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PubMed2005

Respiratory syncytial virus infection: denominator-based studies in Indonesia, Mozambique, Nigeria and South Africa.

OBJECTIVE: To assess the burden of respiratory syncytial virus (RSV)-associated lower respiratory infections (LRI) in children in four developing countries. METHODS: A WHO protocol for prospective population-based surveillance of acute respiratory infections in children aged less than 5 years was used at sites in Indonesia, Mozambique, Nigeria and South Africa. RSV antigen was identified by enzyme-linked immunosorbent assay performed on nasopharyngeal specimens from children meeting clinical case definitions. FINDINGS: Among children aged < 5 years, the incidence of RSV-associated LRI per 1000 child-years was 34 in Indonesia and 94 in Nigeria. The incidence of RSV-associated severe LRI per 1000 child-years was 5 in Mozambique, 10 in Indonesia, and 9 in South Africa. At all study sites, the majority of RSV cases occurred in infants. CONCLUSION: These studies demonstrate that RSV contributes to a substantial but quite variable burden of LRI in children aged < 5 years in four developing countries. The possible explanations for this variation include social factors, such as family size and patterns of seeking health care; the proportion of children infected by human immunodeficiency syndrome (HIV); and differences in clinical definitions used for obtaining samples. The age distribution of cases indicates the need for an RSV vaccine that can protect children early in life.

Age Distribution↗

PubMed2000

Prevalence and biodiversity of helminth parasites in donkeys from South Africa.

Seven donkeys (Equus asinus) from North-West and Mpumalanga Provinces in South Africa were examined at necropsy. Quantitative samples were collected from the gastrointestinal tract for recovery of helminth parasites from the stomach, small intestine, cecum, ventral colon, dorsal colon, descending colon, and cranial mesenteric artery. Fifteen genera and 29 species of helminths were identified comprising 27 species of nematodes in the Ascarididae, Atractidae, Habronematidae, Onchocercidae, Oxyuridae, and Strongylidae; 1 species of cestode in the Anoplocephalidae; and 1 species of trematode in the Paramphistomatidae. In addition, 2 species of oestrid fly larvae in the Gastrophiliidae were identified. The most abundant group in number of species was the cyathostomes (small strongyles) and, of these, Cyathostomum montgomeryi, Cylicocyclus sp. (a), and Cylicostephanus minutus were the most numerous. The most prevalent cyathostomes were C. montgomeryi and Cylicocyclus sp. n. (a). Strongylus vulgaris was the most abundant and prevalent large strongyle species. The occurrence of small strongyle species and their prevalences in this study are compared with 3 other studies on donkeys in Africa.

Animals↗

PubMedDate not supplied

An economic comparison of chloroquine and sulfadoxine-pyrimethamine as first-line treatment for malaria in South Africa: development of a model for estimating recurrent direct costs.

The relative cost-effectiveness of chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) as first-line antimalarial therapy in southern Africa is of great interest to policymakers, clinicians and researchers in the subregion. A model was developed to access the cost-effectiveness of replacing CQ with SP as first-line treatment in Mpumalanga, South Africa, where malaria is seasonal and the population is non-immune. In-vivo drug resistance levels were used to derive a 'resistance variable' for each drug, which was used to compare the costs to the public healthcare provider associated with either therapeutic option. Costs including drugs, staff time, transport, maintenance, utilities, training and consumables were determined and subjected to Monte Carlo simulation and subsequent analysis to generate an average cost-effectiveness ratio (ACER) with confidence intervals for each drug. SP was found to be 4.8 (95% CI 3.3-6.7) times more cost-effective than CQ in Mpumalanga at 1997 resistance levels and costs, despite the far greater cost per treatment course of SP (US$ 4.02 as opposed to US$ 0.22 for CQ) in South Africa. At the price of SP in Kenya and Uganda (US$ 0.47-4.80 per treatment course), the ACER for SP does not change materially, increasing to between 5.1 and 5.6. Resistance emerged as the factor that most influenced the ACER of a specific drug. Indirect costs, compliance, changes in effectiveness and costs over time and costs of adverse events were not included in the model owing to paucity of data and logistical difficulties. Since most of these are likely to be similar in both drug models, the relative ACER is unlikely to be significantly altered by their inclusion.

Adult↗

PubMed1994

Radiation therapy services in South Africa.

A survey of both private and public sector radiation therapy facilities in South Africa shows that they are available in only 7 major urban centres. About 20,000 cases are treated yearly by 58 therapists and 190 therapy radiographers, with 37 megavoltage and 24 X-ray machines. Brachytherapy, imaging and planning equipment is also inadequate. With limited epidemiological data it appears that less than 50% of all patients appropriately treated with radiation therapy present for such treatment. Increased referrals from sub-Saharan Africa place further strains on the system.

Brachytherapy↗

PubMed2000

Experiences of breastfeeding and vulnerability among a group of HIV-positive women in Durban, South Africa.

While international guidelines are currently being drawn up about HIV and infant feeding practices, and national and regional guidelines are under discussion in South Africa, there have been remarkably few studies that have sought to elicit HIV-positive mothers' experiences of breastfeeding and of paediatric infection. There is an urgent need to document this 'grass roots' knowledge in different sites, and for this data to be used to inform policy development, and for advocacy and counselling purposes. This qualitative investigation reports on the experiences and decisions taken around breastfeeding by a peer support group of 13 HIV-positive mothers meeting at King Edward VIII Hospital, Durban. In this study, the particular focus of information-giving and decision-making as to breast or formula feed is concerned with the impact on individual HIV-positive women and their babies. The most significant finding is that at no stage during their pregnancy were any of these mothers given information about the risks of HIV transmission through breastmilk. The study data were elicited in an in-depth group discussion, and individual women were invited to re-enact their stories in a follow-up discussion for clarification purposes. The women also discussed how they dealt with problems surrounding confidentiality in cases where few have been able to disclose their status to the extended family. There have been renewed calls for further investment in counsellors, with an enhanced role for community activists as peer educators. While there are severe resource constraints and low morale among many overworked nurses, one of the general problems in hospital settings remains the vertical health paradigm. This does not accommodate women's experiences, preferences, social networks and lay knowledge, and inhibits many women from becoming full participants in decisions affecting their own and their family's health.

Adult↗

PubMed2003

Efficacy and safety of sildenafil citrate (Viagra) for the treatment of erectile dysfunction in men in Egypt and South Africa.

The efficacy of sildenafil citrate (Viagra), an oral agent for the treatment of erectile dysfunction (ED), has been demonstrated in global studies. This 12-week randomized, double-blind, placebo-controlled, parallel-group, flexible-dose study assessed the efficacy and safety of sildenafil to treat ED in men in Egypt and South Africa. Men with ED of varied etiology were randomized to receive sildenafil 50 mg (n=128) or placebo (n=126); doses could be adjusted to 100 or 25 mg. Questions from the International Index of Erectile Function (IIEF) assessing the ability to achieve (Q3) and maintain (Q4) erections demonstrated a significant improvement with sildenafil compared with placebo (P<0.0001). Improved erections were reported by 74% of patients receiving sildenafil and 27% of those receiving placebo (P<0.0001). Headache, dyspepsia, and flushing were the most common adverse events in sildenafil-treated patients. These results are consistent with clinical trials in other countries. We conclude that sildenafil is an efficacious and well-tolerated treatment for men with ED in Egypt and South Africa.

Adult↗

PubMed1998

The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 1. South Africa.

OBJECTIVE: To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labout. DESIGN: Multicentre randomised controlled trial. SETTING: Four urban academic hospitals in South Africa. Obstetric surveillance included the use of electronic fetal heart rate monitoring in most cases. PARTICIPANTS: Women in labour at term with moderate or thick meconium staining of the amniotic fluid. INTERVENTIONS: Transcervical amnioinfusion of 800 mL saline at 15 mL per minute, followed by a maintenance infusion at 3 mL per minute. The control group received routine care. Blinding of the intervention was not possible. MAIN OUTCOME MEASURES: Caesarean section, meconium aspiration syndrome and perinatal mortality. RESULTS: Caesarean section rates were similar (amnioinfusion group 70/167 vs control group 68/159; RR 0.98, 95% CI 0.76-1.26). The incidence of meconium aspiration syndrome was lower than expected on the basis of previous studies (4/162 vs 6/163; RR 0.67, 95% CI 0.19-2.33). There were no perinatal deaths. There were no significant differences between any of the subsidiary outcomes. CONCLUSIONS: This study concurred with three previous trials which found no effect of amnioinfusion for meconium-stained amniotic fluid on caesarean section rate, though the pooled data from all identified trials to date show a significant reduction. The findings with respect to meconium aspiration syndrome were inconclusive in this study alone because of the small number of babies affected, but the point estimate of the relative risk was consistent with the finding of a significant reduction in previous studies and with the Zimbabwe arm (CRAMP 2) of this study. Pooled data clearly support the use of amnioinfusion for meconium stained amniotic fluid to reduce the incidence of meconium aspiration syndrome.

Amnion↗

PubMed2004

Present concerns of survivors of human rights violations in South Africa.

Most research on persons subjected to physical torture for political reasons has framed this experience as traumatic, with the sequelae approximating the diagnostic criteria of posttraumatic stress disorder (PTSD). However, responses to checklists, questionnaires, and structured interview schedules may reflect the effect of demand characteristics more than the actual concerns of respondents. Thus semi-structured qualitative interviews were conducted with 20 South Africans who were detained for political reasons during the apartheid era. The interviews were transcribed and analyzed with the assistance of the Atlas.ti 4.5 programme. Results showed that the major concerns expressed by the sample were somatic problems, economic marginalization, non-clinical emotional distress, and dissatisfaction with the present political dispensation in South Africa. Respondents also expressed concerns that reflected symptoms of traumatization, but these were not salient in comparison with the other themes that emerged. These data suggest that a model of trauma and the diagnostic category of PTSD may be less appropriate than suggested by most of the literature in accounting for the concerns of many South African former political detainees. This paper critiques the hegemony of the psychiatric model of traumatization in conceptualizing the needs of this population, and suggests an alternate perspective that is broader and more inclusive than a psychiatric paradigm. It also discusses the research and possible clinical implications of the results in terms of addressing the needs of former detainees in South Africa.

Adult↗

PubMed1994

Legal limitations in primary health care nursing practice in South Africa (Part 1).

In this, the first of two articles, legal limitations in the practice of the primary health care nurse in the Republic of South Africa, having direct implications for the achievement of the goal 'health for all by the year 2000', are discussed. The questions which had to be answered by means of research relate to the nature and scope of the limitations as well as to how these limitations should be addressed in order to facilitate the practice of the primary health care nurse. A content analysis was done and recommendations formulated to amend and/or clarify certain health legislation. It is recommended that an empirical investigation be done to verify the results.

Delivery of Health Care↗

PubMed2004

Evidence for relatively greater subcutaneous fat deposition in stunted girls in the North West Province, South Africa, as compared with non-stunted girls.

OBJECTIVE: We examined differences in body composition between stunted and non-stunted girls, with adjustments for confounding factors. METHODS: A cross-sectional study was conducted in a representative sample of 478 African school girls, ages 10 to 15 y, in the North West Province, South Africa. Height, weight, skinfold thicknesses, and waist and mid upper arm circumferences were measured by trained biokineticists using standard methods. Trained field workers measured dietary intakes by 24-h recall, and physical activity was measured by using the physical activity recall of the previous day. Body mass index and physical activity category were calculated. RESULTS: Stunted girls had significantly lower weight and skinfold thicknesses than did non-stunted ones. After including the covariates: age, years since menarche, school, type of housing, dietary energy and fat intakes, physical activity category, body weight, and stratum of urbanization in analysis of variance, the mean sum of triceps skinfold and subscapular skinfold thicknesses of stunted girls was greater than that of the non-stunted girls (P < 0.002). Stunted subjects were less active than non-stunted ones. CONCLUSION: This manifestation of relatively more subcutaneous fat and greater waist circumference in stunted girls may be involved in the development of obesity among black women in South Africa.

Adipose Tissue↗

PubMed1991

Laboratory evaluation of B-2 as a molluscicide in the control of the snail intermediate hosts of schistosomiasis in South Africa.

There is a continuous need for the development and evaluation of new, inexpensive but highly effective molluscides for the control of freshwater snails acting as intermediate hosts of schistomiasis. For this reason B-2 (Hokko Chemical Industry Co. Ltd, Japan), also called Phebrol (sodium 2,5-dichloro-4-bromophenol), was evaluated in our laboratory as a candidate molluscicide for the control of freshwater snails in South Africa. Bulinus africanus and Biomphalaria pfeifferi, intermediate hosts of Schistosoma haematobium and Schistosoma mansoni respectively, were exposed to different B-2 concentrations for 24 and 48 hours. An indigenous fish species, Oreochromis mossambicus, which is common in local schistosomiasis endemic areas, was also exposed to the molluscicide. The calculated values obtained from a probit analysis (LC50, 24 hours: B. africanus = 2.6 mg 1(-1) and B. pfeifferi = 2.9 mg 1(-1), indicated that these species from southern Africa are less sensitive to B-2 than are B. truncatus and B. pfeifferi from northern Africa, which in turn are less sensitive than the Oncomelania spp. from Japan, China and the Philippines. It is expected that molluscicidal levels of B-2 would be harmful to O. mossambicus populations. Although B-2 has a marked potential for snail control in South Africa, niclosamide (Bayluscide) remains the molluscicide of choice.

Animals↗

PubMed2000

Stroke in the young in South Africa--an analysis of 320 patients.

BACKGROUND: Aetiology of young stroke populations varies markedly between countries. AIM: We present one of the largest prospective studies of stroke in young adults, with specific attention given to aetiology and black-white differences to assist with secondary prevention and economic planning. SETTING: Durban, KwaZulu-Natal, South Africa. METHODS: Only first occurrence of stroke by World Health Organisation definition was recorded in patients who had undergone anatomical brain imaging. A hierarchy of investigative modalities divided into three tiers was applied and a range of standardised scales was scored for each patient. This protocol allowed for quantification of clinical deficit, aetiopathogenesis, disability and handicap. Cognitive impairment was evaluated separately according to predefined criteria. RESULTS: Young stroke patients (15-49 years) comprised one-quarter of patients seen at this tertiary referral institution (320:1, 260, 25.4%). Significant black-white differences were encountered for mean age, risk factors, severity of clinical stroke, topography of stroke, severity of neurological deficit (Canadian Neurological scale), handicap (Rankin scale), aetiology (Trial of Org 10172 in Acute Stroke (TOAST) classification) and frequency and subtype of cognitive impairment. In blacks, HIV-associated stroke was highest in the otherwise unknown aetiological TOAST category. CONCLUSION: In South Africa, race and endemic disease both appear to be important determinants of stroke in young adults. Knowledge of these variations will streamline the increasingly expensive diagnostic and therapeutic approach.

Adolescent↗

PubMed2000

Studies on the genus Setaria Viborg, 1795 in South Africa. I. Setaria africana (Yeh, 1959).

Setaria africana (Yeh, 1959) is represented by two subspecies, Setaria africana africana Troncy, Graber & Thal, 1976 from giant eland (Taurotragus derbianus) from the Central African Republic and Cameroon and Setaria africana farchai Troncy, Graber & Thal, 1976 from bushbuck (Tragelaphus scriptus), also from the Central African Republic. Material collected from nyala (Tragelaphus angasii), bushbuck and kudu (Tragelaphus strepsiceros) from several localities in the eastern region of South Africa was re-examined. Measurements of adult worms confirmed the differences between the two subspecies and scanning electron microscopy showed that the deirids of S. africana africana are single whereas those of S. africana farchaiare double. Setaria africana farchaiis recorded for the first time in South Africa.

Animals↗

PubMed2004

The occurrence of campylobacters in water sources in South Africa.

Campylobacter spp., mainly C. jejuni and C. coli, are recognized as significant human bacterial pathogens, being responsible for increasing numbers of gastroenteritis cases worldwide. Several reports have indicated that environmental waters are potential reservoirs and transmitting vehicles for these bacteria. The purpose of this study was thus to examine the occurrence of campylobacters in drinking and environmental water sources of South Africa, a country with a warmer climate and higher microbial pollution levels than those previously addressed in the Northern Hemisphere where similar investigations have been undertaken. Various types of water samples (five drinking water, four ground water, 11 surface water and four raw sewage) were collected from different parts of South Africa. Detection was by enrichment in Bolton broth prior to plating on both selective mCCDA or through a 0.6microm membrane filter on non-selective blood agar isolation media. Out of 100 initially selected Campylobacter-like isolates, only 22 did not grow aerobically and were subsequently identified as Campylobacter spp. by biochemical tests. However, the results obtained by 16S rRNA sequence analysis indicated that only three of these strains (13.6%) were Campylobacter jejuni and the remaining 19 strains were identified as Arcobacter butzleri. The spread of Arcobacter via water warrants further investigation, especially in view of the higher levels of detection and pathogenic nature of these bacteria.

Campylobacter↗

PubMed2002

HIV Vaccine Trial participation in South Africa - an ethical assessment.

Trial participation in the proposed HIV Vaccine Trials in South Africa is discussed in the context of the ethical tension that exists between international ethical research standards and local standards of care and cultural norms in the Third World. The important concepts of informed consent, risk-benefit ratio and fair treatment of trial participants are interpreted differently in traditional, rural African communities, where a moderate form of communitarianism referred to as "Ubuntu" or "communalism" is still prevalent. Research is an altruistic endeavor that benefits communities and societies as a result of risks taken by individuals. Universal ethical guidelines that are highly individualistic and fail to emphasize communalism may represent serious problems for the sort of research needed in Africa today.

AIDS Vaccines↗

PubMed1999

Health policy, health services, and cancer pain management in the New South Africa.

In 1982, the World Health Organization (WHO) identified inadequate relief from cancer pain as an international health problem. WHO recommended that governments develop and implement national policies and programs for cancer pain relief. This report evaluates national health policy and the systems of health care delivery in relation to cancer pain management in the new South Africa. This field study included multiple methods of data collection: analysis of documents, field trips with participant observation in sites of care delivery, focused interviews, and in-depth interviews of key informants. The purposive sample of key informants (n = 33) represented multiple stakeholders in a variety of settings. Strengths of the developing health policy include specific recommendations related to palliative care; the shift to universal primary care; policies to support drug availability; the inclusion of morphine and codeine as essential drug at the primary health care level; and the development of a national standard related to cancer pain management. Health services are characterized by two parallel systems of care (private and public) with numerous vestiges of the inequities of apartheid. The management of pain varies by provider and setting; major problems with access exist in the rural areas. Health services in South Africa have been plagued by inequity and inadequate resources. New health policies have set a path to ensure universal access to health care including palliative care for cancer. Their successful implementation is the next necessary step toward improving health services and alleviating the suffering of increasing numbers of individuals with cancer.

Health Policy↗

PubMed2004

Ten years of democracy in South Africa: documenting transformation in reproductive health policy and status.

The advent of democracy in South Africa in 1994 created a unique opportunity for new lows and policies to be passed. Today, a decade later, South African reproductive health policies and the laws that underwrite them are among the most progressive and comprehensive in the world in terms of the recognition that they give to human rights, including sexual and reproductive rights. This paper documents the changes in health policy and services that have occurred, focusing particularly on key areas of sexual and reproductive health: contraception, maternal health, termination of pregnancy, cervical and breast cancer, gender-based and sexual violence, HIV/AIDS and sexually transmitted infections and infertility. Despite important advances, significant changes in women's reproductive health status are difficult to discern, given the relatively short period of time and the multitude of complex factors that influence health, especially inequalities in socio-economic and gender status. Gaps remain in the implementation of reproductive health policies and in service delivery that need to be addressed in order for meaningful improvements in women's reproductive health status to be achieved. Civil society has played a major role in securing these legislative and policy changes, and health activist groups continue to pressure the government to introduce further changes in policy and service delivery, especially in the area of HIV/AIDS.

Democracy↗

PubMed1998

The cost implications of participatory research. Experience of a health services review in a rural region in South Africa

OBJECTIVES: The study objectives were to estimate the total costs incurred by a comprehensive review of primary health care services in a rural region in South Africa, and to determine which of these costs were incurred because of the participatory research techniques employed by the review. DESIGN: The costing study estimated the direct and indirect costs of each component of the review in order to determine total costs. Costs that were linked to participatory research activities were aggregated separately. SETTING: The review that was costed was conducted in an area that included the former 'homeland' KaNgwane and the adjacent areas of 'white' South Africa, in part of what is now known as Mpumalanga Province. SUBJECTS: Not relevant. OUTCOME MEASURES: Direct, indirect, total, research and participation costs were used as outcome measures. RESULTS: Expenditure generated by participatory research techniques was estimated to be almost 14% of the total (direct and indirect) costs. CONCLUSIONS: Despite these costs, participatory research techniques are invaluable in terms of the many benefits they have for a research project. However, because of these costs, it is important that the financing of participatory research should be carefully planned. Projects must budget for the direct costs of participatory techniques, participating organisations and individuals must be committed to bearing the indirect costs of participation, and, increasingly, funders must consider funding these indirect costs. This is important in the South African situation, where public health research relies increasingly on the participation of relevant stakeholders.

Journal Article↗