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PubMed2004

Provision of abortion services by midwives in Limpopo province of South Africa.

South Africa's Choice on Termination of Pregnancy (CTOP) Act of 1996 allows provision of abortion on request up to 12 weeks of gestation and permits midwives who have completed required training to conduct termination of pregnancies. This unique codification of midwives' role in abortion care reflects legislators' recognition that the right to safe legal abortion would be meaningless to the vast majority of South African women who live in remote rural areas unless appropriate steps were taken to ensure their access to such services and an understanding that, by dint of their numbers and skills, this cadre of health care providers have much to offer. Though not without considerable challenges, experience from Limpopo Province demonstrates the important impact of involving midlevel providers has had in expanding the availability and accessibility of safe legal abortion.

Abortion, Legal↗
PubMed1989

Research on the health implications of the use of recycled water in South Africa.

South Africa has an inadequate and unreliable supply of water. It is expected that water resources will be a limiting factor to development by the year 2020. Reclamation and reuse of sewage effluent is one possible method of supplementing existing supplies. Windhoek has had direct supplementation of its water supply for over a decade. Guidelines for using recycled sewage as a source of potable water are given and South African studies on chemical, microbiological and virological aspects of reclaimed water are reviewed. Epidemiological studies, retrospective in Windhoek and prospective for Cape Town, are discussed.

Fresh Water↗
PubMedDate not supplied

The sociological spread of HIV/AIDS in South Africa.

South Africa (SA) now accounts for more than 50% of newly reported HIV cases in sub-Saharan Africa annually. In 1993, approximately 90% of those reported as HIV positive in SA were of African descent. This paper examines sociological factors in the spread of HIV in SA through the application of Lalonde's (1974) Health Field Concept. SA's emerging District Health System (DHS) is discussed, as well as barriers to effective implementation and recommendations. Through Lalonde's sociopolitical view of health, a coordinated and multisectorial approach to HIV/AIDS in SA can be established. Without this approach, health care interventions will fail to target the population effectively, thereby reducing effectiveness and sustainability.

Adolescent↗
PubMed2001

Genetic analysis of the complete gag and env genes of HIV type 1 subtype C primary isolates from South Africa.

South Africa has one of the fastest growing HIV-1 epidemics, with an estimated 4.7 million people infected. To better understand the genetic diversity of this epidemic and its potential impact on vaccine development, we have cloned and sequenced the complete gag and env genes of 13 primary virus isolates. Phylogenetic analysis of our sequences and 69 complete env genes from the Los Alamos and GenBank databases revealed multiple subclusters within subtype C. The V3 loop region was relatively conserved in all our strains when compared with other subtypes, but the region immediately downstream was highly variable. No intersubtype recombinant forms were observed when comparing the gag and env sequences. Characterization of the complete gag and env genes enabled us to select specific strains for further vaccine development.

Amino Acid Sequence↗
PubMed2000

The value of advocacy in promoting social change: implementing the new Domestic Violence Act in South Africa.

South Africa's first democratic government passed the Domestic Violence Act (DVA) into law in 1998 as part of local and international commitments to protecting the human rights of women. Although the Act was welcomed as groundbreaking legislation, delays in implementing it led to increasing frustration. This paper describes an advocacy campaign conducted by the Soul City Institute for Health and Development Communication in partnership with the National Network on Violence against Women, to ensure the effective implementation of the DVA. Lessons from the campaign stress the importance of coalition building to draw on diverse strengths, and the use of a combination of advocacy tools, including lobbying, media advocacy and social mobilisation to achieve campaign goals. Given the critical role NGOs dealing with victims/survivors of domestic violence and the justice system played in lobbying for change and drafting the new law, their exclusion from the implementation process was ironic. While many advocacy efforts focus on the development of policy and legislation, ongoing efforts are needed to ensure effective implementation, the commitment of adequate resources and monitoring to identify gaps and propose new solutions. Our experience highlights the important role of policy advocates in connecting the multiple streams at play in the policy and legislative arena.

Communication↗
PubMed1999

The current status and future needs of education and training in family medicine and primary care in South Africa.

South Africa is undergoing tremendous political and social change affecting every sphere of society, including medical education and the delivery of health services. The legacy of its history created a health system that in some respects can be compared to the best in the world, but one also characterized by inequity, discrimination and lack of access to even basic services for the rural and the poor. Its medical education system trails behind modern trends such as problem-based learning, community-based education and the utilizing of general/family practitioners as trainers. Vocational training in family practice is not compulsory for independent practice. The discipline of family practice has nevertheless developed the programmes and core infrastructure for such a future undertaking in the form of masters programmes in family medicine at all medical schools. The recently introduced system of compulsory recertification through continuous professional development provides a window of opportunity to develop locally relevant curricula and appropriate education and training methods for family practitioners. Challenges for family practice include the establishment of the role and value of the discipline in a developing country with a health system based on a nurse-driven primary care service and the re-orientation of family medicine teachers, trained in a biomedical paradigm, to the patient-centred approach. The aspirations of family practice are to define the core content of the discipline, establish and nurture a culture of research in primary care, and to develop and introduce appropriate under and postgraduate training programmes for the new generation of family doctors.

Education, Medical, Continuing↗
PubMed2001

The role of primary school teachers in HIV prevention in South Africa.

South Africa has the fastest growing HIV epidemic in the world. The need for an intensive campaign against its spread cannot be overemphasised. Such efforts may be particularly effective if introduced prior to the onset of risk behaviour. The purpose of this study was to investigate the knowledge of grade 3 and 4 schoolteachers on HIV/AIDS and their opinion on educating their pupils about HIV prevention. A self-administered questionnaire with knowledge, perception and sociodemographic variables was sent to all 120 grade 3 and 4 teachers in the Southern Bushveld district of Northern Province. Descriptive statistics and multiple regression analysis were used to analyse the data. The response rate was 67% (N = 81) and 87.7% were females. The mean age of the respondents was 37.7 (+/- 8.7 SD) years, 55% had a 3-year teacher's training qualification and 27% had a 4-year training qualification. The average teaching experience was 12 years. Most respondents (93.8%) had knowledge of what HIV/AIDS is, but only 85.2% indicated it could be prevented. 14.8% either did not know HIV/AIDS could be prevented or were not sure. Some teachers had an incomplete understanding of the transmission and prevention of HIV/AIDS. Furthermore only 9% mentioned education as a way to prevent HIV/AIDS and 16% abstinence. Of the respondents, 58% indicated teaching HIV prevention to their pupils. Of those who do not teach HIV prevention, 41.2% believed that the pupils were too young, and 20.6% claimed non-availability of guidelines and resources as reasons for not teaching. A significant negative correlation was found between level of qualification and teaching of HIV to pupils (p < 0.05). In conclusion, many primary school teachers were found to be wanting in their HIV/AIDS knowledge. This suggests that the schoolteachers would need to be adequately trained prior to their involvement in HIV/AIDS education to pupils. Grade 3 and 4 teachers may be considered suitable to provide HIV education to their pupils, but there is a need for structured educational programmes they can follow. This study also suggests that teachers were not aware of the Department of Education's HIV policy of providing age-appropriate education to all pupils.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Radioactivity standardization in South Africa.

South Africa's national radioactivity measurement standard is maintained at a satellite laboratory in Cape Town by the National Metrology Laboratory (NML) of the Council for Scientific and Industrial Research. Standardizations are undertaken by a number of direct methods utilizing liquid scintillation counting (LSC). The successful application of LSC to the 4pi beta-gamma coincidence method is reviewed. The activity unit is maintained through radionuclide specific calibration factors relating to a pressurized re-entrant well type ionization chamber. A comparison is made between normalized factors given by the manufacturer and deduced factors obtained by a method used to transfer calibration factors from the International Reference System of the International Bureau of Weights and Measures based on the NML's own absolute standardizations.

Journal Article↗
PubMed1996

Anthropometric, vitamin A, iron and immunisation coverage status in children aged 6-71 months in South Africa, 1994. South African Vitamin A Consultative Group (SAVACG).

OBJECTIVE AND DESIGN: To establish the anthropometric, vitamin A, iron and immunisation coverage status of children 6-71 months of age in South Africa by means of a national survey. SETTING: South Africa. PARTICIPANTS: The study population consisted of all children in the country aged 6-71 months. A total of 18,219 households (19,003 families) was selected on the basis of a national probability sample with disproportionate stratification by province. OUTCOME MEASURES: Serum retinol, serum ferritin, haemoglobin, mean corpuscular volume, weight, height and immunisation status. RESULTS: According to international criteria, the national prevalence of marginal vitamin A status found in the survey identifies the country as having a serious public health problem of vitamin A deficiency. Stunting is a major problem in the country and is more prevalent in rural than in urban communities. In terms of anaemia and poor iron status, children in the 6-23-month age group were the most severely affected. A trend for increased immunisation coverage over the past 5 years was evident in every dose and in the percentage of fully immunised children.

Anemia↗
PubMed1978

A survey of obstetric anaesthesia in the Republic of South Africa and South West Africa.

In this report we analyse the results of a questionaire sent to 341 hospitals throughout the Republic and South West Africa, asking for details of their caesarean section rate and obstetric anesthetic techniques used. Non-specialist practitioners provided 90% of anaesthetic services in the 131 (38,4%) hospitals from which replies were received. General anaesthesia was used in preference to regional anaesthesia in 90% of these hospitals. Of the institutions surveyed, 24% used neither stomach emptying nor antacid therapy pre-operatively. These and other results pertaining to their choice of anaesthetic agents and techniques are presented and discussed.

Anesthesia, Conduction↗
PubMed2002

Obesity in South Africa: the South African demographic and health survey.

OBJECTIVES: To ascertain the anthropometric profile and determinants of obesity in South Africans who participated in the Demographic and Health Survey in 1998. RESEARCH METHODS AND PROCEDURES: A sample of 13,089 men and women (age, > or =15 years) were randomly selected and then stratified by province and urban and nonurban areas. Height, weight, mid-upper arm circumference, and waist and hip circumference were measured. Body mass index (BMI) was used as an indicator of obesity, and the waist/hip ratio (WHR) was used as an indicator of abdominal obesity. Multivariate regression identified sociodemographic predictors of BMI and waist circumference in the data. RESULTS: Mean BMI values for men and women were 22.9 kg/m(2) and 27.1 kg/m(2), respectively. For men, 29.2% were overweight or obese (> or =25 kg/m(2)) and 9.2% had abdominal obesity (WHR > or =1.0), whereas 56.6% of women were overweight or obese and 42% had abdominal obesity (WHR >0.85). Underweight (BMI <18.5 kg/m(2)) was found in 12.2% of men and 5.6% of women. For men, 19% of the variation of BMI and 34% of the variation in waist circumference could be explained by age, level of education, population group, and area of residence. For women, these variables explained 16% of the variation of BMI and 24% of the variation in waist circumference. Obesity increased with age, and higher levels of obesity were found in urban African women. DISCUSSION: Overnutrition is prevalent among adult South Africans, particularly women. Determinants of overnutrition include age, level of education, ethnicity, and area of residence.

Adolescent↗
PubMed1989

The current status of research on diseases of wildlife in South Africa and south west Africa/Namibia.

This paper contains a review of the formal research being done on the diseases and parasitic infestations of wild animals by universities and the state as well as other institutions in this part of the African continent. It is clear that most information obtained in this research is of an epidemiological or ecological nature and that ungulates, which form the bulk of the game-farming industry, are receiving the most attention. An analysis of the 20 most important diseases, which cover 6 disciplines, revealed that most of the research is being done for the benefit of livestock rather than wildlife. Seventeen of these diseases can be regarded as indigenous and 3 as being exotic to this part of Africa. Arguments are provided in favour of the concept that our game is genetically endowed, by virtue of centuries of adaptation, to handle the indigenous diseases, if their resistance is not compromised. None of the indigenous diseases constitute a threat to game populations, and hence no research on them is justified from an economic point of view. What is, however, absolutely essential, is research on game management with particular reference to those ecological factors which enable game on game-fenced farms to lead the sort of lives to which they are adapted. If this approach is not followed, further destruction of the habitat and deterioration of genetic disease resistance seem inevitable.

Animal Diseases↗
PubMed1995

The availability of health information in South Africa.

The South African Medical Research Council (MRC) has provided access to on-line health and biomedical information since 1976, when the MRC became an international partner of NLM. This was done to support research and health care when the Institute of Biomedical Communication was established. The institute has since reorganized and is now the Information Systems Division in the Research Systems Support Group MRC. he MRC and medical libraries in South Africa are able to access various automated services via telecommunication. The major systems available are MEDLARS, DIALOG, DATASTAR and BRS, with ECRI being the latest addition; most used are MEDLARS and DIALOG. New technologies (e.g., CD-ROM) have given more people access. This technology is not available to many people working in Primary Health Care (PHC), as they do not have access to computer networks. Beyond on-line is statistical and printed information, called "Gray Literature," not accessible through on-line systems as it is not published in conventional sources used to build databases. With a shift to Essential National Health Research and the focus on PHC and preventative medicine, demand for health information and "gray literature" is growing. The MRC collects and produces this material and has its own database called SAMED, which is to be made available to others as our contribution to health. It is hoped to make this available for inclusion in the proposed African Index Medicus presently investigated by the World Health Organization. Africa as a continent, and South Africa as a country, are experiencing major changes in health care and medical practice, and inevitably, provision of health information services. With South Africa's re-entry into the global village and its acceptance by the rest of Africa, it can be a key player in information provision to the rest of the continent. The MRC, as a major provider of Health information, can play a vital role in the information flow throughout Africa by continuously improving and expanding its services. A large proportion of South Africans live in rural areas where health care is provided by clinics not linked to information networks. This does not mean these clinics are excluded from the use of information. The major challenge is to find the ways and means of getting the relevant information to these clinics. Information is needed to help with patient care and continuing education. With this in mind, the MRC is evaluating different formats in which information can be supplied. Due to the lack of computer literacy, facilities, and financial constraints, it is better to supply printed information. With the spread of technology through the country and continent, it can be assumed that information flow and transfer will be more rapid. Repackaging of information means that it is possible to get the relevant information to the right people at the right time. The first such package developed is for hospital managers. With the help from experts in the field of PHC, it is hoped to develop packages aimed specifically at the CHWs and other workers in the field. All packages developed by the MRC are backed by a document provision service, using the most cost-effective route to obtain documents. A printed product must comply with certain criteria; these are: 1) purpose for which the information is needed; 2) kind of information needed and the format in which it is needed; 3) when the information is needed; 4) is the information to be supplied on an ongoing basis i.e., updated with latest information; 5) cost involved; and 6) how to get the information to the relevant user.

Computer Communication Networks↗