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Sickle gene. Its origin and diffusion from West Africa.

Linked DNA polymorphisms can be used to study the evolution of structural gene mutations. Both the beta S-(beta 6Glu leads to Val) and beta C-(beta 6Glu leads to Lys) genes are common in West Africa. We have analyzed their linkage to a polymorphic Hpa 1 site appearing 3' to the beta-globin gene locus in selected populations from Wes Africa. A large reservoir of beta A-genes linked to 13-kilobase Hpa 1 fragments with a frequency of 17-18% has been identified. In addition, the beta S- and beta C-genes in Togo are found to be tightly linked to the 13-kilobase Hpa 1 fragment, whereas 72% of the beta S-genes in the Ivory Coast reside on the 7.6-kilobase Hpa 1 fragment. These studies are consistent with the selection and expansion of two different chromosomes bearing beta S-genes in at least two physically close, but ethnically separate regions of West Africa, with subsequent diffusion to North, Equatorial, and East Africa.

Africa↗

[The state of research in French-speaking Africa].

Given the mortality and morbidity attributed to tobacco worldwide, global funding for tobacco control research, is greatly insufficient If compared with the fight against other diseases, tobacco control remains grossly under-funded. Data necessary to monitor the tobacco epidemic is inadequate even in the richer countries. It is therefore hardly surprising that studies on the state of data in developing countries and especially in francophone Africa conclude that standardised and comparable data are missing in all fields of tobacco control. Data available is often old, incomplete and hardly representative. This can be explained by both the lack of adequate capacity to conduct research and the low priority given to tobacco control as a health problem. In poor countries and regions where other diseases such as malaria and AIDS seem more pressing, the tobacco industry has almost no difficulty in using unfounded arguments about its contribution to the economy. Public authorities are thus intimidated by the threats of economic loss or attracted by immediate economic gains. This too often weakens the political will to act on issues of tobacco control. The little data available for the region, however, is alarming. Tobacco consumption has rapidly increased in recent years. This trend is confirmed by tobacco industry projected expansion in the region. Consequently, research programmes for Francophone African countries need to take into account the emergency of the situation, the context of Francophone Africa and, as well as, the limited resources available. Recently global research programmes such as the "Global Youth Tobacco Survey" have begun helping low-income countries in addressing the need for comparable and standardised data. The subject of an appropriate research agenda for tobacco control for low income countries has been discussed by international, national agencies, as well as, the NGO community in the context of the development of the Framework Convention on Tobacco Control. Given that the most important factors as regards changing tobacco use in a population include changing its social acceptability, as well as, providing a legal framework for tobacco control, recommendations for appropriate research for low-income countries have highlighted the need to define research programmes able to support actions which will produce the largest impact on the population, will serve to accelerate the ratification of the FCTC, will hasten the adoption of low-cost evidence-based measures such as tax increases, complete bans on advertising, smoke-free legislation, and will stop the tobacco industry's offensive in these countries. Large international initiatives to support the development of tobacco control research in low-income countries and particularly Africa have been launched. However, because of the language barriers, African Francophone countries may not have the same access to them than their Anglophone counterparts. Special attention should, therefore, be given to strengthen recent initiatives in this field which take into consideration the important dimension of language for Francophone Africa.

Africa, Northern↗

Can biotechnology help meet the nutrition challenge in sub-Saharan Africa?

The successful efforts in the 1980s to redress nutrition problems in sub-Saharan Africa are being eroded. Countries in eastern and southern Africa are now facing serious food shortages because of recurrent droughts, floods, civil wars, and the concomitant growing poverty. The potential for biotechnology to alleviate hunger holds promise if the new technology can be adapted to the prevailing sociocultural context in Africa. Agronomists and biotechnologists need to work together to ensure that the biotechnology agenda for Africa is responsive to the food and nutrition needs of its people.

Africa South of the Sahara↗

HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study.

BACKGROUND: Cervical cancer and infection with human immunodeficiency virus (HIV) are both major public health problems in South Africa. The aim of this study was to determine the risk of cervical pre-cancer and cancer among HIV positive women in South Africa. METHODS: Data were derived from a case-control study that examined the association between hormonal contraceptives and invasive cervical cancer. The study was conducted in the Western Cape (South Africa), from January 1998 to December 2001. There were 486 women with invasive cervical cancer, 103 control women with atypical squamous cells of undetermined significance (ASCUS), 53 with low-grade squamous intraepithelial lesions (LSIL), 50 with high-grade squamous intraepithelial lesions (HSIL) and 1159 with normal cytology. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multiple logistic regression. RESULTS: The adjusted odds ratios associated with HIV infection were: 4.4 [95% CI (2.3 - 8.4) for ASCUS, 7.4 (3.5 - 15.7) for LSIL, 5.8 (2.4 - 13.6) for HSIL and 1.17 (0.75 - 1.85) for invasive cervical cancer. HIV positive women were nearly 5 times more likely to have high-risk human papillomavirus infection (HR-HPV) present compared to HIV negative women [OR 4.6 (95 % CI 2.8 - 7.5)]. Women infected with both HIV and high-risk HPV had a more than 40 fold higher risk of SIL than women infected with neither of these viruses. CONCLUSION: HIV positive women were at an increased risk of cervical pre-cancer, but did not demonstrate an excess risk of invasive cervical cancer. An interaction between HIV and HR-HPV infection was demonstrated. Our findings underscore the importance of developing locally relevant screening and management guidelines for HIV positive women in South Africa.

Adult↗

Preliminary inventory and classification of indigenous afromontane forests on the Blyde River Canyon Nature Reserve, Mpumalanga, South Africa.

BACKGROUND: Mixed evergreen forests form the smallest, most widely distributed and fragmented biome in southern Africa. Within South Africa, 44% of this vegetation type has been transformed. Afromontane forest only covers 0.56 % of South Africa, yet it contains 5.35% of South Africa's plant species. Prior to this investigation of the indigenous forests on the Blyde River Canyon Nature Reserve (BRCNR), very little was known about the size, floristic composition and conservation status of the forest biome conserved within the reserve. We report here an inventory of the forest size, fragmentation, species composition and the basic floristic communities along environmental gradients. RESULTS: A total of 2111 ha of forest occurs on Blyde River Canyon Nature Reserve. The forest is fragmented, with a total of 60 forest patches recorded, varying from 0.21 ha to 567 ha in size. On average, patch size was 23 ha. Two forest communities - high altitude moist afromontane forest and low altitude dry afromontane forest - are identified. Sub-communities are recognized based on canopy development and slope, respectively. An altitudinal gradient accounts for most of the variation within the forest communities. CONCLUSION: BRCNR has a fragmented network of small forest patches that together make up 7.3% of the reserve's surface area. These forest patches host a variety of forest-dependent trees, including some species considered rare, insufficiently known, or listed under the Red Data List of South African Plants. The fragmented nature of the relatively small forest patches accentuates the need for careful fire management and stringent alien plant control.

Altitude↗

Improving epidemic malaria planning, preparedness and response in Southern Africa. Report on the 1st Southern African Regional Epidemic Outlook Forum, Harare, Zimbabwe, 26-29 September, 2004.

Malaria is a major public health problem for countries in the Southern Africa Development Community (SADC). While the endemicity of malaria varies enormously across this region, many of the countries have districts that are prone to periodic epidemics, which can be regional in their extent, and to resurgent outbreaks that are much more localized. These epidemics are frequently triggered by climate anomalies and often follow periods of drought. Many parts of Southern Africa have suffered rainfall deficit over the past three years and countries expect to see increased levels of malaria when the rains return to more 'normal' levels. Problems with drug and insecticide resistance are documented widely and the region contains countries with the highest rates of HIV prevalence to be found anywhere in the world. Consequently, many communities are vulnerable to severe disease outcomes should epidemics occur. The SADC countries have adopted the Abuja targets for Roll Back Malaria in Africa, which include improved epidemic detection and response, i.e., that 60% of epidemics will be detected within two weeks of onset, and 60% of epidemics will be responded to within two weeks of detection. The SADC countries recognize that to achieve these targets they need improved information on where and when to look for epidemics. The WHO integrated framework for improved early warning and early detection of malaria epidemics has been recognized as a potentially useful tool for epidemic preparedness and response planning. Following evidence of successful adoption and implementation of this approach in Botswana, the SADC countries, the WHO Southern Africa Inter-Country Programme on Malaria Control, and the SADC Drought Monitoring Centre decided to organize a regional meeting where countries could gather to assess their current control status and community vulnerability, consider changes in epidemic risk, and develop a detailed plan of action for the forthcoming 2004-2005 season. The following is a report on the 1st Southern African Regional Epidemic Outlook Forum, which was held in Harare, Zimbabwe, 26th-29th September, 2004.

Africa, Southern↗

Pharmacovigilance of antimalarial treatment in Africa: is it possible?

Pharmacovigilance, defined as "the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug related problem", is increasingly being recognized in Africa. Many African countries have simultaneously adopted artemisinin derivative based combination therapy (ACT) as first-line treatment for uncomplicated malaria, offering an opportunity to assess the safety of these drugs when used widely. While ACTs appear to be safe and well-tolerated, there is little experience with these medicines in Africa, outside clinical trials. Pharmacovigilance for ACTs and other combination treatments in Africa is essential. Malaria transmission intensity is high and antimalarial medicines are used frequently. Presumptive treatment of fever with antimalarials is common, often in the absence of a confirmed diagnosis, using drugs obtained without a prescription. Informal use of antimalarial drugs may increase the risk of incorrect dosing, inappropriate treatment, and drug interactions, which may impact negatively on drug safety. Furthermore, the administration of antimalarial treatments in patients with a concomitant illness, including HIV/AIDs, tuberculosis and malnutrition, is a concern. African countries are being encouraged to establish pharmacovigilance systems as ACTs are rolled out. However, pharmacovigilance is difficult, even in countries with a well-developed health care system. The rationale for pharmacovigilance of antimalarial drugs is discussed here, outlining the practical challenges and proposing approaches that could be adopted in Africa.

Adverse Drug Reaction Reporting Systems↗

Assessing the role of anal intercourse in the epidemiology of AIDS in Africa.

Public health authorities have long believed that the preponderance of AIDS cases in Africa are attributable to 'heterosexual transmission'; most people silently assume this rubric to indicate penile-vaginal intercourse only. Recent epidemiologic analyses suggest that the majority of HIV cases in sub-Saharan Africa may be due to non-sterile health care practices. The present paper reviews the anthropological, proctologic, and infectious disease literature, and argues that both homosexuality and heterosexual anal intercourse are more prevalent in Africa than has traditionally been believed. The authors hypothesize that perhaps the majority of HIV transmission not accounted for by iatrogenic exposure could be accounted for by unsuspected and unreported penile-anal intercourse. Given the authors' findings, properly conducted studies to measure this HIV transmission vector, while controlling for iatrogenic exposure confound, are clearly warranted in Africa and in countries with similar epidemiologic characteristics.

Acquired Immunodeficiency Syndrome↗

Parallel and overlapping HIV and bloodborne hepatitis epidemics in Africa.

A world overview of HIV and hepatitis B and C virus (HBV and HCV) infections shows strong parallels in the distribution of generalized epidemics. However, several recent papers have argued that HCV prevalence in countries and cohorts in sub-Saharan Africa is too low to allow parenteral transmission to account for an important proportion of HIV infections. This conclusion is unwarranted. The transmission efficiencies of HCV and HIV through needlestick accidents are similar, while some parenteral exposures - such as intramuscular injections - may be more efficient in transmitting HIV than HCV. Much of the data used to show current low HCV prevalence in Africa comes from blood samples collected in 1986-95. For South Africa, the picture of low and stable HCV prevalence in the 1990s is based on selected evidence and ignores multiple studies reporting 3-5.4% prevalence in the black population. From a literature search, we found 62 cohorts in Africa with information on HCV and HIV prevalence. Across these cohorts, there is a trend for HCV prevalence to increase with HIV, though much of the variance is unexplained. For 25 cohorts with sufficient data, the median relative risk for HCV infection for persons with HIV is 1.52.

Africa↗

Social security in Africa: a brief review.

Africa is the poorest region of the world and has the youngest and least developed social security programs. Most Africans are not covered by social security programs. The high prevalence of HIV/AIDS in some sub-Saharan countries and internal armed conflicts in others have created difficult problems in some countries for social security programs. As a result, some countries do not have functioning social security programs. The social security programs that do exist in Africa are influenced by their colonial heritage, with the programs in English-speaking Africa differing from those in French-speaking Africa. Six different patterns of social security provision can be identified.

Acquired Immunodeficiency Syndrome↗

Does knowing someone with AIDS affect condom use? An analysis from South Africa.

Prior research in Africa suggests that personally knowing someone with HIV/AIDS or who died of AIDS (PWA) may positively influence HIV-preventive behaviors such as condom use, by countering denial and increasing perceived risk. This article uses data from the 1998 South Africa Demographic and Health Survey (DHS) of women to examine this hypothesis in South Africa, where AIDS mortality is high. Logistic regression was applied to assess whether knowing a PWA was associated with condom use, net of the effects of possible confounders. Contrary to previous findings, analyses showed no association between condom use and having known a PWA. Condom use was strongly associated with knowledge that condoms can prevent HIV/AIDS, sex with a non-marital partner, higher education level, younger age, and urban residency. Findings suggest that communities should expand preventive efforts given the current level of AIDS mortality. Campaigns must reinforce messages that condoms are effective, and reach rural, less educated women, for whom HIV risk is high in South Africa.

Acquired Immunodeficiency Syndrome↗

Alcohol use and sexual risks for HIV infection among men and women receiving sexually transmitted infection clinic services in Cape Town, South Africa.

OBJECTIVE: To examine the association of alcohol use and sexual risks for HIV infection in South Africa. METHOD: 149 men and 78 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa, completed measures of demographic characteristics, sexual behaviors, HIV risk reduction skills and substance use, including global measures (e.g., Alcohol Use Disorders Identification Test [AUDIT]) and situational measures of alcohol use. RESULTS: 52% of men (n = 72) and 17% of women (n = 13) indicated problem drinking (AUDIT score > or = 9). Problem drinking was associated with greater numbers of sex partners in the past month, history of condom failures and lifetime history of having an STI, as well as lower rates of practicing risk reduction skills. In a separate analysis controlling for global use of alcohol indexed by AUDIT scores, we found that alcohol use in sexual contexts was associated with greater numbers of sex partners, higher rates of unprotected intercourse and condom failures. CONCLUSIONS: Findings from this initial study of alcohol use and sexual risks in South Africa parallel those from other countries in sub-Saharan Africa. Although limited to STI clinic patients, the results suggest that effective HIV risk reduction interventions will require attention to alcohol use, particularly among South Africans at highest risk for HIV infection.

Adult↗

Public health risks associated with the utilisation of wildlife products in certain regions of Africa.

The authors describe the public health risks associated with wildlife products in certain regions of Africa. Most of the information presented is obtained from the Republic of South Africa, particularly the Kruger National Park. There are no statutory requirements in South Africa regarding the general inspection of game carcasses prior to sale: however, current regulatory inspection requirements are explained. Game farming systems in southern Africa are generally extensive systems with wild herbivores living in a near-natural 'free-ranging' state. Several pathological processes and disease entities have been confirmed in wildlife carcasses and these are listed with zoonotic implications.

Animals↗

The provision of animal health care to smallholders in Africa: an analytical approach.

Many of the problems associated with the delivery of quality veterinary services to smallholders in Africa are attributed to the complexity of the provision of animal health care (AHC) in sub-Saharan Africa. In this region, a holistic and analytical approach is needed to determine area-specific requirements for sustainable, and thus quality, AHC. This study examines three components of the animal health care system in sub-Saharan Africa, namely, the structure, the process and the outcomes. It focuses particularly on the factors that contribute to the quality of the structure and the process. For this purpose, two measures of quality are used, i.e. availability (in relation to the structure) and acceptability (in relation to the process). The authors identify factors that affect the availability and acceptability of AHC and suggest ways in which they, and hence the quality of AHC provided to smallholders in Africa, can be improved.

Africa South of the Sahara↗

Blood transfusions in the early years of AIDS in sub-Saharan Africa.

Blood transfusions transmit HIV more effectively than other means, yet there has been little examination of their role in the origins and early course of AIDS in sub-Saharan Africa. We review historical data in archives, government reports, and medical literature from African and European sources documenting the introduction, establishment, use, and growth of blood transfusions in sub-Saharan Africa. These data allow estimation of the geographic diffusion and growth of blood transfusions between 1940 and 1990. By 1955, 19 African colonies and countries reported transfusion programs-with national rates of 718 to 1372 per 100 000 by 1964, and urban rates similar to those in developed countries. We estimated 1 million transfusions per year in sub-Saharan Africa by 1970 and 2 million per year by the 1980s, indicating that transfusions were widely used throughout sub-Saharan Africa during the crucial period of 1950-1970, when all epidemic strains of HIV first emerged in this region.

Acquired Immunodeficiency Syndrome↗

Uneven health outcomes and political resistance under residual neoliberalism in Africa.

Africa has suffered two decades of policy implementation associated with the "neoliberal" macroeconomic as well as micro-development paradigm, and the health status of this continent has deteriorated markedly. Notwithstanding the discrediting of such policies since the late 1990s, they continue to be applied in Africa, especially by the World Bank and IMF, through Poverty Reduction Strategy Papers and the Highly Indebted Poor Countries debt relief initiative. Evidence can be found in the inadequate fiscal allocations to the health sector; the inadequate conceptualization of health in relation to other sectors; insufficient consultation with civil society; ongoing implementation of cost-recovery and user-fee provisions; a failed strategy to access pharmaceutical products, by respecting unnecessary Trade in Intellectual Property Rights provisos; and, most importantly, glaring insufficiencies in reducing Africa's foreign debt. One reflection of the balance of forces between Washington financial agencies and African societies is the adoption of the New Partnership for Africa's Development at the urging of the South African and Nigerian governments. While the WHO has helped to research, publicize, and criticize the problems associated with durable neoliberalism in African health care, it also continues to make serious mistakes as it remains locked within the paradigm. A human rights perspective being developed by the African Social Forum is, in contrast, consistent with broader international trends in the opposition to corporate globalization.

Africa↗

African tick-bite fever: four cases among Swiss travelers returning from South Africa.

BACKGROUND: African tick-bite fever (ATBF) is a recently described disease belonging to the spotted fever group. It is caused by Rickettsia africae, and cases are mainly diagnosed in travelers returning from sub-Saharan Africa. METHODS: We report four cases of ATBF among Swiss travelers returning from a 1-month trip in rural South Africa. Diagnosis was made on the basis of clinical, epidemiologic and serologic findings that we describe in detail. Serology was performed using microimmunofluorescence (MIF) assay 2 weeks, 6 weeks and 14 months after the commencement of symptoms. RESULTS: All patients developed the typical eschar and a rash; two had a local lymphadenopathy and one a lymphangitic reaction. Two patients developed transient neuropsychiatric symptoms such as headache, irritability and depressed mood. All four patients had rises in both IgM and IgG classes of anti-R. africae antibodies. After 1 year, only two patients still had measurable circulating antibodies. Cross-reactions with R. conorii were noted. Three patients were cured after a short course of doxycycline; one required 15 days of treatment. CONCLUSIONS: ATBF is a benign disease increasingly being diagnosed in travelers. After ruling out malaria, ATBF diagnosis relies upon a detailed travel history and the classical findings of influenza-like symptoms, fever, one or more necrotic eschars, and rash. Serologic tests usually help to confirm the diagnosis. Neuropsychiatric symptoms specifically associated with ATBF are reported here for the first time.

Adolescent↗

The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa.

OBJECTIVE: To determine the prevalence of NIDDM and associated risk factors in urban Africans in Cape Town, South Africa. RESEARCH DESIGN AND METHODS: With a three-stage, proportional, stratified, random cluster method, we sampled 1000 Africans, > 30 yr of age, living in African residential areas in Cape Town. We assessed glucose tolerance with a 75-g oral glucose tolerance test, according to World Health Organization criteria, and obtained anthropometric and demographic data. RESULTS: The response rate was 79%. The prevalence of NIDDM was 8.0% (confidence interval 5.8-10.3%), age-adjusted to world population figures and that of impaired glucose tolerance, 7.0% (confidence interval 4.9-9.1%). Multivariate analysis indicated that increased age (odds ratio 4.18), upper-segment fat distribution (odds ratio 2.94), proportion of life spent in an urban area (odds ratio 2.32), and obesity (odds ratio 2.31) were significant independent risk factors for NIDDM. In contrast, sex, family history, alcohol intake, and physical activity were not independent risk factors. Only increased age (odds ratio 4.06) was a significant risk factor for impaired glucose tolerance. CONCLUSIONS: The prevalence of NIDDM in urban Africans in Cape Town, South Africa, is moderately high, and considerably higher than previous reports from Africa. The association of NIDDM with urbanization has important implications in view of the large-scale urbanization occurring in southern Africa.

Adult↗