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A survey of Paget's disease of bone in Johannesburg South Africa, has revealed a prevalence of 2.4% in whites aged 55 years and over, which is similar to some centres in Europe; it has also revealed an unexpectedly high prevalence of 1.3% among blacks. These findings are discussed in relation to recent concepts of the pathogenesis of Paget's disease.
This paper focuses on the geographical distribution and habitats of Lymnaea truncatula, the intermediate, snail host of the liver fluke, Fasciola hepatica, as reflected by the 723 samples in the database of the National Freshwater Snail Collection, Potchefstroom, South Africa. The 221 different loci (1/16-degree squares) on record reflect an extensive but discontinuous distribution, except in Lesotho and in parts of the Mpumalanga, Gauteng and North West provinces of South Africa. Although recorded from 12 different types of waterbody, it was mostly (42.0%) recovered from swamps. Most samples (45.8%) were collected in habitats with slow-flowing water. A muddy substratum was recorded for 62.5% of the samples. Most samples (86.3%) were collected in habitats with a mean annual air temperature of 10-20 degrees C, and more than 69% came from localities with a mean annual rainfall of 600-900 mm. An integrated decision tree constructed from the data indicated that temperature and types of waterbody play a decisive role in determining the presence of L. truncatula in a given area. A temperature index calculated for all mollusc species ranked L. truncatula second in a total of 53 species according to its association with low temperatures. It remains to be established whether its distribution is indeed discontinuous, and whether its preference for a particular habitat, amphibious habits and ability to aestivate could have resulted in some populations having been overlooked during surveys.
Whereas international trends show that many developed countries are adopting policies that promote pesticide reduction, use of pesticides in South Africa continues to expand. In particular, macroeconomic policies encourage pesticides use among emergent small-scale black farmers, while potential exposures of workers on commercial farms remain high. Despite having legal controls that seem to conform to international standards, the present health and environmental impacts of pesticide use in South Africa are substantial and generally underestimated. The reasons lie in the fragmentation of regulatory mechanisms as well as the absence of public awareness and participation in policy-making related to pesticides. Failure to enforce existing legislation, an ambivalent relationship between government and industry, and the existence of a "pesticide culture" will continue to prevent implementation of meaningful control measures. As a result, it is marginalized groups, such as small-scale farmers and farm workers, who bear the brunt of policies that have not kept pace with a growing international awareness of the hazards of widespread pesticide use for human health and for the environment. Opportunities for fundamental transformation of the legal and policy framework relating to pesticides in order to promote environmental justice are explored.
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The epidemiology of wildebeest-derived malignant catarrhal fever in South Africa differs from the worldwide accepted pattern. Here the occurrence of the disease is often not related to close contact between cattle and wildebeest, and most cases are observed during late winter and spring, when wildebeest calves are 8-10 months old. This is in contrast to the situation in Kenya and Tanzania, where most cases are encountered during autumn, when wildebeest calves are 3-4 months old.
Recent work on assessing household food insecurity has focused mainly on experiential-based measures using qualitative survey questions. In this paper, we employed two quantitative measures to estimate prevalence rates for household food insecurity in South Africa. One measure, termed food poverty, assessed whether the amount spent by a household on food was inadequate to purchase a low cost food plan. Low energy availability assessed whether the food energy available to a household, through its purchases and home production, was less than the sum of its members' recommended energy intakes. The 1995 Income and Expenditure Survey, a large representative survey of South African households (n = 28,704), was used for this secondary data analysis. Results showed that 43% of households were in food poverty in October 1995, and 55% had a low energy availability. These indicators allowed classification of households into four groups: food poverty only; low energy availability only; food insecure on both measures; and food secure. These groups differed on various aspects of household food consumption, suggesting that these indicators can be used to target different types of interventions to meet specific needs. Both bivariate and multivariate analyses showed that households that were food insecure on both measures were more likely to be in rural areas, have low incomes or large household sizes, and be headed by Africans or individuals of mixed ancestry. These patterns of food insecurity were corroborated by previous research on income poverty and nutritional status, suggesting that food poverty and low energy availability are useful, quantitative indicators for assessing food insecurity in South Africa.
Huntington's chorea is prevalent among the Afrikaner population of South Africa. The origin of the gene for the disorder in this population group has been traced over 14 generations from the present time to the days of the first free burghers at the Cape of Good Hope. Over 200 affected individuals in more than 50 supposedly unrelated families have been found to be ancestrally related through a common progenitor in the 17th century.
The prevalence of urinary schistosomiasis (Schistosoma haematobium) in canoeists in South Africa was estimated from examinations of urine samples taken from participants in the 1988 and 1989 Duzi Canoe Marathons on the Umsinduzi/Umgeni river in Natal. As an indicator of water quality during races, water samples were taken from the river for bacteriological analysis. Results showed a very low prevalence of S. haematobium and possible reasons for this are offered. Faecal coliform levels in the river water were unacceptably high during the races.
Hypertrophic cardiomyopathy (HCM), a common primary cardiac disorder with an increased risk of sudden death, affects all population groups in South Africa. Distinct causal mutations in multiple sarcomeric protein-encoding genes correlate with the risk of sudden death. Such genotype/phenotype correlations cannot be extrapolated geographically or ethnically, necessitating the generation of South African-specific data. We used DNA-based techniques to search for the causal mutations in a panel of South African HCM-affected subjects (37 with unequivocal HCM, 47 with HCM-like disease). Mutations detected were traced in family members and carriers assessed by echocardiography and electrocardiography. Nine different HCM-causing mutations (5 unique to South Africa, 3 showing a founder effect) were identified in 3 genes in 24 index cases (57% HCM group, 6% HCM-like group). The different mutations were associated with variable hypertrophy, independent of the risk of sudden death. The disease was generally familial and many at-risk mutation carriers did not meet clinical diagnostic criteria for HCM. Rigorous diagnosis of index cases facilitates detection of causal mutations, which allows for unequivocal DNA-based diagnosis of at-risk family members, regardless of age or clinical status. This permits focused patient management, informed prognostication and realistic counselling for this insidious disease, as well as time and cost savings.
Rheumatic fever is a major health problem in South Africa. Although intramuscular benzathine penicillin (bicillin) 1.2 million units (MU) every 4 weeks is widely used for secondary prophylaxis, studies in other countries have shown a recurrence rate of 3-8% over 5-6 years in patients on this regimen. It has been recommended that serum penicillin concentrations should be maintained above 0.02 mg/ml to prevent such recurrences. The World Health Organisation (WHO) and the American Heart Association have recommended since 1988 that patients in high-risk areas for the development of rheumatic fever should receive benzathine penicillin 1.2 MU every 3 weeks rather than every 4. The aims of this study were, firstly, to determine the prevalence of serum penicillin concentrations below 0.02 micrograms/ml in rheumatic fever patients on benzathine penicillin 1.2 MU 4-weekly and, secondly, to study the effect of increasing the dose of 1.8 MU 4-weekly in patients with subtherapeutic concentrations. Forty-five of 51 rheumatic fever patients (88%) in this study on benzathine penicillin 1.2 MU 4-weekly had low serum penicillin concentrations (< 0.02 micrograms/ml) at the end of the 4th week after the injection. Penicillin was detected in the urine of 30 of the 45 patients (67%) with low concentrations, suggesting that such patients have tissue-bound penicillin which might be important in preventing rheumatic fever. The 15 patients (33%) with subtherapeutic serum penicillin concentrations and no detectable penicillin in the urine could be at very high risk for recurrent attacks of rheumatic fever. Fourteen of 29 patients (48%) given the higher dose of benzathine penicillin (1.8 MU 4-weekly) had subtherapeutic serum penicillin concentrations at the end of the 4th week after the injection, but in all 29 penicillin was detected in the urine. Review of our present policy of secondary prophylaxis for rheumatic fever is necessary. Concentrated preparations of benzathine penicillin (600,000 U/ml) are not available in South Africa; administration of a higher dose (1.8 MU) 4-weekly would therefore require a double injection, which could affect compliance adversely. We recommend that rheumatic fever patients in our area should receive benzathine penicillin 1.2 MU 3-weekly as recommended by the WHO until strategies for secondary prophylaxis have been evaluated further.
The prevalence of virulent Rhodococcus equi in soil isolates from two horse farms in South Africa and nine clinical isolates from six foals, a foal foetus, a dog, and a monkey was investigated. The isolates were tested for the presence of virulence plasmid DNA and 15- to 17-kDa antigens by immunoblotting. Rhodococcus equi was isolated from almost all of the soil samples obtained from the two farms with 5.0 x 10(1) to 3.3 x 10(4) colony forming units per gram of soil. Virulent R. equi was isolated from three soil samples from one of the farms and appeared in 3.8% (three of 80 isolates), but not in any of the 182 isolates from the other farm. Of the three virulent R. equi isolates, one contained an 85-kb type I plasmid and two an 87-kb type I plasmid. Of nine clinical isolates from the foals, foal foetus, dog and monkey, five from the foals were virulent R. equi which expressed the virulence-associated antigens and contained a virulence plasmid 85-kb type I, and were all isolated from cases of pneumonia typical of that induced by R. equi in young foals living in widely separated areas in South Africa. The isolates from the other four foals, the dog and the monkey were avirulent R. equi.
It is estimated that each HIV-positive child in South Africa costs the government more in terms of health and welfare expenses than it does to reduce mother-to-child transmission (MTCT) of HIV through the use of antiretroviral regimens (where the mother continues to breast-feed). Programmes to reduce MTCT of HIV/AIDS are, thus, clearly affordable. Using Nevirapine (according to the HIVNET 012 Protocol) saves more lives and [corrected] is more cost-effective than using Zidovudine (CDC 2 weeks regime).
In December 1993, a light-trap survey was made of the Culicoides found at eight horse stables and dairies in the sandy dune field west of Port Elizabeth, South Africa. While it was notable that Culicoides numbers were low (4749) and that the diversity was poor (15 species), the most remarkable fact to emerge, was that C. imicola, the only proven vector of the virus of African horse sickness (AHS), was entirely absent. Though not abundant, C. bolitinos, a sister species of C. imicola, was overwhelmingly dominant (91.7%). Its larvae and pupae develop exclusively in the dung of cattle, but it is a species that is not implicated in the transmission of animal viruses. Elsewhere in South Africa, a frost-free climate, good rainfall and a plentiful supply of livestock would normally lead to the development of large foci of C. imicola. That this is not the case in the Port Elizabeth (P.E.) area is most likely owing to the winds inhibiting adult flight and the sandy soils being nutrient-poor and too well-drained to sustain Culicoides larvae. Studies are needed to confirm that sandy soils cannot sustain C. imicola. If so, the sandy coastal areas hold promise for quarantining against AHS.
In a collaborative study from Washington, D. C., and Johannesburg, South Africa, the clinical, laboratory, and immunologic features of 64 black patients (25 male, 39 female) who had pernicious anemia were studied. Mean age at diagnosis was 53 +/- 20 years (mean +/- SD); 29.6% of the patients were under 40 years of age, and 14% were 30 years of age or younger. This suggests that there may be an earlier age of onset of pernicious anemia amongst blacks than the reported age incidence in whites. Serum anti-intrinsic factor blocking antibodies were found in 25 of 37 patients tested (67.5%). There was a significantly higher incidence of the antibody in women (85%) than in men (50%) (P < 0.01).
Malignant melanoma constitutes about 2% of all cancers occurring in South Africa. It is between 2,5 and 6 times more frequent in Whites than in Blacks, but the lowest incidence occurs in the Coloured population. The incidence of malignant melanoma in Whites (as reflected by mortality figures) varies with latitude, being higher nearer the Equator. The disease is more common among females and the older age groups in all sections of the population. Whites present with small lesions (generally less than 20 mm in diameter) which may be situated on any part of the body. In Blacks the tumours are large (sometimes more than 100 mm in diameter) when first seen and are predominantly situated on the sole of the foot and the palm of the hand. The 5-year survival rate is 20% in Blacks and 42% in Whites. The survival rates are more favourable in women.
SETTING: Low income, high density, urban settlements in Cape Town, South Africa. OBJECTIVES: To evaluate community treatment supervision as part of tuberculosis (TB) programme implementation. DESIGN: A non-randomised prospective study was conducted under programme conditions from January 1998 to December 1999, comparing TB programme performance in an area with (Guguletu), and an area without (Nyanga) the option of TB treatment supervision by community health workers. RESULTS: Data were collected for 2873 adult TB patients. For smear-positive TB patients, treatment cure rates were higher in the intervention area (Guguletu) than in the control area (Nyanga) (58% vs. 50%, P = 0.0378) and for retreatment cases (47% vs. 35%, P = 0.0791), treatment success rates were similar. CONCLUSIONS: Community health worker support contributed to better TB control programme performance than an approach based exclusively on health facilities. Clear government policy and support for lay health worker programmes in TB control is needed.
This paper examines the role expansion of community pharmacy in South Africa against the background of phenomena such as professional dominance and boundary encroachments. The study demonstrates pharmacy's thrust towards an extended and more meaningful role, making a clear distinction between the role extension concerning the granting of additional powers to prescribe medications, and that of a wider range of activities. It confirms previous claims that the opposition from the medical profession is particularly fierce when it relates to the pharmacist's ability to prescribe. The successful granting of special permits to a selected group of pharmacists to practice an extended role can be explained by the fact that it has been restricted to rural, under-served areas. The developments to date signify a partial success by the pharmacy profession towards its role extension. However, this is likely to remain limited due to the forces operating against it. Considering this context, the development of "health centres" might prove to be an alternative venue for the integration of pharmacists into the health care team.
AIDS-related stigmas are pervasive in some segments of South African society and stigmas can impede efforts to promote voluntary counselling and testing and other HIV-AIDS prevention efforts. The current study examined associations among the belief that AIDS is caused by spirits and supernatural forces, AIDS-related knowledge and AIDS-related stigmas. A street intercept survey with 487 men and women living in a Black township in Cape Town, South Africa showed that 11% (n=54) believed that AIDS is caused by spirits and supernatural forces, 21% (n=105) were unsure if AIDS is caused by spirits and the supernatural, and 68% (n=355) did not believe that AIDS is caused by spirits and supernatural forces. Multiple logistic regression analyses controlling for participant age, gender, years of education and survey venue showed that people who believed HIV-AIDS is caused by spirits and the supernatural demonstrated significantly more misinformation about AIDS and were significantly more likely to endorse repulsion and social sanction stigmatizing beliefs against people living with HIV-AIDS. However, nearly all associations between beliefs that AIDS is caused by spirits and AIDS stigmas were non-significant when logistic regressions were repeated with AIDS-related knowledge included as a control variable. This finding suggests that relationships between traditional beliefs about the cause of HIV-AIDS and AIDS stigmas are mediated by AIDS-related knowledge. AIDS education efforts are urgently needed to reach people who hold traditional beliefs about AIDS to remedy AIDS stigmas.