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Biomedical subjects

D Yach

Publications and source records attributed to D Yach.

At least 73 records · Page 4Linked to original sources
PubMed1993

Public health initiatives in South Africa in the 1940s and 1950s: lessons for a post-apartheid era.

Inspiration drawn from South African public health initiatives in the 1940s played an important role in the development of the network of community and migrant health centers in the United States. The first such center at Pholela in Natal emphasized the need for a comprehensive (preventive and curative) service that based its practices on empirical data derived from epidemiological and anthropological research. In addition, community consultation preceded the introduction of new service or research initiatives. The Institute of Family and Community Health in Durban pioneered community-based multidisciplinary training and developed Pholela and other sites as centers for service, teaching, and research. Several important lessons for South African health professionals emerge from the Pholela experience. First, public health models of the past need to be reintroduced locally; second, the training of public health professionals needs to be upgraded and reoriented; third, appropriate research programs need to respond to community needs and address service demands; fourth, community involvement strategies need to be implemented early on; and fifth, funding sources for innovation in health service provision should be sought.

Community Health Centers↗
PubMed1992

Availability of environmental health services among blacks in urban and peri-urban areas of South Africa.

Fundamental to primary health care is the need to provide adequate environmental health services to the population. Such services constitute primary prevention, and, under some circumstances, may have a greater impact on health than the provision of personal health services. This study aimed to assess the availability of environmental health services among blacks living in urban and peri-urban areas of South Africa. A stratified random sample of 800 households was selected. After discussions with the Urban Foundation, it was felt that the proportion of informal dwellings obtained (20%) underestimated the true figure, which was closer to 50%. For that reason estimates are presented for a range of values (20-50% informal dwellings). For environmental health services the percentage availability was 30-45% for reticulated water in the home; 18-29% for an inside flush toilet; and 48-62% for possession of a personal refuse receptacle. Data obtained on domestic fuel use indicated that 41-61% of households had electricity. General indicators of social class showed that 62% of households had a monthly income less than R400, and that 22-30% of mothers with children under 5 years of age had an educational level of less than Standard 5. All of the measures were substantially worse among people living in informal dwellings. The data indicate that urgent attention should be given to improving the foundations of primary health care, particularly by providing and giving attention to equity, intersectoral co-ordination and community participation in the provision of essential environmental health services.

Black or African American↗
PubMed1992

Mortality from external causes in South African adolescents, 1984-1986.

The external causes of death in South African adolescents are described. Nationally registered mortality data for 1984-1986 were used to calculate proportional mortality. Mortality rates were also calculated, except in the case of black deaths, since these deaths are known to be under-registered and the estimated population figures are known to be inaccurate. Of the 16,348 adolescent deaths registered in 1984-1986, external causes accounted for 56.8% and symptoms, signs and ill-defined conditions for 10.0%. A greater proportion of girls died from symptoms, signs and ill-defined conditions whereas a greater proportion of boys died from external causes. A larger proportion of black adolescent deaths were categorised as symptoms, signs and ill-defined conditions. The risk of death by external cause for coloureds aged 15-19 years was 1.7 that of whites, while in the 10-14 year age group it was the same as that of whites. In the 15-19-year age group assault was the most common external cause of death in blacks and coloureds, compared with road accidents for whites. The highest number of deaths by external cause per day occurred over the Christmas period. The analysis indicated that mortality rates in South African adolescents are high and that many deaths may be the result of risk-taking behaviour. With the increasing urbanisation of blacks, the impact of external causes of death can be expected to increase further.

Accidents↗
PubMed1992

Smoking policies in the workplace in the western Cape.

A postal survey of workplace smoking restrictions among the member organisations of the Cape Chamber of Industries was carried out in 1989. The response rate was 57.1%. Of the 572 respondent organisations, 66.1% had some smoking restrictions. Large workplaces were more likely to restrict smoking than small workplaces: 42.0% of those with fewer than 10 employees had restrictions, increasing to 90.9% of those with more than 500 employees. Organisations producing manufactured goods (other than engineering) were more likely to have restrictions than non-manufacturing concerns. Smoking was commonly restricted on the factory floor (61.3%) and in warehouses (55.8%), but only 7.4% prohibited smoking in shared offices. The reasons for smoking restrictions stated most frequently were the fire hazard (85.3%) and legislation (66.0%). Only 29.1% stated that health care concerns were an important reason for restrictions, while a further 16.3% stated that health was a minor reason for restrictions. Of the respondents, 48.4% expressed a need for guidance in improving their smoking policies. These results indicate that there is considerable potential for intervention to decrease both active and passive smoking in local workplace settings.

Humans↗
PubMed1992

The use and value of qualitative methods in health research in developing countries.

Qualitative and quantitative research methods for public health were integrated in the past. Work at the Polela Health Center and the Institute of Family and Community Health (South Africa) in the 1940's epitomized how true integration was possible. Since the 1950's the growth of disciplines and boundaries between them; the growing emphasis by funding agencies on quantitative research that yields results rapidly at low cost and the dominance of the medical profession in public health together resulted in a separation of approaches. Recently, recognition of the need for integrated approaches has reemerged but the capacity to conduct appropriate research in developing countries is weak and they have relied on importing both researchers and their methods. Examples are given (mainly using focus group methods) of how innovative integrated approaches in developing countries have been used to implement community diagnoses, understand factors affecting health service utilization and identify factors amenable to intervention. It is concluded that while qualitative methods are needed (and used) in developing countries, their use will only increase if appropriate training initiatives in developing countries are undertaken.

Cross-Cultural Comparison↗
PubMed1992

Assessment of epidemiological and HIV/AIDS publications in Africa.

To assess the quantity of epidemiological publications emanating from Africa, three international epidemiology journals were examined. In addition, a separate MEDLINE search was undertaken for 1987 and 1989-1990 to assess AIDS/HIV prevalence and incidence publications. Of 361 general epidemiological articles examined for 1974-1975, 49.3% were from the US, 20.5% from the UK, 11.1% from Europe, 10.2% from the rest of America, 4.4% from Asia, 3.9% from Australasia and 0.06% (only two) from Africa. The overall proportion from the USA declined to 44.0% by 1989-1990; from the UK to 11.1% while from South America and Australasia the proportion remained similar. Striking increases occurred in Europe and to a lesser extent in Asia. By 1989-1990 African articles contributed 3.6% (31) of the total. While over 90% of first authors came from the study region in the US, UK, Europe and Australasia; 85.7% in Asia; 70.8% in South America in 1989-1990, in Africa only 32.2% were authors from their continent. Of the 220 published articles on AIDS/HIV epidemiology 6.8% emanated from Africa in 1987 and 12% of 606 articles in 1989-1990. African scientists were first authors in 46.7% of articles from the continent in 1987 and only 35.5% in 1989 and 1990. In 1987, 60% of the articles were co-authored by overseas scientists of various nationalities while collaborative publications increased to 78.4% in 1989-1990. Only 15% of these articles were published in African Journals. This study stresses the urgent need for improving all aspects of epidemiological research and training in Africa with particular need with respect to AIDS/HIV research capacity.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Beliefs about smoking and health and attitudes toward tobacco control measures.

The opinions of a representative sample of adult South Africans about the effects of smoking on health and their attitudes toward tobacco control measures were surveyed by means of an interviewer-administered questionnaire. Seventy-five per cent of the respondents were black and 55.3% were female. More than 50% of blacks and Asians (61.7% and 53.2%) were non-smokers, whereas 52.1% of 'coloureds' were current smokers and 23.8% of whites ex-smokers. The majority of smokers (68.5%) acknowledged the harmful effects of direct smoking and a larger percentage of non- and ex-smokers (79.7% and 77% respectively) shared this view. A similar trend was observed in beliefs about passive smoking. Seventy-five per cent of participants felt that tobacco sales to minors should be banned and 55.8% thought that taxes on tobacco products should be increased. There was substantial white opposition to measures that prohibit tobacco companies from sponsoring sporting events. Most respondents felt that tobacco advertising should be banned on television (59.7%), radio (60.1%), in newspapers (58.4%), on billboards (58.7%) and in cinemas (59.3%). The results indicate that in the main the public supports the introduction of the measures proposed in the draft Tobacco Products Control Act and even more extensive legislation to control tobacco consumption. This augurs well for future strategies aimed at tobacco control in South Africa.

Adolescent↗
PubMed1991

Acute respiratory infections as an important cause of childhood deaths in South Africa.

Compared with other major preventable childhood diseases, such as diarrhoea, acute respiratory infections (ARI) have received comparatively little attention as an important cause of death in children. In this study of mortality from ARI in South Africa, national data was examined for the period 1968-1985, and data for Greater Cape Town for 1987. Almost 90% of ARI deaths were attributable to pneumonia and large inter-group differences were found that favoured whites and Asians over blacks and coloureds. For example, during 1980-1985 the mortality rate for pneumonia in coloured infants under 1 year of age was 11 times that observed in whites (88 v. 981/100,000). Pneumonia accounted for 14.5% of coloured and 12.7% of black deaths under 1 year of age during this period, compared with 6.7% of white and Asian deaths. The mortality rates from pneumonia declined substantially (50%) over the 18-year period in whites, coloureds and Asians. Sequential data for blacks is not available. There was a marked seasonality of deaths among coloured and Asian infants, with rates peaking in winter months. In Cape Town, pneumonia is now a more important cause of death among white and coloured children than diarrhoea, while it ranks with diarrhoea as a cause of death in black children. In all population groups, death rates from ARI are from 7 times to 270 times greater than those recorded in Western European countries. Studies are urgently required to discover why South African children suffer such a high mortality from ARI and how these deaths can be prevented.

Acute Disease↗
PubMed1991

Peering into the black hole--the quality of black mortality data in Port Elizabeth and the rest of South Africa.

In the year ending 30 June 1989, 26.8% of 5,345 deaths in the Port Elizabeth area were classified as ill-defined. A study was undertaken in an attempt to identify the reasons for the high proportion of such deaths. Copies of all death notifications and death register forms of black people in the area served by the Port Elizabeth City Health Department were collected for a 6-week period. Of the 316 deaths, 154 (48.7%) were certified by medical practitioners at a hospital, 158 (50%) by the police and 4 (1.3%) by private medical practitioners. Of the police-certified deaths 116 (73.4%) were recorded as due to 'natural causes', with the remainder being submitted to autopsy. Of the hospital deaths, 26% were not adequately described in the section for the cause of death on the death certificate. Review of national mortality data for 1985 showed that only 29.9% of ill-defined deaths (in all population groups) were certified by a medical practitioner. The prime source of deaths classified as ill-defined, both in Port Elizabeth and nationally, were those not certified by a medical practitioner. Strategies aimed at minimising the number of deaths certified by the police need to be developed.

Black or African American↗
PubMed1991

An evaluation of the national measles vaccination campaign in the new shanty areas of Khayelitsha.

A local component of the national measles vaccination campaign was evaluated in an area undergoing rapid urbanisation near Cape Town. Four serial cross-sectional cluster samples were used. Proven vaccination coverage before the campaign was 55.8% (95% confidence interval (CI) 46-66%), immediately afterwards it was 71.1% (95% CI 65-77%), and 6 months later 73.6% (95% CI 67-80%). The increase was not sustained among Transkei-born children. Significant determinants of vaccination coverage were: place of birth (chi 2 = 9.7; 2 df; P = 0.008); less than or equal to 6 months stay in Cape Town (odds ratio (OR) 2.22; 95% CI 1.2-4.0%); and home birth (OR 3.21; 95% CI 1.2-8.4%). The value of campaigns in controlling measles, as well as the role of a comprehensive health care service are discussed.

Child, Preschool↗
PubMed1991

Missed opportunities for measles immunisation in selected western Cape hospitals.

Measles is still a major cause of childhood mortality and morbidity in South Africa. The World Health Organisation (WHO) has recently recommended that greater attention be paid to opportunities for immunisation in the curative sector. This study quantified the extent of missed opportunities for measles immunisation in children attending primary, secondary and tertiary level curative hospitals in the western Cape. Exit interviews of 1,068 carers of children aged between 6 and 59 months inclusive showed that 2.4-40.7% of carers had been requested to produce a Road-to-Health card, and that 4.8-43.1% of carers had a card available. The proportion of children with documented evidence of measles immunisation available ranged from 4.8% to 40.0% between facilities. The study demonstrated that a considerable number of potential opportunities to immunise children against measles are currently being missed in children attending hospitals and day hospitals in the western Cape. The study documents the effect of a fragmented approach to health care, and indicates a need for rapid integration of preventive and curative components of health care into a metropolitan-based primary health care service.

Child, Hospitalized↗