Tuberculosis control -- a new paradigm for South Africa.
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Biomedical subjects
Publications and source records attributed to N Cameron.
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The population under study in the South African longitudinal study of urban children and their families, 'Birth to Ten' (BTT), comprised all births during a 7-week period from April to June 1990 in Soweto-Johannesburg. Specification of the population base for the cohort was hampered by a number of flaws in the notification and record-keeping systems of the local authorities. As far as could be ascertained, 5460 singleton births occurred during this time to women who gave a permanent address within the defined region. Enrolment into BTT took place over the first 15 months of the study and covered the antenatal, delivery, 6-month and 1-year periods. By the end of this time, and despite a major health service strike during the delivery phase, 74% of all births (4029 cases) had been enrolled into the study. There were marked variations in levels of enrolment, however, by population group membership, residential area and place of delivery. In general, there was substantial under-enrolment of largely middle-class white women and their babies. Initial non-enrolment of specific segments of the population and attrition of the enrolled sample up to the end of the first year are discussed in the context of racial and social differentiation in South Africa.
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A major reason for admission of community hospice clients to the hospital is exhaustion of the primary caregiver. One way to prevent the problem of caregiver exhaustion may be the use of trained laypersons who remain overnight with the ill person, thereby providing respite that allows the caregiver to sleep. A survey was conducted to assess primary caregivers' appraisal of the need for overnight respite and their willingness to receive this support from trained laypersons. Thirty-seven primary caregivers, who used the services of a community hospice, were interviewed to determine primary caregivers' appraisals of problems, resources, and needs. Ten (27%) primary caregivers reported usually receiving 0 to 4 of sleep per night and 27 (73%) reported receiving > 4 h. Sleep time was described by the majority as insufficient, but insufficient, sleep was statistically not a main reason for hospital admission. Findings suggested that those in the 0- to 4-h category were more vulnerable to exhaustion. Seventy percent of respondents indicated that they would use the services of a trained layperson for overnight respite and an additional 6% indicated that they would under certain conditions.
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Adolescent growth in height, fatness, and fat patterning was investigated in a sample of 79 rural South African black children studied longitudinally from 6-18 years. Data were analyzed relative to peak height velocity (PHV) to identify the phenomenon of "compensatory" growth in height during adolescence and to describe changes in fatness and fat patterning. Compensatory growth following PHV was clearly observed relative to NHANES data for African-Americans in that Z-scores for height at the start of the adolescent growth spurt were greater than those at the end of the spurt. Statistically significant differences in fatness and centralization between males and females did not occur until about 2 years after PHV was attained. Centralization of fat occurred in both sexes but more so in males. The lack of centralization in females was due to relatively greater triceps skinfold velocities. The rapid gain in post-PHV fatness in females may represent a physiological adaptation to an energetically sub-optimal environment, buffering the energetic costs of reproduction.
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Clinical techniques currently used to assess adolescent growth and maturation are critically assessed with regard to anthropometric dimensions, measurement reliability, maturity indicators, and growth standards. While anthropometric measurements are virtually standardized throughout the world, a choice of techniques is available for the assessment of skeletal maturity, dental maturity and secondary sexual development. In addition, a variety of charts of international and national reference data are available for the comparison of individuals and groups. These assessment and comparison techniques are contrasted and compared to arrive at a scientifically appropriate set of recommendations for the clinical assessment of growth and maturity during adolescence.
The growth status of two samples of South African rural black children, from Ubombo, KwaZulu, and Vaalwater, northern Transvaal, was compared with that of samples of American black children and three other rural sub-Saharan groups. All the sub-Saharan black children were shorter, lighter and had less subcutaneous fat than the American children. Their growth curves demonstrated the well-recognised pattern of deviation from American means before adolescence so that, by the start of adolescence, approximately 50% of the children were below the 10th centile of American norms. Adolescence in all groups is delayed and the magnitude of peak velocity reduced. The adolescent growth spurt appears, however, to be extended along the time base so that pre- and post-peak velocities are raised; this leads to apparent catch-up growth in the late teenage years. While the Vaalwater sample demonstrated growth patterns very similar to those of other rural sub-Saharan black groups, the Ubombo children were consistently taller and heavier than all the others. These data are discussed in relation to the need for national norms that reflect the growth status of black South African children.
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.
'Birth to Ten' is a birth cohort study currently being conducted in the Johannesburg-Soweto area. This paper describes the various pilot studies that were undertaken to investigate the feasibility of a cohort study in an urban area. These studies were designed to determine the monthly birth rate, the timing, frequency and duration of maternal antenatal visits, the timing and frequency of visits to well-baby clinics and the accuracy and reliability of routinely collected growth data. In addition, a birth data collection form was tested to ascertain the appropriateness of its use in clinics within the study area.
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Birth to Ten is a longitudinal birth cohort study which began in April 1990 in the Johannesburg/Soweto area of Transvaal, South Africa. In this paper, the reason for the initiation of the study and its location in the current sociopolitical context is discussed. The health status of South Africa children in terms of infant mortality, morbidity (notifiable diseases) and nutritional status is described and mention is made of measures of psychological health and the importance of environmental pollution on health. The existing health service infrastructure in the study area is described and the fragmentation of health services between races, between preventive and curative services and on a geographical basis is highlighted. The study objectives, design, population, inclusion and exclusion criteria, methods of measurement and logistics are described.
Age at the start of breast development and at menarche are important maturity indicators in adolescent females. Breast development is usually the first event of puberty and menarche virtually the last. Irregularities in the age of the subject at their appearance can denote a lack of synchronisation between pubertal events, which, in turn, may indicate hormonal or psychosocial disturbance. Data are presented on the age of occurrence of breast development, according to Tanner's criteria, and age at menarche for urban and rural South African black females. In addition published reports are reviewed to determine whether there is a pattern of change in these ages. Breast development seems to be fairly stable, occurring in girls between the ages of 10.5 years and 11.5 years. Age at menarche appears to have decreased over the last 40 years in children from both urban and rural environments. Girls from rural areas have a delay of about 1.5 years in both pubertal events.
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The width coefficient, K, was assessed critically to examine its underlying assumptions, its relationship to absolute dimensions of body size, and its ability to identify children classified as malnourished by internationally accepted criteria. The scientific integrity of the formula to calculate K depended on the assumption that the body could be viewed as a cylinder with a density of 1.0 g/ml. The empirical testing of the former assumption showed that the body could not be viewed as a cylinder and papers describing body density suggest that age and sex dependency militate against the acceptance of an age- and sex-independent value of 1.0 g/ml. As an indicator of nutritional status K performed well in that it identified children below 75% of weight for age, but it could only identify 47% of children below 90% weight for height. The relative complexity of its calculation and interpretation militate against the use of K as an indicator of malnutrition for the general health worker, but its ability to identify moderately malnourished children by weight for age gives it credibility in the absence of an age assessment.