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PubMed1999

Nephrotic syndrome in Namibian children.

BACKGROUND AND OBJECTIVES: Patterns of nephrotic syndrome vary between regions and countries, and influence approaches to management. In the mid-1970s the University of Stellenbosch became involved in providing tertiary care to Namibia, including a paediatric nephrology service. The aim of this study was to document the clinical, pathological and outcome features of nephrotic syndrome in Namibian children. SUBJECTS: Seventy black Namibian children with nephrotic syndrome were managed from 1975 to 1988. Sixty-eight renal specimens (67 biopsies and 1 autopsy specimen) were evaluated. RESULTS: Twenty-nine of the 70 children (41.4%) were hepatitis B virus (HBV) carriers, of whom 25 (86.2%) were male. Of the 29, 26 had predominantly membranous glomerulonephritis (MGN), 1 mesangiocapillary glomerulonephritis (MCGN), and 1 focal segmental glomerulosclerosis (FSGS); 1 child in advanced renal failure was not biopsied. Five children (7.4%) showed minimal change disease (MCD), 11 (16.2%) FSGS and 15 (22.1%) diffuse mesangial proliferative glomerulonephritis (DMP). The remaining 10 children showed diffuse glomerulosclerosis (6), MCGN (3) and endocapillary proliferative GN (1). Four of the 5 children with MCD went into remission on immunosuppressive treatment. Of the 15 with DMP, 4 improved spontaneously and only 1 of those treated did not improve. Only 2 of those with FSGS improved on treatment. The children with HBV-associated MGN and MCGN were offered symptomatic rather than specific treatment. Thirteen children presented with degrees of chronic renal failure. Eight are known to have died, 3 of relentless nephrotic syndrome and 4 (of whom 3 were HBV carriers) of end-stage renal failure. One child died of penicillin anaphylaxis. CONCLUSIONS: The pattern of nephrotic syndrome in black Namibian children differed greatly from the non-African pattern elsewhere in that MCD was uncommon and HBV-associated GN was the most common single group. The most frequent pattern of HBV-associated GN was MGN with some mesangiocapillary features showing marked male predominance. MCD and DMP were potentially treatable and could only be identified by biopsy. HBV carrier rates exert a major influence on the proportions of morphological subgroups of nephrotic syndrome in children. As these HBV carrier rates alter in future due to the influence of vaccination and urbanisation, the relative size of nephrotic subgroups seems likely to alter.

Adolescent↗

PubMed1990

Shell structure and distribution of Cloudina, a potential index fossil for the terminal Proterozoic.

Cloudina-bearing biosparites and biomicrites in the lower part of the Nama Group, Namibia, contain a wide morphological diversity of shell fragments that can all be attributed to the two named species C. hartmannae and C. riemkeae. The curved to sinuous tubular shells of Cloudina were multi-layered. Each shell layer was 8 to 50 micrometers thick and in the form of a slightly flaring tube with one end open and the other closed. Growth appears to have been periodic with successive shell layers forming within older layers. Each added layer was slightly elevated from the previous layer at the proximal end and was asymmetrically placed within the older layer so that only a portion of the new shell layer was fused to the previous layer. This type of growth left a relatively large unminerialized area between the shell layers which was often partially or fully occluded by early marine cements. The thin shell layers exhibit both plastic and brittle deformation and were likely formed of a rigid CaCO3-impregnated organic-rich material. Often the shell layers are preferentially dolomitized suggesting an original mineralogy of high-magnesian calcite. Both species in the Nama Group formed thickets, or perhaps bioherms, and this sedentary and gregarious habit suggests that Cloudina was probably a filter-feeding metazoan of at least a cnidarian grade of organization. The unusual shell structure of Cloudina gives rise to a characteristic suite of taphonomic and diagenetic features that can be used to identify Cloudina-bearing deposits within the Nama Group and in other terminal Proterozoic deposits around the world. Species of Cloudina occur in limestones from Brazil, Spain, China, and Oman in sequences consistent with a latest Proterozoic age assignment. In addition, supposed lower Cambrian, pre-trilobitic, shelly fossils from northwest Mexico and the White-Inyo Mountains in California and Nevada, including Sinotubulites, Nevadatubulus, and Wyattia, are all either closely related to or con-generic with Cloudina. Hence, it is probable that these outcrops are latest Proterozoic in age, and that Cloudina or Cloudina-like organisms were widely distributed at that time. It is possible, moreover, to suggest that metazoan biomineralization occurred on a global scale by the latest Proterozoic, at the same time that evidence for complex multicellularity and locomotion in animals appears in siliciclastic "Ediacaran" rocks in the form of body and trace fossils.

Animals↗

PubMed2001

The HIV/AIDS pandemic and its gender implications.

From 13-18 November 2000, the United Nations Division for the Advancement of Women, the World Health Organization, and UNAIDS convened an international meeting of experts in Windhoek, Namibia, to discuss the linkages between HIV/AIDS, gender, human rights, and human security.

Congresses as Topic↗

PubMed1990

International migrations to and from Zimbabwe and the influence of political changes on population movements, 1965-1987.

"This article suggests that the special case of [international migration in] southern African countries (Namibia, South Africa and Zimbabwe), in which the majority of permanent movers have historically been whites of European origin, requires that greater attention should be given to the politico-structural context of voluntary international migrations [as compared to economic motivation]. Statistical data on international migrations to and from Zimbabwe during the past quarter of a century are used to demonstrate that the temporal magnitude and spatial patterns of population movements are best explained by reference to the changing political, rather than economic, conditions within the country."

Africa↗

PubMed2004

Socioecological aspects of human reproduction in Sub-Saharan Africa.

The purpose of this study was to compare fertility outcome of two populations of northern Namibia, following different ways of subsistence. The total number of offspring, but also the number of dead and surviving offspring was compared between 236 !Kung San (91 females, 145 males) hunter gatherers and 248 Kavango (87 females, 161 males) horticultural pastoralists and a small number of Kavango people living in the urban center of Rundu. While no typical differences in fertility outcome between the study populations could be observed in males, marked differences were found for the female sample. As to be expected traditional Kavango women had given birth to a higher number of children and these children had a higher chance to survive in comparison to those of !Kung San women. On the other hand Kavango females living in urban centers reported a significantly lower number of offspring. It can be concluded that even in recent populations fertility differences according to subsistence patterns are observable.

Adult↗

PubMedDate not supplied

[Migration patterns of health professionals].

The past three decades have seen the number of international migrants double, to reach the unprecedented total of 175 million people in 2003. National health systems are often the biggest national employer, responsible for an estimated 35 million workers worldwide. Health professionals are part of the expanding global labour market. Today, foreign-educated health professionals represent more than a quarter of the medical and nursing workforces of Australia, Canada, the United Kingdom and the United States. Destination countries, however, are not limited to industrialised nations. For example, 50 per cent of physicians in the Namibia public services are expatriates and South Africa continues to recruit close to 80% of its rural physicians from other countries. International migration often imitates patterns of internal migration. The exodus from rural to urban areas, from lower to higher income urban neighbourhoods and from lower-income to higher-income sectors contributes challenges to the universal coverage of the population. International migration is often blamed for the dramatic health professional shortages witnessed in the developing countries. A recent OECD study, however, concludes that many registered nurses in South Africa (far exceeding the number that emigrate) are either inactive or unemployed. These dire situations constitute a modern paradox which is for the most part ignored. Shared language, promises of a better quality of life and globalization all support the continued existence of health professionals' international migration. The ethical dimension o this mobility is a sensitive issue that needs to be addressed. A major paradigm shift, however, is required in order to lessen the need to migrate rather than artificially curb the flows.

Australia↗

PubMed1999

HIV- periodontal disease. A review of research prospects: a South African and Namibian perspective.

In the course of infection by the human immunodeficiency virus (HIV) typical changes of inflammatory periodontal disease may arise. It is estimated that the prevalence of HIV-associated periodontal diseases may vary between 5% and 12% and can occur in both symptomatic and asymptomatic individuals. These oral lesions are very important either as an initial presentation of AIDS or as a sign of established immunosuppression. For the patients, HIV-associated periodontal diseases can cause pain, severe discomfort and a decreased quality of life. It is therefore important, from both diagnostic and therapeutic aspects, for dentists to be able to distinguish and diagnose HIV-associated periodontal diseases as early recognition and treatment of these oral lesions may reduce morbidity and allow more comfort to the patient during progression of the disease. This paper reviews the current international and regional status of HIV-associated periodontal diseases and highlights research prospects in countries such as Namibia and South Africa, to further analyse periodontal diseases in HIV/AIDS patients.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Comparison of three fluorosis indices in a Namibian community with twice optimum fluoride in the drinking water.

In Otjiwarongo, a town in Namibia with twice the optimum fluoride in the drinking water (1.56 ppm) the Dean (Dean, Arnold and Elvove, 1942), Thylstrup and Fejerskov (Thylstrup and Fejerskov, 1978) and TSIF (Horowitz et al, 1984) indices of fluorosis were compared in permanent teeth of the children aged 11 y living in the region. Fluorosis severety was skewed in all instances to lower scores within each index. With the Thylstrup and Fejerskov and TSIF indices it was possible to compare fluorosis by individual teeth; the former was significantly more sensitive in diagnosis (56 per cent vs 50 per cent prevalence). It is recommended that the aims of a fluorosis investigation be carefully detailed before selecting the fluorosis index to be used. If detailed information on individual teeth related to fluoride ingestion is needed the Thylstrup and Fejerskov index is recommended, especially in areas with raised fluoride intakes where it is anticipated that the fluorosis levels will be mainly in the low levels of severity.

Chi-Square Distribution↗

PubMed1990

[Sex hormone level and body shape of the !Kung San. A contribution to explaining pedomorphic stature of San populations].

In order to test the hypothesis that oestrogens as well as androgens modify the body shape resp. the paedomorphous habitus of !Kung San circulating levels of sex hormones (testosterone, 5 alpha-dihydrotestosterone, and oestradiol in the serum as well as free testosterone in the saliva) of 114 healthy !Kung San men from the Northern Kalahari of Namibia were quantitatively determined by means of the radioimmunoassay method. The probands were described by 50 body measurements and morphological characters like gynaecomastia. The results show that sex hormone concentrations and body shape are significantly correlated in !Kung San men as it has been previously demonstrated for non-African samples. This does not only refer to the expression of sexual dimorphism but also to the special aspect of paedomorphism. The hypothesis of Marrett, Davies and Tobias, however, that the paedomorphous type of the San is due to "over-oestrogenization" could not be confirmed. Rather, the comparatively low testosterone level of the !Kung San men seems to be of significance.

Adult↗

PubMed1990

Heat stress in dairy cattle and other livestock under southern African conditions. III. Monthly temperature-humidity index mean values and their significance in the performance of dairy cattle.

Temperature-humidity index (THI) values applicable to South Africa and Namibia have been established during this investigation for each month of the year by means of computerized modelling and mapping techniques. The data indicate that each year heat stress risk areas (HSRA's) expand from August to January and retract from February to July. The THI values classified according to the Livestock Weather Safety Index (LWSI) for lactating dairy cattle (LDC), suggest that, especially during November to March there is the risk of moderate to advanced heat stress in most South African dairy cows. This has important implications for their general health, udder health, production and reproduction. Careful planning of facilities and highly adaptable herd management are required to protect dairy cattle from heat stress.

Animals↗

PubMed1987

Thiamin status and biochemical indices of malnutrition and alcoholism in settled communities of !Kung San.

Thiamin status and biochemical indices of malnutrition and alcoholism have been studied in groups of settled !Kung San living in the northern Kalahari Desert of Namibia. One third of the men and 20% of the women had low red cell thiamin concentrations. Raised serum gamma glutamyl transferase (gamma GT) activities were present in 30% of the men and 11% of the women. gamma GT activities were negatively correlated with red cell thiamin concentrations (r = -0.321, P less than 0.01). Raised mean corpuscular volumes were observed in over half the subjects. Anaemia was rare. Plasma protein and albumin concentrations were satisfactory. Cholesterol concentrations were relatively low (mean 4.1 mmol 1-1). The present results identify a high prevalence of thiamin deficiency in settled !Kung San, and suggest that alcohol abuse is the main contributory factor.

Adult↗

PubMed1995

Hepatitis B viral markers in Bushmen at Schmidtsdrift, South Africa: baseline studies for immunisation.

In an effort to control hepatitis B virus (HBV), the prevalence rates of the virus need to be ascertained in different regions or populations. As a baseline for a hepatitis B immunisation programme, the seroprevalence of HBV markers was determined in 400 San Bushmen from a community who were translocated from Northern Namibia to South Africa. HBsAg was detected in 6.8% while 57.0% showed one or more markers of HBV infection. The balance of the population (43.0%) showed no evidence of previous exposure to HBV. The HBV exposure rate of 57.0% is intermediate to high with reference to internationally reported figures and protection of seronegative individuals through immunisation is recommended. Individuals without possible natural immunity against HBV such as those with anti-HBc or anti-HBs as a sole marker may provide insight into the circulation of HBV mutants in this community, since these sole markers could be seroconversion in response to a mutant HBV strain.

Adolescent↗

PubMed1993

Frontoethmoidal meningoencephaloceles: a review of 14 consecutive patients.

Over a period of 4.5 years, 14 patients with frontoethmoidal meningoencephaloceles were treated. Most patients came from Northern Namibia. Precise delineation of all cranial abnormalities was obtained by modern imaging techniques, and specific patterns of cerebral abnormality were found. The malformation was corrected in a single stage, and significant modifications have been developed to render the procedure simpler and safer. Information from our series favors delayed neural tube closure as the primary pathogenesis of the defect and suggests a common teratogen as the most probable etiological agent. Our experience leads us to advocate early correction of even small defects.

Encephalocele↗

PubMed1993

Metric characters of the hard palate and their cephalometric correlations in Namibian !Kung San and Kenyan tribes.

The metric characters of the head and hard palate of 138 black males from Kenya and 110 male !Kung San from Namibia have for the first time been compared to describe the black and Khoisan variation with respect to these special trait systems. The palate measurements were taken from prints of self-hardening plastic. Nearly all metric characters show significant differences between the two populations, which are reflected in a relevant discriminant function. The analyses of correlations between the individual head and palate measurements yield different correlation patterns in the two samples also with regard to their significance and direction. These results and the generally low correlation coefficients can be explained by the complex processes of allometric head growth, resulting in the Sans' pedomorphous and the blacks' more adultiform head and palate trait combinations.

Adult↗

PubMed1996

The usefulness of faecal phosphorus and nitrogen in interpreting differences in live-mass gain and the response to P supplementation in grazing cattle in arid regions.

The average daily gains of heifers and oxen on commercial and experimental farms in Namibia were used to indicate production differences in several areas and at different rates of phosphorus and protein supplementation. Faecal concentrations of phosphorus and nitrogen were used to indicate concentrations of these nutrients in grazing. Areas with high concentrations of nitrogen in faeces proved to support high levels of average daily gain. Animals responded positively to phosphorus supplementation only when faecal nitrogen concentrations were above 12 g/kg DM. Nitrogen concentrations in faeces were directly related to average daily gain of heifers, but protein supplementation did not have a significantly positive effect on average daily gain.

Animal Nutritional Physiological Phenomena↗

PubMed1997

Health evaluation of black-faced impala (Aepyceros melampus petersi) using blood chemistry and serology.

As part of ongoing ecological studies of black-faced impala (Aepyceros melampus petersi) in northern Namibia, blood samples were collected and analyzed from 26 animals captured for translocation in 1992. All animals appeared to be in good condition and no abnormality was noted during physical examination. Serum chemistry and mineral levels were measured and correlated with the results of bacterial and viral serology and were within the normal ranges for domestic ruminants. Antibody titers for infectious bovine rhinotracheitis and bovine viral diarrhea were detected. Serological tests for bluetongue, foot-and-mouth disease, rinderpest, parainfluenza 3, brucellosis, leptospirosis, and anaplasmosis were negative. Significant differences in disease prevalence were not found between sexes.

Animals↗

PubMed1998

Haemostatic profile of the San (Bushmen) relocated to Schmidtsdrif.

OBJECTIVE: To document the routine haemostatic variables of a group of San relocated from Namibia to South Africa. DESIGN: Cross-sectional study done in two stages. SETTING: Schmidtsdrif military camp in late 1990 and early 1991. SUBJECTS: Healthy adult San volunteers: 31 males and 54 females from the Vasakela and Barakwena groups in 1990; 135 males from the Vasakela group in 1991. The subjects were all soldiers or their dependants. MAIN OUTCOME MEASURES: The following tests were performed: activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen and coagulation factors V, VII, VIII, IX, X, XI and XII. The results were compared with a Western population reference group (N = 50). MAIN RESULTS: Almost all the haemostatic variables were statistically significantly lower than those of the reference group. The mean derived fibrinogen concentration in the plasma in the first stage of the study (1990) was significantly higher, but this reverted to normal during the second stage (1991), perhaps reflecting a general improvement in health. CONCLUSIONS: Even though the San are one of the best studied groups of indigenous people, this is the first published report on their haemostatic condition. The generally lower levels of haemostatic variables may reflect the lower prevalence of cardiovascular disease in the San. The population needs to be followed up as they westernise.

Adult↗

PubMed2005

Private health insurance: implications for developing countries.

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

Developing Countries↗