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PubMed2006

Albinism in Africa as a public health issue.

BACKGROUND: Oculocutaneous albinism (OCA) is a genetically inherited autosomal recessive condition and OCA2, tyrosine-positive albinism, is the most prevalent type found throughout Africa. Due to the lack of melanin, people with albinism are more susceptible to the harmful effects of ultraviolet radiation exposure. This population must deal with issues such as photophobia, decreased visual acuity, extreme sun sensitivity and skin cancer. People with albinism also face social discrimination as a result of their difference in appearance. The World Health Organization is currently investigating the issues concerning this vulnerable population. METHODS: Systematic electronic search of articles in PubMed concerning albinism in Africa. Furthermore, a World Health Organization (WHO) pilot survey of albinism was drafted in English, French and Portuguese, and distributed to African countries through WHO African Regional Offices (AFRO) in an attempt to gather further information on albinism. RESULTS: Epidemiologic data on albinism, such as prevalence, were available for South Africa, Zimbabwe, Tanzania and Nigeria. Prevalences as high as 1 in 1,000 were reported for selected populations in Zimbabwe and other specific ethnic groups in Southern Africa. An overall estimate of albinism prevalences ranges from 1/5,000-1/15,000. In addition, both the literature review and the survey underscored the medical and social issues facing people with albinism. CONCLUSION: The estimated prevalence of albinism suggests the existence of tens of thousands of people living with albinism in Africa. This finding reiterates the need for increased awareness of and public health interventions for albinism in order to better address the medical, psychological and social needs of this vulnerable population.

Africa↗
PubMed2006

Rickettsioses in sub-Saharan Africa.

Although rickettsioses are among the oldest known vector-borne zoonoses, several species or subspecies of rickettsias have been identified in recent years as emerging pathogens throughout the world including in sub-Saharan Africa. To date, six tick-borne spotted fever group pathogenic rickettsias are known to occur in sub-Saharan Africa, including Rickettsia conorii conorii, the agent of Mediterranean spotted fever; R. conorii caspia, the agent of Astrakhan fever; R. africae, the agent of African tick-bite fever; R. aeschlimannii; R. sibirica mongolitimonae; and R. massiliae. On the other hand, fleas have long been known as vectors of the ubiquitous murine typhus, a typhus group rickettsiosis induced by R. typhi. However, a new spotted fever rickettsia, R. felis, has also been found to be associated with fleas, to be a human pathogen, and to be present in sub-Saharan Africa. Finally, R. prowazekii the agent of louse-borne epidemic typhus continues to strikes tens to hundreds of thousands of persons who live in Sub-Saharan with civil war, famine and poor conditions. We present an overview of these rickettsioses occurring in sub-Saharan Africa, focusing on the epidemiological aspects of emerging diseases.

Africa South of the Sahara↗
PubMed1995

Epidemiology of Mycobacterium bovis infection in animals and humans, with particular reference to Africa.

The epidemiology of Mycobacterium bovis infection in animals and humans is described, together with a review of available reports on the distribution and prevalence of this mycobacteriosis in Africa. The significance of these reports is considered, with particular emphasis on the potential zoonotic importance of bovine tuberculosis as a cause for public health concern in Africa. Published data describing tuberculosis in Europe in the 1930s and 1940s show that bovine tuberculosis was considered to be a significant zoonosis: M. bovis was responsible for more than 50% of cervical lymphadenitis cases in children. Despite the paucity of information on M. bovis infection in Africa, there is sufficient evidence to suggest that it is widely distributed and is found at significantly high prevalence in some populations of animals. Some epidemiological conditions for the spread of M. bovis infection between animals and humans are very similar in Africa today to those in Europe in the 1930s, with the added and potent impact of the epidemic of human immunodeficiency virus infection. The public health threat of tuberculosis in Africa requires urgent investigation through collaborative veterinary/medical research programmes.

Africa↗
PubMed2006

Estimation of mortality from vital registrations in South Africa.

Sentinel surveillance surveys combined with epidemiological/demographic models have been used in monitoring trends in mortality due to HIV in South Africa as in most other countries. The potential biases in such surveys have been highlighted in recent studies. South Africa's HIV prevalence (29.5% among pregnant women attending antenatal clinics in 2004) is one of the highest in the world. National HIV prevalence from population-based survey has been carried out twice in South Africa, but is of limited use as a surveillance system independent of antenatal data. The use of vital registration in monitoring HIV related mortality has been largely unexplored. This study utilises data on registered deaths for the period 1997-2001 to estimate trends in mortality and TB/HIV related death rates in South Africa. The analysis utilizes the Growth Balance method to estimate the completeness of the death records from the registration system, and hence an adjustment factor for the registered deaths including TB/HIV related deaths in the period. The results indicate that coverage of registration of deaths in South Africa has increased over time but the completeness of registration of female deaths lags behind completeness of registration of male deaths. The absolute number of deaths is estimated to have increased from about 400,000 in 1997 to about 565,000 in 2002. Crude HIV related plus TB-AIDS death rate is estimated to have increased from about 9.6 per 10,000 in 1997 to about 19.1 per 10,000 in 2002. The increase in the number of deaths could not be attributed to population growth.

AIDS-Related Opportunistic Infections↗
PubMed2004

Double standards: the multinational asbestos industry and asbestos-related disease in South Africa.

This study documents and contrasts the development of knowledge about asbestos-related disease (ARD) in South Africa and the United Kingdom. It also contributes to the globalization debate by exploring corporate decision-making in a multinational industry. Between the 1930s and 1960s, the leading U.K. asbestos companies developed a sophisticated knowledge of ARD, though in South Africa, where the leading companies such as Turner & Newall and Cape Asbestos owned mines, there was little attempt to apply this knowledge. Asbestos mines (and their environments) in South Africa were uniquely dusty and ARD was rife. Social and political factors in South Africa, especially apartheid, allowed these companies to apply double standards, even after 1960 when the much more serious hazard of mesothelioma was identified. This shows the need for greater regulation of multinationals. Because of the lack of such regulation in the early 1960s, an opportunity was lost to prevent the current high morbidity and mortality of ARD both in South Africa and worldwide.

Asbestos↗
PubMed1987

Epidemiologic and clinical features of Crimean-Congo hemorrhagic fever in southern Africa.

Following the diagnosis in 1981 of the first case of Crimean-Congo hemorrhagic fever (CCHF) in South Africa, an antibody survey was undertaken on cattle sera to determine the distribution of the virus and specific diagnostic tests were routinely applied to specimens from suspected cases of hemorrhagic fever to establish the medical significance of its presence. Antibody to CCHF virus was demonstrated by reversed passive hemagglutination-inhibition technique in 2,460/8,667 (28%) cattle sera and in 140/180 herds tested in South Africa, as well as in 347/763 (45%) cattle sera and in 32/34 (94%) herds tested in Zimbabwe. The antibody was found in all major cattle farming areas, but was of low prevalence along the southern coast where 2 of the 3 species of Hyalomma tick which occur in South Africa are absent. From February 1981 to January 1986, inclusive, 29 indigenous cases of CCHF were diagnosed in 16 outbreaks which arose in various locations throughout South Africa. A further 2 imported cases of CCHF arose in Zaire and Tanzania. The clinical features of infection conformed to the classical descriptions of CCHF in the Soviet Union. The fatal outcome in 11/31 cases indicates that the African disease is no less severe than that which occurs in Eurasia. It is inferred that the virus is widespread in all countries in Africa and Eurasia which lie within the limits of world distribution of ticks of the genus Hyalomma.

Animals↗
PubMed2005

Socio-behaviour challenges to phase III HIV vaccine trials in Sub-Saharan Africa.

BACKGROUND: A number of countries in sub-Saharan Africa are preparing for HIV vaccine efficacy trials. Social and behavioural factors related to HIV transmission require examination in each setting where these trials are considered. As part of this, several countries have also recently begun preparatory research investigating relevant social and behavioural issues. There is a need for a review of the literature to help focus such research efforts in Sub-Saharan Africa. OBJECTIVES: To examine key social and behavioural issues that may impact on the conduct of HIV vaccine efficacy trials in sub-Saharan Africa. DESIGN: Literature review METHODS: Major databases (PubMed, PsychInfo, EBSCOhost, and AIDSline) were searched for literature that discussed social and behavioural issues related to HIV vaccine trials. Three areas are highlighted as being particularly significant for HIV vaccine research: (1) willingness to participate in future HIV vaccine efficacy trials, (2) retention of participants in studies, and (3) sexual risk reporting during trials. For each of these topics, major findings from both developed and developing countries are described and avenues for further research are discussed. RESULTS: There are few data from Sub-Saharan Africa regarding willingness to participate in HIV vaccine trials. Data on participant retention rates varies widely, and maintaining large cohorts of individuals within Phase III trials presents an important challenge. In addition, the possible impact of trial participation on sexual disinhibition, and response bias on sexual risk-reporting remain as issues for HIV vaccine trials in African contexts. CONCLUSION: Social and behavioural research forms an important part of preparations for HIV vaccine efficacy trials, and there is a clear need for more research of this type in Sub-Saharan Africa. Innovative approaches are required to address issues such as willingness to participate in vaccine research, participant retention during efficacy trials, and the accurate reporting by participants of sexual risk behaviours.

AIDS Vaccines↗
PubMed2000

[HIV infection in Africa. Clinical and therapeutical research].

UNLABELLED: A MAJOR HEALTH PROBLEM: Human Immunodeficiency Virus (HIV) infection is a major public health problem in sub-Saharan Africa and the care of HIV-infected patients is limited by the lack of resources. Clinical research can play a major role to assess the benefit of preventive and/or curative measures adapted to the context of these countries. To illustrate advances and gaps in HIV/AIDS clinical research in Africa, we explored three issues relevant to this research: opportunistic infections in adults, mother-to-child transmission of HIV and the ethical questions. EPIDEMIOLOGY: Epidemiological African studies have shown: the omnipresence of tuberculosis, first cause of death among HIV+ patients; the frequency of bacterial infections, first cause of serious morbidity and second cause of death; the high frequency of toxoplasmosis, cryptococcal meningitis, isosporiasis, cryptosporidiasis, and other infectious syndromes of unknown etiology. More research efforts need to be done for improving tuberculosis diagnosis, compliance to treatment (evaluation of Directed Observed Therapy), resistance to treatment and primary chemoprophylaxis which has shown clear short term benefit but median term interest remains to be demonstrated. Chemoprophylaxis of opportunistic infections other than tuberculosis needs also to be evaluated: cotrimoxazole reduces the short term mortality of HIV+ patients with tuberculosis and the early serious morbidity of HIV+ patients without tuberculosis. TRANSMISSION: Mother-to-child transmission of HIV can occur during pregnancy, during delivery and the postnatal period by breastfeeding, a common practice in Africa. The overall risk of vertical transmission is estimated to be 30% but the attributable part of breastfeeding needs to be further explored. Beyond the prevention of sexual transmission of HIV among childbearing women and family planning for HIV+ women, interventions aimed to reduce mother-to-child transmission depend on the availability or not of a proposing and realising an HIV counselling and testing: antiretroviral treatments and/or breastfeeding alternatives which reduce efficaciously transmission require HIV testing, while vaginal disinfection and vitamin supplementation whom efficacy needs to be demonstrated do not. PREVENTION: Prevention of mother-to-child transmission and care of HIV+ adults in the area of opportunistic infections are feasible in Africa with an acceptable cost. This requires first to train and inform health care providers and the populations. Lots of uncertainties in these areas are likely to be alleviated by reinforcing clinical and therapeutic research of good quality including the questions of antiretroviral treatment. Ethical issues raised by the design and conduct of clinical research in Africa need a positive thinking to face the HIV African pandemic.

AIDS-Related Opportunistic Infections↗
PubMed2000

[Molecular epidemiology of large bacterial endemics in Sub-Saharan Africa].

Over the past decades, the differentiation of bacterial strains for epidemiological purposes had been based on conventional phenotypic characters. More recently, methods studying the directly coded molecules or semantides (nucleic acids or proteins) have allowed, concomitantly with the technical progresses of electrophoresis, the description of stable, discriminant, reproducible markers, which were applicable to large series of isolates. Initially applied to study nosocomial infections in industrialised countries, these methods appear to be particularly suitable for an approach of the epidemiology of endemic bacterial infections in sub-Saharan Africa. The fact that these tools remain costly and technically complicated explains that most of these studies are conducted in the laboratories of industrialized countries. This research reveals the epidemiological complexity of most of these infections. Thus, the epidemiology of trachoma was studied by the analysis of polymorphism of the major outer membrane protein gene of Chlamydia trachomatis in a village of Gambia. A PCR based technique was used to determine the frequency of infection in symptomatic and clinically negative subjects and to specify the prevalence of the genotypes. The epidemiology of plague was studied by the restriction fragment length polymorphism (RFLP) analysis of the ribosomal RNA genes (ribotyping). Distinct ribotypes differentiated the strains of the first two pandemics from the third one. The strains of African origin were particularly heterogeneous, especially in Kenya. This diversity may be explained by the fact that the plague focus is extremely ancient in Central Africa. Bacterial agents of meningitis were also studied. The electrophoretic polymorphism of outer membrane proteins of Haemophilus influenzae of b type was used to specify the epidemiology of meningitis in Gambia. The invasive strains exhibited distinct profiles from non-invasive strains. Different types were evidenced in the west, east and central parts of the country. The antigenic polymorphism of outer membrane proteins of Neisseria meningitidis allowed the differentiation of the strains isolated in Mali according to the period of isolation. Thus, the endemic strains of A serotype were distinguished from those belonging to the same serotype, which were responsible for the 1994 epidemic. Several molecular methods were applied to the typing of Vibrio cholerae strains, particularly those of the seventh pandemic. The enzyme electrophoretic polymorphism (MLEE), a technique based on RFLP analysis of toxin genes, the arbitrarily primed PCR (AP-PCR) and mainly the ribotyping were applied. This last method revealed that in Africa several clones of V. Cholerae El Tor were responsible for the seventh pandemic. Moreover the technique has evidenced the intercontinental spread of a clone of V. Cholerae isolated in 1993 in Calcutta and identified a year later in Guinea-Bissau. Tuberculosis is at present the first opportunistic infection linked to HIV infection in sub-Saharan Africa. Tuberculosis incidence is particularly high and is expected to increase. Several molecular methods, including IS 6110 RFLP analysis, AP-PCR and spoligotyping were used to study the epidemiology of tuberculosis in various countries: South Africa, Tanzania, Zimbabwe, Kenya and Malawi. The aims of this research varied: prevalence of reactivation and of recently acquired infections, routes of contamination, degree of genetic diversity of the organisms isolated in a given geographic area, urban and rural origins of the infections, comparison of isolates from HIV seropositive and HIV seronegative patients. Identical profiles in the strains isolated from several patients could correspond to clusters of infections. However, the identification of epidemiological links in most clusters is hard to obtain. (ABSTRACT TRUNCATED)

Africa South of the Sahara↗
PubMed2001

Occupational respiratory diseases in South Africa--results from SORDSA, 1997-1999.

OBJECTIVES: To describe the nature and extent of work-related respiratory diseases reported to the national Surveillance of Work-related and Occupational Respiratory Diseases in South Africa (SORDSA) reporting scheme. The causative agents and industrial categories in which they occurred are also characterised. DESIGN: Voluntary monthly reporting of newly diagnosed cases by pulmonologists, occupational medicine practitioners and occupational health nurses. SETTING: Medical and occupational health referral centres in the nine provinces of South Africa. SUBJECTS: Cases were workers from non-mining industries or ex-miners, suffering from a newly diagnosed occupational respiratory disease, reported to SORDSA between October 1996 and December 1999. OUTCOME MEASURES: Frequencies of reported occupational respiratory disease by year, reporting source, province and sex. Frequencies of short- and long-latency diseases by industry and causative agent. RESULTS: There was incomplete reporting coverage of the nine provinces in the first 3 years. Reporting was most comprehensive from Gauteng, KwaZulu-Natal and the Western Cape. Diseases with long latency periods made up 76.2% of the cases. Pneumoconiosis, even in non-mining industries, was the most frequently reported disease, followed by inhalation accidents. Occupational asthma was the fourth most reported disease. Apart from the prominence of pneumoconiosis, the results obtained by SORDSA are similar to those from a British occupational lung disease surveillance scheme. This study showed that newly diagnosed cases of occupational lung disease occurred in many industries and were caused by a variety of agents. CONCLUSION: SORDSA has contributed insight into the nature, extent and distribution of occupational respiratory diseases in South Africa. It has also highlighted important causes of occupational respiratory diseases in South Africa, as well as hazardous industries. The data indicate that South Africa has a widespread occupational lung disease problem, and provide a platform for targeted prevention strategies.

Accidents, Occupational↗
PubMed2001

[HIV infection from Africa to Norway].

BACKGROUND: More than two thirds of the world's HIV infected persons live in Africa. Africans seek asylum in Norway and some Norwegians work for longer periods in Africa. We used the Norwegian surveillance system for communicable diseases (1983-99) to assess the connections between the Norwegian and African epidemics. MATERIAL AND METHODS: We estimated the incidence of HIV infection in persons from Norway who acquired HIV from Africans, and measured the annual number of Africans diagnosed in Norway. RESULTS: Out of the 2,016 cases of HIV infection ever diagnosed in Norway (population 4.4 million), 489 (24%) had connections to Africa. 80 persons from Norway have been infected in Africa, usually during work for aid agencies. 39 persons have been infected by Africans in Norway. For both groups the annual number of new cases was 0-2 in 1997-99. Cumulatively, 370 Africans have been diagnosed with HIV infection acquired before immigration. Median time from immigration to diagnosis is three months. INTERPRETATION: Currently, few Norwegians are infected by Africans in Norway or Africa. African immigrants constitute an increasing proportion of the HIV positive population in Norway. This is a challenge to the health services and to society at large.

Adolescent↗
PubMed2004

Prevalence of HIV in workforces in southern Africa, 2000-2001.

OBJECTIVES: Most data on HIV prevalence in low-risk populations in sub-Saharan Africa are drawn from sentinel surveys of pregnant women attending antenatal clinics and are not representative of formal sector workforces. We surveyed workforces in southern Africa to determine HIV prevalence among formally employed, largely male populations. METHODS: Voluntary, anonymous, unlinked seroprevalence surveys of 34 workforces with 44,000 employees were carried out in South Africa, Botswana, and Zambia in 2000-2001. Results were stratified to obtain estimates of prevalence by industrial sector, location, age, sex, and job level. RESULTS: Average HIV prevalence for the entire sample was 16.6% (95% CI: 16.3-17.0%). Country-wide prevalence was 14.5% (14.1-14.9%) in South Africa, 17.9% (17.1-18.7%) in Zambia, and 24.6% (23.6-25.7%) in Botswana. Among industrial sectors, mining (18.0%, 17.6-18.5%) and metal processing (17.3%, 15.9-18.7%) had the highest infection rates. Males, who comprised 85% of participants of known sex, were more likely (16.3%, 15.3-17.4%) to be infected than were females (10.7%, 8.7-12.7%). Contract (23%, 21.9-24.1%), unskilled (18.3%, 17.5-19.1%), and semi-skilled workers (18.7%, 18.1-19.4%) were much more likely to be infected than were skilled workers (10.5%, 9.5-11.4%) and managers (4.5%, 3.4-5.6%). Participation in the surveys averaged 63% of eligible employees. CONCLUSIONS: HIV prevalence among formally employed workers in southern Africa shows different patterns than among antenatal clinic attendees. Anonymous workplace surveys generate prevalence estimates for demographic groups that are not represented in antenatal surveys and can strengthen support for prevention and treatment interventions.

Adult↗
PubMed2003

[Medical research in French-speaking Africa: unrecognized research].

A postal survey carried out by TDR (UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases) on sixty three (63) African medical journals in July 2002 found that the majority of medical and health journals were under-funded, did not publish regularly, lacked high quality articles and standard peer review practice and were mostly invisible to the rest of the international medical community. In French speaking Africa less than ten medical journals publish regularly and only five are indexed in Medline. Ten (10) countries out of twenty three (23) have no medical journal at all. Five thousand six hundred and twelve (5612) articles on French speaking Africa could be retrieved in Medline from 1998 to 2003. Thirty three per cent (33%) of these articles were published in French in ninety four (94) journals while sixty six per cent (66%) were published in English in eight hundred and forty eight (848) journals. Fifteen (15) African medical journals published 8.5% of all these articles and nine international journals specialized in tropical medicine published 19% of them. The rest was published by medical journals of all specialities, mainly American, British and French. This study illustrates the consequences of the lack of local medical journals in Africa. Academic traditions play an important role on the decision of French speaking African researchers to publish outside their country. The impact of African health research on local researchers, health professionals and policy makers in French speaking Africa, all of whom have little access to major international health journals and a poor command of the English language, is questionable. In 2002, TDR facilitated the launching of the Forum of African Medical Editors (FAME) to promote the creation of sustainable, high quality public health and medical journals in Africa in order to encourage African health researchers to publish also for their colleagues in their country.

Africa↗
PubMed2004

Fertility trend and pattern in a rural area of South Africa in the context of HIV/AIDS.

Little is known about the dynamics of fertility transition in South Africa, though recent studies have begun to shed light on demographic changes in the country. This study presents trends and patterns of fertility observed in a rural South African population. Various demographic and statistical techniques were used to examine fertility patterns in a population of 21,847 women in a rural KwaZulu-Natal (KZN) demographic surveillance area. These are compared with patterns seen in another South African rural population under demographic surveillance, and with data from the 1998 South Africa Demographic and Health Survey. Findings are interpreted in light of contraceptive use patterns and HIV prevalence in the population. In South Africa, the end of the fertility transition is now in sight. In rural KZN, where national fertility levels are highest, fertility has declined rapidly for about two decades and would have reached below replacement level in 2003. While fertility has declined rapidly among all women over age 18 years, fertility levels among adolescents have not changed in decades. Although most adolescents in rural KZN were sexually active (60%), few had ever used contraception (200%). High HIV seroprevalence appears to explain a small part of the fertility decline (12%); however, this effect is likely to grow in the near future as the HIV/AIDS epidemic continues in South Africa. If the current trends continue in the future, below replacement fertility, together with high mortality due to AIDS, it could soon lead to negative natural population growth in rural South Africa.

Adolescent↗
PubMed2006

What interventions do South African qualified doctors think will retain them in rural hospitals of the Limpopo province of South Africa?

INTRODUCTION: In South Africa, the health system faces a variety of problems, such as an overall shortage of and misdistribution of healthcare workers. The Department of Health in South Africa has attempted to address the shortage of rural doctors by introducing various interventions, including an increase in salaries, introduction of scarce skills and rural allowances, the deployment of foreign doctors, and upgrading of clinics and hospitals. Despite these, the maldistribution of doctors working in South Africa has not improved significantly. This attests to the multifactorial nature of this problem and to the fact that intensive and sustained efforts are needed to rectify it. Few South African studies have been undertaken to establish the needs of rural doctors in South Africa and to seek possible solutions to their problems. While a number of studies have identified some of the major problems, much still needs to be done. Innovative ways to address this crisis are urgently needed. The main objectives of this study were to identify interventions as proposed by doctors in the rural Limpopo province of South Africa and to develop recommendations based on these. METHODS: This study utilised a descriptive qualitative design using a semi-structured questionnaire. Ten doctors from rural hospitals within all six districts of the Limpopo province were randomly selected and interviewed. RESULTS: Themes recommended included: increasing salaries and rural allowances; improving rural hospital accommodation; ensuring career progression; providing continuing medical education; increasing support by specialist consultants; improving the physical hospital infrastructure and rural referral systems; ensuring the availability of essential medical equipment and medicines; strengthening rural hospital management and increasing the role of doctors in management; improving the working conditions; establishing private-public collaborations with private general practitioners; increasing rural doctors' leave allocations; ensuring adequate senior support for junior doctors; improving rural hospital environments and providing recreational facilities; assisting rural doctors' families, and providing recognition and appreciation for the work rural doctors do. CONCLUSION: The resolution of one isolated factor without improving the host of push factors currently present in the health system is unlikely to lead to significant improvements in the retention of rural doctors. The results of this study can be used to assist the Limpopo Department of Health to identify the most pressing needs of rural doctors in the province. A number of interventions are suggested by rural doctors that they feel would retain them in their current rural practices. The recommendations include various interventions involving different levels of the healthcare system. It also recommends an incentive package for doctors willing to serve longer term in rural hospitals.

Adult↗
PubMedDate not supplied

The prevalence of microalbuminuria and ECG left ventricular hypertrophy in hypertensive patients in private practices in South Africa.

INTRODUCTION: In South Africa a cluster of cardiovascular diseases accounts for 17% of all deaths. It is also predicted that South Africa will face an epidemic of chronic kidney disease due to obesity, type 2 diabetes and hypertension. It is important to estimate the burden of underlying cardiovascular and renal disease in South Africa. OBJECTIVES: The primary objective of the study was to establish the prevalence of left ventricular hypertrophy by ECG criteria, and micro- and macroalbuminuria in mild, moderate and severe hypertensive groups. The secondary objective was to establish the prevalence of left ventricular hypertrophy and micro- and macroalbuminuria in hypertensive patients with underlying type 2 diabetes. METHODS: Patients > or = 35 years with essential hypertension with or without type 2 diabetes were recruited from 100 general practices throughout South Africa. BP, weight, height, waist circumference and urinary albumin/creatinine ratio were measured, and an ECG was performed. The Sokolow-Lyon and Cornell criteria were used for estimation of left ventricular hypertrophy. An overall prevalence rate was determined using weights from the severity category distribution inside the study population. RESULTS: One thousand and ninety-one patients were available for analysis. There were 530 (48.5%) males and 561 (51.5%) females, 691 (63.3%) whites, 162 (14.8%) blacks, 150 (13.7%) Asians and 88 (8.1%) Coloureds. Of the patients, 10.9% had newly diagnosed hypertension, 20% had type 2 diabetes, and 38.1% mild, 32.1% moderate and 30.6% severe hypertension. The prevalence of left ventricular hypertrophy in the sample weighted to the hypertensive population over the age of 35 years with access to medical aids was 18.9%. Relative to white ethnicity, black ethnicity (OR 2, p = 0.03), and relative to mild hypertension, moderate (OR 2.2, p = 0.05) and severe hypertension (OR 4.9, p < 0.0001) were independent predictors of left ventricular hypertrophy. The overall prevalence of micro- and macroalbuminuria in the weighted sample was 21.3 and 4.1%, respectively. In the diabetics the prevalence of microalbuminuria was 32.3% and macroalbuminuria 10.4%, respectively. The independent predictors of microalbuminuria or worse were severe hypertension (OR 2.9, p < 0.0001), type 2 diabetes (OR 2.5, p < 0.002), and Asian ethnic group (OR 2, p = 0.02). CONCLUSIONS: The study, based on a convenience sample of hypertensives from private practices in South Africa showed that the prevalence of left ventricular hypertrophy and microalbuminuria or worse was 18.9 and 25.4%, respectively.

Adult↗
PubMed1991

Spread in South Africa of the Oriental latrine fly Chrysomya megacephala. (Fabricius) (Diptera: Calliphoridae), an introduced species closely resembling Chrysomya bezziana Villeneuve.

Chrysomya megacephala, also known as the Oriental latrine fly, is indigenous to south-east Asia. During the 1970's it successfully invaded Africa and South America, and more recently during the 1980's also established itself in the United States of America. Although the first specimens from South Africa were collected from the south-western Cape Province in 1978, no published data appears to exist on its subsequent spread or status in southern Africa. During May 1991 a specimen of C. megacephala was incidentally captured near Beaufort West, Cape Province, South Africa, which prompted re-examination of blow-flies captured in the Kruger National Park during 1984. In this way it was found that C. megacephala was already well established in the south-eastern Transvaal by mid-1984. Adult C. megacephala can easily be confused with C. bezziana and medical/veterinary entomologists and veterinarians should take note of the existence of this species and the fact that it is probably widespread throughout southern Africa at this state.

Animals↗
PubMed1990

Malaria chemoprophylaxis among European tourists in tropical Africa: use, adverse reactions, and efficacy.

In order to determine knowledge, attitudes and practices towards malaria prophylaxis, as well as its side-effects and efficacy, a self-administered questionnaire was distributed to European travellers on return flights from tropical Africa to Europe. Between 1985 and 1988 the questionnaire was completed by 44,472 passengers (80.1% of those on board) on 242 flights. A follow-up questionnaire was completed by 42,202 (94.9%) of the same travellers 3 months later. Almost all knew about the risk of malaria, but 10% relied solely on advice from nonmedical sources. While 55.6% had taken at least one measure against mosquito bites, only 4.5% adopted three such measures (used repellents and insecticides and wore long clothing after dusk). Compliance with chemoprophylaxis use was reported by 57.0% of travellers who spent less than 3 months in Africa, compared with 29.2% who stayed 3-12 months. Depending on the antimalaria regimen taken, 11-44% of the travellers experienced adverse effects, while four deaths were attributed to the chemoprophylaxis. The incidence of malaria per month of exposure for travellers who took no chemoprophylaxis was 15.2 per 1000 in East Africa and 24.2 per 1000 in West Africa. In East Africa, the prophylactic efficacy of the currently recommended antimalaria regimens (relative to that of no chemoprophylaxis) was zero for a chloroquine dosage of 300 mg base per week (4 malaria fatalities), 64.1% for a chloroquine dosage of 600 mg base per week (P = 0.03), and 94.0% for mefloquine (P = 0.003).

Adult↗