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PubMed1997

Detection of human herpes virus 8 DNA and sequence polymorphism in classical, epidemic, and iatrogenic Kaposi's sarcoma in South Africa.

The aetiology and detection of human herpes virus type 8 (HHV-8) DNA sequences in Kaposi's sarcoma (KS) is a matter of intense investigation. We report on the detection of HHV-8 DNA and sequence polymorphism in different clinicopathological subtypes of cutaneous KS samples from South Africa. The diagnosis was confirmed by histological examination in all cases. Six patients had classic KS (CKS), 3 epidemic KS (EKS), and 3 iatrogenic KS (IKS). A nested polymerase chain reaction (PCR) assay was used to detect HHV-8 DNA in cell lysates, prepared from formalin fixed, paraffin embedded sections. We investigated polymorphism in the HHV-8 DNA using single-stranded conformational polymorphism (SSCP) analysis on the PCR products, followed by direct sequencing. HHV-8 DNA was detected in all the patients with KS, irrespective of the clinicopathological subtype. Direct sequencing was performed on 5 selected cases and showed single base pair substitutions in all. The spectrum of mutations was similar to those described previously. No correlation was found between the different types of KS and sequence variation. The results support the hypothesis that HHV-8 is strongly associated with different clinicopathological subtypes of KS and confirm the occurrence of HHV-8 in patients with CKS, EKS, and IKS in South Africa.

DNA, Viral↗

PubMed1997

The plaque acidogenic response to carbohydrates of children from three ethnic groups in South Africa.

The plaque acidogenic response of children from three ethnic groups in South Africa to four different carbohydrates was investigated using the plaque sampling method. A total of 30, 12-year-old children, ten black, ten 'coloured' and ten white, completed this study. The foods tested were 10 per cent sucrose solution, maize porridge, strawberry flavoured yoghurt and banana. The blacks produced an intermediate plaque pH response to sucrose compared with the 'coloureds' and whites but the smallest response for the other carbohydrate challenges. It was concluded that a difference exists in the plaque acidogenic response to carbohydrate between the three ethnic groups and that this may in part account for differences in caries prevalences.

Acids↗

PubMed2006

Impact of conjugate Haemophilus influenzae type b (Hib) vaccine introduction in South Africa.

OBJECTIVE: To analyse trends in reported invasive Haemophilus influenzae disease in South Africa within the first five years of introduction of conjugate Haemophilus influenzae type b (Hib) vaccine in the routine child immunization schedule. METHODS: We used national laboratory-based surveillance data to identify cases of invasive H. influenzae disease between July 1999 and June 2004, and submitted isolates for serotyping and antimicrobial susceptibility testing. FINDINGS: The absolute number of Hib cases (reported to the national surveillance system) among children below one year of age decreased by 65%, from 55 cases in 1999-2000 to 19 cases in 2003-04. Enhanced surveillance initiated in 2003, identified human immunodeficiency virus (HIV)-infection and incomplete vaccination as contributing factors for Hib transmission. The total number of laboratory-confirmed cases of H. influenzae remained unchanged because non-type b disease was being increasingly reported to the surveillance system concomitant with system enhancements. Children with non-typable disease were more likely to be HIV-positive (32 of 34, 94%) than children with Hib disease (10 of 14, 71%), P = 0.051. Recent Hib isolates were more likely to be multidrug resistant (2% in 1999-2000 versus 19% in 2003-04, P = 0.001). CONCLUSION: Data from a newly established national laboratory-based surveillance system showed a decrease in Hib disease burden among South African children following conjugate vaccine introduction and identified cases of non-typable disease associated with HIV infection.

Bacterial Capsules↗

PubMed2002

Distribution of genotypes of F-specific RNA bacteriophages in human and non-human sources of faecal pollution in South Africa and Spain.

AIMS: To assess whether the distribution of genotypes of F-specific RNA bacteriophages reflects faecal pollution of human and animal origin in water environments. METHODS AND RESULTS: Stool samples, animal feedlot waste slurries and a wide variety of faecally polluted waters were studied in South Africa and Spain. Genotyping was performed by plaque and spot hybridization with genotype-specific probes. Only genotypes II and III were detected in human stool. Animal faeces contained predominantly, but not exclusively, genotypes I and IV. Raw hospital and municipal sewage contained mostly genotypes II and III, whereas genotypes I and II prevailed in settled sewage, secondary treated sewage and non-point diffuse effluents from developing communities. Abattoir wastewaters contained mostly genotypes I and IV. No differences were observed between the distribution of genotypes in Spain and South Africa. CONCLUSIONS: Although the association of genotypes II and III with human excreta and I and IV with animal excreta was statistically significant, the results suggest that the association cannot be used for absolute distinction between faecal pollution of human and animal origin. SIGNIFICANCE AND IMPACT OF THE STUDY: This study contributes greatly to understanding the usefulness of genotypes of F-specific RNA bacteriophages in source tracking of faecal wastes.

Animals↗

PubMed1983

An evaluation of institutional care of the aged in South Africa.

Problems associated with the care of elderly persons in institutions in South Africa are described. The importance of keeping ageing people in the community is stressed. The results of questionnaires sent to general hospitals, psychiatric institutions and old-age homes relative to the quality of medical and psychosocial care, availability of beds and finance are described. Recommendations for improvement in preventive sociomedical facilities in the community and in the education of medical, paramedical and nursing personnel involved in the care of the elderly are made. The development of assessment units and facilities for rehabilitation and convalescence as well as day-care centres and day hospitals is discussed. Improved co-ordination of services between hospitals, local authorities and voluntary organizations is required. Suggestions are made for the subsidization of old-age homes.

Black or African American↗

PubMed1993

Motor neuron disease and multiple sclerosis mortality in Australia, New Zealand and South Africa compared with England and Wales.

There has been a marked increase in the reported mortality from motor neuron disease (MND) but not multiple sclerosis (MS) in England and Wales and in a number of other countries. A comparison has been made of the mortality from MND and from MS for two time periods in Australia, New Zealand and South Africa. An increase in MND mortality occurred in Australia and New Zealand between 1968-77 and 1978-87, greater than that which occurred in England and Wales, but there was no increase in MS mortality. Among the white population of South Africa, the MND mortality was half of that in England and Wales, Australia and New Zealand in both time periods. Both MND and MS mortality is higher in the English-speaking than in the Afrikaans-speaking white South African-born. The marked increase in MND mortality which has now been reported from many countries, is good evidence that an environmental factor is important in causing this disease. The large differences in MND mortality in different populations may be important clues to the environment factors causing the disease.

Adult↗

PubMed1998

In-vitro antibiotic susceptibility and molecular analysis of anaerobic bacteria isolated in Cape Town, South Africa.

One hundred and twenty-three anaerobic isolates from Cape Town, South Africa, were tested in vitro against cefoxitin, chloramphenicol, metronidazole, co-amoxiclav, benzylpenicillin and clindamycin. Forty-five Gram-positive organisms were tested against RP59500 (a streptogramin). Resistance in the Gram-positive isolates was as follows: of the Clostridium perfringens isolates, 4% were resistant to benzylpenicillin and 4% to clindamycin; of the Peptostreptococcus anaerobius isolates, 10% were resistant to benzylpenicillin, 10% to cefoxitin and 10% to metronidazole; of the isolates of Peptostreptococcus spp., 12% were resistant to benzylpenicillin, 6% to metronidazole, 6% to chloramphenicol and 12% to RP59500. Of the Gram-negative organisms, those in the Bacteroides fragilis group were resistant to benzylpenicillin (83%), cefoxitin (5%), clindamycin (5%) and co-amoxiclav (2%). One clindamycin-resistant B. fragilis isolate carried a plasmid homologous to the ermF erythromycin resistance determinant.

Anti-Bacterial Agents↗

PubMed1999

Training for transformation: reorientating primary health care nurses for the provision of mental health care in South Africa.

Using programme research, this paper reports on the evaluation of a programme designed to orientate primary health care nurses towards the provision of a comprehensive approach to care. In addition to training in psychiatric care, this was deemed necessary in order to facilitate comprehensive integrated primary mental health care in South Africa. Nurse-patient consultations were evaluated on indicators of comprehensive care before and after the programme. Interviews were also conducted with the participants individually and in a group. The results indicate that there are several factors which mediate the provision of comprehensive care by primary health care nurses. These include individual factors as well as contextual factors, inter alia, the structure and organization of the health care system, which historically has been organized to promote biomedical care. Furthermore, biomedicine has dominated training models in South Africa, instilling in nurses a biomedical approach to patient care.

Culture↗

PubMed1995

African horse sickness surveillance systems and regionalisation/zoning: the case of South Africa.

Central and Southern Africa are generally regarded as being endemic areas for African horse sickness (AHS). With the advent of the concepts of risk analysis and regionalisation/zoning, however, the possibility has now arisen of establishing 'zones' within South Africa for AHS surveillance purposes. In 1993, a protocol was submitted to the European Community (now European Union: EU), proposing the establishment of an AHS-free zone in the Cape peninsula. The proposal is based on historical evidence that AHS virus overwinters (in zebra) only in the Kruger National Park, from where it spreads westwards and southwards every year. The infection only extends to the Western Cape Province once every fifteen years. A ban on vaccination in the proposed AHS-free zone has been suggested, together with strict control of the movement of horses into and through this zone. The entire equine population of this zone (some 8,000 animals) would serve as sentinels. All equine mortalities would be notifiable, with mandatory post-mortem examinations. The establishment of an insect-free quarantine station in this zone would enable the movement of certified AHS virus-free horses from South Africa to the EU and the rest of the world.

African Horse Sickness↗

PubMed1995

An integrated analysis of health facilities in the nine provinces of South Africa.

The development of a comprehensive national health plan must take into account an analysis of the provision and distribution of health facilities. This study collected and verified data from a number of different sources, on the number and types of hospital beds, the number of fixed clinics, and the population sizes in each of the nine new provinces of South Africa. A comprehensive database of these figures was compiled for the years 1988 and 1993. Integrated analyses were made of the distribution and types of health facilities in South Africa by using population/facility ratios. Notable disparities were found to exist between provinces in the total (public and private) distribution of hospital beds per 1,000 population, but the distribution of acute hospital beds between provinces is more even. In provinces where there is more than one medical school, there is a marked imbalance between the levels of care, with greater emphasis placed on tertiary care, at the expense of the secondary level. Given the World Health Organisation recommendation of 10,000 people per clinic, there is a shortfall in most provinces. Recommendations are made with regard to the rationalisation of academic and referral beds, and the factors to be considered in the addressing of shortages of clinic facilities. However, the limitations of a resource-based planning approach must be recognised, and it is recommended that comprehensive analyses be carried out at regional and sub-regional levels to determine the appropriate delivery of health care.

Health Facilities↗

PubMed1997

Twenty-year birth prevalence of Down syndrome in Cape Town, South Africa.

The 20-year birth prevalence of Down syndrome in Cape Town, South Africa, was determined. All cases delivered to mothers in Cape Town, plus terminations following prenatal diagnosis, between 1 January 1974 and 31 December 1993 were ascertained. There were 784 Down syndrome pregnancies, of which 95% were trisomies. The 32 terminations comprised 18.3% of the white, 5.8% of the coloured (mixed race) and 1.4% of the black cases. The overall prevalence rate was 1.49 per 1000 (white 1.88, coloured 1.54 and black 1.29 per 1000). Analysis for linear trends showed a significant decline in rates for the total population and for whites, a downward trend for coloureds, but no decline for blacks. Over the last 5-year period the prevalence rates in all three population groups were 1.3 per 1000. An increasing risk with advancing maternal age was confirmed, but no maternal age-specific differences in rates by race were demonstrated.

Abortion, Induced↗

PubMed2006

TB in health care workers in KwaZulu-Natal, South Africa.

SETTING: Eight public sector hospitals in Ethekwini municipality, KwaZulu-Natal, South Africa. OBJECTIVE: To describe the incidence of TB, clinical presentation and treatment outcomes among health care workers (HCWs) in public sector hospitals in Ethekwini Municipality, KwaZulu-Natal. METHODS: A descriptive study using a retrospective record review for the period January 1999 to June 2004 was conducted from July 2004 to February 2005. RESULTS: Five hundred and eighty three HCWs were diagnosed with TB. The mean incidence of TB among HCWs for the study period was 1133.0 per 100000 HCWs (standard deviation 282.8). The incidence of TB was highest in the age group 25-29 years and among paramedical staff (registered health professionals other than doctors and nurses). Clinical presentation of TB in HCWs included pulmonary TB 76.5% (n = 322) and MDR-TB 3% (n = 13). Cure was achieved in 22.2% (n = 118) of HCWs, and 40.7% (n = 212) of HCWs completed their treatment. CONCLUSION: The incidence of TB in HCWs in KwaZulu-Natal is alarmingly high, and the high incidence in the younger age groups and the poor treatment outcomes are cause for concern.

Adult↗

PubMed1996

Health learning materials support in South Africa compared with other developing countries.

Actions to promote media use for education at all levels in developing countries have to cope with a number of deterrents like the lack of appropriate audiovisual materials and a media support infrastructure. In the early eighties the World Health Organization and United Nations Development Programme initiated a capacity building project to enable developing countries to generate sufficient instructional and learning materials for medical and health education. Since South Africa is still a non-participator in the programme, this article presents the findings of a recent survey to get a global picture of health learning materials support in developing countries as a possible model for South Africa.

Developing Countries↗

PubMed2002

Rhinitis (allergic and nonallergic) in an atopic pediatric referral population in the grasslands of inland South Africa.

BACKGROUND: Allergic rhinitis is a common condition, which causes considerable morbidity. South African data are scarce. OBJECTIVE: We sought to describe allergic rhinitis in atopic children in inland South Africa. METHODS: An observational, descriptive study of rhinitis occurring in 771 new patients seen consecutively by a single observer at a referral pediatric allergy clinic (Universitas Hospital, Bloemfontein) over an 8 1/2-year period (August 1984 to March 1993) was carried out. A detailed questionnaire was used to record clinical data. Chest and sinus x-rays, skin prick testing, and radioallergosorbent test were performed, and serum immunoglobulin E levels were determined. Response to drug treatment regimens was recorded at subsequent followup visits. RESULTS: Significant rhinitis was reported in 78.1% of patients, and mild intermittent rhinitis was reported in 21.4%. Male to female ratio was 1.6:1. Median age at onset of rhinitis symptoms was 6 months (range 0 months to 12 years), with 30.1% experiencing symptoms from birth. Rhinitis was chronic in 61.3%, although 53.5% reported seasonal variation. More children with rhinitis were born in midsummer than during other seasons, although this did not reach statistical significance (P = 0.46). Breast-feeding had no protective effect, and parental smoking and household pets were not found to be risk factors. Family history was positive for allergic rhinitis in 88% of patients. Exposure to dust, weather changes, strong odors, pets, pollens, and tobacco smoke were the most common trigger factors. Sinus x-ray findings associated poorly with clinical findings. The most common allergens identified were grass pollen, tree pollen, and cat. Oral antihistamines provided good symptomatic relief in 62.9% of patients who used them. Intranasal corticosteroids provided good relief in 78.0% of those who used them, and ketotifen provided relief in 54.4% of those who used it. CONCLUSIONS: Rhinitis is a common manifestation of allergy in the population studied. Onset occurs early in childhood. A family history of allergy is a risk factor for the development of the condition, and grass pollen is the most common allergen involved. Special investigations are of limited value. Appropriate treatment is very effective.

Child↗

PubMed2005

Predicting the potential public health impact of disease-modifying HIV vaccines in South Africa: the problem of subtypes.

Current HIV vaccines in development appear unlikely to prevent infection, but could provide benefits by increasing survival; such vaccines are described as disease-modifying vaccines. We review the current status of vaccines and modeling vaccines. We also predict the impact that disease-modifying vaccines could have in South Africa, where multiple subtypes are co-circulating. We model transmissibility/fitness differences among subtypes. We used uncertainty analyses to model vaccines with four characteristics: (i) take, (ii) duration of immunity, (iii) reduction in transmissibility/fitness, and (iv) increase in survival. We reconstructed, and forecasted, the South African epidemic from 1940 to 2140 (assuming no vaccination). We predict that: (i) incidence will peak in 2014, decline, and stabilize, (ii) prevalence will continue to rise, and (iii) the AIDS death rate curve will peak in 2022. Our predictions show that (over the next 135 years) the epidemic in South Africa will switch from a predominantly Subtype C epidemic to an epidemic driven by other subtypes. We predict that the epidemic could remain unchanged, even with mass vaccination with a vaccine that is equally effective against all co-circulating subtypes. However, if the non-C subtypes are less (or equally) transmissible as Subtype C then disease-modifying vaccines could result in eradication. Thus, in countries where multiple-subtypes are co-circulating it is critical to realize that small biological differences among subtypes will have dramatic consequences for the effectiveness of HIV vaccination campaigns. A slight difference in fitness will determine whether a disease-modifying vaccine has almost no impact on the epidemic or can achieve eradication.

AIDS Vaccines↗

PubMed2006

Poliovirus vaccine strains in sewage and river water in South Africa.

Since the initiation of the global poliomyelitis eradication program in 1988, the number of wild-type polio cases decreased from 350,000 to fewer than 500, and the number of polio endemic countries declined from more than 125 to 10. The last case of polio in South Africa caused by a wild-type poliovirus (PV) occurred in 1989. The live attenuated oral poliovirus vaccine (OPV) has been effectively used in the reduction and control of poliomyelitis. However, as OPV strains are excreted in stools after vaccination, this vaccine could become a source of dissemination of PVs in the environment and the potential cause of poliomyelitis. Therefore, the aim of the study was to determine the occurrence of OPV strains in selected sewage and river water samples. During the period between 2001 and 2003, 138 samples of river water and 213 samples of settled sewage were collected from selected areas of South Africa. A total of 860 plaques were analysed, which consisted of 703 plaques from the sewage and 157 plaques from the river water samples. Using a reverse transcriptase (RT)-multiplex PCR, 49 PVs were successfully distinguished from 176 non-polio enteroviruses (NPEVs). The 176 NPEVs consisted of 50 coxsackie B2 viruses (CBV2), followed by 39 echoviruses 11 (ECV11), 25 CBV5, 21 CBV3, 15 CBV4, 14 coxsackie A6 viruses (CAV6), 7 CBV6, 2 CAV5, 2 CBV1, and 1 ECV19, which was in agreement with the prevalence of these EVs in other parts of the world. The Sabin-specific RT-triplex PCR revealed the presence of 29 Sabin PV type 1, 8 Sabin PV type 2, and 12 Sabin PV type 3 isolates. Buffalo green monkey kidney and primary liver carcinoma cell cultures allowed the amplification of a broad spectrum of EVs, whereas human epidermoid carcinoma cells were more selective for PVs. This study addressed some of the issues regarding the prevalence of OPV strains in the environment. The identification of 49 viable OPV isolates confirmed the presence and circulation of PV vaccine strains in sewage and river water. The extent of the potential health risk constituted by these OPV isolates remains to be investigated.

Animals↗

PubMed1997

Variegate porphyria in South Africa, 1688-1996--new developments in an old disease.

Variegate porphyria, an autosomal dominant inherited trait resulting in decreased activity of protoporphyrinogen oxidase, the penultimate haem biosynthetic enzyme, is characterised clinically by photosensitive skin disease and a propensity to acute neurovisceral crises. The disease has an exceptionally high frequency in South Africa, owing to a founder effect. The specific mutation in the protoporphyrinogen oxidase gene sequence which represents this founder gene has been identified. Genetic diagnosis is therefore now possible in families in whom the gene defect is known. However, the exact nature and degree of activity of the porphyria can only be determined by detailed quantitative biochemical analysis of excreted porphyrins. The relative contributions of the acute attack and the skin disease to the total disease burden of patients with variegate porphyria is not static, and in South Africa there have been significant changes over the past 25 years, with fewer patients presenting with acute attacks, leaving a greater proportion to present with skin disease or to remain asymptomatic with the diagnosis being made in the laboratory. The most common precipitating cause of the acute attack of VP is administration of porphyrinogenic drugs. Specific suppression of haem synthesis with intravenous haem arginate is the most useful treatment of a moderate or severe acute attack. Although cutaneous lesions are limited to the sun-exposed areas, management of the skin disease of VP remains inadequate.

Animals↗

PubMed2004

Primary level psychological services in South Africa: can a new psychological professional fill the gap?

Care for common mental health problems in medium-resourced countries has been conceptualized by the World Health Organization as needing to be provided by primary health care personnel, in particular primary health care nurses. This study, which comprised a file audit of a psychological referral service at primary level in South Africa, suggests that in contexts where specialized psychological services are lacking, the demand for mental health services includes that of psychometric assessment services for mental retardation and/or scholastic problems. It is argued that in these contexts, third generation health systems reforms should be applied to the provision of care for more common mental health problems as well as mental retardation and/or scholastic problems in medium-resourced countries. This would require the insertion of a 'package' comprised of both psychological assessment and intervention services. It is suggested that in South Africa, such a 'package' could be provided by the new professional category of 'counsellor', which the Professional Board of Psychology of the South African Health Professions Council has recently accredited.

Adolescent↗