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PubMed2004

The political environment of HIV: lessons from a comparison of Uganda and South Africa.

Considerable interest has arisen in the role of governance or political commitment in determining the success or failure of HIV/AIDS policies in sub-Saharan Africa. During the 1990s, Uganda and South Africa both faced dramatic HIV/AIDS epidemics and also saw transformations to new political systems. However, their responses to the disease differed in many ways. This paper compares and contrasts the ways in which policy environments, particularly government structures, can impede or expedite implementation of effective HIV prevention. Four elements of these environments are discussed--the role of political leadership, the existing bureaucratic system, the health care infrastructure, and the roles assigned to non-state actors. Two common international strategies for HIV prevention, syndromic management of sexually transmitted infections and sexual behaviour change interventions, are examined in relation to these elements in Uganda and South Africa during the mid-to-late 1990s. During this period, Uganda's political system succeeded in promoting behaviour change interventions, while South Africa was more successful in syndromic management efforts. Interactions between the four elements of the policy environment were found to be conducive to such results. These elements are relatively static features of the socio-political environments, so lessons can be drawn for current HIV/AIDS policy, both in these two countries and for a wider audience addressing the epidemic.

Cross-Cultural Comparison↗
PubMed2003

Differences in extent of genetic introgression between sympatric Culex pipiens and Culex quinquefasciatus (Diptera: Culicidae) in California and South Africa.

Comparisons of five morphological characters, 12 enzyme electrophoresis profiles, and Wolbachia pipientis infection rates were used to characterize populations of members of the Culex pipiens L. complex in California and South Africa. In South Africa, male phallosome DV/D ratio, male maxillary palp index, branching of siphonal seta 1a, the enzyme locus Mdhp-1, and W. pipientis infection rates proved highly diagnostic for separating Culex quinquefasciatus from Cx. pipiens phenotypes. In Johannesburg, where sympatric members of the Cx. pipiens complex were analyzed as one population, a significant Wahlund Effect was observed in the enzyme loci such as Ao, 6-Pgdh, Mdh-2, and Pgm. In California, all populations of the Cx. pipiens complex were in Hardy Weinberg equilibrium at all polymorphic enzyme loci examined. Additionally, in California, all populations had similar W. pipientis infection rates and appeared morphologically identical (except for DV/D ratio, in extreme north and south). These findings indicate that in South Africa, Cx. pipiens and Cx. quinquefasciatus remain as genetically distinct populations and behave as separate species. Conversely, in California, there is considerable genetic introgression between Cx. pipiens and Cx. quinquefasciatus, and they behave as a single species.

Animals↗
PubMed1986

The significance of secondary school education for education and training of nurses in South Africa.

This paper examines current basic nursing education in South Africa and suggests that problems in the secondary school education of Black recruits affect their later training potential as professional nurses. It reports the move towards the transfer of nurse training into higher education from 1986 in South Africa. Black nurses' learning and studying difficulties are considered in the light of their high failure rate in the South African Nursing Council qualifying examinations. It is agreed that in order to prepare the high number of qualified Black nurses required by South Africa within the tertiary education sector from 1986, special attention would need to be paid to secondary education provision for Blacks.

Black or African American↗
PubMed1996

The illegal alien question in South Africa: scope, issues and policy.

"Of the many problems facing South Africa, perhaps one of the most important is that of the illegal alien. The scope, issues and policy implications of the illegal alien problem are examined. Different geographical streams of alien immigration are identified and profiled. Official policy responses are reviewed. The pressures for action to be taken against the rising numbers of illegal aliens in South Africa are discussed. In particular, the cost implications of illegal aliens capturing scarce resources and employment opportunities are set against other pressing demands encapsulated in the Reconstruction and Development Programme."

Africa↗
PubMed1990

Implications of differential urbanization on deconcentration in the Pretoria-Witwatersrand-Vaal Triangle metropolitan area, South Africa.

Population migration and differences in urbanization patterns in South Africa are examined. "Indications are that the Blacks--a low-income group--are increasing proportionally, while the Whites--the highest-income group--are diminishing proportionally in the inner core zone of the Pretoria-Witwatersrand-Vaal Triangle metropolitan area (PWV), and vice versa in the other zones.... Study results presented in this paper reiterate [inadequacies of government policies] and stress the need for changes in the present official spatial policy for the PWV."

Africa↗
PubMed1997

Emergent migration policy in a democratic South Africa.

This article sets recent debates on migration policy in South Africa against broader historical realities that have shaped patterns of population movement on the subcontinent since the end of the nineteenth century. During the course of the last century, most forms of population movement were the result of disjointed regional economic development which can be traced to two epochal events at the end of the nineteenth century: the creation of the modern African state system and the discovery of mineral wealth in Southern Africa. Although regulation of migrant labor was a fundamental feature of the colonial period, it was only after 1950, when independent states began to define specific migration priorities, that states began to restrict significantly the flow of transnational labor. From this point notions such as internally displaced person, refugee and illegal immigrant become increasingly appropriate to the study of regional migration. Particular attention is given to current debate on the definition of refugee which forms part of a broader international debate. A number of South African writers have argued that, given the structural imbalances contained in the regional economy, the term "refugee" should be redefined to included economic migrants. This position is not shared by the South African Government, and an analysis of current policy and legislation demonstrates a growing tendency to restrict the influx of undocumented migrants. This is due, in part, to the recent political transition and the institutional compromises that it produced as well as the growth of negative sentiment towards illegal immigrants at both mass and elite levels, as demonstrated by two recent research findings. The article concludes with a summation of recent trends in South African migration policy and an evaluation of the ambiguous position that South Africa occupies within Southern Africa.

Africa↗
PubMed1997

Nutrition surveillance and intervention, South Africa.

Under the apartheid regime there was no national framework for development in South Africa. Now, for the first time in South Africa, the government of national unity has provided a framework for development. This is a people-centered development strategy that calls for intersectoral collaboration and a vision for community involvement. Within this framework, the Department of Health has developed an integrated nutrition program with a health-based component and a community-based aspect. There is now a movement towards community-based program and nutrition surveillance. Although it is still early, there are some lessons that can be learned from these programs: growth monitoring can be used to promote community-based surveillance and to provide information upon which the communities can act; training, supervision, and information dissemination is essential, and it is also important to identify indicators to monitor success; building on existing infrastructure and capabilities within communities and linking up with NGOs and other organizations who have long-standing relationships with the communities is essential; identifying and capitalizing on indigenous resources and capabilities within countries is important; and there has to be political commitment.

Africa↗
PubMed1996

Sexually transmitted diseases in South Africa.

AIM: To review the epidemiology of and data collection for sexually transmitted diseases (STDs) in South Africa. METHODS: Literature published since 1980 on STDs in South Africa were complied and evaluated. Historical reports and salient unpublished literature were also used in the literature review. Studies were critically reviewed in the light of sample populations and study methods, and a baseline picture of the patterns of STD burden was developed. RESULTS: The STD burden in apparently asymptomatic study populations is significant. Ulcerative infections, primarily caused by syphilis and chancroid, are present in 5-15% of asymptomatic clinic attenders; prevalence rates of gonorrhoea average 8%, with up to 13% of gonococcal isolates resistant to penicillin antibiotics. In addition, on average, chlamydia and vaginal infections are detected in 16% and 20-49%, respectively, of antenatal and family planning clinic attenders. HIV seroprevalence rates have reached 7.6% in antenatal clinic attenders. Most South African STD data are derived from ad hoc surveys which have traditionally focused only on several major infections and particular urban centres. Almost all STD studies have been facility-based, with many studies based at STD clinics, thus reporting only relative frequencies and not population-based prevalences of STDs. With the possible exception of HIV, systematic surveillance data for STDs are conspicuously lacking. CONCLUSION: The disease burden of classic sexually transmitted infections has historically been heavy, and continues to be a serious public health problem in South Africa. Morbidity from both ulcerative and non-ulcerative infections, particularly in women, is significant. The body of STD data, although mostly sound, remains incomplete, and with the rapid emergence of HIV in South Africa, surveillance of STDs and focused STD policies will be critical.

Chancroid↗
PubMed1998

Review of tsetse flies and trypanosomosis in South Africa.

The history of tsetse flies and nagana (trypanosomosis) in South Africa, and especially in Zululand, is reviewed. Four valid tsetse fly species have been recorded from South Africa. Glossina morsitans morsitans disappeared from the most northerly parts of South Africa during the rinderpest epizootic between 1896-1897. Of the three remaining species that occurred in Zululand, now part of KwaZuluNatal Province, G. pallidipes was the most common vector of nagana in cattle, but was eradicated from this area in 1954. G. brevipalpis and G. austeni remained but were responsible for only a few sporadic cases of nagana up until 1990. A widespread outbreak occurred in 1990 where cattle served by 61 diptanks were found infected with Trypanosoma congolense and T. vivax. Dipping of cattle in a pyrethroid plus the therapeutic treatment of infected animals brought the disease under control. The outbreak also led to a trial to control G. brevipalpis from the most northerly parts of the Hluhluwe/Umfolozi Game Reserve making use of target technology as for savannah species. The results were not satisfactory and the trial was discontinued until further research could provide a more appropriate system for the control of this species. A Tsetse Research Station was established at Hellsgate near St. Lucia Lake where research on G. brevipalpis and G. austeni is conducted into ways and means of monitoring and controlling these species.

Animals↗
PubMed2006

Improving street food vending in South Africa: achievements and lessons learned.

Until the late 1990s there were limited scientific data on the microbiological quality and safety of street-vended foods in South Africa, while information was already available in other developing countries, including those within the African region. At that time street-vended foods were perceived as unsafe and street food vending in South Africa was regarded as a practice, which should be outlawed. The first comprehensively documented scientific research into the safety of street-vended foods in South Africa was carried out through university-based research. This research found that street food vendors in South Africa were capable of producing relatively safe foods, with low bacterial counts, although there was still a need for proper hygiene conditions and access to basic sanitary facilities. The Department of Health of South Africa, when coordinating an FAO Technical Cooperation Programme (TCP) project on Improving Street Foods in South Africa, drew similar conclusions. This article provides information of the efforts by universities and health authorities in South Africa towards improving the safety and promoting the sale of street-vended foods. It is shown that a successful transition from street food vending being perceived as a nuisance by health authorities can be made to these authorities promoting and improving street food vending instead.

Commerce↗
PubMed2005

Racial differences in public perceptions of voluntariness of medical research participants in South Africa.

The reign of apartheid in South Africa was characterized by systematic violation of the human rights of the Black population. Ruling institutions of the country perpetuated and enforced such violations. Consequently, Black South Africans may be apprehensive of scientific research in which the Black population is targeted for participants, regardless of the reason for their being selected. This exploratory study aims to (1) contribute to the relatively limited body of empirical research on the concept of voluntariness and (2) assess racial differences in public perceptions of the voluntariness of medical research participants. We sampled 111 employees from two companies. The sample consisted of 39 Black, 37 Indian, and 38 White participants. A structured questionnaire was used to interview respondents. Results showed that Black respondents scored significantly lower on scores of perceived voluntariness than both Indian and White respondents. These racial differences in perceptions of voluntariness were found to be independent of level of education, knowledge of medical research procedures, and close or personal experience of medical research. Perceptions of voluntariness did not however appear to impact on participants' personal willingness to participate in future research. Implications for recruitment of future health research participants in South Africa are discussed.

Adult↗
PubMed1998

Risk of malaria in visitors to the Kruger National Park, South Africa.

BACKGROUND: The risk of malaria to visitors to South Africa's nature reserves is unknown. Current recommendations for travelers are based on malaria incidence rates in local communities. These rates may well overestimate travelers' malaria risk and lead to unnecessary use of antimalarial prophylaxis with associated drug-related adverse events. This study investigated the incidence of malaria in visitors to South Africa's Kruger National Park (KNP). METHODS: Postal questionnaires were sent to the cohort of visitors staying in the KNP during April 1996, 6 to 8 weeks after they returned to their homes. Nonrespondents received duplicate questionnaires 8 weeks later. Responses from 3267 groups, representing 11,107 visitors (56. 8%) allowed determination of the malaria attack rate in this group of travelers and assessment of associations between malaria risk and a number of factors, including type of accommodation used during the visit; duration of stay; use of chemoprophylaxis; and use of personal protection measures. All travelers indicating that they had suffered an episode of malaria following their visit were telephonically contacted and their health providers traced to determine the basis of diagnosis and clinical outcome. RESULTS: One clinically suspected and four confirmed cases of Plasmodium falciparum malaria among the visitors suggest a low attack rate of 4. 5 cases per 10,000 visitors during April, the highest risk month for malaria in South Africa. No association was found between malaria risk and accommodation type, duration of stay, use and type of chemoprophylaxis, and use and number of personal protection measures. CONCLUSIONS: These findings confirm the importance of careful assessment of local malaria risk before individualized advice is provided to travelers.

Adult↗
PubMed2003

Agricultural chemical exposures and birth defects in the Eastern Cape Province, South Africa: a case-control study.

BACKGROUND: South Africa is one of the major users of pesticides on the African continent. The Eastern Cape is the second largest province in South Africa. There has been growing concern about the occurrence of certain birth defects which seemed to have increased in the past few years. In this paper we investigate associations between exposure to agricultural chemicals and certain birth defects. Few such studies have been undertaken in the developing world previously. METHODS: Between September 2000 and March 2001 a case - control study was conducted among rural women in the area of the Eastern cape to investigate the association between women's exposure to pesticides and the occurrence of birth defects. Information on birth defects was obtained from the register of the Paediatrics Department at the Cecilia Makiwane Hospital in Mdantsane, one of the largest referral hospitals in the province. The cases were children who were diagnosed with selected birth defects. The controls were children born in the same areas as the cases. Exposure information on the mothers was obtained by interview concerning from their activities in gardens and fields. Data were analysed using conditional logistic regression. RESULTS: A total of 89 case mothers and 178 control mothers was interviewed. Babies with birth defects were seven times more likely to be born to women exposed to chemicals used in gardens and fields compared to no reported exposure (Odds Ratio 7.18, 95% CI 3.99, 13.25); and were almost twice as likely to be born to women who were involved in dipping livestock used to prevent ticks (OR 1.92, 95% CI 1.15, 3.14). They were also 6.5 times more likely to be born to women who were using plastic containers for fetching water (OR 6.5, 95% CI 2.2, 27.9). Some of these containers had previously contained pesticides (OR 1.87, 95% CI 1.06, 3.31). CONCLUSIONS: These findings suggest a link between exposure to pesticides and certain birth defects among the children of rural South African women who work on the land. Education programmes for women alerting them to the dangers to their babies from the use of pesticides and alternative farming methods and elimination of the reuse of pesticide containers are indicated as preventive measures.

Abnormalities, Drug-Induced↗
PubMed1989

Analysis of available measures for malaria control in Africa south of the Sahara.

Africa south of the Sahara is not homogeneous and presents several extreme conditions where malaria persistence is ensured by a complex and highly adaptable vector system. Plasmodium falciparum is the most widespread and life threatening of the malaria parasites of man, particularly for young children and pregnant women. Large-scale residual spraying was not totally effective and was very costly, and mass chemoprophylaxis was not feasible. The spread of chloroquine resistance added arguments against uncontrolled use of drugs. Chemoprophylaxis is now recommended only for pregnant women, especially in their first pregnancy, whilst chloroquine 25 mg base/kg over 3 days is recommended for curative treatment in villages. Second line treatment regimens should be available, together with the possibility of referring severe malaria cases quickly to appropriate clinical facilities. Other control measures include self-protection against mosquito bites by bednets (especially those impregnated with synthetic pyrethroids), mosquito coils, repellents, window and door screening; other measures to prevent man-mosquito contact, such as careful siting of settlements and zooprophylaxis; anti-larval measures, i.e. source reduction, protection of wells and water reservoirs, larviciding, introduction of larvivorous fish; and sprays against adult mosquitoes. The elaboration of strategies for control and their application requires a study of the existing situation. A core of specialists is required in each country, to help with decentralized planning and evaluation of malaria control and to ensure quality control of services, training and applied field research. Additional measures may become available in the future, especially anti-malaria vaccines, and countries should be ready to study their application.

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↗
PubMed1998

Epidemiology of African horse sickness and the role of the zebra in South Africa.

Zebra are the only equine species native to South Africa. These animals roamed over much of the country in the 17th century when horses and donkeys were first imported. The first cases of African horse sickness (AHS) then occurred in the horses of hunters who entered zebra territory. AHS continued to occur on a country-wide basis until the beginning of the 20th century, though the number of outbreaks decreased as the populations of zebra collapsed through overhunting. For most of the 20th century almost all free-living zebra have been confined to the north-eastern parts of South Africa which are now the only areas in the country where AHS is endemic; though when climatic conditions are favourable, temporarily, it spreads beyond these areas. The minimum size of a zebra population necessary to maintain a focus of AHS virus is unknown but the small, isolated populations that have inhabited the majority of South Africa for most of the 20th century are apparently insufficient to maintain the virus in the long term. In this context, the restocking of many parts of the country with zebra should be viewed with caution since conditions may be generated that will facilitate the re-establishment of permanent foci of AHS virus.

African Horse Sickness↗
PubMed1998

The UDHR and The Limits of Medical Ethics: The Case of South Africa.

The leadership of South Africa's medical profession remained silent in the face of gross human rights violations by the apartheid government or affirmatively defended the government's conduct. While there were strong cultural and economic reasons for this alliance between leaders of the medical profession and the apartheid state, the leadership also embraced western medical ethics. As a result, when confronted about its conduct, it continually sought to defend its behavior on traditional ethical grounds. This article looks at the nature of that "ethical defense" in three areas, torture in detention, racial discrimination in health services, and breach of confidentiality in the case of political activists. The article concludes that the rules of medical ethics left too great a space for making such a defense and urges that ethical rules consistent with the Universal Declaration of Human Rights be adopted.

Journal Article↗
PubMed1999

The 'dop' system, alcohol abuse and social control amongst farm workers in South Africa: a public health challenge.

Many farm workers in South Africa continue to live and work under adverse conditions that are the legacy of apartheid policies. Despite its official prohibition, the arrangement by which workers are given alcohol' as a benefit of employment, known as the 'dop' system, appears to persist. Even though it is a minority of farms that currently actively practice the dop system, the ramifications of the historical 'institutionalisation of massive alcohol consumption are widespread. Heavy alcohol consumption is not only directly injurious to the health of farm workers and their families, but places them at risk to various social and environmental hazards. This is illustrated in a case of pesticide poisoning in which 24 workers were poisoned when given wine contaminated with the carbamate insecticide aldicarb. The case illustrates (i) the ongoing application of the dop system on farms in South Africa and (ii) the interaction between social factors and chemical exposures amongst farm workers. Public perceptions about the natural tendencies of 'coloured' people to drink heavily have much to do with perpetuating the dop system, and reinforcing a system geared towards the social control of rural farm workers and their families. The dop system poses a major challenge to the public health authorities in South Africa who are charged with the task of restructuring health services to address the human rights and health needs of marginal farming communities within a primary health care framework.

Agriculture↗