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PubMed2005

The cost of treating serious abdominal firearm-related injuries in South Africa.

INTRODUCTION: Firearms, the leading external cause of non-natural deaths in South Africa, claim approximately 15,000 lives annually. Up to 127,000 firearm-injured victims seek state health care assistance per annum. The fiscal burden of treating these injuries is not known. METHODS: All serious abdominal firearm-related injuries (requiring admission to hospital and emergency surgery) presenting to a state hospital over a 6-month period were reviewed. A cost analysis using five variables was performed: operating theatre time, duration of hospital and high-care unit stay, pharmaceutical and blood products used, laboratory services used and diagnostic imaging studies performed. RESULTS: Twenty-three patients with serious abdominal gunshot injuries were admitted, of whom 21 (91%) were treated at the hospital from admission until discharge. Each admission cost approximately US dollars 1,467. Hospital stay (47%) and operating theatre (30%) costs accounted for most of the total cost. Pharmaceuticals and blood products (20%), laboratory services (2%) and imaging studies (1%) contributed less than 25% to the total cost. CONCLUSION: Serious abdominal gunshot injuries cost at least 13-fold more than the annual per capita South African government expenditure on health. This fiscal burden of approximately US dollars 2.9 million, almost 4% of the annual health budget, does not include the cost of treating other serious gunshot injuries. These findings highlight the need for successful violence prevention strategies in South African.

Abdominal Injuries↗
PubMed2003

Temba glaucoma study: a population-based cross-sectional survey in urban South Africa.

OBJECTIVE: To determine the prevalence and features of glaucoma in an urban South African black population. DESIGN: Random sampling cross-sectional population survey. PARTICIPANTS: Black residents of Temba, North West Province, South Africa, age > or =40 years. MAIN OUTCOME MEASURES: Automated visual field testing and detailed, standardized slit-lamp examination were attempted on all subjects. Glaucoma was diagnosed by use of the scheme proposed by the Working Group for Defining Glaucoma of the International Society of Geographical and Epidemiologic Ophthalmology on the basis of evidence of end-organ damage. RESULTS: Of 1120 subjects, 839 (74.9%) were examined. The age- and gender-adjusted prevalence of glaucoma of all types was 5.3% (95% confidence interval [CI], 3.9%-7.1%). Primary open-angle glaucoma (POAG) was the most common glaucoma diagnosis, with an adjusted prevalence of 2.9% (95% CI, 1.9%-4.3%). Secondary glaucoma occurred with an adjusted prevalence of 2.0% (95% CI, 1.2%-3.3%). Exfoliative glaucoma was responsible for 16% of all glaucoma cases. The prevalence of primary angle-closure glaucoma was 0.5% (95% CI, 0.13%-1.2%). Of all subjects with glaucoma, 58% were blind in at least one eye. The prevalence of all types of glaucoma increased with age. Of subjects with POAG, 87% had not been previously diagnosed. CONCLUSIONS: The prevalence of glaucoma in this South African population was higher than that found in white populations, and most cases were undiagnosed and untreated. Glaucoma is a major cause of blindness in this population.

Adult↗
PubMed1998

[Gerontologic studies in South Africa--a report].

The paper reviews the present state of gerontological research in South Africa and provides examples of relevant studies. So far, most of the research has focused on socioeconomic conditions, e.g, financial status, living arrangements, and intergeneration family relations. During recent years another topic has gained prominence, e.g., the subjective well-being of the elderly. Another aspect of research in this area is its inter- and multidisciplinary nature and its concern with practical relevance. Terms often used in new research on aging are "empowerment of the elderly" and "self-care strategies". In this context, the elderly are beginning to be considered as significant brokers in development planning. In the last part of the paper, the trend to qualitative methods is discussed.

Aged↗
PubMed2006

Epidemiology of suicide by hanging in Transkei, South Africa.

To describe the epidemiology of suicide by hanging, in Transkei region of South Africa. This is a record review of the autopsy register from 1993 to 2003. There is an increasing trend of hangings from 5.2 per 100,000 to 16.2 in 2003. The highest was in the 20- to 29-year age group. The least number of hangings of 2.2 per 100,000 was in those over 70 years of age. Males (86.4%) outnumber females. The ratio of male to female suicide is 6.4:1. The 2 youngest suicide victims were also males aged 9 years. Peak of these hangings is in May and November and least in September. There is increasing trend of hanging especially among young adults between 20 and 29 years old.

Adolescent↗
PubMedDate not supplied

Primary HIV infection diagnosed in South Africa masquerading as another tropical disease.

Eleven patients referred to a hospital in South Africa with suspected tropical diseases such as malaria, typhoid fever and South African tick bite fever were found to be suffering from primary human immunodeficiency virus (HIV) infection. Hospital records were reviewed retrospectively in those acutely ill, febrile patients where a clinical suspicion of HIV seroconversion existed and no other diagnosis could be found. A history of recent travel, particularly to malarious areas, was given by most of these patients. The clinical presentation was dominated by high fevers and headaches. The most helpful pointers to primary HIV infection included a characteristic palatal enanthem, leucopenia and thrombocytopenia. Ironically, the history of recent travel appeared to have confounded the diagnosis despite the fact that travel has often been associated with the acquisition of HIV in Africa. Recognition of primary HIV infection masquerading as a tropical disease may result in more frequent diagnosis of this serious condition.

Adult↗
PubMed2002

Improving the accessibility of condoms in South Africa: the role of informal distribution.

Lack of access to condoms presents a fundamental barrier to HIV prevention across most of sub-Saharan Africa. One strategy to enhance the accessibility of condoms is to promote their informal distribution outside of health facilities through existing social networks. To investigate the prevalence and practices of informal condom distribution, we administered a questionnaire to individuals procuring condoms at 12 public health facilities in four regions of South Africa. Of the 554 individuals interviewed, 269 (48%) reported either giving or receiving condoms informally in the month before the study. In multivariate analysis, reporting informal condom distribution was associated with increased education, male gender, multiple sex partners and recent condom use. The specific practices involved in giving or receiving condoms differed between males and females, with women more likely to involve family members and men more likely to involve friends. These results indicate that informal condom distribution is surprisingly common among individuals procuring public sector condoms in South Africa, and begin to suggest the gendered nature of informal condom distribution networks. While these findings require confirmation in other populations, the practices of informal condom distribution described here provide an excellent opportunity for enhancing condom accessibility and delivering other interventions for HIV prevention.

Adolescent↗
PubMed2002

Antimicrobial activity of some plants used for the treatment of livestock disease in the Eastern Cape, South Africa.

Approximately 75% of rural livestock owners in the Eastern Cape province of South Africa use plants or plant based remedies to treat their livestock. Prominent among these plants are Combretum caffrum, Salix capensis and Schotia latifolia. Water, methanolic and acetonic extracts as well as decoctions of the three plants were screened against ten bacteria and five fungi. The results of the antibacterial assay indicated significant activity against all the Gram-positive bacteria tested with the minimum inhibitory concentrations ranging from 0.1 to 5.0 mg/ml. A few of the extracts showed minimal activity, but the majority of extracts were not active on the Gram-negative bacteria. Generally, all the extracts showed some antifungal activity against the five test fungi. Methanolic extracts exhibited higher fungal growth inhibition, whereas the water extracts showed the least inhibition. It was noteworthy that some water extracts promoted fungal growth.

Animal Diseases↗
PubMed1997

Fatal railway injuries in Cape Town, South Africa.

To describe the features of railway-related deaths in Cape Town, South Africa, we reviewed demographic, autopsy, and accident report data on all such deaths between 1 April 1992 and 30 September 1994. Of the 379 railway-related deaths, 27 were among pedestrians or commuters who were hit by a train while crossing the track, 38 were among commuters who fell from moving trains, 32 were suicides, 43 were the result of criminal violence on trains or at railway stations, and 38 were due to other causes. Most railway fatalities were among men between the ages of 25 and 44 years. About half of all railway fatalities occurred at peak commuting times, with high levels of violence (often robbery related) recorded during the evening peak. A blood alcohol concentration > 0.1 g/100 ml was found in 35% of the people who died from crossing the track or falling from moving trains. Fatal railway injury is characterized by extensive disruption of more than one body region. The high levels of fatal railway injury make a strong case for a range of injury control interventions, including ticket control, surveillance, law enforcement, and safety engineering.

Accidents↗
PubMed1993

Hypoglycaemic admissions among diabetic patients in Soweto, South Africa.

An audit of hypoglycaemic admissions among diabetic patients to Baragwanath Hospital, Soweto, South Africa was carried out prospectively during a recent 5-month period. A total of 51 episodes of biochemically confirmed hypoglycaemia (blood glucose < 2.2 mmol l-1 with coma or pre-coma, and requiring intravenous glucose) were observed in 43 patients. There was a wide range of ages (22-88 years) and an excess of males (27 M:16 F). Fourteen (33%) cases were associated with sulphonylurea (gliclazide) treatment. Doses of insulin or sulphonylureas were not excessive. The major cause precipitating the event was a missed meal (36%), though alcohol (22%), gastrointestinal upset (20%), and inappropriate treatment (18%) were also important contributory factors. Following recovery from the event, doses of drugs or insulin were frequently reduced, and three patients were successfully taken off insulin, and six off gliclazide. There was no mortality in this series, and no obvious long-term morbidity. We conclude that severe hypoglycaemia is a frequent and important acute diabetic complication in Soweto. Patient education and care in prescribing for Type 2 diabetic patients may help reduce its occurrence and severity.

Adult↗
PubMed2003

An unusual intraerythrocytic parasite of Parablennius cornutus from South Africa.

An intertidal horned blenny, Parablennius cornutus, captured at De Hoop Nature Reserve, South Africa, was found to harbor an unusual blood parasite and the haemogregarine Haemogregarina bigemina. In Giemsa-stained blood films, the enigmatic parasite occurred primarily as intraerythrocytic ringlike stages, with unstained centers and peripheral bands of beaded chromatin, not unlike Haemohormidium spp. Larger forms of the same organism stained pink with Giemsa, with nuclei occurring as 4-8 minute structures around the parasite body or distributed within it. These larger parasites apparently segmented into up to 8 individuals that were rounded or oval with deep-stained, comma-shaped or polar regions surrounding blue cytoplasm. Extracellular, binucleate, sporelike structures in clusters of as many as 16 individuals were also seen in blood films. Praniza larvae of the isopod Gnathia africana were seen in histological sections of gill tissue. Examination of spleen tissue by transmission electron microscopy showed intraerythrocytic organisms with ultrastructural characteristics like those of Haematractidium scombri, namely, a single boundary membrane, sometimes closely apposed nuclei with nucleoli, and profiles of dense material of variable structure. It is concluded that the parasite is probably related to Haemohormidium spp. and H. scombri, but it also shares features with some Microsporida.

Animals↗
PubMed1990

Considerations on the further expansion of the AIDS epidemic in South Africa--1990.

An epidemiological composite of the human immunodeficiency virus (HIV) epidemic in South Africa was constructed from reported acquired immunodeficiency syndrome (AIDS) figures, blood donor seroprevalence data and a family of active surveillance studies in the Johannesburg area. Of great concern is the extensive and continuing silent spread of HIV in the urban black population, manifested by doubling times in male and female sexually transmitted disease (STD) clinic attenders of 10.67 and 9.78 months respectively, a doubling time in female family planning (FP) attenders of 6.55 months, and HIV infection rates of 1:56, 1:37 and 1:91, respectively. These data suggest a spread of infection far more extensive than the relatively lower AIDS figures. However, seroprevalence figures in municipal employees of mainly rural origin were considerably lower, only 1:1,250 in black men and none in women, but regular movements between urban and rural areas could well introduce and amplify infection in rural areas. A complete epidemiological picture of HIV can only be attained by employing both the above approach of the family of surveys complemented by a nationwide seroprevalence study to assess HIV penetration into the general 'background' population. Educational interventions should now be particularly targeted to the major risk groups in the urban black heterosexual community.

Acquired Immunodeficiency Syndrome↗
PubMed2006

A cranial base of Australopithecus robustus from the hanging remnant of Swartkrans, South Africa.

SKW 18, a partial hominin cranium recovered from the site of Swartkrans, South Africa, in 1968 is described. It is derived from ex situ breccia of the Hanging Remnant of Member 1, dated to approximately 1.5-1.8 Mya. Although partially encased in breccia, it was refit to the facial fragment SK 52 (Clarke 1977 The Cranium of the Swartkrans Hominid SK 847 and Its Relevance to Human Origins, Ph.D. dissertation, University of the Witwatersrand, Johannesburg), producing the composite cranium SKW 18/SK 52. Subsequent preparation revealed the most complete cranial base attributable to the species Australopithecus robustus. SKW 18 suffered weathering and slight postdepositional distortion, but retains considerable anatomical detail. The composite cranium most likely represents a large, subadult male, based on the incomplete fusion of the spheno-occipital synchondrosis; unerupted third molar; pronounced development of muscular insertions; and large teeth. Cranial base measures of SKW 18 expand the range of values previously recorded for A. robustus. SKW 18 provides information on anatomical features not previously visible in this taxon, and expands our knowledge of morphological variability recognizable in the cranial base. Morphological heterogeneity in the development of the prevertebral and nuchal muscular insertions is likely the result of sexual dimorphism in A. robustus, while differences in cranial base angles and the development of the occipital/marginal sinus drainage system cannot be attributed to size dimorphism.

Age Determination by Skeleton↗
PubMed2000

Cerebrovascular disease in young, HIV-infected, black Africans in the KwaZulu Natal province of South Africa.

The objective of this study was to elucidate the mechanisms of an ischemic stroke in a human immunodeficiency virus, type 1 (HIV)-infected population. Several clinical and autopsy studies have suggested an increased incidence of strokes in HIV-infected persons. These studies have been performed on diverse populations with numerous confounds for strokes, including, drug abuse and coexistent opportunistic infection. Because of these confounding factors, it has been difficult to assess whether a unique stroke propensity exists among HIV-infected persons. A retrospective case-controlled study was carried out of patients registered in the Durban Stroke Data Bank (DSDB) (n=1298) located in KwaZulu Natal province of South Africa. Sixteen per cent of all strokes in young (<50 year old) black Africans living in KwaZulu Natal province on the east coast of South Africa reported to the DSDB occurred in association with HIV infection. This HIV-infected population was free of drug abuse and relatively devoid of opportunistic infections. The incidence rate of HIV in this stroke population paralleled that of the young black population at large, suggesting no significant overall increased rate of stroke in association with HIV. However, when compared to strokes occurring in an age- and sex-matched, HIV-seronegative control population, the cryptogenic stroke was more common in the HIV-infected population. Although the incidence of rate of stroke appeared to be no higher among HIV-infected young black Africans in the KwaZulu province than among HIV-seronegative controls, the increased incidence of a large vessel cryptogenic stroke in the former suggests the presence of a co-existent prothromobotic state.

Adolescent↗
PubMed2006

The impact of aerial application of organophosphates on the cholinesterase levels of rural residents in the Vaalharts district, Northern Cape Province, South Africa.

A cluster of Guillaine-Barre syndrome cases in the Vaalharts region, South Africa prompted an investigation of the impact of aerial organophosphate spraying on cholinesterase levels of residents in the region. A prospective study of cholinesterase levels among residents and workers in the area and a control area was performed. Standardized red blood cell cholinesterase levels amongst participants were monitored before (round 1), during (round 2), and after (round 3) the 1996/1997 aerial spraying season. Participants were assigned environmental exposure categories based on the time since (within 10 or 30 days) and distance from (on farm, on neighboring farm, <10 km from farm) aerial pesticide application. There were 342 participants in round 1, of whom 78% participated in round 2, 62% in round 3, and 56% in all three rounds. There was an increase in cholinesterase levels in round 2 (mean increase = 5.96+/-6.25 IU/g hemoglobin) and then a decrease in round 3 (6.17+/-6.51), significantly associated with environmental exposure (participants living on farm or neighboring farm and <10 km from spraying area) controlling for age, gender, alcohol dependence, and usual and recent domestic and occupational pesticide use (e.g., for round 2-round 1 cholinesterase differences, beta; (exposed group relative to unexposed)=5.72+/-1.21 IU/g hemoglobin, P = 0.000, R2 = 0.27, n = 171). The results show a shift in cholinesterase levels associated with residence in the spraying area, but in the direction opposite to that expected from the spraying of pesticides. Seasonal fluctuations in ambient temperature during the study may have influenced the results.

Adult↗
PubMed1995

An aquatic toxicological evaluation of fenthion in the context of finch control in South Africa.

Queletox, containing fenthion as active ingredient, is the avicide formulation used in South Africa to control red-billed finches (Quelea quelea). Control measures involve night spraying of roosting areas with a light aircraft. Since roosting areas often include reedbeds along riversides and on islands, proper control is difficult without exposing the aquatic environment to some risk of contamination. This study tested the acute effects of fenthion, in association with the queletox formulation, on the cladocerans Daphnia pulex and Ceriodaphnia dubia and the fish species Poecilia reticulata, Tilapia rendalli, Cyprinus carpio, and Oreochromis mossambicus. The chronic effects of fenthion on D. pulex were evaluated in a 14-day reproduction test. Mean 48-hr LC50 values estimated for D. pulex and C. dubia were 1.30 and 1.72 micrograms liter-1 respectively. For the fish estimated 96-hr LC50 values were as follows: 2.12 (P. reticulata), 2.53 (C. carpio), 2.92 (T. rendalli) and 1.71 micrograms liter-1 (O. mossambicus). In the chronic test reproduction of the exposed population was stimulated at the lowest two fenthion concentrations (0.1 and 0.6 ng liter-1), while a reproductive impairment was recorded at concentrations varying from 1 to 10 ng liter-1. Concentrations of fenthion measured in dams after spraying are given to indicate the levels of contamination that may occur. QSAR was used to estimate the toxicity of some fenthion metabolites. The results of this study reveal that fenthion, at the concentrations occurring in the environment after aerial spraying, can have marked effects on the survival and reproduction of D. pulex for long periods after spraying.

Animals↗
PubMed2005

The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change.

OBJECTIVE: In 1996 termination of pregnancy was legalised in South Africa. This article examines the impact of age on the epidemiology of incomplete abortion after legislative change. It draws comparison with the findings of a similar study undertaken in 1994. DESIGN: Multicentre, prospective, descriptive study. SETTING: Forty-seven public hospitals in all nine provinces. SAMPLE: A stratified random sample of all hospitals treating gynaecological emergencies was drawn. All women of gestation under 22 weeks who presented with incomplete abortion during three weeks of data collection in 2000 were included. METHODS: A data capture sheet completed by a clinician from the case notes. MAIN OUTCOME MEASURES: Demographic characteristics and clinical findings on admission by age of women. RESULTS: Overall, there was a significant increase in the proportion of cases with no signs of infection on admission (from 79.5% to 90.1%) and a significant decrease in evidence of interference on evacuation (4.5% to 0.6%) between 1994 and 2000. Substantial age differentials were seen. Women over 30 were significantly less likely than those 21-30 years or under 21 to be low severity (65.5% vs 75.2% vs 76.4%, P= 0.0087) and more likely to have offensive products (16.3% vs 6.0% vs 6.4%, P= 0.01) than the younger women. CONCLUSIONS: Legalisation of abortion had an immediate positive impact on morbidity, especially in younger women. This is an important change as teenagers had the highest morbidity in 1994. The trend is supported by evidence from the 1999-2001 Confidential Enquiry into Maternal Deaths, which further suggested that abortion mortality dropped by more than 90% since 1994.

Abortion, Incomplete↗