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PubMed2006

[Extent of visual impairment in a population attending an ophthalmology center in Africa. Findings in 828 cases at the Tropical Ophthalmology Institute of Africa in Bamako, Mali].

The purpose of this prospective observational study was to evaluate the extent of visual impairment in a socially and professionally active population attending the Tropical Ophthalmology Institute of Africa (IOTA). Thanks to high recruitment rate at the IOTA, which is the third reference eye centre, a total of 828 patients ranging from 18 and 50 years of age and consulting for the first time were included between February 1 and May 4, 2003. Each patient underwent a thorough ocular examination. Data were recorded using a dedicated study form. Most patients (40%) consulted for reduced visual acuity. Diagnosis determined organic disease in 75.6% of cases (626 patients) and ametropia (including presbyopia) in 18.5% (153 patients). In the remaining 6% of cases (49 patients), ophthalmic examination was normal. Bilateral blindness was observed in 5.8% of cases (48 patients). The main cause of bilateral blindness was cataract (19.2%). The third most common cause (14.6%) was ocular manifestations of HIV infection, confirming that the epidemiology of blindness is changing and that HIV/AIDS should be taken into account. Unilateral blindness accounted for 11.5% of cases (95 patients). The main causes of unilateral blindness were trauma (50.5%), infection (26%) and degenerative disease (18%). Low vision accounted for 8.5% of cases (70 patients). The main cause of low vision was ametropia. This is one of the few hospital-based studies on causes of blindness in West Africa. The major finding is the high prevalence of blinding ocular complications of HIV infection. Another important finding is the high incidence of low vision that is often disregarded in West Africa.

Adolescent↗
PubMed1993

A host-parasite list of the haematozoa of domestic poultry in sub-Saharan Africa and the isolation of Plasmodium durae Herman from turkeys and francolins in South Africa.

An annotated host-parasite list of the blood parasites of domestic poultry in sub-Saharan Africa is presented. This list contains the haematozoa found in domestic waterfowl (ducks, geese and muscovies) and phasianids (turkey, fowl and peafowl). In South Africa Plasmodium durae was isolated from 4 out of 8 backyard turkeys, from 3 out of 26 Swainson's francolins and from 1 redwing francolin, but not from 20 helmeted guineafowls and 9 greywing francolins. This points at Swainson's and redwing francolins as being the main natural hosts of P. durae in South Africa. The increase in the period of prepatency after intramuscular subinoculation as compared with the intravenous route was found to correspond to that of a 1,000 fold dilution of an intravenous inoculum of parasitized blood. This delay was not due to an intervening cycle of exoerythrocytic schizogony, but to large numbers of the injected erythrocytes apparently not finding their way into the circulation of the new host.

Animals↗
PubMed2006

Comparison of SAT-1 foot-and-mouth disease virus isolates obtained from East Africa between 1971 and 2000 with viruses from the rest of sub-Saharan Africa.

Foot-and-mouth disease serotype SAT-1 seems to be endemic in many sub-Saharan African countries. Phylogenetic analysis using the 1D gene of 51 SAT-1 isolates from East, West and southern Africa indicated the presence of at least 6 lineages and 11 genotypes with linkages between various geographical regions of the subcontinent. Differences were observed between countries in East Africa, the main focus of this study, with individual countries suffering outbreaks from isolates belonging to various genotypes, which is evidence of reintroduction of strains and long-term circulation of outbreak viruses. The amount of variation observed has significant implications for disease control on the subcontinent.

Africa South of the Sahara↗
PubMed2005

Risk factors associated with myocardial infarction in Africa: the INTERHEART Africa study.

BACKGROUND: Cardiovascular disease (CVD) is rising in low-income countries. However, the impact of modifiable CVD risk factors on myocardial infarction (MI) has not been studied in sub-Saharan Africa (SSA). Therefore, we conducted a case-control study among patients with acute MI (AMI) in SSA to explore its association with known CVD risk factors. METHODS AND RESULTS: First-time AMI patients (n=578) were matched to 785 controls by age and sex in 9 SSA countries, with South Africa contributing approximately 80% of the participants. The relationships between risk factors and AMI were investigated in the African population and in 3 ethnic subgroups (black, colored, and European/other Africans) and compared with those found in the overall INTERHEART study. Relationships between common CVD risk factors and AMI were found to be similar to those in the overall INTERHEART study. Modeling of 5 risk factors (smoking history, diabetes history, hypertension history, abdominal obesity, and ratio of apolipoprotein B to apolipoprotein A-1) provided a population attributable risk of 89.2% for AMI. The risk for AMI increased with higher income and education in the black African group in contrast to findings in the other African groups. A history of hypertension revealed higher MI risk in the black African group than in the overall INTERHEART group. CONCLUSIONS: Known CVD risk factors account for approximately 90% of MI observed in African populations, which is consistent with the overall INTERHEART study. Contrasting gradients found in socioeconomic class, risk factor patterns, and AMI risk in the ethnic groups suggest that they are at different stages of the epidemiological transition.

Africa↗
PubMedDate not supplied

PVO / NGO initiatives, Africa. Society for Women and AIDS in Africa (SWAA), Mauritania.

Society for Women and AIDS in Africa (SWAA), Mauritania, uses a multi-sectoral approach to raise awareness of the HIV/AIDS pandemic and provide assistance when needed. SWAA believes that in order to have an impact on women and development in their country they must address issues of health, education, and society. To these ends they have created a special center to provide health care and counseling to HIV-positive women and their children; they conduct health and general education sessions geared towards women; and they have formed local chapters of SWAA throughout Mauritania to provide support and information to women within their own communities. SWAA has also taken on a mass education campaign which includes the production of flyers, educational materials, and public service announcements for radio and television. For more information, please contact Mme. Sana Mint Abass, President, SWAA/Mauritanie, BP 118, Nouakchott, Mauritanie; tel: +222 564 69 (office), +222 524 04 (home); fax: +222 599 26.

Adolescent↗
PubMed1996

Street children in South Africa: findings from interviews on the background of street children in Pretoria, South Africa.

In the present study findings from interviews on the background of street children in Pretoria, South Africa are presented, discussed, and compared with research done in the past on South African street children. Findings from the investigation indicate that the average age of South African street children is approximately 13 years, predominantly of male African origin. Most have been on the streets for three years or longer, and they cited family violence, parental alcoholism, abuse, and poverty as the main motivating factors for leaving home. Most of these findings are common among street children all over the world.

Adolescent↗
PubMed1997

An evaluation of clinical laboratory services in sub-Saharan Africa. Ex africa semper aliquid novi?

Pathology services represent the rational, scientific basis of the practice of clinical care. It does not represent deus ex machina, an implausible solution to a complex plot, but rather the way in which clinical care can be audited, controlled, guided and kept appropriate to the funds and the skills available. Arguments are presented to support this statement as well as to analyse what is wrong with health care, from the point of view of laboratory medicine, in sub-Saharan Africa. In most African countries 'first world' technology has to be imported by economies barely able to sustain the basic requirements of human life. Badly needed foreign exchange is obtained by growing export crops at the cost of traditional lifestyle, disenfranchising communities, urbanisation, and even at the cost not being able to grow food. War, corruption, lack of accountability even in the Western sense of being able to go to the polls every so often, lack of empowerment, low literacy rate etc all debase the communities, with minimal exceptions, of Africa. Health care is under the same capricious rule as all other public services: investment in laboratories is poor and most have no access to a professional laboratory at all. More investment, not less; expansion of pathology services not restricting them, is needed throughout the continent.

Africa South of the Sahara↗
PubMed2003

Diabetes in Africa. Diabetes microvascular and macrovascular disease in Africa.

This review on the prevalence and characteristics of diabetes micro- and macrovascular disease in Africa is based on a bibliographical Medline search and diabetes conference proceedings of published data over the past decade. The prevalence of diabetic retinopathy varies from 16 to 77% depending on the duration of diabetes and glycaemic control, with severe retinopathy representing 15% of all cases. At diagnosis, 21-25% of type 2 patients and 9.5% of type 1 patients have retinopathy. The prevalence of nephropathy varies between 32-57% after a mean duration of diabetes of 5-10 years, and 5-28% within the first year following the diagnosis of diabetes. The prevalence of neuropathy varies widely depending on the methodology used. Macrovascular complications of diabetes are considered rare in Africa despite a high prevalence of hypertension. Coronary heart disease may affect 5-8% of type 2 diabetic patients and cardiomyopathy up to 50% of all patients. Lower extremity amputation varies from 1.5 to 7%, and about 12% of all hospitalized diabetic patients have foot ulceration. Neuropathy underlies diabetic foot more often than peripheral vascular disease. In conclusion, whereas microvascular complications of diabetes are highly prevalent and occur early during the course of disease, macrovascular disease is rare. Late diagnosis of diabetes, poor metabolic control and nonstandardized diagnostic procedures rather than genetic predisposition may account for this difference from other populations around the world.

Africa↗
PubMed1996

Progress towards the comprehensive control of hepatitis B in Africa: a view from South Africa.

The carrier rate of hepatitis B virus (HBV) in black Africans averages 10.4% throughout the continent. Even within each country, however, there may be wide variations. HBV carriage in black Africans is largely established in early childhood, mostly through horizontal transmission. Perinatal transmission also occurs but to a much lesser extent than in the Far East. For unknown reasons, HBeAg positivity rates are much lower in black Africans of childbearing age than in women in the Far East. Universal HBV vaccination of infants in South Africa started in April 1995. Effective integration into the Expanded Programme on Vaccination will probably be necessary if administration of second and third doses is to be ensured. Fortunately, a natural process of urbanisation is also having a beneficial effect on the black carrier rate in South Africa, as urban carrier rates tend to be much lower than those in rural area. Within the next 20 years, therefore, there should be a great reduction in the numbers of acute HBV infections and new carriers. However, it will take much longer before there is any substantial impact on the burden of the longterm sequelae of HBV infection--that is, cirrhosis and hepatocellular carcinoma.

Carrier State↗
PubMed1987

Mental health in Africa: II. The nature of mental disorder in Africa today. Some clinical observations.

Aspects of clinical psychiatric syndromes described in Africa which are discussed include the issue of schizophrenic disorders having a better prognosis in developing countries; controversy over this is by no means at an end. There is an increasing realisation as to the frequency of affective disorders in Africa; while somatisation is common, cherished beliefs, such as the absence of guilt, have not been confirmed by more recent research. Nor is suicide as infrequent as has been suggested. The relationship of background physiological abnormalities of cerebral functioning may be relevant to some of the clinical issues that are currently under discussion in African psychiatry.

Africa↗
PubMed1989

Reproduction of Angola free-tailed bats (Tadarida condylura) and little free-tailed bats (Tadarida pumila) in Malawi (Central Africa) and elsewhere in Africa.

Angola free-tailed bats and little free-tailed bats occur in diverse habitats throughout most of Africa south of the Sahara. This study investigated the reproductive strategies and related biology of these species in Malawi where they were sympatric, and analysed data from elsewhere in Africa to show how the strategies varied along a gradient of habitats from approximately 12 degrees N to 25 degrees S. Both the Angola free-tailed bat and the little free-tailed bat were normally monotocous. Angola free-tailed bats invariably had 2 births/year, and the interval between consecutive births decreased with increasing latitude. When the interval was shortest (approximately 90 days) a post-partum oestrus occurred. Little free-tailed bats differed by having a shorter gestation (approximately 60 days), and the ability to have up to 5 births/year with a postpartum oestrus after each birth. The extent to which this potential is achieved varies with latitude and rainfall, mainly so that lactation can coincide with peaks in the abundance of food. The interaction between rainfall and reproductive characteristics results in the two species having patterns of reproduction which are sometimes similar, but more often different. Competition between the species is unlikely to be affected by differences in their reproduction.

Africa↗
PubMed1999

The role of the College of Medicine of South Africa Diploma in Anaesthesia in southern Africa.

OBJECTIVE: To determine the role that the College of Medicine Diploma in Anaesthesia (DA) plays in health services in southern Africa. DESIGN: A postal questionnaire. MAIN INFORMATION SOUGHT: Reasons for doing the DA, percentage of diplomates still actively involved in anaesthesia, career pathways of diplomates, perceived value of the DA, geography and type of anaesthetic practice of diplomates, and participation in continuing medical education. SUBJECTS: The 1,096 candidates who passed the DA between 1974 and 1993. METHODS: Questionnaires were sent to all 861 diplomates with known addresses. RESULTS: The response rate was 62.1% (535/861). Over 70% of diplomates are still actively involved in anaesthesia. Approximately one-third of all diplomates specialize in anaesthesia. The majority of GP anaesthetists with the DA have trained in anaesthesia for more than 1 year. Thirty-three per cent of GP anaesthetists work in small towns or rural areas. Nearly 20% of GP anaesthetists spend more than 75% of their time in anaesthetic practice. Twenty-eight diplomates are working in southern African countries outside South Africa. The DA is perceived to have been of value by the majority of specialist and non-specialist diplomates. CONCLUSIONS: Diplomates are playing a valuable role in anaesthesia throughout the southern African region.

Adult↗
PubMed2001

[Fever and vesiculopapular exanthema due to infection with Rickettsia africae after a sojourn in South Africa].

A 26-year-old woman, who had visited the Krugerpark in South Africa 5 days before, presented with fever, a skin lesion with a black crust (eschar), lymphadenopathy and a vesiculo papular rash. The clinical diagnosis 'Rickettsia africae infection' was confirmed by specific serological tests. A second patient aged 43 years, whose vesicular rash did not respond to flucloxacillin had been in the Krugerpark one week before and on examination was found with 2 eschars. Based on epidemiological and clinical grounds African tick fever can be distinguished from Mediterranean spotted fever (fièvre boutonneuse). In the Netherlands specific diagnostic tests are not available. For treatment the distinction is not necessary; treatment is with tetracycline or doxycycline. Both patients recovered upon this treatment.

Adult↗
PubMed1999

From Africa to Africa.

Chiropractic, an American-born profession, has grown and developed internationally, especially within the last decade. In reality, however, this growth started long ago in other countries. This article explores the development of the profession in South Africa by examining the life of an American-trained, South African-born, chiropractor. During this time, the international chiropractic community was a small group with close ties to America. This was, in part, due to the fact that chiropractic education was only available in the United States and one was not considered "legitimate" unless he or she was American trained. The struggles of the profession are not unique to America; they have also occurred elsewhere. Chiropractic evolution in South Africa is examined as well as the development of registration (licensing) and tertiary education.

Chiropractic↗
PubMed1998

Chloroquine in Africa: critical assessment and recommendations for monitoring and evaluating chloroquine therapy efficacy in sub-Saharan Africa.

Chloroquine-resistant malaria is a major public health threat in sub-Saharan Africa. While a few countries have already replaced chloroquine as the first-line therapy for uncomplicated malaria or are in the process of doing so, other countries are faced with the complicated task of assessing the current status of drug resistance, making national policy-level decisions about whether to replace chloroquine or not, and initiating a monitoring system to track changes in the efficacy of malaria therapy. There is currently no standardized approach for collecting and interpreting data on therapy efficacy. There is also no agreement as to how much chloroquine resistance or treatment failure is acceptable and how much warrants a change in treatment policy. Using data collected in 10 sites in eastern and southern Africa between 1990 and 1996, we have assessed the therapeutic response to chloroquine and investigated predictors of clinical success or failure. Based on these experiences and analyses, a standardized protocol for in vivo studies of the efficacy of malaria therapy and for approaches to designing monitoring systems are proposed. The process of making policy-level decisions based on data collected by these systems is also discussed.

Antimalarials↗
PubMed2002

Volunteering in Africa: an orthopaedic surgeon-pilot flies to Africa to volunteer.

I lived a dream. After 45 years service as an orthopaedic surgeon, a career military officer, private practice, and an appointment to the faculty at Duke University, I retired to begin another career--volunteerism. Specifically, I volunteered to serve at Tenwek Hospital in Africa. Tenwek, a World Medical Mission Hospital, is a 4-hour drive west of Nairobi, Kenya. The hospital serves 400,000 Kenyans. Tenwek is a wonderful hospital, modern by African standards, well-equipped and staffed. The average daily orthopaedic case load is five to nine cases. Fractures, sepsis, and deformity are the usual surgical challenges. An essential part of the dream was to commute to serve-to fly myself across the Atlantic, through Europe, and on to Africa in a manner reminiscent of aviation pioneers long past. This portion of the dream was not realized completely, but was sufficiently achieved to appreciate the accomplishments and difficulties of those who went before. For me, my dream was realized. Volunteer service brings heartache and joy but adds a special dimension to our profession. The motto "We make a living by what we earn, we make a life by what we give" was reinforced each day.

Developing Countries↗
PubMed1979

[Symptoms of rabies in pets and domestic animals in South Africa and South West Africa (author's transl)].

The most obvious symptoms of rabies in farm animals and pets in South Africa and South-West Africa are discussed in the light of information obtained during routine examination of specimens for the 10-year-period 1967--1976. More than 55% of the cases encountered were cattle in which the most obvious symptoms were salivation (92%), bellowing (69%), aggressiveness (47%), paresis or paralysis (30%) and straining (12%). Unlike cattle, the most obvious symptom in goats was aggressiveness (83%). Salivation was observed in ony 29% of goats but, like bellowing in cattle, bleating was very obvious in 72% of cases. Sheep were usually quiet, but 67% were aggressive. Salivation was observed in 30%, while 27% showed an abnormal sexual desire. The second highest incidence of rabies was recorded in dogs (20%). Aggressiveness was the most obvious symptom (71%) followed by salivation (48%), paresis and paralysis (28%) and barking (11%). With the exception of salivation and paresis, which were rarely encountered, aggressiveness was the only symptom observed in cats. Several cats were encountered with rabies-like symptoms due to organic phosphate poisoning. The most obvious symptoms in horses and donkeys were aggressiveness (77%), paresis or paralysis 33%), the chewing of foreign matter (33%) and salivation 22%). It is obvious that other conditions can easily be confused with rabies. Therefore every possible cause for rabies-like behaviour must be considered and eliminated to avoid unnecessary destruction of animals.

Animals↗