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PubMed1985

Lung cancer 1978-1981 in the black peoples of South Africa.

Mortality data on lung cancer among the black populations of South Africa, newly available from the first ever nation-wide enumerations, are analysed for age-specific rates and significant geographical and intertribal variations. This study finds a higher incidence at younger ages than among whites, an urban excess similar to other population groups in South Africa and a higher incidence among the Xhosa than Zulu. It is suggested that an anti-smoking campaign is urgently required among blacks in South Africa.

Adult↗
PubMed2003

The health impact of environmental pollutants: a special focus on lead exposure in South Africa.

Studies have shown blood lead levels of some children in South Africa at levels of health concern. New studies show even relatively low lead levels to have detrimental effects on cognitive function in young children. Large numbers of South African inner-city and other children have been shown to have unacceptably high blood lead levels. Studies indicate that blood lead levels of children living in South Africa's urban areas are higher than those of children in most developed countries, including Great Britain, Europe, and the United States. Although data and reported studies are very sparse, mean blood lead levels of approximately 15 microg/dl have been reported in children. Elevated blood lead levels were associated with socioeconomic status and housing conditions. Key environmental risk factors for elevated blood levels were contaminated soil and dust in the urban environment, and the still large number of automobiles using leaded gasoline. In view of emerging evidence linking lead at increasingly lower levels to adverse effects in children, the South African government is taking actions to reduce lead exposure among vulnerable groups. Currently, South Africa has no national lead surveillance program. The government, therefore, has developed international and regional partnerships to prevent and address the problem of lead exposure.

Child↗
PubMed1988

South Africa's urban policy: a new form of influx control.

"The South African government has repealed influx control for blacks living in the 'non-independent homelands.' Although the urban shift of the black population is increasingly accepted, controls on the supply of housing and land for housing blacks have been retained. The emphasis is now on alternative restrictions on black urbanization. The restrictions, however, contrast with the wishes of South Africa's business leadership. The 1986 'reforms' are explained by exploring the relationship between government policy and business interests. Finally, the urban policies are contrasted with the new metropolitan government, the Regional Services Councils, through which blacks are being brought into multiracial governmental structures but on unequal terms."

Africa↗
PubMedDate not supplied

Newcastle disease and avian influenza A virus in wild waterfowl in South Africa.

In an intensive ostrich farming area in South Africa with a history of ostrich influenza outbreaks, we conducted a survey of avian influenza virus (AIV) and Newcastle disease virus (NDV) in wild aquatic birds. During late autumn and winter 1998, the time of year when outbreaks in ostriches typically start to occur, 262 aquatic birds comprising 14 species were sampled and tested for both virus infections. From eight samples, AIV, serotype H10N9, could be isolated. All isolates were apathogenic as determined by the intravenous pathogenicity index (0.00). Conversely, none of 33 sera of these wild birds showed antibodies against H10. However, one bird was found serologically positive for H6 AIV. This AIV serotype was later isolated from ostriches during an avian influenza outbreak in this area. No NDV was isolated although 34 of 46 serum samples contained NDV-specific antibodies. This is the first H10N9 isolate to be reported from Africa. In addition, our data support the notion that wild aquatic birds may function as a reservoir for AIV and NDV in South Africa.

Animals↗
PubMed1996

Lyme disease in South Africa.

OBJECTIVE: This article presents an overview of Lyme disease (LD) as it applies to neuropsychiatry and summarises research results on the epidemiology of LD in South Africa. METHOD: The study is based on a review of research papers from various medical disciplines that focused on the epidemiology of LD in South Africa. RESULTS: Assessment of the incidence of LD in South Africa is based on a few anecdotal studies. The results of the studies are dominated by experimental weeknesses. CONCLUSIONS: The sporadic nature of LD Incidence in South Africa may either reflect a restriction of research efforts or be a true indication of the epidemiology of the disease. This review lends support to the former hypothesis. The low reported incidence of LD in South Africa is probably due to a lack of awareness and research effort.

Humans↗
PubMed2000

Stroke therapy clinical guideline. South African Medical Association-- Neurological Association of South Africa Stroke Working Group.

OBJECTIVE: To describe the prevention, management and rehabilitation of stroke in South Africa as provided by a range of caregivers. OPTIONS: Emphasis should predominantly be on finding the cause, preventing, and treating stroke in the transient and mild stroke group. Moderate stroke patients require maximal rehabilitation and secondary prevention. Severe disabling stroke patients require home and community care. OUTCOMES: The most effective use of resources (personnel and facilities) in relation to the different types of stroke. These should be used to decrease stroke incidence, increase stroke awareness, improve acute stroke therapy, and improve access to rehabilitation. EVIDENCE: Based on international reports and research. Meta-analyses were used when the topic warranted such specific literature review. Stroke consensus has been achieved internationally and widely reported. A wide range of South African reviewers from various health fields, including representatives of local and national health groups, were consulted. Evidence-based documents were considered and incorporated. VALUES: As far as possible, cultural and economic preferences were given major emphasis. The aim of the guideline is to optimise stroke care from the point of view of individual patients, health practitioners, reimbursing agencies and society as a whole. Where possible, best-practice stroke care of international standard has been used in this document. However, at no stage has the Working Group deviated from the unique set of South African stroke problems, namely differing risk and preventive factors, multi-cultural, genetic and traditional practices and the problems of cost saving from best-practice funding for stroke care. BENEFITS, HARMS, COSTS: It is difficult to assess the local situation without prospective research. However, stroke causes the following in South Africa: between 8% and 10% of all reported deaths 7.5% of deaths in the workforce (25-64 years of age) age-standardised mortality rate of 125-175/100,000. More can be done to improve the cost-effectiveness of available resources by increasing education of health care professionals and patients. RECOMMENDATIONS: Assess and treat all cerebral vascular events within 6 hours if possible; categorize the stoke into mild, moderate or severe; transient ischaemic attack (TIA), minor or reversible stroke should be intensively investigated to find the cause and this should be treated vigorously; all risk factors should be treated; moderate strokes require active rehabilitation; secondary prevention is required to prevent another stroke; when vegetative symptoms persist after 7 days, therapy should be supportive. VALIDATION: This guideline is similar to others produced in other countries but with reference to South Africa, and has been developed in collaboration with the Neurological Association of South Africa. The initial document was developed in 1997 with a multidisciplinary group with special interest in the management of stroke. In July 1998 a nationally representative stroke consensus meeting was held and the document was widely scrutinised. The guideline is endorsed by the South African Medical Association.

Algorithms↗
PubMed1991

Molecular epidemiology of an outbreak of poliomyelitis in South Africa in 1987/1988.

An outbreak of paralytic poliomyelitis occurred in the Republic of South Africa in 1987/88. The epidemic took place in the Natal/KwaZulu region of South Africa and was due to type 1 poliovirus. Twenty-four isolates were characterised by 1- and 2-dimensional oligonucleotide mapping and a single strain of wild-type poliovirus was identified. The same strain of virus was also isolated in other areas of South Africa at the time of the outbreak and has persisted into 1989.

Disease Outbreaks↗
PubMed2006

Graded landfill requirements in South Africa--the climatic water balance classification.

Landfilling in South Africa is controlled by a set of statutory Minimum Requirements, based on a landfill classification system. Landfills are classified according to the type of waste, the projected final size of the landfill and the climate. Climate is important as climatic conditions in South Africa vary from humid sub-tropical in the east, to semi-arid on the central plateau, to semi-desert in the west. Anti-pollution measures are closely related to climate and size, with the pollution potential of small, general (i.e. domestic) waste landfills in dry climates being regarded as negligible. At the other end of the scale, large landfills where hazardous wastes are disposed have a serious pollution potential and must be designed as containment systems. The paper describes the method currently in use for deciding on the climatic classification of a site, followed by the new method that will be adopted when the latest revision of the Minimum Requirements appears shortly.

Climate↗
PubMed1988

Smoking and health in South Africa.

In 1984 smoking rates among adults in South Africa were highest in coloureds (41.1%), followed by whites (34.9%), Asians (29.0%), and blacks (27.7%). With increased urbanisation, income, and education, black and coloured smoking rates are likely to rise. Current trends suggest that the proportion of smoking-related disease mortality and morbidity among coloureds and blacks will increase. Studies in South Africa and elsewhere have shown that smokers run an increased risk of coronary artery disease, lung, oesophageal, and cervical cancer, respiratory disease, gastrointestinal ulcers, and leukoedema. Non-smokers exposed to 'involuntary smoking' are also at risk, and smokeless tobacco is not a safe alternative to smoking. The evidence for smoking-induced health damage is so compelling that action against smoking is urgently needed. Surveys of smoking habits among specific groups show the importance of peer and role model example, and suggest guidelines for the targeting of health education.

Adolescent↗
PubMed1997

Increasing HIV prevalence in a rural district of South Africa from 1992 through 1995.

OBJECTIVES: To describe the increasing prevalence of HIV infection in a rural district in South Africa, to compare this with a nearby urban setting, and to estimate the prevalence of infection in the general population of the rural district. DESIGN: Serial anonymous cross-sectional HIV seroprevalence surveys among consecutive women attending antenatal clinics in the rural Hlabisa health district, and the urban King Edward VIII Hospital, Durban, South Africa. RESULTS: Crude antenatal HIV seroprevalence in Hlabisa increased from 4.2% (95% confidence interval [95%CI], 3.0-5.7) in 1992, to 14% (95%CI, 10.4-18.4) in 1995 (p < 0.0001). Age-specific prevalence was highest in women aged 20 to 24 years (21.1% in 1995) and in the more urbanized areas of the district (29.5% in 1995). Prevalence in Durban, at 19% (95%CI, 16.5-21.7), was higher than in Hlabisa in 1995 (p = 0.046), in large part as a result of the higher prevalence in the 15 to 19 year age group in Durban (22.4% vs. 7.4%, p = 0.004). An estimated 5.6% (95%CI, 3.0-9.6) of the general population of the Hlabisa district was HIV infected in 1995. CONCLUSIONS: The HIV epidemic, fueled by a high incidence in young people, has escalated rapidly in this part of rural South Africa. Lower crude rural than urban prevalence is largely a result of a lower prevalence in young rural women; the underlying social reasons for this need to be fully explored. South Africa urgently needs to implement effective prevention programs, to plan for the impact of HIV-related disease on the health service, and to develop community-based care strategies.

Adolescent↗
PubMed1997

The Links between Legal Status and Environmental Health: A Case Study of Mozambican Refugees and Their Hosts in the Mpumalanga (Eastern Transvaal) Lowveld, South Africa.

This article relates the legal status of Mozambicans in South Africa from 1985 onwards to key findings of a demographic census taken in 1992, an environmental health survey conducted in 1993, and in-depth fieldwork in some of the surveyed settlements in 1995. The case study area on the border with Mozambique is typical of South Africa's rural former homelands, with the exception that it has a large and long-standing refugee population. The environmental health indicators for refugees are considerably worse than for their hosts, and in-depth fieldwork suggests that this can be attributed to their legal and political vulnerability. This raises issues for South Africa's Reconstruction and Development Program, as well as conceptual challenges for promoters of human rights.

Journal Article↗
PubMed1999

Early communication intervention within a community-based intervention model in South Africa.

Infants and toddlers with special needs within the developing context in South Africa are not currently receiving adequate early communication intervention services. The development of a model for service delivery to this population is imperative for the successful implementation of early communication intervention in the developing context in South Africa. The basic model of early intervention service delivery provides a theoretical basis for early intervention service delivery but has certain limitations when applied to the developing context in South Africa. Community-based intervention is proposed as an avenue for the delivery of health care services within primary health care although constraints in the application of community-based intervention exist. An integrated model of early communication intervention service delivery within community-based intervention is proposed and illustrated by presenting a case example.

Child, Preschool↗
PubMed1988

Health and health care in post-apartheid South Africa: a future vision.

This paper accepts the idea that patterns and distribution of health care and resources are determined by "realpolitik," and that South Africa is at present in the throes of a political revolution, the outcome of which is bound to reflect a considerable degree of "self-determination" of the majority black (African, Asian, and mixed-race) people. It is postulated that the health services-and other pre-determinants of the health of the black people-will be shaped by a mixed socialist-capitalist economy and a socialized or nationalized form of health care service. This is because all the leading players in the revolutionary stakes, especially the exiled African National Congress of South Africa (ANC) and the above-ground United Democratic Front (UDF) and its affiliate, the National Alternative Medical and Dental Association (NAMDA), who are the front-runners, advocate these kind of changes for the future of South Africa, as exemplified in the ANC's Freedom Charter of 1955.Powerful political forces, both inside South Africa and in the Western World, are resisting this outcome, despite it clearly being the democratic will of the people, as shown by all the polls. These reactionary strategies would leave the health of most blacks in South Africa and Namibia little improved over its present status.

Delivery of Health Care↗
PubMed2000

Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility?

While the vision for restructuring health care in South Africa is based on a comprehensive primary health care system, care at the primary level remains largely biomedical in orientation. Given this, I argue that whilst adding mental health care to primary level care may increase accessibility of psychiatric care. it will not, however, provide for comprehensive integrated primary mental health care as planned. This would require a paradigm shift towards a comprehensive discourse of care which includes mental health care. While efforts towards reorienting health care personnel in South Africa towards the primary health care approach have been initiated, an examination of the primary health care system in one sub-district in South Africa, reveals that the delivery of biomedical care is sustained by a number of factors within the primary health care system as well as within the macro-context. A shift in the paradigm of care provided would therefore require the transformation of the system on many fronts. Of central importance would be the restructuring of the primary health care system to be supportive of emotional labour, health promotion, empowerment of service users and of care which takes the subjectivity of the illness experience for the patient into account.

Culture↗
PubMed1988

Socioeconomic factors affecting fertility in the developing countries and of the developing population groups in South Africa.

"In the present paper...socioeconomic factors affecting the fertility of the developing population groups in South Africa, are discussed and compared with findings [for developing countries] from the WFS [World Fertility Survey]." Data for South Africa are from an independent survey conducted during 1981-1982. "The relationship between socioeconomic factors and three dependent variables (marital fertility, desired family size, and current contraceptive use) is analysed.... The analyses are restricted to the examination of the extent to which the wife's differentials in fertility and associated variables related to education, employment status, and rural/urban residence persist, when other socioeconomic characteristics of the couple are controlled statistically."

Africa↗
PubMed2002

Does race matter? Children's height in Brazil and South Africa.

I examine racial differences in child stunting in mid-1990s South Africa and Brazil, two multiracial societies with different histories of legal support for racial discrimination. Using data from nationally representative household samples linked to community-level measures, the analysis shows that racial inequality in the distribution of socioeconomic resources across households and communities explains much of the racial difference in stunting in both countries. Even after these factors are controlled, however, the results indicate that in South Africa, nonwhite children are still at greater risk of growth faltering than are white children. The nature of socioeconomic and racial differences in children's growth is examined, and major determinants are discussed. These findings suggest that although state-sanctioned racism may help to explain the greater racial inequality in stunting in South Africa than in Brazil, the eradication of a disadvantage for nonwhites will depend on changes in the same fundamental socioeconomic inequalities that characterize both nations.

Black or African American↗
PubMed1987

The health and wealth of South Africa.

The per capita gross national product (GNP) in South Africa is examined as it relates to life expectancy and the infant mortality rate. Despite South Africa's relative wealth in per capita GNP terms, life expectancy at birth is 63-65 years and the national infant mortality rate according to Unicef, is unlikely to reach the target of 50/1,000 live births by the year 2000. The distribution of expenditure on health is contrasted between the former provincial administrations, the major local authorities, the national states and the homelands. The health resources allocation distribution is unlikely to ensure health for all by the year 2000.

Developing Countries↗