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PubMed2005

Heroin treatment demand in South Africa: trends from two large metropolitan sites (January 1997-December 2003).

Accurate prevalence data on heroin use, that points to where problems exist and the extent of these problems, is necessary to guide the formulation of effective substance abuse policy and practice. The purpose of this study was to provide surveillance information about the nature and extent of heroin use in South Africa. Data were collected from 41 specialist alcohol and other drug treatment centres in two metropolitan sites (Cape Town and Gauteng Province) between January 1997 and December 2003. Treatment indicators point to a substantial increase in heroin use over time. Most heroin users in treatment tend to be white, male, between the ages of 21 and 24 years and tend to smoke rather than inject the substance. However, this profile is changing. These emerging trends point to the possibility of heroin use becoming a serious health and social issue in South Africa and demonstrate the need for continued monitoring of heroin use patterns in the future and the development of a strategic plan for intervening before the situation deteriorates further.

Adult↗

PubMed1998

Introducing quality assurance to health service delivery--some approaches from South Africa, Ghana and Kenya.

The following report combines the contributions of four health care professionals engaged in quality improvement activities in three different areas of Africa--Ghana in West Africa, Kenya in the East, and the Republic of South Africa. These reports provide current and vivid accounts of the impact of quality assurance and quality improvement activities on areas of change in each country's rapidly expanding health care system.

Delivery of Health Care↗

PubMed2004

Parental perception of neonatal intensive care in public sector hospitals in South Africa.

BACKGROUND: Little is known about parental experience and decision making with regard to premature infants requiring intensive care in developing countries. We undertook this study to characterise parents' experience of physician counselling and their role in making life-support decisions for very low-birth-weight (VLBW) (birth weight < 1 501 g) infants born in South Africa's public-sector neonatal intensive care units (NICUs). METHODS: Parents of surviving VLBW infants treated in three Johannesburg-area public hospitals and attending follow-up clinics in August 2001 were interviewed regarding their experience of perinatal counselling on outcomes (pain, survival, disability), perception of actual and optimal decision making, and satisfaction with NICU communication. RESULTS: Parents of 51 infants were interviewed. Seventy-five per cent of parents reported antenatal counselling by physicians on at least one perinatal topic (severe disability, pain, death, finances or religious/moral considerations). The majority of parents (> 60%) who received counselling thought that these topics had been discussed adequately. Most parents reported that doctors had the primary decision-making role, either without consulting them (41%) or after consulting them (37%). Joint decision making was rare (14%). Parents wanted more input in life-support decisions than they reported being given. CONCLUSION: Counselling is not consistently provided in public-sector hospitals in Johannesburg. Parents of premature infants want a larger share in NICU decision making than they currently experience. Most parents were satisfied with communication later during their infant's hospitalisation. South Africa presents a unique opportunity to study the use of advanced medical technologies in a nation with marked disparities in access to care.

Adult↗

PubMed1989

Afrotropical Culicoides: a redescription of C. (Avaritia) imicola Kieffer, 1913 (Diptera: Ceratopogonidae) with description of the closely allied C. (A.) bolitinos sp. nov. reared from the dung of the African buffalo, blue wildebeest and cattle in South Africa.

Culicoides (Avaritia) imicola, Kieffer is redescribed and its current worldwide distribution reviewed. It is compared with the closely allied C. (A.) bolitinos sp. nov. Descriptions of both sexes of C. imicola and C. bolitinos sp. nov. are based entirely on series of reared adults. T-tests were performed on antennal and palpal data to differentiate more clearly these 2 species. The results are tabulated. Short notes are given on the larval habitat of C. bolitinos sp. nov. in South Africa, namely the dung of the African buffalo, Syncerus caffer, the blue wildebeest, Connochaetes taurinus, and cattle, Bos races. The existence of C. bolitinos in Nigeria, Kenya, Malawi, Zimbabwe, Lesotho and South Africa is established while C. imicola is newly recorded from Malawi, Botswana, Namibia and Swaziland. Finally seven references in the literature are shown to refer either to C. bolitinos sp. nov. or to closely allied as yet undescribed species.

Animals↗

PubMed1975

History of mental health services in South Africa. Part VIII. Services for epileptics.

The development of services for epileptics in South Africa is reviewed. In the field of education, the history of the Jan Kriel school at Kuils River in the Western Cape is described. Treatment is provided at government mental hospitals, institutions for defectives, and general hospitals. The Epileptic Employment Association provides epileptics with work and opportunity to live a normal life. Information about epilepsy is provided by the South African National Epilepsy League, which also provides opportunities for employment.

Adolescent↗

PubMed2003

West Nile virus infection of Thoroughbred horses in South Africa (2000-2001).

REASONS FOR PERFORMING STUDY: West Nile virus (WNV) infection is endemic in southern Africa. With the recent emergence of WNV infection of horses in Europe and the USA the present study was performed to estimate the risk of seroconversion to WNV in a cohort of 488 young Thoroughbred (TB) horses. OBJECTIVES: To estimate the risk of seroconversion to WNV among a cohort of South African TB yearlings sold at the 2001 National Yearling Sales (NYS) and to determine whether the risk varied geographically. Two horses were also infected with a recent South African isolate of WNV to evaluate its virulence in horses. METHODS: Serum samples were collected from the cohort of 488 TB yearlings at the 2001 NYS. Serum samples that were collected from the same horses at the time that they were identified were sourced from our serum bank. Sera from 243 of the dams that were collected at the time that the foals were identified were also sourced from our serum bank. These sera were subjected to serum neutralisation (SN) tests for antibody to WNV. RESULTS: Approximately 11% of yearlings seroconverted to WNV on paired serum samples collected from each animal approximately 12 months apart. Studfarms with WNV-seropositive yearlings were widely distributed throughout South Africa and SN tests on sera from their dams indicated that exposure to WNV was even more prevalent (75%) in this population. Neurological disease was not described in any of the horses included in this study and 2 horses inoculated with a recent lineage 2 South African isolate of WNV showed no clinical signs of disease after infection and virus was not detected in their blood. CONCLUSIONS: Infection of horses with WNV is common in South Africa, but infection is not associated with neurological disease. POTENTIAL RELEVANCE: In contrast to recent reports from Europe, North Africa, Asia and North America, the results of our field and experimental studies indicated that exposure of horses to the endemic southern African strains of WNV was not associated with neurological disease.

Animals↗

PubMed2001

Kaposi sarcoma-associated herpesvirus/human herpesvirus 8 and multiple myeloma in South Africa.

Kaposi sarcoma-associated herpesvirus/human herpesvirus 8 (KSHV/HHV-8) has been implicated in the etiopathogenesis of multiple myeloma. Although the association is biologically plausible and attractive, conflicting data have been reported, including evidence against the involvement of KSHV in the pathogenesis of the disease. The purpose of this study was to determine the relationship between KSHV and myeloma in blacks in South Africa, in whom the disease is not uncommon and the seroprevalence of KSHV is higher than in the areas in which this association has been documented. Using a nested polymerase chain reaction (PCR) assay, the authors initially tested for the presence of KSHV DNA sequences (KS330(233)) in bone marrow aspirates, bone marrow biopsy material, and cultured bone marrow adherent cell samples of patients with myeloma. KSHV DNA sequences were detected in 4 of 10 (40%) of the adherent cell cultures and 1 of 20 (5%) of the bone marrow aspirate samples. None of the bone marrow biopsy samples (0/9) or control bone marrow aspirate samples (0/19) was positive. To confirm the positive results in the bone marrow cultures noted above and to exclude contamination, the procedure was repeated in a further 7 patients with myeloma and 11 controls with lymphoproliferative disorders using the same nested PCR assay. In addition, the authors used a different set of primers that recognize sequences internal to the 233-bp fragment to yield a final product of 186 bp. The authors were unable to detect any KSHV DNA sequences in the patients with myeloma (0/7) or the control patients with other lymphoproliferative disorders (0/11). Taken together, the finding of a positive result in 4 of 17 patients (23.5%), which is similar to the background seroprevalence rate, does not support a clear association between myeloma and KSHV in blacks in South Africa.

Adult↗

PubMed1985

The epizootiology and control of heartwater and other tick-borne diseases of cattle in South Africa.

The history of the main bovine tick-borne diseases occurring in South Africa and the role Onderstepoort played in their identification and control is briefly reviewed. The present attitudes regarding the control of tick-borne diseases, taking into account their complexity, is discussed. Gaps in our knowledge regarding heartwater epizootiology and possible future studies are defined.

Animals↗

PubMed1988

The spatial distribution of infant mortality rates in South Africa, 1982.

Infant mortality rates (IMRs) systematically calculated for the statistical regions of South Africa are presented for those groups of the population for which birth and death data are routinely collected. The geographical variation in the IMR and its statistical significance is presented in a series of maps. A more detailed analysis is also provided for the larger metropolitan areas.

Black or African American↗

PubMed1995

Chronic fatigue syndrome. Committee for Science and Education, Medical Association of South Africa.

OBJECTIVE: To acknowledge the clinical syndrome chronic fatigue syndrome (CFS) and outline the diagnostic criteria and reasonable management. OUTCOMES: Attempt at containment of treatment cost and improvement of the quality of care of patients with CFS. EVIDENCE: Delphi-type commentary from 20 expert clinicians and appropriate organisations. Limited literature survey. VALUES: To clarify the reasonable management of CFS amid conflicting clinical opinion on a condition of concern to patients, funders and doctors. An adaptation of an existing guideline was sent to organisations and individuals for comment. Comments received were included in this guideline where possible. BENEFITS, HARMS AND COSTS. To acknowledge a clinical syndrome with a reasonable approach to management considering the cost implications. No cost analysis was done. RECOMMENDATIONS: To recommend the following: (i) diagnostic criteria for CFS; (ii) potential differential diagnoses and possible investigations; and (iii) management protocol. VALIDATION: The draft guidelines were subjected to external review by individual doctors who are acknowledged CFS treaters, doctor groups and the patient support group. There were major disputes about the content, with the responses falling into two groups: those who do not believe CFS is a distinguishable illness, and those who do. DEVELOPER AND FUNDING: The Committee for Science and Education, Medical Association of South Africa. ENDORSEMENTS: Medical Association of South Africa and national health care organisations (see list at the end of the document).

Fatigue Syndrome, Chronic↗

PubMed2002

Geographic patterns of deprivation in South Africa: informing health equity analyses and public resource allocation strategies.

There is a growing interest in the use of small area analyses in investigating the relationship between socioeconomic status and health, and in informing resource allocation decision-making. However, few such studies have been undertaken in low- and middle-income countries (LMICs). This paper reports on such a study undertaken in South Africa. It both looked at the feasibility of developing a broad-based area deprivation index in a data scarce context and considered the implications of such an index for geographic resource allocations. Despite certain data problems, it was possible to construct and compare three different indices: a general index of deprivation (GID), compiled from census data using principal component analysis; a policy-perspective index of deprivation (PID), based on groups identified as priorities within policy documents; and a single indicator of deprivation (SID), selected for relevance and feasibility of use. The findings demonstrate clearly that in South Africa deprivation is multi-faceted, is concentrated in specific areas within the country and is correlated with ill-health. However, the formula currently used by the National Treasury to allocate resources between geographic areas, biases these allocations towards less deprived areas within the country. The inclusion of the GID within this formula would dramatically alter allocations towards those areas suffering from human development deficits. The area in which analysis was undertaken was not, however, sufficiently small to identify pockets of deprivation within the less deprived metropolitan areas. These findings suggest that it is feasible to conduct small area analyses in LMICs but that specific attention needs to be given to the size of the geographic unit used in analysis. In addition, they highlight the importance of considering deprivation in resource allocation mechanisms if vertical equity goals are to be promoted through resource allocation, particularly within decentralized health systems.

Censuses↗

PubMed1999

HIV infection among women admitted to the gynaecology service of a district hospital in South Africa.

Our objective was to determine the prevalence of HIV infection and disease-specific HIV prevalence among women admitted to the gynaecology service of a district hospital in South Africa over a 3-month period in 1997. This was done with the goal of developing HIV education and counselling services in this setting. HIV status was determined among 196 (96%) of 205 consecutive admissions; 82 (42%) tested HIV positive. The HIV-infected women were younger than the HIV uninfected women (mean age 27 vs 33 years, P=0.001). The disease-specific HIV prevalence was > or = 40% among women who had had abortions, pelvic inflammatory disease, or ectopic pregnancy. The length of hospital stay (mean 5.4 days) and mortality (1%) were similar in the 2 groups. Inpatient gynaecology services may be an important setting in Africa, within which to provide HIV education, counselling and care.

Adult↗

PubMed2000

Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection.

BACKGROUND AND OBJECTIVES: While genital ulcers are a risk factor in HIV infection, the association of specific agents of genital ulcer disease (GUD) with HIV infection may vary. GOAL: To determine the etiology of GUD in HIV-infected and HIV-uninfected men attending sexually transmitted disease (STD) clinics in Durban, Johannesburg, and Cape Town, South Africa, and the association of previous and current sexually transmitted infections with HIV infection in men with ulcerative and nonulcerative STDs. STUDY DESIGN: A cross-sectional study of 558 men with genital ulcers and 602 men with urethritis. RESULTS: Patients with GUD were more likely to be infected with HIV than patients with urethritis (39.4% versus 21.4%, P< or =0.001). Herpes simplex virus 2 (HSV-2) was the most common agent identified in ulcer specimens (35.9%), and was detected in a significantly higher proportion of ulcer specimens from HIV-infected patients than in specimens from HIV-uninfected patients (47.4% versus 28.2%, P< or =0.001). Patients infected with HIV-1 were significantly more likely to have HSV-2 infection, as measured by the presence of the antibody to glycoprotein G-2, than patients not infected with HIV (63.1% versus 38.5%, P< or =0.001). Patients infected with HIV-1 were also significantly more likely to have initial HSV-2 infection than HIV-uninfected patients with GUD (50.0% versus 31.6%, P = 0.007). Haemophilus ducreyi was detected in 31.7% of ulcer specimens; prevalence did not vary by HIV-infection status. Treponema pallidum DNA was detected significantly less frequently in ulcer specimens from patients infected with HIV than in specimens from patients not infected with HIV (10.2% versus 26%, P< or =0.001); no association was found between HIV-infection status and fluorescent treponemal antibody absorption test seroreactivity, even when men with M-PCR-positive syphilis lesions were excluded from the analyses. CONCLUSION: The authors found that HSV-2 is a more common etiology of GUD than has been suggested by previous studies conducted in South Africa; serologic evidence of HSV-2 infection and current cases of genital herpes are strongly associated with HIV infection among men who present to STD clinics with GUD or urethritis.

Adolescent↗

PubMed1999

Restriction fragment length polymorphism analysis for rapid gag subtype determination of human immunodeficiency virus type 1 in South Africa.

A rapid method for identification of human immunodeficiency virus Type 1 (HIV-1) gag subtypes was developed based on restriction fragment length polymorphism (RFLP) analysis of 400 or 650 bp long polymerase chain reaction (PCR) fragments encompassing the start of the p17 (400 bp) and part of the p24 (650bp) regions. The consensus sequences of subtypes A-D, the only subtypes identified in South Africa, were analyzed to detect restriction endonucleases which generate unique patterns for each subtype. Four restriction endonucleases were identified: AluI, AccI, SwaI and XmnI. Digestion of a 400 bp fragment with AluI allowed identification of subtype C. Samples not identified were then reamplified, and a 650 bp fragment digested with AccI to identify subtype B, followed by SwaI and XmnI to distinguish between subtypes A and D. This strategy was applied to 87 samples previously subtyped by either sequence analysis of the gag p17 region (n = 33); or heteroduplex mobility assay (HMA) based on the env gene (n = 75); or both (n = 21). Out of the 87 samples, RFLP identified two samples as subtype A, 28 as subtype B, 56 as subtype C and one as a subtype D virus. No discrepancies were found between RFLP gag subtypes and gag sequence subtypes demonstrating the reliability of this method. There was also no discordance between gag RFLP subtypes and env HMA subtypes, suggesting that there were no recombinant viruses detected relating to the genomic regions analyzed. RFLP is an effective technique for the rapid screening in an HIV epidemic of limited diversity, such as in South Africa.

DNA, Viral↗

PubMed2002

HIV-1 Subtype A, D, G, AG and unclassified sequences identified in South Africa.

HIV-1 subtype C accounts for the vast majority of infections in South Africa. However, increasingly non-C subtypes are being detected. Here we report 10 viruses that contain sequences that group with subtypes A, D, and G as well as CRF02_AG and 1 that could not be classified. Most of these individuals were from other countries in Africa. Some of these sequences were in combination with subtype C, possibly indicating local recombination events. Although there is no indication of endemic spread of these viruses, continued monitoring is warranted to track genetic changes, which may impact on diagnostic testing, therapeutic responses to antiretroviral therapies, and vaccine design.

HIV Infections↗

PubMed2001

Laboratory analysis of fluoride containing toothpaste available in South Africa.

Since the introduction of fluoridated toothpaste more than 30 years ago, it has become by far the most widespread source of fluoride in the world and after fluoridated water the most effective at reducing dental caries. Both the total soluble and the soluble ionic fluoride present in toothpaste are important in determining the effectiveness of the paste as it is important in remineralising demineralised lesions, a characteristic of fluoride which has proven to be the most important in preventing dental caries. The purpose of this study was to evaluate toothpaste currently available to the South African public regarding total soluble and soluble ionic fluoride. A variation of the method used by Grobler et al. (1983) and Du Preez et al. (1993) in previous studies conducted in South Africa was used in preparing the samples for fluoride analysis. Measurements of fluoride concentrations were done using an ionselective electrode. For all toothpaste studied (n=62), large variations occurred for the soluble ionic fluoride (mean = 318.44 microg F/g toothpaste; median = 139.69; standard deviation = 398.77). Correspondingly a mean total soluble fluoride of 848.84 microg F/g toothpaste was found (standard deviation = 189.35; median = 857.38). From this study it can be concluded that fluoride concentrations in toothpaste available to the South African public are in line with those found in the two previous South African studies. In the absence of artificially fluoridated water, toothpaste remains the most cost-effective strategy in the prevention of dental caries in South Africa.

Cariostatic Agents↗

PubMed1994

An investigation into the structure and functioning of nursing councils in South Africa.

This postal survey was done to investigate the opinions of nurses in South Africa about the four regulating bodies for nurses in this country. All categories were included in a sample consisting of a random and a purposive section. The results showed a generally neutral attitude towards the councils, and a more positive attitude towards the disciplinary process. However, there are significant objections against the way in which the councils are constituted, how members are elected, the way regulations are made and the people involved in disciplinary hearing. Nurses also feel that the relationships of the councils are not satisfactory and communication is poor.

Attitude of Health Personnel↗

PubMed1998

Sexually transmitted disease syndromes in rural South Africa. Results from health facility surveillance.

BACKGROUND AND OBJECTIVE: Surveillance for sexually transmitted diseases (STD) is important for priority setting, service development, and evaluating interventions. GOAL: To conduct health facility-based surveillance for STDs to inform design of a control program and to provide baseline measures for evaluation of interventions. STUDY DESIGN: Surveillance system for patients with STD syndromes in public and private sector health facilities in Hlabisa, South Africa. RESULTS: Over a 5-month period, 4,781 patients with an STD were reported, 3,126 (65%) by clinics and 1,655 (35%) by general practitioners; 2,582 (54%) were in men. Most were diagnosed with a single syndrome. Discharge was most common (49% of both male and female patients), followed by ulcer (36% of men and 14% of women). Mean symptom duration was 18 days for women and 10 days for men (p < 0.0001). A quarter reported having another STD in the previous 3 months. The highest age-specific incidence was estimated at 16.4% among women 20 to 24 years of age. CONCLUSIONS: The burden of STDs is high in rural South Africa. There is considerable scope for improved disease control, and the private sector has an important role to play.

Adolescent↗