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PubMed2003

Ancestor reverence and mental health in South Africa.

The great majority of South Africa's people consult traditional healers. The deeper meaning of much traditional healing centres on ancestor reverence. This belief system and its accompanying rituals may positively influence the mental health of the individual and the community. Among traditional Xhosa-speaking peoples, the relationship with the ancestors is given expression in life cycle rituals that have much in common with Western psychotherapeutic principles and practices. The common thread that underpins many rituals is that of making links via concrete, literal means. Examples include the participation of the community in the healing of the individual; the linking of body and mind through dancing and drumming. Dreams form an essential connection between conscious life and the unconscious. Understanding the psychological depth of these practices is important so that a respectful relationship between Western-trained professionals and traditional healers can develop. Analytical psychology, with its notion of the collective unconscious has a particular contribution to make to cross-cultural understanding. The ancestors may be understood as archetypal representations of the collective unconscious.

Culture↗
PubMed2005

Factors that could motivate people to adopt safe hygienic practices in the Eastern Cape Province, South Africa.

BACKGROUND: Approximately 18 million South Africans do not have access to adequate sanitation. This problem is not unique to South Africa but is a challenge to many developing countries. OBJECTIVES: The purpose of this qualitative study was to gain insight and understanding of factors that could motivate people to adopt safe hygienic practices. METHODS: A non-probability purposive sample of 122 participants was drawn from sanitation stakeholder organisations in the Eastern Cape Province. Of these, 74 were male and 48 were female. The mean age of the participants was 40.1 years. The 122 participants were divided into 15 focus groups, each consisting of about eight members. The focus group discussions were conducted using seven guiding questions. Responses were examined and clustered in terms of the primary focus group questions. RESULTS: Regular water supply, provision of sanitation facilities, stakeholder participation and improvement of consumer sanitation knowledge are factors which can motivate people to adopt safe hygienic practices. CONCLUSIONS: There are cultural, educational, economic, institutional, environmental and psycho-social factors that could motivate people to adopt safe hygienic practices.

Adult↗
PubMed2000

Middle and Later Stone Age large mammal and tortoise remains from Die Kelders Cave 1, Western Cape Province, South Africa.

Die Kelders Cave 1, South Africa, has provided more than 150,000 taxonomically identifiable mammal and tortoise bones from Middle Stone Age (MSA) and Later Stone Age (LSA) deposits. Cape dune mole-rats dominate the mammal sample, and they appear to have been accumulated mainly by people during the LSA occupation and mainly by eagle owls in the MSA. In sharp contrast to the LSA fauna, the MSA sample contains extralimital ungulates that imply relatively moist, grassy conditions. The large mean size of the MSA mole-rats also points to greater humidity, while the large size of the gray mongooses implies cooler temperatures. The sum supports luminescence and ESR dates that place the MSA occupation within the early part of the Last Glaciation (global isotope stage 4). The Die Kelders ungulate bones support those from Klasies River Mouth in suggesting that MSA people obtained dangerous terrestrial prey much less frequently than their LSA successors, probably because MSA people lacked the bow and arrow and other projectile weapons. The Die Kelders tortoise bones constrain the extent of climatic change, since their abundance indicates that warm, dry days remained common, at least seasonally. The tortoises tend to be much larger in the MSA layers than in the LSA ones, suggesting that MSA people collected tortoises less intensively, probably because MSA populations were relatively sparse.

Animals↗
PubMed2005

Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa.

This paper describes the South Africa component of a World Health Organization multi-site rapid assessment and response project seeking to develop a methodology for studying factors associated with alcohol use-related sexual risk behaviour in diverse cultural settings. This report focuses on the qualitative assessments that were conducted in order to profile alcohol use and sexual behaviour in the communities concerned, ascertain the relationships between alcohol use and sexual behaviour, and develop a conceptual model of the relationships between alcohol use and sexual risk behaviour. The participants consisted of adults aged between 25 and 44 years in a township and city site in Gauteng province. The assessments involved conducting 18 key informant interviews, observations in seven drinking venues, six focus groups and 16 in-depth interviews of 'risky drinkers' and their partners. Most participants felt that there were high levels of alcohol consumption and unprotected sex among some members of their communities, with the latter occurring mainly among casual sexual partners. The findings also pointed to strong links between alcohol consumption and sexual risk behaviour. A conceptual model of the association between alcohol use and risky sexual behaviour is proposed. This study suggests a need for multi-faceted HIV intervention strategies for reducing levels of alcohol abuse in general, and enhancing protective sexual behaviours among alcohol-using populations.

Adult↗
PubMed2003

Challenges in saving babies--avoidable factors, missed opportunities and substandard care in perinatal deaths in South Africa.

OBJECTIVE: To identify the most common avoidable factors, missed opportunities and substandard care in perinatal care in South Africa. SETTING: Seventy-three state hospitals throughout South Africa representing metropolitan areas, cities and towns, and rural areas. METHOD: Users of the Perinatal Problem Identification Programme (PPIP) amalgamated their data to provide descriptive information on the causes of perinatal death and the avoidable factors, missed opportunities and substandard care in South Africa. RESULTS: A total of 8,085 perinatal deaths among babies weighing 1,000 g or more were reported from 232,718 births at the PPIP sentinel sites. Avoidable factors, missed opportunities and substandard care were reported to be patient-related (between 31.5% and 47.5% of deaths), due to administrative problems (between 10.1% and 31.1% of deaths), and due to health worker-related problems (between 28.4% and 36.0% of deaths) in the metropolitan and rural areas respectively. Figures for cities and towns lay between these ranges. Deaths due to intrapartum asphyxia and birth trauma were thought to be clearly preventable within the health system in 63.1%, 34.4% and 35.7% of cases in the metropolitan areas, cities and towns, and rural areas respectively. Deaths due to hypertension and antepartum haemorrhage were thought to be clearly preventable within the health system in 18.7%, 15.4% and 20.0% of cases in the metropolitan areas, cities and towns, and rural areas respectively. Far fewer preventable deaths were recorded in the spontaneous preterm labour category. CONCLUSION: Concentration on the remediable priority problems identified (namely labour management, resuscitation of the asphyxiated neonate, and care of the premature neonate) makes the reduction of perinatal mortality in South Africa feasible and inexpensive.

Asphyxia Neonatorum↗
PubMed2005

Why are women still aborting outside designated facilities in metropolitan South Africa?

OBJECTIVE: To explore why South African women still abort outside designated services where there is substantial legal service provision. DESIGN: Descriptive study. SETTING: Three hospitals in Gauteng Province in South Africa. Sample Forty-six women attending hospital with incomplete abortion who had abortions induced outside of designated facilities. METHODS: An interviewer-administered questionnaire with open and closed questions was completed. Induction status was determined from answers to a set of closed questions. Open-ended questions explored the circumstances of induction. Main focus of interviews Methods of induction used, barriers to legal service use. RESULTS: Nearly two-thirds of women (n= 38) had self-induced or had consulted a traditional healer. A minority of these women (n= 11) indicated that they did this because they experienced barriers to legal service use. For others it was presented as a 'natural' response to a health problem (unwanted pregnancy). Several women (n= 10) were given misoprostol by a doctor, nurse, or pharmacist. Fifty-four percent of the women had not used legal services because they did not know about the law, while 15% knew of their legal rights, but did not know of a legal facility. Others did know where to access legal services but feared rude staff (17%) or breaches of confidentiality (6.5%). Others (6.5%) had been unable to get a legal abortion early enough in pregnancy to comply with the law. CONCLUSIONS: Lack of information on abortion rights under the Act and perceived poor quality of designated facilities were the most important barriers to access and should be addressed by policymakers and health service management. The willingness of women to self-medicate and visit traditional healers in these circumstances may influence the overall ability of the new legislation to reduce abortion morbidity.

Abortifacient Agents↗
PubMed2002

Leprosy in Mpumalanga Province, South Africa--eliminated or hidden?

In South Africa, leprosy has been a notifiable condition since 1921. Although the WHO elimination target of less than one case per 10,000 population has been achieved at country level, the distribution of leprosy in the country is distinctly heterogeneous, with a prominent 'leprosy belt' of greater prevalence stretching across Mpumalanga Province into northern Kwa-Zulu Natal. The highest prevalence in this 'belt' has historically been in Ermelo District. Recent trends of few newly detected leprosy patients in this district raised concerns that health system changes may have resulted in failure to detect leprosy cases. Thus a large-scale community awareness campaign was conducted followed by an intensively advertised screening programme of 3-month duration at schools and central gathering points in villages and farms from 1 June to 31 August 2000. One thousand one hundred and seventy-seven people presented for clinical screening at designated points, while 790 scholars were screened at schools and an additional 1433 people were screened at their homes by the field team. Forty-four people with skin or nervous system lesions compatible with leprosy were referred for specialized assessment and biopsy where indicated. Four new leprosy patients were diagnosed, including an elderly lady with pronounced disability. Two of these patients had prior contact with the health service due to dermatological manifestations of leprosy without diagnosis being made. All patients provided a history of close prolonged contact with known leprosy patients. Ongoing intense tracing and follow-up of close contacts of proven leprosy cases may be a more efficient method of detecting leprosy cases in areas with relatively stable populations that have accomplished 'leprosy elimination', than resource intensive community surveys.

Adult↗
PubMed2005

Paradoxical helminthiasis and giardiasis in Cape Town, South Africa: epidemiology and control.

BACKGROUND: South Africa has endorsed a World Health Assembly (WHA) resolution calling for control of soil-transmitted helminths (STHs). In Cape Town, services and housing that exist in old-established suburbs should minimise the prevalence of intestinal parasitic infections, even when residents are poor. Where families live in shacks in densely-populated areas without effective sanitation, more than 90% of children can be infected by STHs. The humoral immune response to worms theoretically favours infection by Mycobacterium tuberculosis and HIV. OBJECTIVES: Obtain estimates of gender-, age-, school-related and overall prevalence of helminthiasis and giardiasis in a low-income but well-serviced community. Assess possible sources of infection. Alert health services to the need for control measures and the threat from protozoal pathogens. Warn that the immune response to intestinal parasites may favour tuberculosis (TB) and HIV/AIDS. METHODS: A cross-sectional study of the prevalence of helminthiasis and giardiasis was carried out in a large, non-selective sample of children attending nine schools. Gender, school and age effects were related to non-medical preventive services, sewage disposal practices and possible sources of infection. RESULTS: The overall STH infestation rate was 55.8%. Prevalence was inluenced by school and age but not by gender. Eggs and cysts were seen at the following prevalence: Ascaris 24.8%; Trichuris 50.6%; Hymenolepis nana 2.2%; Enterobius 0.6%; Giardia 17.3%; hookworm 0.08%; and Trichostrongylus 0.1%. Approximately 60% of sewage sludge is used in a form that will contain viable eggs and cysts. CONCLUSION: Prevalence trends in this old community in Cape Town could indicate infection by swallowing eggs or cysts on food or in water, more than by exposure to polluted soil. Sewage sludge and effluent might be sources of infection. In adjacent, under serviced, newer communities, promiscuous defecation occurs. Probable vectors are discussed. The immune response to intestinal parasites might be a risk factor for HIV/AIDS and TB.

Adolescent↗
PubMed2005

Paradoxical helminthiasis and giardiasis in Cape Town, South Africa: epidemiology and control.

BACKGROUND: South Africa has endorsed a World Health Assembly (WHA) resolution calling for control of soil-transmitted helminths (STHs). In Cape Town, services and housing that exist in old-established suburbs should minimise the prevalence of intestinal parasitic infections, even when residents are poor. Where families live in shacks in densely-populated areas without effective sanitation, more than 90% of children can be infected by STHs. The humoral immune response to worms theoretically favours infection by Mycobacterium tuberculosis and HIV. OBJECTIVES: Obtain estimates of gender-, age-, school-related and overall prevalence of helminthiasis and giardiasis in a low-income but well-serviced community. Assess possible sources of infection. Alert health services to the need for control measures and the threat from protozoal pathogens. Warn that the immune response to intestinal parasites may favour tuberculosis (TB) and HIV/AIDS. METHODS: A cross-sectional study of the prevalence of helminthiasis and giardiasis was carried out in a large, non-selective sample of children attending nine schools. Gender, school and age effects were related to non-medical preventive services, sewage disposal practices and possible sources of infection. RESULTS: The overall STH infestation rate was 55.8%. Prevalence was influenced by school and age but not by gender. Eggs and cysts were seen at the following prevalences: Ascaris 24.8%; Trichuris 50.6%; Hymenolepis nana 2.2%; Enterobius 0.6%; Giardia 17.3%; hookworm 0.08%; and Trichostrongylus 0.1%. Approximately 60% of sewage sludge is used in a form that will contain viable eggs and cysts. CONCLUSIONS: Prevalence trends in this old community in Cape Town could indicate infection by swallowing eggs or cysts on food or in water, more than by exposure to polluted soil. Sewage sludge and effluent might be sources of infection. In adjacent, under-serviced, newer communities, promiscuous defaecation occurs. Probable vectors are discussed. The immune response to intestinal parasites might be a risk factor for HIV/AIDS and TB.

Adolescent↗
PubMed1997

Women's health status and use of health services in a rapidly growing peri-urban area of South Africa.

Women's health in South Africa and particularly women living in peri-urban areas is being influenced by three major factors. These include the political transition that is occurring in the country, urbanization and the international interest in women's health. Changes in the delivery of health care to the population, and in particular to women are being planned. It is therefore important that data are available for the purpose of planning and evaluation of health services. This paper describes a household survey in which 661 women were interviewed. Socio-demographic patterns of women living in a rapidly urbanizing area were determined and related to health status, use of health services and knowledge of the services. Poverty appeared to be an overriding factor affecting the health of the population. One third of the women were living in unserviced shacks. There was a high rate of unemployment and those who were employed worked in low status jobs and earned very little. Rates of reported acute and chronic illness were lower than described elsewhere in similar household interview surveys. A third of the acute illnesses were due to respiratory disease. Reported rates of diabetes and hypertension were low indicating undiagnosed disease in the area. Being a member of an alliance household-a mixture of family, friends and lodgers-was the main predictor of acute illness. For chronic disease, age and increasing educational status were the main predictors. Knowledge of services apart from those for cervical cancer screening was good. The latter improved with increasing education, urbanization and being a member of an alliance household. As many of the women lived in unserviced areas and had little or no income the provision of infrastructural services and development programs are essential if their health is to be improved. The existing health services need to be developed to provide a comprehensive primary care service with special attention being paid to the health of women. The service should be close to their homes and be affordable. The information gathered in this survey will be used to plan services for women in the area and will act as baseline data for evaluation.

Acute Disease↗
PubMed2003

Polymorphisms and mutations found in the regions flanking exons 5 to 8 of the TP53 gene in a population at high risk for esophageal cancer in South Africa.

A previous study in esophageal cancer (EC) patients from South Africa showed that 17% of tumors contained somatic mutations, including small deletions, insertions, and point mutations, resulting in frameshifts or amino acid changes in exons 5-8 of the TP53 gene. In the present study, polymerase chain reaction single-strand conformation polymorphism and DNA sequence analysis were used to search for sequence variation in the regions flanking exons 5-8 in a series of 74 primary human esophageal squamous cell carcinomas (ESCC). DNA from blood from 37 of the same EC patients and 118 blood samples from the same ethnic group, originating from the Transkei region of South Africa, a high-risk area for EC, served as controls. Mutations were rarely found in the regions flanking exons 5-8, but polymorphisms were frequent. Two mutations (G-->A, codon 331; G-->T, donor splice site) were found in the exon 9 region, while four polymorphisms occurred in intron 3 (16 bp duplication) and exon 4 (C-->A, codon 34; G-->C, codon 36; G-->C, codon 72) regions. Loss of heterozygosity occurred for the 16 bp polymorphism in the EC patients, but not in the controls. Certain genotypes were common in the EC group while others were common in the control group. Graphic representation illustrates the various mutations/polymorphisms found in the TP53 gene in samples from EC patients from South Africa. The results indicate that various small deletions and insertions occur at direct repeat sequences and can be explained by slipped mispairing. The point mutations include the polymorphism in codon 72 (Arg-->Pro), which has recently been associated with an increased risk of developing human papilloma virus-associated cancers.

Black People↗
PubMed2003

HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa.

OBJECTIVES: A cornerstone of HIV prevention in South Africa is voluntary HIV antibody counselling and testing (VCT), but only one in five South Africans aware of VCT have been tested. This study examined the relation between HIV testing history, attitudes towards testing, and AIDS stigmas. METHODS: Men (n = 224) and women (n = 276) living in a black township in Cape Town completed venue intercept surveys; 98% were black, 74% age 35 or younger. RESULTS: 47% of participants had been tested for HIV. Risks for exposure to HIV were high and comparable among people tested and not tested. Comparisons on attitudes toward VCT, controlling for demographics and survey venue, showed that individuals who had not been tested for HIV and those tested but who did not know their results held significantly more negative testing attitudes than individuals who were tested, particularly people who knew their test results. Compared to people who had been tested, individuals who were not tested for HIV demonstrated significantly greater AIDS related stigmas; ascribing greater shame, guilt, and social disapproval to people living with HIV. Knowing test results among those tested was not related to stigmatising beliefs. CONCLUSIONS: Efforts to promote VCT in South Africa require education about the benefits of testing and, perhaps more important, reductions in stigmatising attitudes towards people living with AIDS. Structural and social marketing interventions that aim to reduce AIDS stigmas will probably decrease resistance to seeking VCT.

Adult↗
PubMed1991

Notes on the demography of black Africans in South Africa in the early 1980s.

The demography of the black population of South Africa is analyzed and compared with that of blacks in the rest of Sub-Saharan Africa, using data from official sources. "The article is organized into four sections. First, it surveys what is known about mortality and fertility (and family planning). Then it turns to the issue of the population's size, past growth and projected future growth. Finally, the article takes a bold leap into the morass of population distribution, involving forays into migration and urbanization." It is found that "black Africans in South Africa are demographically quite similar to other sub-Saharan populations."

Africa↗
PubMed2004

Gangrenous ergotism in cattle grazing fescue (Festuca elatior L.) in South Africa.

The 1st outbreak of fescue toxicosis in South Africa was recently confirmed in a Brahman herd at Perdekop, near Standerton, in Mpumalanga province, South Africa. Within 3 weeks of being placed on a fescue pasture in mid-winter, 50 of 385 cattle developed lameness and/or necrosis of the tail. The farmer had established Festuca elatior L. (tall fescue, Iewag variety) on c. 140 ha for winter grazing. Fescue may be infected by an endophyte, Neotyphodium coenophialum, which produces ergot alkaloids, in particular ergovaline. Ergovaline concentrations in basal leaf sheaths and grass stems collected during the outbreak ranged from 1720-8170 ppb on a dry-matter basis.

Animals↗
PubMed1999

Small fish in a big pond? External aid and the health sector in South Africa.

Since a new government was elected in 1994, South Africa has become a favoured nation for the many bilateral and multi-lateral agencies providing aid to developing countries. Despite several relatively large pledges of 'transition support', however, external resources constitute less than 2% of the annual government budget. This non-dependence has established a degree of equilibrium in a relationship normally regarded as highly unequal in other African countries. Although international donors funded the antiapartheid movement in South Africa prior to 1994, the new government inherited a chaotic administration that had little institutional experience of conventional development aid. Many of the new cadres entering government had not been exposed to the workings of government, let alone donor, bureaucratic processes. It is not surprising, therefore, that in the first few years after 1994, the aid relationship was characterized by low disbursements, unrealistic expectations and a degree of conflict. Since 1997, however, aid supported projects have started to become more visible. Within the broad objective of supporting transformation of the health system, one of the key areas of donor support is managerial capacity development, particularly of district, hospital and provincial health structures. These initiatives tend to be poorly coordinated, a problem compounded by a quasi-federal system in which provinces have large amounts of autonomy. The contribution of donor aid to strengthening the health system could be enhanced by the establishment of a clear national framework to guide the many externally supported projects building managerial skills and systems.

Financing, Organized↗
PubMed2003

Why babies die--a perinatal care survey of South Africa, 2000-2002.

OBJECTIVE: To identify the major causes of perinatal mortality in South Africa. SETTING: Seventy-three state hospitals throughout South Africa representing metropolitan areas, cities and towns and rural areas. METHOD: Users of the Perinatal Problem Identification Programme (PPIP) amalgamated their data to provide descriptive information on the causes of perinatal death and the avoidable factors, missed opportunities and substandard care in South Africa. RESULTS: A total of 8,085 perinatal deaths among babies weighing 1,000 g or more were reported from 232,718 births at the PPIP user sites. The perinatal mortality rates for the metropolitan, city and town, and rural groupings were 36.2, 38.6 and 26.7/1,000 births, respectively. The neonatal death rate was highest in the city and town group (14.5/1,000 live births) followed by the rural and metropolitan groups (11.3 and 10.0/1,000 live births respectively). The low birth weight rate was highest in the metropolitan group (19.6%), followed by the city and town group (16.5%) and the rural group (13.0%). The most common primary cause of perinatal death in the rural group was intrapartum asphyxia and birth trauma (rate 6.92/1,000 births) followed by spontaneous preterm delivery (5.37/1,000 births). The most common primary cause of death in the city and town group was spontaneous preterm delivery (6.79/1,000 births) followed by intrapartum asphyxia and birth trauma (6.21/1,000 births) and antepartum haemorrhage (5.7/1,000 births). The metropolitan group's most common primary causes were antepartum haemorrhage (7.14/1,000 births), complications of hypertension in pregnancy (5.09/1000 births) and spontaneous preterm labour (4.01/1,000 births). Unexplained intrauterine deaths were the most common recorded primary obstetric cause of death in all areas. Complications of prematurity and hypoxia were the most common final causes of neonatal death in all groups. CONCLUSION: Intrapartum asphyxia, birth trauma, antepartum haemorrhage, complications of hypertension in pregnancy and spontaneous preterm labour account for more than 80% of the primary obstetric causes of death.

Asphyxia Neonatorum↗
PubMed2003

Recruiting foreign doctors to South Africa: difficulties and dilemmas.

In 2003, the Medical and Dental Professional Board of the Health Professions Council of South Africa again made it possible for foreign-qualified doctors to obtain registration without sitting an examination. This eased the way for eligible non-South African doctors to work in South Africa in order to assist with the current staffing crisis in rural hospitals. This personal view examines the issues and difficulties related to foreign-trained doctors practising in South Africa, such as short-term practice vs long-term commitment; strategies to promote preparation of local doctors for rural hospital practice; the loss of recruited doctors to third-party countries; the principle of distributive justice in international medical training; and defining acceptable standards of training. The conclusions reached are that while doctors from developing countries, especially from neighbouring African nations, have historically brought a wealth of practical experience to South Africa's rural hospitals, there are also mutual benefits in recruiting from doctors trained in developed countries. The guiding principle is to obtain well-trained and experienced doctors who are able to function in a rural hospital until there are sufficient local-trained doctors. While the article focuses specifically on medical staffing in rural South Africa, the principles discussed apply equally to other health-care professionals and other, similar countries.

Journal Article↗
PubMed2005

Developing a competence framework and evaluation tool for primary care nursing in South Africa.

CONTEXT: Nurses provide the bulk of primary care services in South Africa. Post-apartheid health legislation envisions the provision of comprehensive primary services at all public clinics, which implies the need for a cadre of primary care nurses able to render such services. OBJECTIVES: To identify core competencies of clinic nurses and develop an evaluation tool for primary care nursing in South Africa. METHODS: The descriptive and exploratory techniques used included two meetings of a reference group of South African primary care professionals, followed by a consensus-building exercise. Using the Delphi technique expert opinion was solicited from South Africa, Canada and the USA. FINDINGS: The reference group meetings yielded a list of nine core competencies. Infrastructure issues, such as the supermarket (one-stop shopping) approach to service delivery, communication and transport systems, and the quality of supervision still cause concern. These issues underscore that competence cannot be measured in a vacuum. Input from Delphi participants affirmed the nine core competencies and the need to assess the impact of core competency training. One possible way to measure the nine core competencies would be to use proxy indicators. DISCUSSION/CONCLUSIONS: Identifying core competencies is a complex process. There is a need to process a wide range of views and ideas. Also, balancing academic concerns with service delivery needs and constraints is an ongoing challenge. A potential limitation of the Delphi technique is participant selection bias and fatigue. Accessing a diverse international panel and making numerous follow up attempts via phone, mail and email were used to attempt to ameliorate these inherent limitations. Although the process is cumbersome, providing "experts" with a venue to wrestle with these ideas can be fruitful. Future studies would help to assess the reliability of the findings.

Clinical Competence↗