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Salinity tolerances of selected macroinvertebrates of the Sabie River, Kruger National Park, South Africa.

Salinization has been identified as the most important problem facing the managers of South African freshwaters. Laboratory-based toxicity tests were conducted to assess the tolerance of selected macroinvertebrates to elevated salt concentrations. Since the Kruger National Park is the focus of river research in South Africa, and the Sabie River is the least mineralized river in the park, 96-h acute toxicity tests were conducted using Sabie River water and an ephemeropteran mayfly Tricorythus sp. found in the river. Experiments were conducted inflowing water systems known as raceways. The tolerance of the mayfly to two sodium salts, sodium chloride and sodium sulphate, was assessed at a range of selected conductivity levels/concentrations. The results indicated that mortality cannot be linked only to conductivity or total dissolved solid(TDS) concentrations, but also to the nature of the salt. Sodium sulphate was considerably more toxic to Tricorythus sp. than sodium chloride. Causes of mortality and implications for the development of water quality guidelines for the natural aquatic environment are discussed.

Animals↗

Contextualizing group rape in post-apartheid South Africa.

Collective male sexual violence is part of a continuum of sexual coercion in South Africa. This paper is based on long-term ethnographic work in an urban township in the former Transkei region. Drawing on intensive participant observation and interviews with young men in particular, it attempts to make sense of emergent narratives relating to streamlining, a local term for a not uncommon form of collective sexual coercion involving a group of male friends and one or more women. The paper begins with an overview of existing anthropological literature on collective male sexual violence, going onto elaborate the different scenarios associated with group sexual violence in the fieldsite. It seeks to provide a multi-layered contextualization of the phenomenon by considering prevailing gender discourses, subcultural issues pertaining to the urban tsotsi phenomenon, the rural practice of ukuthwala (bride capture), young working-class Africans' experiences of marginalization, and the complex links between political economy and violence in this setting.

Adult↗

Ethnicity, hypertension, coronary heart disease and renal diseases in South Africa.

This paper reviews the impact of race and environment upon hypertension, coronary heart disease and renal diseases in South Africa. Inequalities of socioeconomic status, lifestyle, and access to South African health care have produced striking differences in the prevalence and complications of hypertension. Coronary heart disease is 'epidemic' in the white and Indian population and is still relatively uncommon in blacks. There are different histological patterns of glomerulonephritis among the racial groups, which may lead to end-stage renal disease. Hypertension is an important cause of end-stage renal disease in the black population whilst analgesic nephropathy is important in the white population. Efforts are now being made to comprehend these daunting realities and to minimize the inequalities.

Black People↗

First report of annual ryegrass toxicity in the Republic of South Africa.

The occurrence of annual ryegrass toxicity (ARGT) in sheep and cattle is reported for the first time in South Africa. To date it has been diagnosed conclusively in South African Mutton Merino sheep on a farm in the Caledon district and in cattle on 3 farms, 2 of which are situated in the Bredasdorp district and 1 in the Ceres district. It is a neurological disease characterized by symptoms of tremor, ataxia, intermittent epileptiform seizures, nystagmus, opisthotonus, abortions and high mortality. The history, clinical signs and experimental reproduction of the disease as well as the pathology of 4 experimental and 10 natural cases in sheep and 2 in cattle are described.

Animals↗

Epidemiologic and histologic patterns of Hodgkin's disease: comparison of the black and white populations of Johannesburg, South Africa.

Histologic patterns of Hodgkin's disease in black and white patients in Johannesburg, South Africa, were studied in relation to sex and age, and compared with each other and with published studies on American, Nigerian, and Ugandan black and American white patients. Pretreatment lymph node biospy specimens from 88 black and 54 white patients were reviewed and histologically subtyped according to the Rye classification. In Johannesburg, black patients have a high frequency of mixed cellular (MC) and lymphocyte depleted (LD) subtypes, and of childhood disease. Male patients predominate in all subtypes including nodular sclerosis (NS) which equals LD in frequency. White Johannesburg patients have a low frequency of childhood disease, an increased rate in young adults, and a relatively high frequency of NS with female patients predominating, although MC is the predominant subtype. Both population groups tend to fall into the intermediate epidemiologic Pattern II, with a bias to Pattern I in black patients, reflecting their poorer socioeconomic condition, and a bias to Pattern III in white patients, reflecting their improved socioeconomic situation.

Adolescent↗

Cost-effectiveness analysis of hypertension guidelines in South Africa: absolute risk versus blood pressure level.

BACKGROUND: Hypertension is responsible for more deaths worldwide than any other cardiovascular risk factor. Guidelines based on blood pressure level for initiation of treatment of hypertension may be too costly compared with an approach based on absolute cardiovascular disease (CVD) risk, especially in developing countries. METHODS AND RESULTS: Using a Markov CVD model, we compared 6 strategies for initiation of drug treatment--2 different blood pressure levels (160/95 and 140/90 mm Hg) and 4 different levels of absolute CVD risk over 10 years (40%, 30%, 20%, and 15%)--with one of no treatment. We modeled a hypothetical cohort of all adults without CVD in South Africa, a multiethnic developing country, over 10 years. The incremental cost-effectiveness ratios for treating those with 10-year absolute risk for CVD >40%, 30%, 20%, and 15% were 700 dollars, 1600 dollars, 4900 dollars, and 11,000 dollars per quality-adjusted life-year gained, respectively. Strategies based on a target blood pressure level were both more expensive and less effective than treatment decisions based on the strategy that used absolute CVD risk of >15%. Sensitivity analysis of cost of treatments, prevalence estimates of risk factors, and benefits expected from treatment did not change the ranking of the strategies. CONCLUSIONS: In South Africa, current guidelines based on blood pressure levels are both more expensive and less effective than guidelines based on absolute risk of cardiovascular disease. The use of quantitative risk-based guidelines for treatment of hypertension could free up major resources for other pressing needs, especially in developing countries.

Adult↗

Cryptococcus anemochoreius sp. nov., a novel anamorphic basidiomycetous yeast isolated from the atmosphere in central South Africa.

A novel yeast strain, CBS 10258T, was isolated from the atmosphere in central South Africa. Sequence analysis of the D1/D2 domain and internal transcribed spacer region of the novel strain indicates that it represents a novel species within the Cryptococcus laurentii complex. Phylogenetic analyses based on the D1/D2 domain revealed that the novel strain occupies a relatively isolated position within this complex with Papiliotrema bandonii, Cryptococcus perniciosus, Cryptococcus nemorosus and Cryptococcus sp. CBS 8363 being the closest relatives. However, the novel strain could be distinguished from related species by standard physiological tests including the inability to assimilate rhamnose, methyl alpha-d-glucoside, salicin, lactose, erythritol, ribitol, xylitol, citrate and ethanol. In addition, no extracellular starch production was observed and the isolate was able to grow in the absence of additional vitamins. On the basis of these results, we suggest that the new strain represents a novel species for which the name Cryptococcus anemochoreius sp. nov. is proposed [type strain CBS 10258T (=NRRL Y-27920T)].

Air Microbiology↗

Family practice as a part of undergraduate medical training in South Africa.

Undergraduate tiution in family practice was fully instituted for the first time in South Africa at the University of Pretoria in 1977. Students in the 2nd-5th years of study are taught the various aspects of family medicine and practice management by means of formal lectures and practical clinical work. The treachers are all general practitioners, most of whom hold a higher degree in family practice. In addition, each student spends at least 1 week with a practitioner in general practice. In Pretoria the outpatient and casualty departments of the two teaching hospitals are run by the Department of Family Practice. Large numbers of patients who would not be seen in the wards are thus made available for teaching purposes, and the standard of service to patients is improved. Until recently, medical teaching was confined to the various specialities and only patients admitted to teaching hospitals were available for teaching purposes. As less than 1% of persons reporting sick are admitted to hospital inpatients are not representative of the disease profile seen in general practice. Undergraduate medical training in family practice could be further improved by more participation in the teaching programme by experienced general practitioners in active practice.

Curriculum↗

Lack of taxonomic differentiation in an apparently widespread freshwater isopod morphotype (Phreatoicidea: Mesamphisopidae: Mesamphisopus) from South Africa.

The unambiguous identification of phreatoicidean isopods occurring in the mountainous southwestern region of South Africa is problematic, as the most recent key is based on morphological characters showing continuous variation among two species: Mesamphisopus abbreviatus and M. depressus. This study uses variation at 12 allozyme loci, phylogenetic analyses of 600 bp of a COI (cytochrome c oxidase subunit I) mtDNA fragment and morphometric comparisons to determine whether 15 populations are conspecific, and, if not, to elucidate their evolutionary relationships. Molecular evidence suggested that the most easterly population, collected from the Tsitsikamma Forest, was representative of a yet undescribed species. Patterns of differentiation and evolutionary relationships among the remaining populations were unrelated to geographic proximity or drainage system. Patterns of isolation by distance were also absent. An apparent disparity among the extent of genetic differentiation was also revealed by the two molecular marker sets. Mitochondrial sequence divergences among individuals were comparable to currently recognized intraspecific divergences. Surprisingly, nuclear markers revealed more extensive differentiation, more characteristic of interspecific divergences. This disparity and the mosaic pattern of differentiation may be driven by stochastic population crashes and genetic bottlenecks (caused by seasonal habitat fluctuations), coupled with genetic drift.

Animals↗

Universal immunization of infants with low doses of a low-cost, plasma-derived hepatitis B vaccine in South Africa.

OBJECTIVE: To evaluate the effectiveness of universal vaccination against viral hepatitis B in South Africa among 18-month-old rural children. METHODS: Children were immunized with a course of low-dose (1.5 microg), plasma-derived hepatitis B vaccine at 6, 10 and 14 weeks of age, and blood samples from the children were tested for three hepatitis B markers: hepatitis B surface antigen (HBsAg), anti-HBs and anti-HBc. FINDINGS: One year after vaccination, a protective anti-HBs antibody titre of at least 10 IU/l was present in 669/769 (87.0%) of blood serum samples tested. Only 3/756 children (0.4%) were HBsAg positive and a fourth child was anti-HBc positive (HBsAg negative). This is a marked decrease compared to the hepatitis B prevalences reported in previous studies. Among rural migrant mine-workers, for example, HBsAg prevalence was 9.9%, and was 10.1% among children 0-6 years of age in the Eastern Cape Province. CONCLUSION: The low-dose, plasma-derived hepatitis B vaccine, which is affordable to most developing countries, was very successful in controlling endemic hepatitis B infection, where the virus is predominantly spread by horizontal transmission among infants and young children.

Biomarkers↗

Molecular characteristics of human immunodeficiency virus type 1 subtype C viruses from KwaZulu-Natal, South Africa: implications for vaccine and antiretroviral control strategies.

The KwaZulu-Natal region of South Africa is experiencing an explosive outbreak of human immunodeficiency virus type 1 (HIV-1) subtype C infections. Understanding the genetic diversity of C viruses and the biological consequences of this diversity is important for the design of effective control strategies. We analyzed the protease gene, the first 935 nucleotides of reverse transcriptase, and the C2V5 envelope region of a representative set of 72 treatment-naïve patients from KwaZulu-Natal and correlated the results with amino acid signature and resistance patterns. Phylogenetic analysis revealed multiple clusters or "lineages" of HIV-1 subtype C that segregated with other C viruses from southern Africa. The same pattern was observed for both black and Indian subgroups and for retrospective specimens collected prior to 1990, indicating that multiple sublineages of HIV-1 C have been present in KwaZulu-Natal since the early stages of the epidemic. With the exception of three nonnucleoside reverse transcriptase inhibitor mutations, no primary resistance mutations were identified. Numerous accessory polymorphisms were present in the protease, but none were located at drug-binding or active sites of the enzyme. One frequent polymorphism, I93L, was located near the protease/reverse transcriptase cleavage site. In the envelope, disruption of the glycosylation motif at the beginning of V3 was associated with the presence of an extra protein kinase C phosphorylation site at codon 11. Many polymorphisms were embedded within cytotoxic T lymphocyte or overlapping cytotoxic T-lymphocyte/T-helper epitopes, as defined for subtype B. This work forms a baseline for future studies aimed at understanding the impact of genetic diversity on vaccine efficacy and on natural susceptibility to antiretroviral drugs.

AIDS Vaccines↗

Exploring socio-economic conditions and poor follow-up rates of HIV-exposed infants in Johannesburg, South Africa.

In 2002, more than 280,000 HIV-exposed babies were born in South Africa. According to international PMTCT guidelines, these children require follow-up to 12 months of age. Worldwide, the high loss to follow-up rates experienced by PMTCT programs precludes them from identifying and managing HIV-infected children. Socio-economic factors have been identified as potential contributors to poor follow-up. A small descriptive study to examine socio-economic circumstances of women attending the Coronation Women and Children's Hospital PMTCT program was undertaken. Cross-sectional data from 176 women, interviewed at their infants' 12-month visit, was collected using a semi-structured questionnaire. Socio-economic factors such as poverty, geographical relocation and a lack of paternal support may affect the capacity of families to comply with the PMTCT follow-up program. Fifty-seven percent of mothers were unemployed, 25% of fathers did not support their children and only 58% of children remained resident in Johannesburg at the 12-month visit. The lack of follow-up of HIV-infected children denies them access to adequate medical care. Understanding the socio-economic factors that affect the ability of communities to comply with PMTCT programs will assist resource-poor countries in devising strategies to achieve follow-up of HIV-exposed infants.

Child Health Services↗

SLC11A1 (NRAMP1) but not SLC11A2 (NRAMP2) polymorphisms are associated with susceptibility to tuberculosis in a high-incidence community in South Africa.

SETTING: Stellenbosch University Faculty of Health Sciences, and metropolitan Cape Town, Western Cape, South Africa. OBJECTIVE: To investigate whether the reported association between SLC11A1 (also NRAMP1) polymorphisms and susceptibility to tuberculosis (TB) can be confirmed in a different population, and whether polymorphisms in SLC11A2 (also NRAMP2, DCT1, DMT1) are associated with TB. DESIGN: A case-control study design was used to compare the frequencies of five polymorphisms in SLC11A1 and three in SLC11A2 between a group of bacteriologically confirmed TB patients and healthy community controls. RESULTS: The 5' (GT)9 allele in the promoter of SLC1A1 was found at significantly higher frequencies among 265 controls than in 224 pulmonary TB (PTB) patients (P = 0.002; OR 0.6; 95% CI 0.43-0.83). Homozygotes for the TGTG deletion (1729+55del4) in the 3'UTR of SLC11A1 were over-represented among PTB patients (P = 0.013; OR 5.19; 95% CI 1.42-18.94). Stepwise logistic regression analysis indicated that the 5' and 3' polymorphisms contribute separate main effects. Tuberculous meningitis patients (n = 22) showed the same allele and genotype frequency as PTB patients. No SLC11A2 polymorphisms tested were associated with TB. CONCLUSION: The 5' (GT)n allele driving the highest rate of transcription of SLC11A1 appears to be associated with protection against TB in the majority of the populations studied.

Adult↗

Estimation and evaluation of exposures from a large sulfur fire in South Africa.

A massive fire at a sulfur stockpile in the Western Cape Province of South Africa in December 1995 is estimated to have released over 14,000 t of sulfur dioxide (SO(2)) over a 20-h period. High and persistent winds greatly reduced the effectiveness of fire-fighting activities and increased the severity of impacts. Nearby urban and agricultural areas were seriously affected. Thousands of people were evacuated from the nearby town of Macassar located 2.5-4 km downwind, and at least several deaths occurred. Agricultural impacts ranged over a broad area extending to 30 km from the fire site and included severe damage to plants and some animal deaths. This paper describes the chronology of the fire, the emergency responses, and the immediate impacts. SO(2) concentrations are estimated using dispersion modeling, and predictions are evaluated using available monitoring information. Sensitivity analyses are used to test unknown or uncertain model parameters. The SO(2) concentrations estimated in Macassar reached extremely dangerous levels, at times over the IDLH level (100 ppm). Predictions agree with the available but very limited monitoring data, as well as with the symptomology of Macassar residents and plant damage patterns. Procedures to deal with the limited information and variability in this fire and similar incidents are suggested. The fire is a tragic demonstration of shortcomings in hazardous material management and emergency response.

Adolescent↗

Incidence of human calicivirus and rotavirus infection in patients with gastroenteritis in South Africa.

Human caliciviruses (HuCVs) are reportedly responsible for 2.5-4% of nonbacterial sporadic gastroenteritis. The incidence of HuCV infection in South Africa is unknown. Stool specimens from 1,296 South African patients with sporadic gastroenteritis were screened for the presence of HuCVs using electron microscopy, recombinant enzyme immunoassays for Norwalk (NV) and Mexican (MX) viruses, and the reverse transcriptase-polymerase chain reaction (RT-PCR). RT-PCR products were sequenced to ascertain which HuCV genogroups were present. HuCVs were detected in 43/1,296 (3.3%) specimens examined, with RT-PCR proving to be the most sensitive detection method. Genetic analysis of the isolates indicated that 81% were Snow Mountain Agent, or MX-like; 8% were NV-like; and 11% were HuCV/Sapporo-like. This study indicates that a combination of assays is needed for the accurate detection of HuCVs. Comparative data on hospitalised patients showed that the incidence of rotavirus infection was approximately ten times greater than that of HuCV infection.

Adolescent↗

Dedicated land disposal of wastewater sludge in south africa: leaching of trace elements and nutrients.

Most of the wastewater treatment facilities in South Africa (80%) dispose of their sewage sludge on dedicated land disposal (DLD) sites. The impact of this practice on the environment is believed to be negative, but very little research has been carried out to determine the extent of the damage to the soil and water resources. Forty wastewater treatment facilities using DLD, with different soil properties, application techniques, metal concentrations and period of sludge application, were studied. Soil and groundwater samples were collected at each of the selected facilities. Three extraction methods (aqua regia, NH4EDTA and NH4NO3) were used and samples were analysed for total N, P and K, pH, organic carbon and their metal content (Cr, Co, Ni, Cu, Zn, Cd, and Pb). Some degree of leaching of the heavy metals (especially Co and Ni) occurred at some of the sampling sites and the average depth of leaching was 100-200 mm. Deeper than 300 mm, the metal concentrations in most soil samples reached background concentrations. Seven of the nine groundwater samples that could be obtained had high NO3 concentrations (> 6 mg L(-1)). Statistical analyses of the data indicate no significant differences between sludge type (wet or dry) and leaching, or age of the disposal sites and leaching. Taking into account the age of the disposal sites, the frequency of sludge application and the metal load of the sludge, the depth of leaching is surprisingly shallow in most soils, in spite of the low soil pH(H2O) and clay content.

Carbon↗

Exploring the costs of a limited public sector antiretroviral treatment programme in South Africa.

BACKGROUND: The role of antiretroviral treatment for adults in the pubic sector in South Africa is debated with little consideration of programme choices that could impact on the cost-effectiveness of the intervention. This study seeks to explore the impact of these programme choices at an individual level, as well as explore the total cost of a rationed national public sector antiretroviral treatment programme. METHODS: Eight scenarios were modelled of limited national treatment programmes over the next 5 years, reflecting different programme design choices. The individual cost-effectiveness of these scenarios were compared. The total costs of the most cost-effective scenario were calculated, and the potential for savings in other areas of health care utilisation was explored. RESULTS: The direct programme costs per life-year saved varied between scenarios from R5,923 to R11,829. All the costs of the most cost-effective scenario could potentially be offset depending on assumptions of health care access and utilisation. The total programme costs for the most cost-effective scenario in 2007 with 107,000 people on treatment are around R409 million. CONCLUSION: Specific policy choices could almost double the number of people who could benefit from an investment in a limited national antiretroviral treatment programme. Such a programme is affordable within current resource constraints. The consideration of antiretroviral treatment calls for a unique public health approach to the rationing of health services in the public sector.

Adult↗

Lagos bat virus, South Africa.

Three more isolates of Lagos bat virus were recently recovered from fruit bats in South Africa after an apparent absence of this virus for 13 years. The sporadic occurrence of cases is likely due to inadequate surveillance programs for lyssavirus infections among bat populations in Africa.

Animals↗