural persons, 171 strains were from lymph node lesions of swine, and 52 environmental strains were from animal feed and bedding, plants, dust, and soil. Serotyping was undertaken to determine the exposure of humans and animals to various serovars, to ascertain the predominance of individual serovars from the various sources, and to pinpoint, if possible, reservoirs of infection. Occurrence of M. avium serovars 1--3 was low in all sources studied: 1% in humans, 4% in the environment, and 14% in swine. The predominant human serovars were 7, 14, 19, 24, and 13, whereas the predominant swine serovars were 8, 4, double type 4/8, and 10. Serovars found in the environment were 9, 10, 13, 14, 16, and 17, with serovars 4 and 8 predominating.. Therefore, in South Africa, as in Australia, humans and animals are continuously exposed to various serovars, particularly serovars 4--24, which can be frequently and regularly isolated from the environment, the possible source of infection.

Animal Feed↗