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PubMed2000

Human immunodeficiency virus infection and invasive cervical cancer in South Africa.

PURPOSE: The goal of this study was to determine whether South African HIV-seropositive women with invasive cervical cancer present with disease that is more advanced than that of HIV-seronegative women and whether degree of immunosuppression affects the extent of disease at initial presentation. METHODS: This study is a retrospective review of 60 HIV-seropositive and 776 HIV-seronegative new cases of invasive cervical carcinoma seen at the combined gynecologic oncology unit of the University of the Witwatersrand, Johannesburg, South Africa. RESULTS: The HIV seroprevalence was 7.2%. Squamous cell carcinoma was the histologic subtype in more than 90% of both cohorts of patients. Although the HIV-positive patients presented with invasive cervical cancer almost 10 years earlier than the HIV-negative patients, i.e., mean age 44 years +/- 9.8 versus 53 years +/- 12.7, respectively (P </= 0.001), there was no difference in the distribution of advanced lesions in the two groups, i.e., 65% in HIV-positive and 55.4% in HIV-negative patients (P = 0.177). At initial diagnosis 26 of the HIV-seropositive patients had a CD(4) cell count less than 200/mm(3), 20 (77%) of whom presented with stage III or IV cervical cancer; the remaining 34 had a CD(4) cell count above 200/mm(3), 19 (56%) of whom had advanced-stage disease. This was not significantly different (P = 0.109). However, HIV-seropositive patients with CD(4) cell counts less than 200/mm(3) had significantly more advanced-stage disease than HIV-seronegative patients, i.e., 77% versus 55.8% respectively (P = 0.041). CONCLUSION: HIV-seropositive patients presented with invasive cervical cancer almost 10 years earlier than HIV-seronegative patients. Even though HIV seropositivity on its own did not appear to adversely affect extent of disease at presentation, patients with CD(4) cell counts below 200/mm(3) are significantly more likely to have advanced-stage disease at initial diagnosis than HIV-negative patients.

Adult↗

PubMed1993

Proximal femur of Australopithecus africanus from Member 4, Makapansgat, South Africa.

A left proximal femur (MLD 46) from Member 4, Makapansgat, South Africa is described and analyzed. It consists of the head, neck, and a small segment of the shaft that extends to just below the lesser trochanter. The femur exhibits degenerative joint disease in the form of marginal osteophyte formation and thus its taxonomic identity has been somewhat obscured. Consideration of all like-sized mammalian femora from Makapansgat suggests that the femur is that of either a felid or hominid. Comparison of MLD 46 to femora of extent and extinct felids reveals that MLD 46 does not possess two morphological features that are characteristic of felids, namely a deep, prolonged trochanteric fossa and a high neck-shaft angle. Simple shape variables (ratios) and multivariate analyses consistently place MLD 46 with modern and fossil hominids, and most closely align it with the australopithecines. We conclude that the femur is most reasonably attributable to Australopithecus africanus, which is the only hominid yet identified from Makapansgat. Despite its pathological condition, MLD 46 is the most complete proximal femur known for A. africanus, thereby permitting further morphological comparisons with homologues of A. afarensis and Paranthropus. Marginal osteophytes of mammalian femoral heads characteristically occur in individuals of advanced age, suggesting that MLD 46 may have lived some time with the disease. Finally, MLD 46 is considerably larger than the previously described specimen, Sts 14, from Sterkfontein Member 4. There may be as great a contrast in body size in A. africanus as there is between the large and small specimens of A. afarensis.

Animals↗

PubMed2005

Multi-agent modelling of climate outlooks and food security on a community garden scheme in Limpopo, South Africa.

Seasonal climate outlooks provide one tool to help decision-makers allocate resources in anticipation of poor, fair or good seasons. The aim of the 'Climate Outlooks and Agent-Based Simulation of Adaptation in South Africa' project has been to investigate whether individuals, who adapt gradually to annual climate variability, are better equipped to respond to longer-term climate variability and change in a sustainable manner. Seasonal climate outlooks provide information on expected annual rainfall and thus can be used to adjust seasonal agricultural strategies to respond to expected climate conditions. A case study of smallholder farmers in a village in Vhembe district, Limpopo Province, South Africa has been used to examine how such climate outlooks might influence agricultural strategies and how this climate information can be improved to be more useful to farmers. Empirical field data has been collected using surveys, participatory approaches and computer-based knowledge elicitation tools to investigate the drivers of decision-making with a focus on the role of climate, market and livelihood needs. This data is used in an agent-based social simulation which incorporates household agents with varying adaptation options which result in differing impacts on crop yields and thus food security, as a result of using or ignoring the seasonal outlook. Key variables are the skill of the forecast, the social communication of the forecast and the range of available household and community-based risk coping strategies. This research provides a novel approach for exploring adaptation within the context of climate change.

Agriculture↗

PubMed2003

Contribution of traditional healers to a rural tuberculosis control programme in Hlabisa, South Africa.

SETTING: The rural health district of Hlabisa, KwaZulu-Natal, South Africa. OBJECTIVES: To assess the acceptability and effectiveness of traditional healers as supervisors of tuberculosis (TB) treatment in an existing directly observed treatment, short-course (DOTS) programme. DESIGN: An observational study comparing treatment outcomes among new TB patients in the three intervention sub-districts offered the additional option of traditional healers for directly observed treatment (DOT) supervision with those in the remainder of the district offered the standard range of options for DOT supervision (health facility, community health worker and lay persons). A comparison was also made of treatment outcomes between different options for DOT supervision. RESULTS: A total of 3461 TB patients were registered in Hlabisa District from April 1999 to December 2000, of whom 2823 were discharged from hospital to the ambulatory DOT programme. Treatment outcomes were known for 1816 patients in Hlabisa District (275 patients in the intervention area and 1541 patients in the control area). There was no significant difference (P < 0.5) in treatment outcome in the intervention and control areas (77% vs. 75%). Among 275 patients with known outcomes in the intervention area, 48 patients were supervised by traditional healers and 227 patients supervised by people other than traditional healers. Treatment completion was not significantly higher among patients supervised by traditional healers than among patients supervised by other categories of DOT supervisor (88% vs. 75%, P = 0.3841). Interviews with 41 of 51 traditional healer patients who had completed treatment revealed high levels of satisfaction with the care received. CONCLUSIONS: Traditional healers make an effective contribution to TB programme performance in this pilot scheme in Hlabisa district. Further evaluation will be necessary as this approach is scaled up.

Community Health Services↗

PubMed1998

AIDS awareness of secondary school pupils in the northern province of South Africa.

This study investigated AIDS awareness in secondary school pupils (mainly Northern Sotho and Xitsonga) in the Northern Province of South Africa. The randomly chosen sample included 622 Standard 9 pupils (254 boys and 368 girls) in the age range of 17 to 24 years (M of 19.3), who were administered a questionnaire on awareness of AIDS and socioeconomic status. Over 72% of the questions about AIDS were correctly answered, which suggests a fair amount of accurate information about AIDS; however, 18% were of the opinion that "AIDS does not exist" and 19% that "there is a cure for AIDS." Analysis of variance indicated no relationships for sex, age, ethnicity, or socioeconomic status with correct answers.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Competing discourses of vital registration and personhood: perspectives from rural South Africa.

Whilst birth and death data derived from civil registration systems are regarded as essential indicators of health status and important for population planning, in developing countries they are usually perceived by civil servants and researchers to be very incomplete. In South Africa in 1994 only 50% of deaths were registered and 18% of births in the first year of life. A rapid qualitative study was undertaken in a rural district of South Africa to ascertain why registration levels of births, still-births and infant deaths are so low. Fifty-five semi-structured interviews were conducted with 22 local Xhosa women and 33 "professional" key informants, ranging from local civil servants to hospital staff and grave diggers. The study found that local people had complex notions of personhood, before birth and in the years following. Personhood was viewed as a process rather than a stage which is achieved through live birth, as is implied in discourses of vital registration. The women interviewed knew about birth registration although most had registered some or none of their children; they did not know of death registration. There was little knowledge of why registration was necessary and perceptions of this among all informant groups mostly related to the need for a certificate to achieve something else, such as an identity document or welfare payment. Confusion about the procedures to be followed was found among both women and professionals, who advised them. In circumstances in which certificates were officially required, for school entry and burial, other documentation were reported to be accepted. This suggests that the dominance of vital registration as a means of establishing official identity was not recognized. Registration was regarded as a means of achieving something else rather than and end in itself, which discourses of statistical and juridical importance imply. In the light of this we suggest that the present system be replaced by one based on "passive" registration in health care settings if substantially greater levels of completeness are to be achieved.

Adult↗

PubMed1999

Childhood secondary (symptomatic) epilepsy, seizure control, and intellectual handicap in a nontropical region of South Africa.

PURPOSE: To determine the prevalence of secondary (symptomatic) epilepsy and to ascertain levels of seizure control and intellectual function in a clinic population of children drawn from a poor community in a temperate region of South Africa. METHODS: Detailed review of the records of every child with recurrent seizures who attended a special epilepsy outpatient clinic during 1995. RESULTS: A total of 1,017 children was studied. In 432 (43%), there was historic, clinical, and radiologic evidence to suggest that epilepsy was symptomatic of underlying brain damage or defect. Acceptable seizure control was maintained with a single standard anticonvulsant drug (AED) in 65% of cases. In the 6 months preceding the study, 37% of the subjects had remained seizure free. Forty-seven percent of the study population were considered to be of subnormal intelligence. CONCLUSIONS: In a children's hospital outpatient population in the Western Cape region of South Africa, the prevalence of secondary epilepsy is higher than is found in developed countries. There is need within the community for preventive measures aimed at reducing the prevalence of perinatal insults, meningitis, tuberculosis, neurocysticercosis, and cerebral trauma.

Adolescent↗

PubMed1999

STD-related knowledge, beliefs and attitudes of Xhosa-speaking patients attending STD primary health-care clinics in South Africa.

The primary aim of this study was to describe patients at sexually transmitted disease (STD) clinics in Cape Town, South Africa, in terms of gender, education and age differences relative to their STD knowledge and beliefs, their condom use, as well as their attitudes towards condom use and their condom-use behaviour. The information was collected with a view to developing a health education intervention. Structured interviews were conducted with 2978 randomly sampled Xhosa-speaking STD clinic attenders about their knowledge, beliefs and practices regarding STDs and related behaviours. More males (75%) than females (25%) presented for STD treatment. The majority of patients (92%) were younger than 35 years. Female patients were found to be more aware than male patients of the sexual nature of STD transmission, valued personal autonomy in sexual behaviour and expressed a greater need to use condoms. Males perceived STD symptoms to be more serious, had more misconceptions about the cause of STDs and also more negative beliefs and attitudes towards condom use. Only 34.9% of the patients reported using condoms in the last 6 months while only 24.5% reported regular use. Those who reported condom use were more knowledgeable about the sexual transmission of STDs and the effects of STDs on the neonate. They also had fewer misconceptions about the causes of STDs and perceived STD symptoms to be more serious, attached greater value to personal autonomy in sexual behaviour and condom use and had more positive outcome expectancies of refusing sex than those who never used condoms. The data suggest that targeted interventions directed at males will have to address their inadequate knowledge regarding STDs in terms of transmission, causes, consequences, prevention and cure. Their negative beliefs and attitudes towards condoms will need special attention, especially in view of their multiple partner behaviour. Interventions directed at females will need to improve their knowledge regarding STD consequences, causes, recognition of symptoms as well as improve their knowledge of aspects of prevention and cure. All interventions must facilitate personal autonomy in decision making about sexual behaviour and condom use for both men and women, through skills development programmes that promote self-efficacy in the individual and instil a culture of mutual respect of such in the community.

Adult↗

PubMed2003

Emergency medicine in South Africa: a personal perspective.

As efforts are made to make Emergency Medicine and the Journal of Emergency Medicine more international, the different systems of medical education and practice trends in other countries should be considered when making suggestions. This article is a personal perspective of a surgeon who has been involved in emergency care in both the United States and South Africa. The system in the United States can be defined as "mature." Although the system in South Africa has been defined as "underdeveloped," efforts are underway to establish Emergency Medicine as a separate, independent discipline. Some of the differences in medical education, postgraduate training, and disease prevalence are highlighted. A significant number of South Africans use the services of traditional healers, and a brief review of their services is included.

Education, Medical↗

PubMed1989

Economic aspects of smoking in South Africa.

A conservative analysis of some of the costs and benefits of smoking to our society are presented. This preliminary investigation updates and refines the methodology of a previous study. Depending on the underlying economic assumption, smoking cost South Africa between R212 and R481 million in 1985 as a result of lost productivity due to premature death. Lost productivity while smokers were undergoing treatment cost at least R22 million. Hospitalisation and other health care costs amounted to R128 million in public institutions alone. It is likely that the current level of excise duty does not compensate for the high social costs resulting from smoking. Although many of the costs and benefits of smoking are not quantifiable in monetary units, the available information as presented in this study suggests that the cost of the tobacco industry to South Africa at present, and particularly its potential cost in the future, outweigh any possible economic benefit.

Black or African American↗

PubMed2000

Determinants of condom-use behaviour among STD clinic attenders in South Africa.

This cross-sectional study analyses determinants of condom-use behaviour among patients attending dedicated STD clinics in South Africa. A structured interviewer-administered survey was conducted among 1473 patients. Patients' beliefs and attitudes towards condom use in general, as well as their personal condom-use behaviour were measured. Their perceptions, regarding the social influence of their partners and friends on their condom use, and of their self-efficacy in using condoms, while infected with an STD were also measured. Condom use, as a dependent variable, was examined and patients were placed in a pre-contemplation stage if they had never used a condom, contemplation if they had seriously thought of using a condom, some action stage if they sometimes used a condom and regular action stage if they used a condom every time. The relationships between the stages of change, as dependent variables, and the independent variables were investigated for both those patients with steady partners and those with outside partners. This was performed by stepwise multiple regression analyses. The variables that significantly explained stages of change were similar for patients with steady partners and those with outside partners. In both partner groups communication was the variable most strongly associated with the use of condoms. General self-efficacy in condom use, self-efficacy in condom use with a partner and attitudes towards the use of condoms played a role in determining patients' different stages of change.

Adult↗

PubMed2006

Cost-effectiveness of HIV rescreening during late pregnancy to prevent mother-to-child HIV transmission in South Africa and other resource-limited settings.

A decision analysis model, from a health care system perspective, was used to assess the cost-effectiveness of HIV rescreening during late pregnancy to prevent perinatal HIV transmission in South Africa, a country with high HIV prevalence and incidence among pregnant women. Because new HIV prenatal prophylactic and pediatric antiretroviral therapy (ART) regimens are becoming more widely available, the study was carried out with different combinations of the two. With an estimated HIV incidence during pregnancy of 2.3 per 100 person-years, HIV rescreening would prevent additional infant infections and result in net savings when zidovudine plus single-dose nevirapine or single-dose nevirapine is used for perinatal HIV prevention, and ART was available to treat perinatally HIV-infected children. The cost savings were robust over a wide range of parameter values when ART was available to treat perinatally HIV-infected children but were more sensitive to variations around the baseline when ART was not available. The minimum time interval between the initial and repeat screens would be from 3 to 18 weeks, depending on prophylactic and treatment regimens, for HIV rescreening to be cost saving. Overall, HIV rescreening late in pregnancy in high-prevalence, resource-limited settings such as South Africa would be a cost-effective strategy for reducing mother-to-child transmission.

Cost-Benefit Analysis↗

PubMed2005

Laparoscopic urology training in South Africa.

BACKGROUND AND PURPOSE: Laparoscopic urologic surgery is not widely practiced in South Africa. After presenting a laparoscopic training course, we evaluated how effectively this training translated into clinical practice. SUBJECTS AND METHODS: Invitations to the course were sent to all South African urologists. Ten applicants attended the course, which consisted of dry and in-vivo animal surgery. Two questionnaires were sent out after the course. Questionnaire 1 (at course completion) aimed at identifying the precourse laparoscopic experience and expectations of the trainee. Questionnaire 2 (6 months postcourse) assessed how much laparoscopic surgery the participant had performed since the course. RESULTS: Seventeen percent of all South African urologists responded to the invitation. Prior to the course, 40% of trainees had performed >or=10 laparoscopic cases, 30% had performed <10 cases, and 30% had never performed laparoscopy, whereas 60% expected to be doing one or two cases a month after completing the course. Six months after the course, 60% had performed no laparoscopic cases. Of the three trainees who had never before done laparoscopic procedures, none had started to perform procedures since the course. The commonest procedures performed were varicocelectomy and diagnostic laparoscopy for nonpalpable testis. CONCLUSIONS: A hands-on laparoscopic training course to introduce laparoscopic urology into South African private urology practice has not translated into a satisfactory number of clinical cases being performed. The causes are likely multifactorial but are greatly influenced by social and economic forces. One possible solution may be to offer a mentor-based training program.

Clinical Competence↗

PubMed2002

Task orientated nursing in a tuberculosis control programme in South Africa: where does it come from and what keeps it going?

Task oriented nursing is associated with traditional hospital ward organisational practice. This paper describes task orientation in a tuberculosis control programme which forms part of the public health system in Cape Town, South Africa. Task oriented practice is illustrated with clinical data from a focused ethnography on the work of nurses in a tuberculosis control programme. The origins of task orientation are traced to the colonial history of nursing in South Africa. The authors explore both the explicit and more functional reasons for maintaining task orientation, as well as the implicit and mostly unconscious socially structured defences which contribute to the continuation of this form of practice. Unless attention is given to the complexities of this phenomenon, initiatives to change task oriented practice may continue to fail.

Colonialism↗

PubMed2006

Managing anthelmintic resistance in small ruminant livestock of resource-poor farmers in South Africa.

Gastrointestinal parasitism is one of the most important disease complexes of sheep and goats impacting on the resource-poor livestock farmer. Of the responsible nematodes, Haemonchus contortus, a blood-sucking worm of the abomasum, poses possibly the greatest threat. Over the past several decades, the worm has been controlled through the use of anthelmintics, but the emergence of anthelmintic resistance has threatened this chemotherapeutic approach. In Africa, the overall prevalence of anthelmintic resistance has not been extensively investigated, particularly within the resource-poor farming sector, but resistance has been reported from at least 14 countries with most of the reports emanating from Kenya and South Africa and the majority concerning H. contortus. While levels of resistance under commercial sheep farming systems in South Africa is considered to be amongst the worst in the world, resistance has also been reported from the resource-poor farming sector. Increases in productivity and reproduction of livestock and the development of markets for sale of animals are seen by international funding bodies as a way out of poverty for communities that keep livestock. This must lead to the greater need for parasite control. At such times, the risk of levels of anthelmintic resistance escalating is much greater and there is therefore a need to look at alternatives to their use. Proposed strategies include the appropriate, but judicious use of anthelmintics by application of the FAMACHA system and the use of alternatives to anthelmintics such as strategic nutrient supplementation. It is also very clear that there is a strong demand for knowledge about animal diseases, including helminthosis, and their effective management in the resource-poor livestock farming communities. This is an important challenge to meet.

Animals↗

PubMed2002

Amphistome infection of goats farmed under resource-poor conditions in South Africa.

From December 1998 to April 2000, a longitudinal study was conducted of the pooled trematode faecal egg counts of samples collected from goats of resource-poor farmers at Rust de Winter, Gauteng Province, Impendle, KwaZulu-Natal Province, and Kraaipan, North-West Province, South Africa. The amphistome faecal egg counts followed a seasonal pattem, with an increase in the counts during the warmer months of the year (October to March). This is the first work concerning the seasonal cycling of amphistomes in ruminants in South Africa.

Animals↗

PubMed1954

Proved and potential vectors of yellow fever in South Africa.

This paper, based on records obtained from the Entomology Department of the South African Institute for Medical Research, Johannesburg, gives a summary of the distribution, adult habits, and breeding-places of the proved and potential vectors of yellow fever in South Africa.

Animals↗

PubMed2004

'Wanted: 16 nurses of the better educated type': provision of nurses to South Africa in the late nineteenth and early twentieth centuries.

This paper is based on research in progress focusing on the histories of mission hospitals in the rural communities of KwaZulu Natal, while also building on earlier research into the pluralism of medical systems within the South African Cape. Sources have been drawn from a range of historical documents, including medical and nursing journals, the archives of a number of medical missionary societies and of the Overseas Nursing Association, but the research has also been informed by oral histories of a broad cross-section of health professionals who practised in South Africa. A large literature search included a number of biographies and institutional histories. The paper will be divided into three parts--the first provides a brief background to colonialism and the early nursing history of South Africa; the second looks in more detail at the role played by missionary nurses in establishing nursing as a profession and providing training opportunities for African nurses. The final part contrasts missionary nursing with the supply of, and work done by nurses from the Overseas Nursing Association operating within their quite specific, colonial remit. This will show how the two contrasting professional spheres--one reflecting a fairly short-term commitment, the other, a much broader, 'vocational' involvement--may be seen to represent quite different colonial attitudes, and ultimately quite diverse outcomes.

Colonialism↗