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PubMed2003

Assessment of the iodine concentration in table salt at the production stage in South Africa.

OBJECTIVE: To determine the iodine content of iodized salt at the production stage, to assess the perceptions and knowledge of salt producers about the prevention and control of iodine deficiency, and to examine the internal quality control procedures used during iodization in South Africa. METHOD: Salt samples were collected for iodine analysis by titration from the 12 producers iodizing salt in South Africa. Information on the producers' knowledge of iodine deficiency disorders and on internal quality control was obtained by means of questionnaires. FINDINGS: The legal requirement of 40-60 ppm iodine was met in 30.9% of salt samples; 57.9% contained more than 30 ppm iodine; 34.8% contained under 20 ppm iodine. There were shortcomings in perceptions and knowledge about iodine deficiency disorders and in the internal quality control procedures of a substantial proportion of the producers. CONCLUSION: In order to encourage and support salt producers to achieve optimal iodization there should be an information, education and communication strategy aimed at improving knowledge of iodine deficiency disorders and at raising the standard of internal quality control procedures. External monitoring should continue.

Deficiency Diseases↗

PubMed2001

Cost-effectiveness of the female condom in preventing HIV and STDs in commercial sex workers in rural South Africa.

We assessed the cost-effectiveness of the female condom (FC) in preventing HIV infection and other STDs among commercial sex workers (CSWs) and their clients in the Mpumulanga Province of South Africa. The health and economic outcomes of current levels of male condom (MC) use in 1000 CSWs who average 25 partners per year and have an HIV prevalence of 50.3% was compared with the expected outcomes resulting from the additional provision of FCs to these CSWs. A simulation model calculated health and public sector cost outcomes assuming 5 years of HIV infectivity, 1 month of syphilis and gonorrhea infectivity, and FC use in 12% of episodes of vaginal intercourse. Delayed infections and interactions between STDs and HIV were modeled. The simulation was extended to non-CSWs with as few as one casual partner per year. We conducted multiple sensitivity analyses. The program would distribute 6000 FCs annually at a cost of $4002 and would avert 5.9 HIV, 38 syphilis, and 33 gonorrhea cases. This would save the public sector health payer $12,090 in averted HIV/AIDS treatment costs, and $1,074 in averted syphilis and gonorrhea treatment costs for a net saving of $9163. Sensitivity analyses indicate that the economic findings are robust across a wide range of values for key inputs. The program generates net savings of $5421 if HIV prevalence in CSWs is 25% rather than 50.3% and savings of S3591 if each CSW has an average of 10 clients per year rather than 25. A program focusing on non-CSWs with only one casual partner would save $199. We conclude that a well-designed FC program oriented to CSWs and other women with casual partners is likely to be highly cost-effective and can save public sector health funds in rural South Africa.

Condoms↗

PubMed2001

Molecular and genealogical evidence for a founder effect in Fanconi anemia families of the Afrikaner population of South Africa.

Fanconi anemia (FA) is a rare, genetically heterogeneous autosomal recessive disorder associated with progressive aplastic anemia, congenital abnormalities, and cancer. FA has a very high incidence in the Afrikaner population of South Africa, possibly due to a founder effect. Previously we observed allelic association between polymorphic markers flanking the FA group A gene (FANCA) and disease chromosomes in Afrikaners. We genotyped 26 FA families with microsatellite and single nucleotide polymorphic markers and detected five FANCA haplotypes. Mutation scanning of the FANCA gene revealed association of these haplotypes with four different mutations. The most common was an intragenic deletion of exons 12-31, accounting for 60% of FA chromosomes in 46 unrelated Afrikaner FA patients, while two other mutations accounted for an additional 20%. Screening for these mutations in the European populations ancestral to the Afrikaners detected one patient from the Western Ruhr region of Germany who was heterozygous for the major deletion. The mutation was associated with the same unique FANCA haplotype as in Afrikaner patients. Genealogical investigation of 12 Afrikaner families with FA revealed that all were descended from a French Huguenot couple who arrived at the Cape on June 5, 1688, whereas mutation analysis showed that the carriers of the major mutation were descendants of this same couple. The molecular and genealogical evidence is consistent with transmission of the major mutation to Western Germany and the Cape near the end of the 17th century, confirming the existence of a founder effect for FA in South Africa.

Base Sequence↗

PubMed1995

Avian malaria seroprevalence in Jackass penguins (Spheniscus demersus) in South Africa.

Blood samples of 191 adult Jackass penguins (Spheniscus demersus) from South Africa were tested by indirect enzyme-linked immunosorbent assays (ELISA) with Plasmodium falciparum antigen (R32tet32) for avian malaria antibodies (Ab). The samples originated from free-ranging penguins from offshore islands and southern coast colonies (3 groups, n = 110), from 2 penguin groups (n = 66) rescued after offshore oil-spill contamination and rehabilitated at the Rescue Station of the South African National Foundation for the Conservation of Coastal Birds (SANCCOB) in Cape Town, and from SANCCOB-resident penguins (n = 15). The total average malaria Ab seroprevalence was 39%, and the mean malaria seropositivity ranged from 20% to 62% among the 6 S. demersus groups, with a mean of 55% for oiled penguins, and 31% for the remaining birds. The total mean absorbance value was 0.57 for ELISA-positive penguins, 0.43 for birds kept at SANCCOB facilities, and 0.70 for the penguins from wild colonies. The 2 groups of oiled penguins exhibited higher malaria Ab seroprevalence (38% and 62%) than the 3 groups of non-oiled birds (29%, 33% and 35%). Malaria Ab seroprevalence of free-ranging penguins was significantly lower (P < 0.01) than in the 3 groups of birds at SANCCOB facilities and did not differ significantly among 3 wild penguin colonies.

Animals↗

PubMed1997

An association between HIV-1 subtypes and mode of transmission in Cape Town, South Africa.

OBJECTIVES: To determine HIV-1 env and gag subtypes in male homosexual and heterosexual populations in Cape Town, South Africa. DESIGN: DNA was isolated from blood originating from 61 patients attending local clinics. Samples were divided according to presumed mode of transmission: male homosexual (n = 26), heterosexual/vertical (n = 32), blood transfusion (n = 1) and unknown (n = 2). METHODS: Proviral HIV-1 DNA was subtyped by heteroduplex mobility assay (HMA) based on the 799 base-pair V3-V5 region of the env gene (n = 47) or by sequence analysis of the p17 region of the gag gene (n = 33), or both. For HMA, reference plasmids were constructed containing the V1-V5 env region sequences (1.2-kb) representative of local subtypes. Subtype designation of reference subtypes was confirmed by sequence analysis of the V3-loop region. RESULTS: Analysis of the partial gag sequences and HMA of the V3-V5 env region identified three subtypes: B, C and D. A fourth env subtype, subtype E, was also identified by HMA. Subtypes were found to segregate according to mode of transmission, with subtype B viruses found in 96% (25 out of 26) of the male homosexual group and subtype C viruses found in 81% (26 out of 32) of the heterosexual/vertical transmission group. Subtype B viruses were also found in four heterosexual patients, one patient infected by blood transfusion and in two patients with unknown mode of transmission. Subtype D viruses were found in one male homosexual patient and one heterosexual patient. A subtype E virus was identified in a heterosexual patient. No discrepancy was found in subtype designation in samples analysed in both between the gag and env regions (n = 19). CONCLUSIONS: Subtype B viruses were associated with male homosexual transmission and subtype C viruses with heterosexual transmission, suggesting two independent epidemics. This data may have implications in the selection of appropriate vaccines for different risk groups in the country.

Adult↗

PubMed1991

Down's syndrome in South Africa--incidence, maternal age and utilisation of prenatal diagnosis.

Down's syndrome (DS) is the most common chromosomal cause of metal retardation, and amniocentesis is the most significant factor affecting its prevalence. In South Africa, prenatal cytogenetic diagnoses have been available for just over a decade and the utilisation and effect of this procedure in the white population born between 1980 and 1984 was evaluated. On the basis of pooled data involving 4,939,640 births, an overall world mean rate for DS of 1,34/1,000 live births (mainly Caucasian) for single-year maternal ages was calculated. Accordingly, 58 cases of DS were expected in the 40-year and older maternal age group in South Africa. Only 34 cases (59%) were detected prenatally, and a further 3 cases were identified by the notification system during the same period and in the same maternal age group. Another 24 DS cases in the maternal age group of 40 years and over could thus potentially have been detected prenatally and prevented, while 21 cases in this age group (36%) could not be accounted for at all. Cost-benefit analyses are shown and the number of amniocenteses required for various maternal age groups to affect the prevention of DS is calculated.

Adult↗

PubMed2005

Community-based participatory research (CBPR) in South Africa: engaging multiple constituents to shape the research question.

Community engagement is an on-going, arduous, and necessary process for developing effective health promotion programs. The challenges are amplified when the particular health issue or research question is not prominent in the consciousness of the targeted community. In this paper, we explore the community-based participatory research (CBPR) model as a means to negotiate a mutual agenda between communities and researchers. The paper is focused on the (perceived) need for cervical cancer screening in an under-resourced community in Cape Town, South Africa. Cervical cancer is a significant health problem in this community and elsewhere in South Africa. Unlike HIV-AIDS, however, many Black South Africans have not been educated about cervical cancer and the importance of obtaining screening. Many may not consider screening a priority in their lives. Our research included extensive consultations and informal interviews with diverse community and regional stakeholders. Following these, we conducted 27 focus groups and 106 demographic surveys with randomly selected youth, parents, local health care personnel, educators and school staff. Focus group data were summarized and analyzed cross-sectionally. Community stakeholders were involved throughout this research. Our consultations, interviews, and focus group data were key in identifying the concerns and priorities of the community. By engaging community stakeholders, we developed a research framework that incorporated the community's concerns and priorities, and stressed the intersecting roles of poverty, violence, and other cultural forces in shaping community members' health and wellbeing. Community members helped to refocus our research from cervical cancer to 'cervical health,' a concept that acknowledged the impact on women's bodies and lives of HIV-AIDS and STDs, sexual violence, poverty, and multiple social problems. We conclude that the research agenda and questions in community-based health research should not be considered immutable. They need to be open to negotiation, creativity, and constant reinvention.

Adult↗

PubMed2004

Colloquium report: improving the health of school age children in an era of HIV/AIDS in Durban, South Africa.

Increased morbidity and mortality due to the HIV/AIDS epidemic in South Africa necessitates the examination of policies for the protection and support of school age children. At a colloquium held in Durban participants from government and non-government health and education sectors briefed delegates on key policies and programmes for promoting the health and mental health of school age children. Researchers gave evaluative accounts of the impacts of these measures and presented an overview of South African children's health and mental health needs. In the discussions that followed four critical issues emerged: intersectoral collaboration, accountability, retraining middle management, and a more comprehensive strategy to support pupils and teachers infected and affected by HIV/AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Age standardized incidence rates of oral cancer in South Africa, 1988-1991.

While numbers of papers on oral cancer in South Africa have been published, there have been very few studies on standardized morbidity rates. This paper has developed data collected by the National Cancer Registry from the entire country for the four year period 1988-1991 to present frequency, age standardized incidence rates (ASIRs) and life-time risk (LR) for histologically-diagnosed intra-oral cancers in female and male Asian, black, coloured and white South Africans. During this period 5396 cases of oral cancer were diagnosed in a total number of 157,307 cancer cases (3.4 per cent) excluding squamous cell carcinoma (SCC) and basal cell carcinoma (BSC) of the skin. Intra-oral cancer in all South African females and males accounted, respectively, for 1.8 per cent and 5.0 per cent of all cancers. There was a male preponderance in black, coloured and white groups but females were affected more frequently than men among Asians. The incidence in Asian women (6.66) was higher than those of the women in any of the other population groups, whereas the lowest incidence was found in black women (1.75). The incidence rate in coloured men was particularly high (13.13) whereas the incidence in white males (8.06) was not substantially lower than among black males (9.05). Differences between the eight groups were not significant (X2 = 6.24, df = 3, p > 0.1). The Cumulative Life Time Risk (LR) of developing intra-oral cancer for males and females in the four population groups ranged from 1:65 in coloured males to 1:455 for black females. Gender differences in LR in both black and coloured groups, signals substantial differences in exposure to known carcinogens for this disease. It is disturbing to note that the incidence in the period 1988-1991 was higher in Indian women that it was in 1964-1966, and that educative preventive measures have failed. Similarly, the incidence of intra-oral cancer in coloured men of 13.13 is substantially higher than the figure of 8.8 reported in 1979. If this is an accurately reflected trend, then a major educative programme needs to be pursued in this direction if the relative risk of one in 65 is to be reduced.

Adolescent↗

PubMed1992

No serological evidence for the presence of swine vesicular disease virus in South Africa.

An indirect ELISA incorporating a protein A-peroxidase conjugate was developed for detecting antibodies to swine vesicular disease virus (SVDV) in pig sera. This test and a conventional virus neutralization test were found to be equally sensitive. A total of 2846 pig sera collected from various abattoirs in South Africa were tested using the indirect ELISA. No serological evidence of infection with SVDV in pigs in South Africa was found.

Animals↗

PubMed1997

A study of the genetic diversity of Mycobacterium tuberculosis isolated from patients in the eastern province of South Africa using random amplified polymorphic DNA profiling.

This population genetics study was done to determine the degree of genetic diversity amongst clinical isolates of Mycobacterium tuberculosis in one of the largest provinces of South Africa. Three hundred and fifty-nine individual cultures were obtained from single patients over a nine-month period. Bacterial DNA was extracted and amplified with two arbitrary ten-mer primers, using the random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) technique. RAPD markers were separated by agarose gel electrophoresis, visualised with ethidium bromide, and then analysed for similarity using the GelCompar programme. The isolates were seen to fall into two major population groups. A high degree of genetic diversity was seen, with a total of 350 unique strains occurring amongst the 359 isolates. The majority of drug-resistant isolates grouped together in the smaller population group. The genetic data were also correlated with geographical locality. It was found that a slight preponderance of isolates that grouped together closely, vis. that were either genetically identical or very similar (similarity index of approximately 97%), were from areas that were considered to be geographically distant. Antibiotic resistance patterns were also examined, revealing a total of 16 different resistance profiles among the 68 drug-resistant isolates. RAPD-PCR has proved to be a cost- and time-effective technique, suitable for such a large-scale population genetics study. It has provided useful information on the genetic diversity of an organism which is responsible for an increasing amount of morbidity and mortality in South Africa's second-largest province.

DNA Fingerprinting↗

PubMed2004

Towards the establishment and standardization of a veterinary antimicrobial resistance surveillance and monitoring programme in South Africa.

The objective of this study was to establish a repeatable, standardized laboratory procedure for monitoring the development of antimicrobial resistance in bacteria isolated from animals and food of animal origin in South Africa, with reagents prepared in-house. The emergence of resistance and the spread of resistant bacteria can be limited by implementing a veterinary antimicrobial drug policy, in which inter alia systematic monitoring and prudent use play essential roles. The bacteria included in this study represented three different categories, namely zoonotic bacteria (Salmonella), indicator bacteria (Escherichia coli, Enterococcus faecalis and Enterococcus faecium) and veterinary pathogens (Mannheimia haemolytica). Thirty isolates of each species were collected with the aim of standardizing the laboratory methodology for a future national veterinary surveillance and monitoring programme. Susceptibility to ten selected antimicrobial drugs was determined by means of minimum inhibitory concentrations (MICs) using the microdilution method. The method according to the National Committee for Clinical Laboratory Standards was used as the standard. Multi-well plates containing varying dilutions of antimicrobial drugs and prepared in-house for MIC determinations, yielded repeatable results. Storage of plates for 2 months at -70 degrees C did not influence results meaningfully. Within this limited sample of bacteria, MIC results did not indicate meaningful resistance against any of the ten selected antimicrobial drugs. The findings of the study will be used to establish a national veterinary antimicrobial resistance surveillance and monitoring programme in South Africa. To allow for international comparison of data, harmonisation of the surveillance and monitoring programme in accordance with global trends is encouraged. Ideally it should be combined with a programme monitoring the quantities of antimicrobial drugs used. The aim is to contribute to slowing down the emergence of resistance and the problems associated with this phenomenon by means of the rational use of antimicrobial drugs.

Animals↗

PubMed2001

Occurrence and causes of occupational asthma in South Africa--results from SORDSA's Occupational Asthma Registry, 1997-1999.

OBJECTIVE: To present results for the first 3 years of the occupational asthma registry of the Surveillance of Work-related and Occupational Respiratory Diseases in South Africa (SORDSA) programme, ending December 1999. DESIGN: Surveillance was accomplished by collecting voluntary reports of occupational asthma cases from pulmonologists, occupational medicine practitioners and occupational health nurses. SETTING: Medical and occupational health referral centres in the nine provinces of South Africa. SUBJECTS: Patients diagnosed with new-onset occupational asthma with latency or irritant-induced asthma, reported to SORDSA during 1997-1999. OUTCOME MEASURES: Frequencies of cases, causative agents, industries causing exposure and diagnostic methods. Average annual incidence rates by province and by occupation. RESULTS: During this period 324 cases of occupational asthma were reported. The average annual incidence rate of occupational asthma was estimated in the three best-reporting provinces, namely Gauteng, KwaZulu-Natal and the Western Cape, as 17.5 per million employed people annually. This rate was highest in the Western Cape (25.1 per million). Semi-skilled operators had the highest incidence rate of 68.7 per million annually in the three provinces. Isocyanates and latex were the most common agents. Low molecular weight causative agents predominated (68.8%) over high molecular weight agents. Health care was the most frequently reported workplace for occupational asthma (OA) development. Serial peak flow testing was the method most often used for diagnosis. One-fifth of the cases were still occupationally exposed to the causative agent at time of diagnosis. CONCLUSION: Despite underreporting, SORDSA's estimate of the occupational asthma incidence rate was similar to that of the UK. SORDSA has also demonstrated that surveillance programmes in a developing country can provide useful information on which to base prevention activities.

Asthma↗

PubMed2005

HIV vaccine research--South Africa's ethical-legal framework and its ability to promote the welfare of trial participants.

An effective ethical-legal framework for the conduct of research is critical. We describe five essential components of such a system, review the extent to which these components have been realised in South Africa, present brief implications for the ethical conduct of clinical trials of HIV vaccines in South Africa and make recommendations. The components of an effective ethical-legal system that we propose are the existence of scientific ethical and policy-making structures that regulate research; research ethics committees (RECs) that ethically review research; national ethical guidelines and standards; laws protecting research participants; and mechanisms to enforce and monitor legal rights and ethical standards. We conclude that the ethical-legal framework has, for the most part, the necessary institutions, and certain necessary guidelines but does not have many of the laws needed to protect and promote the rights of persons participating in research, including HIV vaccine trials. Recommendations made include advocacy measures to finalise and implement legislation, development of regulations, analysis and comparison of ethical guidelines, and the development of measures to monitor ethical-legal rights at trial sites.

AIDS Vaccines↗

PubMed2006

Levels and differentials in childhood mortality in South Africa, 1977-1998.

This study uses the 1996 Census and the 1998 Demographic and Health Survey (DHS) to investigate the level of and trend in infant and child mortality and their covariates in South Africa. Census estimates of childhood mortality are higher than those from the DHS. Analysis suggests that the former overestimate mortality while the latter are probably slightly too low. Both inquiries document a reversal of the trend toward lower mortality in the 1990s. Under-five mortality increased by about a third during the five years up to early 1998. By then the infant mortality rate was about 55 per 1000 and under-five mortality 72 per 1000. Other factors may explain the tapering off of the decline in mortality after the late 1980s but AIDS deaths account for its increase. Inequalities in childhood mortality between population groups, rooted in past discriminatory apartheid policies, shrank between the late-1970s and mid-1990s. However, they remain substantial and are largely unaccounted for by province, metropolitan residence and inter-group differences in mothers' education. The HIV/AIDS epidemic is likely to offset the beneficial impact of post-apartheid pro-poor policies and may exacerbate racial differences in childhood mortality in South Africa. There is an urgent need to improve the routine collection of statistics to monitor child mortality so as to assess progress towards the Millennium Development Goals and track inequalities.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Distribution, habitats and role as intermediate host of the freshwater snail, Bulinus forskalii, in South Africa.

This paper focuses on the geographical distribution and habitats of Bulinus forskalii, the snail intermediate host of the conical fluke of equids, Gastrodiscus aegyptiacus as reflected by the 1209 samples in the database of the National Freshwater Snail Collection of South Africa. The 362 different loci on record represent an extensive distribution in KwaZulu-Natal Province, the Limpopo Province, the coastal areas of the Eastern Cape Province and the south-eastern part of the North West Province. Although it was recorded from all types of water-body represented in the database, the highest percentages of samples were recovered from dams (30.4%) and brooks (28.2%). The majority of samples came from perennial habitats (59.1%), 60.7% from habitats with standing water, 54.0% from habitats with clear water and 71.8% from habitats of which the water was described as fresh. The majority of samples (39.5%) were collected in habitats of which the substratum was recorded as muddy. The highest percentage of samples, by far (81.5%), was collected in habitats that fell within the mean yearly temperature interval ranging from 15-20 degrees C. An integrated decision tree constructed from the data in the database indicated that temperature and type of water-body played a decisive role in determining the presence of B. forskalii in a given area. The results of experimental exposure to miracidia of a local strain of both Schistosoma haematobium and Schistosoma mattheei in the laboratory indicated that a local strain of B. forskalii was incompatible with both these strains of parasite. Research to clarify the role of B. forskalii in the transmission of both Calicophoron microbothrium and G. aegyptiacus in South Africa, is recommended.

Animals↗

PubMed2005

Using the school feeding system as a vehicle for micronutrient fortification: experience from South Africa.

School-age children are often a neglected group in terms of micronutrient interventions because they are not reached by the intervention strategies aimed at preschool children or pregnant women. School feeding, however, offers an excellent opportunity for targeted intervention in this age group, especially with regard to fortification. This paper first gives a brief overview of the school-feeding program in South Africa, and second reports on a number of trials conducted in South African schools by the South Africa Medical Research Council that examined the feasibility of using school feeding as a vehicle for micronutrient fortification. Various food items, such as biscuits, bread spread, and soup, are evaluated as potential carriers for micronutrients with positive effects on outcomes such as micronutrient status, growth, morbidity and cognitive function. For schoolchildren to realize their full mental and physical potential and to perform optimally at school, both short-term hunger and hidden hunger (micronutrient deficiencies) need to be addressed. School feeding has the potential to contribute toward alleviating both of these conditions and should therefore be fully utilized.

Child↗

PubMed1975

Arsenic resistance in species of multi-host ticks in the Republic of South Africa and Swaziland.

A survey was made in the Republic of South Africa and Swaziland to determine the incidence of arsenic resistance in multi-host ixodid ticks. Arsenic resistant strains were found in the following species:- Rihipicephalus appendiculatus, Rhipicephalus evertsi, Rhipicephalus capensis, Amblyomma hebraeum and a species of Hyalomma, tentatively identified as Hyalomma rufipes. Strains of Haemaphysalis Leachi, Haemaphysalis silacea and Ixodes pilosus were also tested.

Animals↗