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PubMed2004

A first molecular epidemiological study of SAT-2 type foot-and-mouth disease viruses in West Africa.

Thirty-one viruses causing SAT-2 outbreaks in seven West African countries between 1974 and 1991, and four viruses representative of East and Central Africa were genetically characterized in this study. Four major viral lineages (I-IV) were identified by phylogenetic analysis of an homologous 480 nucleotide region corresponding to the C-terminus end of VP1. Lineage I comprised two West African genotypes with viruses clustering according to year of isolation rather than geographical origin. Lineage II was represented by viruses isolated between 1979 and 1983 in two neighbouring West African countries, Senegal and The Gambia. Viruses from Nigeria and Eritrea, representative of West and East Africa respectively, constituted lineage III, whilst lineage IV, comprising viruses from Central and East Africa, was regionally and genetically distinct. This study revealed that unrestricted animal movement in West Africa is a major factor in disease dissemination and has also provided the first indication of trans-regional virus transmission.

Africa, Western↗
PubMedDate not supplied

Terrorism in South Africa.

The Republic of South Africa lies at the southern tip of the African continent. The population encompasses a variety of races, ethnic groups, religions, and cultural identities. The country has had a turbulent history from early tribal conflicts, colonialisation, the apartheid period, and post-apartheid readjustment. Modern terrorism developed mainly during the apartheid period, both by activities of the state and by the liberation movements that continued to the time of the first democratic elections in 1994, which saw South Africa evolve into a fully representative democratic state with equal rights for all. Since 1994, terrorist acts have been criminal-based, evolving in the Cape Town area to political acts, largely laid at the feet of a predominantly Muslim organisation, People against Gangsterism and Drugs, a vigilant organisation allegedly infiltrated by Muslim fundamentalists. Along with this, has been terrorist activities, mainly bombings by disaffected members of white, right-wing groups. In the apartheid era, a Draconian series of laws was enacted to suppress liberation activities. After 1994, most of these were repealed and new legislation was enacted, particularly after the events of 11 September 2001; this legislation allows the government to act against terrorism within the constraints of a democratic system. Disaster management in South Africa has been largely local authority-based, with input from provincial authorities and Civil Defence. After 1994, attempts were made to improve this situation, and national direction was provided. After 11 September 2001, activity was increased and the Disaster Management Act 2002 was brought into effect. This standardized disaster management system at national, provincial, and local levels, also facilites risk assessment and limitation as well as disaster mitigation. The potential still exists for terrorism, mainly from right-wing and Muslim fundamentalist groups, but the new legislation should stimulate disaster management in South Africa to new and improved levels.

Civil Defense↗
PubMed1997

Exposure of cats in southern Africa to Coxiella burnetii, the agent of Q fever.

Recently, the domestic cat has been implicated in numerous outbreaks of Q fever in humans. To determine if cats in southern Africa are infected with the agent of Q fever we tested sera from cats in South Africa and Zimbabwe by indirect fluorescence for antibodies reactive with phase II Coxiella burnetii antigen (Nine Mile strain). Reactive antibodies were detected at titres of > or = 1/40 in sera from cats in South Africa (1/52, 2%) and Zimbabwe (15/119, 13%). Our results indicate that cats in southern Africa are infected with C. burnetii and should be considered as sources of infection for humans.

Animals↗
PubMed2000

Rainfall and drought in equatorial east Africa during the past 1,100 years.

Knowledge of natural long-term rainfall variability is essential for water-resource and land-use management in sub-humid regions of the world. In tropical Africa, data relevant to determining this variability are scarce because of the lack of long instrumental climate records and the limited potential of standard high-resolution proxy records such as tree rings and ice cores. Here we present a decade-scale reconstruction of rainfall and drought in equatorial east Africa over the past 1,100 years, based on lake-level and salinity fluctuations of Lake Naivasha (Kenya) inferred from three different palaeolimnological proxies: sediment stratigraphy and the species compositions of fossil diatom and midge assemblages. Our data indicate that, over the past millennium, equatorial east Africa has alternated between contrasting climate conditions, with significantly drier climate than today during the 'Medieval Warm Period' (approximately AD 1000-1270) and a relatively wet climate during the 'Little Ice Age' (approximately AD 1270-1850) which was interrupted by three prolonged dry episodes. We also find strong chronological links between the reconstructed history of natural long-term rainfall variation and the pre-colonial cultural history of east Africa, highlighting the importance of a detailed knowledge of natural long-term rainfall fluctuations for sustainable socio-economic development.

Africa, Eastern↗
PubMed2005

Urbanization, malaria transmission and disease burden in Africa.

Many attempts have been made to quantify Africa's malaria burden but none has addressed how urbanization will affect disease transmission and outcome, and therefore mortality and morbidity estimates. In 2003, 39% of Africa's 850 million people lived in urban settings; by 2030, 54% of Africans are expected to do so. We present the results of a series of entomological, parasitological and behavioural meta-analyses of studies that have investigated the effect of urbanization on malaria in Africa. We describe the effect of urbanization on both the impact of malaria transmission and the concomitant improvements in access to preventative and curative measures. Using these data, we have recalculated estimates of populations at risk of malaria and the resulting mortality. We find there were 1,068,505 malaria deaths in Africa in 2000 - a modest 6.7% reduction over previous iterations. The public-health implications of these findings and revised estimates are discussed.

Adolescent↗
PubMed2000

Microsatellite analysis of genetic diversity in African buffalo (Syncerus caffer) populations throughout Africa.

Genetic diversity in nine African buffalo (Syncerus caffer) populations throughout Africa was analysed with 14 microsatellites to study the effects of rinderpest epidemics and habitat fragmentation during the 20th century. A gradient of declining expected heterozygosity was observed among populations in Save Valley Conservancy (Zimbabwe), and northern and southern Kruger National Park (South Africa). This was explained by a high mortality in northern Kruger National Park during the rinderpest pandemic at the end of the 19th century followed by recolonization from neighbouring populations, resulting in intermediate heterozygosity levels in northern Kruger National Park. In other populations expected heterozygosity was very high, indicating that rinderpest and recent habitat fragmentation had a limited effect on genetic diversity. From expected heterozygosity, estimates of long-term effective population size were derived. Migration rates among populations in eastern and southern Africa were very high, as shown by a weak isolation by distance and significant correlation in allele frequencies between populations. However, there were indications that dry habitats could limit migration. Genetic distances within buffalo in central Africa were relatively large, supporting their status as distinct subspecies. Finally, it was observed that the higher polymorphic microsatellites were less sensitive at detecting isolation by distance and differences in Ne, which may be a result of the high mutation pressure at these loci.

Africa↗
PubMed2003

Lack of genetic and plumage differentiation in the red-billed quelea Quelea quelea across a migratory divide in southern Africa.

A migratory divide usually signals the presence of a geographical region over which other traits, such as morphology and genotypes, also undergo rapid change. A migratory divide has been hypothesized in central southern Africa for the abundant migratory weaver, the red-billed quelea Quelea quelea. The positioning of the divide in the region is based on the patterns of rainfall in the region that stimulate the annual migrations of queleas. Evidence indicates that premigratory queleas near the divide show two distinct preferred directions for migration. We used eight polymorphic microsatellite loci and a range of plumage characters to determine whether there was population structure among red-billed queleas in southern Africa, and specifically whether this structure coincided with the location of the migratory divide. There was no evidence of population genetic structure. An amova revealed no significant differences between samples taken either side of the migratory divide. Similarly, there was no geographical variation in plumage patterns across southern Africa. For both microsatellites and plumage characteristics, the variation that does exist occurs within each sampled site, with little differentiation between sites. We were therefore unable to find any evidence that either plumage or microsatellite genotypes varied in a similar way to migratory direction preference in red-billed queleas in southern Africa. This is perhaps because the migratory divide does not act to separate individuals into populations within which genetic and plumage differentiation can be maintained.

Africa, Southern↗
PubMed1998

Traditional medicine to DNA vaccines: the advance of medical research in West Africa.

West Africa has a rich medical history. Herbal medicine has been practiced for hundreds of years and the establishment of an effective herbal pharmacopoeia was probably the first medical research carried out in West Africa. Arabic medicine was practiced in the countries of the Sahel in the 15th and 16th centuries. The coming of the Europeans focused research on infectious diseases such as malaria, yellow fever and sleeping sickness, to which Europeans were very susceptible and which caused devastating epidemics among the populations of their new colonies. The end of the colonial era saw the establishment of a few large, well-equipped teaching hospitals but these proved too expensive for the newly independent states of West Africa to run effectively, and the second generation of West African medical schools was based on more modest government hospitals. This led to a change in the focus of research away from the more unusual conditions seen in a specialist referral hospital to an interest in conditions, such as the common infectious diseases, seen more frequently in district hospitals. The advent of the primary health care movement in the 1970s was followed by an increased emphasis on community studies. Molecular biology is likely to have an enormous impact on medicine in general in the coming years. One of the main challenges facing medical researchers in West Africa is how these new technologies can be used most effectively to improve health in countries with limited resources.

Africa, Western↗
PubMed1998

Injury control in Africa: getting governments to do more.

Despite increasing recognition of injury as a major public health problem worldwide, it has received limited attention and resources. This lack of attention is most notable in low-income countries. As part of efforts to develop coordinated injury control activities in Africa, a round table session was held at the Third International Conference on Injury Prevention and Control in Melbourne, Australia. The aims of the forum were to provide injury control researchers from Africa the opportunity to come together and reflect on issues of injury control in Africa, to deliberate on strategies of getting African governments to show more interest in injury control, and to solicit more assistance from the international donor community Participants from Ghana, Kenya, South Africa and Zimbabwe presented the magnitude of the injury burden in their respective countries, reflected on current research efforts and highlighted the preventive efforts being undertaken. The forum made many recommendations including several regarding specific actions required of African governments, individual researchers and donor agencies.

Accidents, Home↗
PubMed2001

An empirical malaria distribution map for West Africa.

The objective of this study was to produce a malaria distribution map that would constitute a useful tool for development and health planners in West Africa. The recently created continental database of malaria survey results (MARA/ARMA 1998) provides the opportunity for producing empirical models and maps of malaria distribution at a regional and eventually at a continental level. This paper reports on the mapping of malaria distribution for sub-Saharan West Africa based on these data. The strategy was to undertake a spatial statistical analysis of malaria parasite prevalence in relation to those potential bio-physical environmental factors involved in the distribution of malaria transmission intensity which are readily available at any map location. The resulting model was then used to predict parasite prevalence for the whole of West Africa. We also produced estimates of the proportion of population of each country in the region exposed to various categories of risk to show the impact that malaria is having on individual countries. The data represent a very large sample of children in West Africa. It constitutes a first attempt to produce a malaria risk map of the West African region, based entirely on malariometric data. We anticipate that it will provide useful additional guidance to control programme managers, and that it can be refined once sufficient additional data become available.

Adolescent↗
PubMed2002

AIDS and Africa. Introduction.

Sub-Saharan Africa is the epicenter of the HIV/AIDS epidemic, and in this issue of the Journal, seven authors discuss the moral, social and medical implications of having 70% of those stricken living in this area. Anton A. van Niekerk considers complexities of plague in this region (poverty, denial, poor leadership, illiteracy, women's vulnerability, and disenchantment of intimacy) and the importance of finding responses that empower its people. Solomon Benatar reinforces these issues, but also discusses the role of global politics in sub-Saharan Africa, especially discrimination, imperialism and its exploitation by first world countries. Given the public health crisis, Udo Schüklenk and Richard E. Ashcroft defend compulsory licensing of essential HIV/AIDS medications on consequentialist grounds. Keymanthri Moodley discusses the importance of conducting research and the need to understand a moderate form of communitarianism, also referred to as "ubuntu" or "communalism", to help some Africans understand research as an altruistic endeavour. Godfrey B. Tangwa also defends traditional African values of empathy and ubuntu, discussing how they should be enlisted to fight this pandemic. Loretta M. Kopelman criticizes the tendency among those outside Africa to dismiss the HIV/AIDS pandemic, attributing one source to the ubiquitous and misguided punishment theory of disease. The authors conclude that good solutions must be cooperative ventures among countries within and outside of sub-Saharan Africa with far more support from wealthy countries.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Laboratory evaluation of B-2 as a molluscicide in the control of the snail intermediate hosts of schistosomiasis in South Africa.

There is a continuous need for the development and evaluation of new, inexpensive but highly effective molluscides for the control of freshwater snails acting as intermediate hosts of schistomiasis. For this reason B-2 (Hokko Chemical Industry Co. Ltd, Japan), also called Phebrol (sodium 2,5-dichloro-4-bromophenol), was evaluated in our laboratory as a candidate molluscicide for the control of freshwater snails in South Africa. Bulinus africanus and Biomphalaria pfeifferi, intermediate hosts of Schistosoma haematobium and Schistosoma mansoni respectively, were exposed to different B-2 concentrations for 24 and 48 hours. An indigenous fish species, Oreochromis mossambicus, which is common in local schistosomiasis endemic areas, was also exposed to the molluscicide. The calculated values obtained from a probit analysis (LC50, 24 hours: B. africanus = 2.6 mg 1(-1) and B. pfeifferi = 2.9 mg 1(-1), indicated that these species from southern Africa are less sensitive to B-2 than are B. truncatus and B. pfeifferi from northern Africa, which in turn are less sensitive than the Oncomelania spp. from Japan, China and the Philippines. It is expected that molluscicidal levels of B-2 would be harmful to O. mossambicus populations. Although B-2 has a marked potential for snail control in South Africa, niclosamide (Bayluscide) remains the molluscicide of choice.

Animals↗
PubMed1997

Meningococcal disease in Africa.

Neisseria meningitidis (the meningococcus) is responsible for endemic and meningococcal disease in Africa. Meningococci are placed into 12 serogroups based on their capsular polysaccharide antigens. Group-B meningococci are responsible for sporadic endemic disease. In the meningitis belt of sub-Saharan Africa, the large spreading epidemics which occur every 5-10 years are usually caused by group-A meningococci, with attack rates of 400-500/100,000 population. In the last epidemic, infection spread from the original meningitis belt to Kenya, Uganda, Rwanda, Zambia and Tanzania. Most cases of meningococcal disease are of meningitis and meningococcal septicaemia is a rare presentation except in South Africa. It is important to exclude meningococcal septicaemia since this carries the highest mortality (up to 75%). Treatment involves intravenous chloramphenicol (or intramuscular, oily chloramphenicol), a drug which is preferable to penicillin because penicillin-resistant meningococci have already emerged in Africa. Dexamethasone treatment of meningococcal meningitis is unproven and may even be deleterious in developing countries. Prevention of epidemic meningococcal disease could be achieved by mass vaccination with protein-conjugate, group-A and -C polysaccharides, but these new vaccines are likely to be expensive.

Adult↗
PubMedDate not supplied

Oculocutaneous albinism in southern Africa: population structure, health and genetic care.

BACKGROUND: People with oculocutaneous albinism (OCA) have reduced levels of melanin in their hair, skin and eyes, with associated visual impairment and extreme sun sensitivity requiring lifelong monitoring. This genetic condition is surrounded by myth, superstition and fear in Africa, where affected individuals and their families may be rejected, shunned and excluded from their community. OBJECTIVE: This review reports population studies in southern Africa to determine the distribution of people with OCA in this predominantly rural and relatively impoverished area-crucial information for health and education providers. Health and genetic care studies document the range of eye and skin problems experienced and suggest effective and sustainable ways to manage these needs in a low resource setting. CONCLUSION: Innovative genetic care programmes in northern South Africa facilitate low-cost management of albinism, raise self-esteem and promote community awareness, helping to improve the long-term health prospects and social integration of those affected. This holistic approach of dealing with albinism from both a medical and a sociological perspective could be applied in other areas of Africa where this condition is prevalent.

Africa, Southern↗
PubMedDate not supplied

Toward a symmetrical and an integrated framework of norms for nutrition communication in sub-Saharan Africa.

Nutrition is crucial to national development; an undernourished or a malnourished population is at risk for infectious diseases that may reduce its working and productive capacities. Sub-Saharan Africa leads the world in the proportion of its population that is chronically malnourished. This article presents a symmetrical and an integrated framework of norms for nutrition communication. It uses three nutrition communication projects in Africa to illustrate the application of those norms. Based on that review, it concludes that a community-based framework should emphasize at the outset--and throughout program implementation and evaluation--the importance of folk media (e.g., Africa's "oramedia") as both formative and summative norms for planning, implementing, and evaluating nutrition communication programs in Africa.

Africa South of the Sahara↗
PubMed2005

Human immunodeficiency virus dementia patients in Africa: How many? Who cares? And where to from here?

Dementia was a frequent consequence of human immunodeficiency virus (HIV) in developed countries before antiretroviral therapy (ART) became available and remains a common neurologic complication of acquired immunodeficiency syndrome (AIDS) among patients receiving appropriate therapy. The epidemiology of HIV dementia (HIV-D) in Africa remains unclear 20+ years into the AIDS epidemic. Early studies of cognitive impairment in HIV-positive populations in Africa were limited by vaguely defined criteria for cognitive impairment, inadequate assessment tools lacking ecologic validation, and the absence of normative population data. More recent studies have clarified definitions of impairment, utilized more sophisticated measures, and included normative comparisons. Unfortunately, these detailed neuropsychiatric assessments are not feasible for population-based studies or routine clinical implementation. Therefore, the prevalence data available for HIV-D in Africa represents rates found in people presenting to tertiary care centers and are unlikely to reflect HIV-D rates in the general population. As ART becomes available in Africa, future research efforts must provide a better understanding of the epidemiology of HIV-D, the effects of available ART regimens on HIV-D in this population, and the impact of HIV-D on ART adherence. Universally accepted terminology and criteria for HIV-D are needed. Population-based studies will require the development of neuropsychiatric batteries that can be adapted across a range of African environments. Ideally, these measures will be viable for nonphysician care providers to use as screening tools in the first stage of epidemiologic studies. Such screening tools could also serve as clinical indicators of possible HIV-related cognitive impairment facilitate implementation of ART adherence.

AIDS Dementia Complex↗
PubMedDate not supplied

HIV/AIDS and debt crises: threat to human survival in sub-Saharan Africa.

Whether originating from the African primates in the Central African forest, or from polio vaccine trials by some western scientists, there is no doubt that HIV/AIDS poses the greatest single challenge to the marginalized poor of Africa, where it has found a malnourished, vulnerable, defenceless host. Collective response is necessary by physicians and health professionals who must be at the forefront of restoring hope and a dignified quality of life. In sub-Saharan Africa, HIV/AIDS is not a security threat but a painful slow death which forces victims into exhausting their lifetime savings on expensive medicines and massive hospital bills. It leaves helpless orphans to struggle for survival in countries where government subsidy on education and healthcare has been long withdrawn so as to channel the meagre state resources into debt servicing. A combination of the HIV/AIDS pandemic and Third World debt is subjecting millions of children to the worst form of violence. This article reviews the situation in sub-Saharan Africa, with special reference to Kenya and South Africa as examples of countries devastated by the HIV/AIDS pandemic. Changes elsewhere are noted and the global response is critically examined.

Africa↗
PubMedDate not supplied

HIV epidemics in Africa: what explains the variations in HIV prevalence?

There are large differences in the prevalence of HIV infection between different regions in sub-Saharan Africa, ranging from less than 10% in pregnant women in most of West Africa, to over 25% in pregnant women in large cities in Eastern and Southern Africa. These differences in HIV prevalence are in many instances due to differences in rate of spread of the virus. The multicenter study on factors determining the differential spread of HIV in four African cities tried to identify factors that could explain differences in spread of HIV between different regions in sub-Saharan Africa. The study was conducted in four cities, including two cities with a relatively low HIV prevalence (Cotonou in Bénin and Yaoundé in Cameroon) and two cities with a high HIV prevalence (Kisumu in Kenya and Ndola in Zambia). The difference in HIV prevalence between the four cities could not be explained by differences in sexual behavior. Any differences in sexual behavior were outweighed by differences in factors that influence HIV transmission, i.e. male circumcision and HSV-2 infection. These findings have important implications for the design of interventions.

Africa↗