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PubMedDate not supplied

AIDS in South Africa.

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AIDS Serodiagnosis↗
PubMedDate not supplied

Emergence of the M phenotype of erythromycin-resistant pneumococci in South Africa.

Erythromycin-resistant pneumococci have been isolated in South Africa since 1978; however, from 1987 to 1996, resistance to macrolides was only detected in 270 (2.7%) of 9,868 blood or cerebrospinal fluid (CSF) pneumococcal isolates, most of which were obtained from the public sector. In South Africa, macrolide use in the public sector is estimated at 56% of that in the private sector. Most erythromycin-resistant strains (89%) exhibited resistance to erythromycin and clindamycin (macrolide-lincosamide-streptogramin B phenotype). In the United States, most erythromycin-resistant pneumococci exhibit the newly described M phenotype (resistance to erythromycin alone), associated with the mefE gene. The M phenotype in South Africa increased significantly in the last 10 years, from 1 of 5,115 to 28 of 4,735 of blood and CSF isolates received from 1987 to 1991 compared with 1992 to 1996 (p = 5 x 10(-7)). These data suggest that, although macrolide resistance in pneumococci remains low in the public sector, the mefE gene is rapidly emerging in South Africa.

Anti-Bacterial Agents↗
PubMed1994

Forensic medicine in South Africa--time for change?

Forensic medical services in South Africa are rendered by state-employed district surgeons and forensic pathologists, who are obliged to utilize the physical infrastructure and personnel of the South African Police in their examinations. Recent highly publicized incidents have (again) highlighted the alleged involvement of the South African Police and/or state security forces in political killings and deaths in custody. The perception has arisen that the South African Police is often a party to a dispute and yet may have virtually unlimited access to evidence and findings, thereby gaining unfair advantage and opportunity for prejudicing the eventual outcome of the investigation. Furthermore, the perceived allegiance (and even possible subservience) of doctors to the South African Police has tarnished the reputation of forensic medical practitioners in this country. It is imperative that the public and the courts perceive the rendering of medicolegal services to be independent and scientifically objective. A model is proposed for the restructuring of medicolegal services in South Africa so as to be autonomous and without the integral involvement of the South African Police. Regard should be had to the opportunity for change now presenting itself in South Africa.

Ethics, Professional↗
PubMed1994

Primary health care in disadvantaged communities in South Africa.

The government of the Republic of South Africa has committed itself to the philosophy that it is only through primary health care that an affordable health service can be rendered to all inhabitants of South Africa. Currently this is taking place through a partnership between the state, the community and the private sector. The role of non-governmental organizations is, however, just as important in the upliftment of disadvantaged communities. Without active community participation in the whole process, no primary health care service can be successful. In order to meet the needs of disadvantaged communities, primary health care projects have been launched with the following objectives: To ensure community participation to render an effective primary health care service; to ensure participation safe and healthy environment with appropriate housing, sanitation, potable water, food and vector control; to coordinate, implement and evaluate projects and to report on their progress; and to ensure an effective referral system of patients from an initial primary point of contact to more specialized services.

Community Participation↗
PubMed2004

Integrating tuberculosis and HIV care in the primary care setting in South Africa.

BACKGROUND: In many countries including South Africa, the increasing human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have impacted significantly on already weakened public health services. This paper reviews the scope, process and performance of the HIV and TB services in a primary care setting where antiretroviral therapy is provided, in Khayelitsha, South Africa, in order to assess whether there is a need for some form of integration. METHODS: The scope and process of both services were assessed through observations of the service and individual and group interviews with key persons. The performance was assessed by examining the 2001-2002 reports from the health information system and clinical data. RESULTS: The TB service is programme oriented to the attainment of an 85% cure rate amongst smear-positive patients while the HIV service has a more holistic approach to the patient with HIV. The TB service is part of a well-established programme that is highly standardized. The HIV service is in the pilot phase. There is a heavy load at both services and there is large degree of cross-referral between the two services. There are lessons that can be learnt from each service. There is an overlap of activities, duplication of services and under-utilization of staff. There are missed opportunities for TB and HIV prevention, diagnosis and management. CONCLUSIONS: The study suggests that there may be benefits to integrating HIV and TB services. Constraints to this process are discussed.

Communicable Disease Control↗
PubMed2006

Community collaborative youth-focused HIV/AIDS prevention in South Africa and Trinidad: preliminary findings.

BACKGROUND: South Africa and Trinidad and Tobago are disproportionately impacted by high rates of HIV/AIDS among adolescents. OBJECTIVE: The article describes the HIV crises in these countries; outlines a community participatory research framework to adapt and deliver family-based prevention; and presents preliminary data from intervention pilots in each setting. METHODS: Adapted interventions were piloted with N = 140 families in South Africa and N=16 families in Trinidad and Tobago to refine recruitment and retention efforts and to assess the adapted interventions' impact on family and risk-related constructs. RESULTS: Both settings reported promising results including high recruitment and retention and favourable pre to post changes in parent/youth frequency and comfort in talking about sensitive subjects, HIV transmission knowledge and attitudes about persons with HIV/AIDS. CONCLUSION: International HIV-prevention alliances are increasing. Such alliances are challenged by trust issues, power-differentials and ideological differences. Recommendations are provided on how some challenges can be overcome.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Surgery in South Africa.

The practice of surgery in South Africa ranges from full-time service in state-funded and academic hospitals serving a largely indigent population to a private sector for medically insured patients. Surgical training occurs at eight medical schools, and specialist registration is obtained after 4 to 5 years with either a university-conferred degree or a fellowship from the College of Surgeons of South Africa. The wide spectrum of First- to Third-World diseases and the high incidence of trauma provide comprehensive experience for practical training. Surgical standards are uniformly high, matching and sometimes pioneering the very best of Western medicine. The health care system is undergoing radical change to correct the imbalances of the apartheid era. Academic institutions are under pressure, and with incipient major financial cutbacks, there is concern that the proud record of service, teaching, and research excellence may be compromised. To facilitate the mission of broadening health care services, diploma training in surgery for rural practitioners is being developed. Outreach programs and closer liaisons with surgical societies in sub-Saharan African countries have also been initiated.

Academic Medical Centers↗
PubMed1988

Occupational health and safety in South Africa: the perspectives of capital, state and unions.

South Africa is one of the most technologically advanced countries of Africa. The main sectors are mining, agriculture and industry. Many work environments are dangerous. Since the early development of the mines in South Africa, occupational health and safety (OHS) has received the attention of the state, the employers, and the workers. Although there have been some advances in legislation, conditions are often still poor and enforcement of legislation is lacking. The paper outlines the history of concern with OHS issues, and draws attention to the Erasmus Commission of Enquiry (1976) into Occupational Health. The paper attempts to provide an overview of the different activities and perspectives of these interest groups: the state is concerned with minimising conflict and disruption of productivity, while ensuring that conditions do not deteriorate too badly; the employers are concerned to maximise profits and to undertake improvements in OHS only insofar as these are profitable and in the interest of stable industrial relations; and the union movement has sought to make work safer. These perspectives are different and conflicting. The only interest group with an unambiguous commitment to improving OHS is the union movement in South Africa. However, many difficulties and problems mitigate against the movement achieving its OHS objectives, including the limited number of workers which have been organised into unions and the many pressing issues which require the movement's immediate attention.

Accident Prevention↗
PubMed2001

Profile of Community Mental Health Service Needs in the Moretele District (North-West Province) in South Africa.

BACKGROUND: The emergence of democracy in South Africa led to a need to transform all public structures, including the health care system. The aim has been to transform these structures in order to bring them in line with the new culture of human rights. Transformation of the whole health care system is motivated by a number of key objectives, which include achieving equity in resource allocation and health service delivery, developing primary health care infrastructure and decentralising services to promote community participation. AIMS OF THE STUDY: In the context of de-institutionalising mental health services in South Africa, this study aimed to investigate community mental health service needs of mental health service users and that of their families in the Moretele district, North-West province, South Africa. METHODS: The study was conducted in three clinics situated in three different communities in the Moretele district. Data collection consisted of : 147 clinical record reviews, 105 interviews with patients followed by a joint interview with a family member, 83 interviews with caregivers and eight interviews with community key informants (traditional healers, a civic leader, a councillor, a retired teacher, and a physician). RESULTS: The majority of service users were males (54%). The mean age was 41 years and 63% had completed primary schooling.Patients were recorded as having only one of two primary diagnoses, namely schizophrenia (57%) or epilepsy (41%). However, a review of prescribed drugs and caregiver interviews showed that there was a presence of mood disorders among service users. The local hospital was service users primary entry point into the mental health care system, followed by traditional healers (30%). Interviews with service users, service providers and caregivers reveal limited knowledge of patient illness. Nevertheless, service users who had epilepsy were more likely to provide details of their illness than those with mental illness. Above half of service users had basic social skills such as bathing, eating, washing and using public transportation independently. Feelings of loneliness and isolation were common among service users in the community; seventy nine percent (79%), for example spent their days entirely in their homes. Only 7% reported contact with friends. Experiences of community discrimination and exploitation of people with mental illness were reported in key informant interviews and by service users themselves. DISCUSSION: The main community mental health service needs identified in this study were: (i) Improved quality of mental health services at clinics. (ii) Better co-ordination of services (clinic, hospital, social work and traditional healers) and removal of barriers to health service utilisation. (iii) Alleviation of the social isolation of mental health service users by building on existing community structures and individuals willing to engage in partnerships with service providers. The authors indentify a need to train primary health care providers in mental health in order to promote the adequate diagnosis and detection of common psychiatric illnesses.They also point out the need for social support interventions to enable people with mental illness to deal with loneliness and isolation and a need for psycho-educational programmes to make patients and caregivers better informed about mental illness.

Journal Article↗
PubMed1995

[More and more Dutch nationals to South Africa].

"From 1950-1994 almost 62 thousand Dutch nationals left for South Africa. Almost half of them left the Netherlands in the fifties. In the same period, more than 43 thousand Dutch nationals returned to the Netherlands. Fluctuations in external migration with South Africa can be related to political events there.... From the end of 1994, emigration of Dutch nationals to South Africa is now higher than immigration from that country." (SUMMARY IN ENG)

Africa↗
PubMed1983

Some economic and philosophical dilemmas facing medicine in South Africa.

Growth of the population in South Africa is not being matched by appropriate expansion of our health care services. Inadequate development of primary health care and community hospitals is placing an increasing burden of clinical service on teaching hospitals, which in turn have not been allocated sufficient resources to cope with both these service demands and academic activities. The current policy, whereby a greater percentage of health care funding is being directed towards preventive medicine, is appropriate, but the coupling of this with a progressive reduction in the relative amount of total expenditure on health (as a percentage of the gross national product) is short-sighted and not in the best interests of academic medicine or health care services in the country. The public and the medical profession in South Africa should recognize these adverse trends and actively participate in reversing them. The profession also needs to re-evaluate its priorities and objectives in relation to economic and sociological developments and prospects. An enlightened approach with adequate financial backing is needed to prevent further erosion in medical standards, to protect academic teaching centres of excellence and to ensure an adequate health care service in the future. Social, economic and political advancement of all people in our country is necessary to allow achievement of these objectives.

Delivery of Health Care↗
PubMed2001

The fate of free male condoms distributed to the public in South Africa.

OBJECTIVES: Public sector male condom distribution in South Africa rose from six million in 1994 to 198 million in 1999 as part of the government's condom promotion efforts for HIV/AIDS prevention. This study investigates what happens to the condoms which are distributed free of charge by the South African Department of Health. METHODS: A prospective study was undertaken during 1998-1999 at 12 representative public health facilities. Five-hundred and fifty-four consecutive subjects leaving the facilities were recruited and followed-up for 5 weeks to ascertain the fate of the 8164 condoms they had procured. RESULTS: A total of 384 participants (69.3%) and their 5528 condoms (67.7%) were followed successfully. After 5 weeks, 43.7% of the condoms had been used or broken in sex, 21.8% had been given away, 8.5% had been lost or discarded, and 26.0% were still available for use. Increased rates of condom use by participants were associated with active (compared to passive) condom procurement. CONCLUSIONS: In light of the rapidly increasing number of free condoms being distributed by the public health service in South Africa, it is reassuring to note that wastage at 5 weeks is less than 10%. Extrapolating these data to the 198 million public sector condoms distributed in South Africa in 1999, at least 87 million condoms were used in sex. This methodology may be used to help evaluate the impact of existing condom distribution systems and the effectiveness of various condom promotion strategies.

Adolescent↗