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PubMed1991

The economic cost of malaria in Africa.

Although malaria is the major health problem in Africa, there is little research on its economic impact. This study adapts a framework for assessing the economic costs of illness to available data on malaria. Direct costs of illness are the costs of treatment and control activities, and indirect costs are the value of lost time due to morbidity and premature mortality. Direct costs were estimated by applying the average estimated health systems costs per case to the number of cases. Indirect costs were assessed by multiplying adult output per day times the estimated productive time lost through both adult and childhood cases. As data are not available to assess the economic impact of malaria in Africa as a whole, four case studies were performed on countries or regions for which needed data could be found. The four sites (Rwanda, Solenzo medical district of Burkina Faso, Mayo-Kebbi district, Chad, and Brazzaville, Congo) were chosen to illustrate the diversity in kinds of data which can be used (aggregate national health statistics versus household surveys) and in locations (urban versus rural). Costs were calculated for the recent past and were projected to 1995 based on recent epidemiological trends. Estimates for all sub-Saharan Africa were derived from the averages of these sites. In 1987, a case of malaria cost $9.84 (in 1987 US dollars)--$1.83 in direct costs and $ 8.01 in indirect costs. As the average value of goods and services produced per day in Africa was $0.82, this cost is equivalent to 12 days of output.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1990

[The geography of infection with the human immunodeficiency virus (HIV) in black Africa: determination of epidemiological and regional factors].

In Africa, the continent most affected by HIV, the geography of the epidemic shows major contrasts. Strong regionalization differentiates both central-east Africa from west Africa and, within the countries, the urban zones from rural ones. Spatial and population factors are important when mapping the geography of the infection. An analysis of the evolution of movements--merchandise as well as populations--of the landlocked countries of the Great Lakes region of Africa leads the author to formulate a hypothesis involving regional considerations.

Acquired Immunodeficiency Syndrome↗
PubMed1986

[Reflections on ankylosing spondylitis in Black Africa. Apropos of a juvenile-onset case].

From the starting point of two cases of ankylosing spondylitis, one of which began in youth, observed in Abidjan, Ivory Coast, a review of the literature concerning the major cases amongst africans is carried out. This disease is unusual in tropical Africa: about thirty published cases, of varied origin. This low incidence of ankylosing spondylitis is correlated to the rarity of the HLA B27 group and of seronegative spondylitic joint diseases in general amongst the black population of Africa. Whereas the high incidence of forms with juvenile onset in North Africa suggests some connection with undetected Reiter's disease, the infrequency of this form of onset of the disease in sub-Saharan Africa and the lack of bacteriologic evidence make it impossible to reach any such conclusions.

Adolescent↗
PubMedDate not supplied

Drug abuse in Africa.

Apart from cannabis abuse in northern and southern Africa and khat chewing in north-eastern Africa, the history of drug abuse in Africa is relatively short. The abuse of drugs in Africa is nevertheless escalating rapidly from cannabis abuse to the more dangerous drugs and from limited groups of drug users to a wider range of people abusing drugs. The most common and available drug of abuse is still cannabis, which is known to be a contributing factor to the occurrence of a schizophrenic-like psychosis. The trafficking in and abuse of cocaine and heroin are the most recent developments in some African countries that had had no previous experience with these drugs. Efforts should be made to design and implement drug abuse assessment programmes to determine the real magnitude and characteristics of the problem and to monitor its trends. A lack of funds and a shortage of adequately trained personnel have made it difficult to implement drug abuse control programmes. In addition to formal drug control involving the implementation of legislation, there is an informal system of drug abuse control operating through the family, church, school, neighbourhood and work environment, as well as healthy recreational activities. It is suggested that efforts in African countries should be directed towards strengthening not only the formal drug control system but also informal control in order to compensate for the insufficient funds and the shortage of personnel trained in implementing formal drug control measures. It is very likely that the drug problems in African countries will worsen in future unless more effective measures are implemented to arrest the current situation.

Africa↗
PubMed1979

[Epidemiologic features of pneumococcal meningitis in Africa. Clinical and serotypical aspects (author's transl)].

Pneumococcal meningitis, because of their frequency and their severity, are regarded as an important problem of Public Health in Africa. In a great number of African countries, particularly Equatorial and Central Africa, the pneumococcus is the first agent of bacterial meningitis. The annual prevalence is estimated as about 14/100 000 persons. The case fatality rate (on 1 600 cases) is 49,5% ; the annual mortality reaches about 7/100 000 (28 000 annual deaths in Africa). The babies and the old persons are more exposed to the risk, with an annual prevalence of 28,5/100 000 before five years old, and of 16,1/100 000 after sixty years old. The risk is small between five and forty five years old. The risk is very high in patients homozygous for sickle-cell disease. The spread of all detected serotypes, by descending frequency is : 1, 5, 6, 3, 23, 12, 2, 14, 9, 18, 19, 4, 8, 29, 40, others (Danish system of nomenclature). The distribution according to age is indicated by the authors. A vaccine with only 8 serotypes (1, 5, 6, 3, 23, 12, 2, 14) could cover 80% of serotypes in Dakar. For the babies, addition to pneumococcal vaccine with polyribose phosphate of Haemophilus influenzae b, could be useful, because high prevalence of meningitis with this germ before five years old in Africa.

Adolescent↗
PubMed1967

Non-tuberculosis mycobacteria in Africa. 2. Sensitivity to mycobacteriophages.

In this-the second of a series of studies on the prevalence of non-tuberculosis mycobacteria in Africa-the susceptibility of 228 cultures of non-tuberculosis mycobacteria isolated at tuberculosis laboratories in Nairobi, Kenya, and Lagos, Nigeria, to 7 laboratory strains of mycobacteriophages was examined. Of the 51 cultures found to be phage-sensitive, just over half (29) were saprophytic. In the cultures from East Africa, phage-sensitive strains were observed only among the saprophytes, whereas in those from West Africa such strains occurred also among unpigmented mycobacteria (Runyon's Group III). All but one strain of non-tuberculosis mycobacteria isolated from domestic animals in East Africa were found to be resistant to all 7 phages used. Unfortunately, the patterns of phage sensitivity showed such variety that it was concluded that phage-typing alone was unsuitable for the classification of non-tuberculosis mycobacteria.

Africa↗
PubMed1984

Malaria chemoprophylaxis for multiple drug resistant Plasmodium falciparum in Africa: an increasing problem.

Resistance of P. falciparum to the two groups of antimalaria drugs commonly used for prophylaxis, i.e. folate antagonists and 4-aminoquinolines has become a matter of great concern, also in Africa. After 1978, P. falciparum developed resistance to the group of 4-aminoquinolines, which was first reported from East Africa. Chloroquine resistant infections are now spreading into Central Africa. Similar developments are now appearing with the combination sulfadoxine/pyrimethamine. With the increasing reports of multiple drug resistance in P. falciparum from Africa, no single drug or combination of drugs in use for chemoprophylaxis can give a complete protection under all circumstances any longer. Until new effective drugs become available, it is advised to use the combination of chloroquine or amodiaquine and proguanil; the traveller should be prepared for action in the event of a breakthrough. A written instruction is suggested to be inserted in the "International Certificate of Vaccination".

Adult↗
PubMed1978

Prevalence of Toxoplasma antibodies in Southern Africa.

An indirect fluorescent antibody survey of the prevalence of Toxoplasma antibodies was carried out on sera from 4 regions of Southern Africa (Natal, Eastern Cape, Western Cape, and South West Africa and Botswana). The overall prevalence of seropositivity at a titre of 1/16 or higher was 20% (of 3379 sera tested), the highest prevalence occurring in Blacks (34%) and Indians (33%) of Natal, and the lowest in San (Bushmen) (9%) and Whites (12%) of South West Africa and Botswana. Differences in prevalence in these areas, and between different ethnic groups, are discussed and compared with previous studies in Southern Africa. Climatic factors affecting prevalence and transmission are compared in relation to cyst and oöcyst survival. The marked differences in prevalence between the San (9%) and the Negroid Dama (27%), both inhabiting the arid Kalahari Desert, are discussed with reference to the lifestyles of these groups.

Antibodies↗
PubMedDate not supplied

[Mycetomas in Africa].

Mycetoma is the pathological process in which exogenous fungal or actinomycotic etiological agents generate grains. These agents belong to two groups: fungi and aerobic actinomycetes. Eumycetoma (caused by fungi) and actinomycetoma (caused by actinomycetes) must be distinguished as their treatments are different. These causative agents are introduced by traumas. Mycetomas are frequent in the northern tropical zones of America in Mexico and Venezuela, Africa in Senegal, Mauritania and Sudan and Asia in India, but can also be observed beyond these areas. In Africa, a high endemicity has been noted in a Sahelian band spanning from Senegal and Mauritania in the west to Somalia and the Republic of Djibouti in the east where there are long dry seasons and short rainy seasons. In this zone, M. mycetomatis (fungi) and S. somaliensis (actinomycetes) are predominant. A. pelletieri is common only in West Africa. Rainfall influences the distribution of these agents. S. somaliensis is more often found in desert areas, and A. pelletieri in more rainy areas. Mycetoma is more frequent in males and affects the age group between the second and fourth decades. Most of the patients are outdoor workers. In Africa, the foot is the most frequent localisation of the disease followed by the leg. Mycetoma is characterized by tumefaction, subcutaneous nodules and in most cases discharging sinuses that drain exudate containing grains. It gradually invades the tissues and bones causing a functional disability. Bone involvement depends on the duration of the disease, the site of the lesion and the causative agent. Invasion of lymph nodes is observed in rare cases, usually with actinomycetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Anthrax control and research, with special reference to national programme development in Africa: memorandum from a WHO meeting.

The prevalence of anthrax in both animal and human populations has been increasing in Africa. It was therefore appropriate for this WHO meeting to be convened in an endemic area of the Western Province of Zambia in 1992. The participants reviewed anthrax epidemiology and control in some African countries, elaborated national anthrax control and research programmes in Africa, discussed international cooperation and work plans, and elaborated recommendations for anthrax control in Africa. The discussions centred on anthrax surveillance and reporting systems, diagnosis, vaccine production and immunization, disinfection and decontamination, carcass disposal, treatment of human cases, health systems, as well as intersectorial cooperation between public health services, veterinary services and other services such as wildlife conservation, so that national control programmes could take full account of the conditions prevailing in epidemic situations in Africa. The recommendations are applicable in other regions where anthrax poses similar problems in public, animal and environmental health.

Africa↗
PubMed1995

[Vaccination strategies for contagious bovine pleuropneumonia in Africa].

Contagious bovine pleuropneumonia (CBPP) is regarded as the second most important disease of cattle in Africa. The disease was eradicated from Europe through drastic slaughter campaigns with quarantine and restriction of cattle movements. CBPP was mastered in Australia using these methods combined with vaccination. However, the disease remains endemic in Asia and Africa, where it inhibits livestock farming. In these continents, vaccination is the preferred means of control; the aim is to reduce incidence until complementary disease control measures can be applied. The success of a vaccination campaign depends on four main factors: good planning and good organisation; staff who are well-trained, fully equipped and highly motivated; high quality vaccines; good international co-operation. Vaccine strains recommended for use in Africa are strain T1/44 and its variant T1-SR. To improve the immunogenicity of these strains, the Pan African Rinderpest Campaign (PARC) secured financial support for research into immunostimulating complexes (ISCOM). It is hoped that this technology can improve vaccines, leading to effective eradication of the disease. In the meanwhile, systematic and repeated vaccination is the method of choice against CBPP in Africa.

Africa↗
PubMed1996

The direct and indirect costs of cardiovascular disease in South Africa in 1991.

BACKGROUND: In South Africa, cardiovascular disease (CVD) is the leading cause of death among all population groups, other than blacks, among whom it ranks third. CVD therefore has a severe impact on the South African economy. OBJECTIVES: To ascertain the availability and quality of South African data on the cost of CVD and to estimate the impact of CVD on the South African economy during 1991. METHODS: The direct health care costs and the indirect costs related to loss of productivity were estimated. Where no direct or complete detailed South African data were available, projections were made based on reasonable assumptions of data and models developed in other countries; these were applied to the limited available South African data. The major disease outcomes considered for this cost estimation were: expenditure on ischaemic heart disease, cerebrovascular disease (stroke), venous thrombosis and embolism, and peripheral vascular diseases and related conditions. These diseases are responsible for the majority of fatal cases of CVD reported in South Africa. RESULTS: The estimated total cost of CVD in South Africa in 1991 was between R4.135 billion and R5.035 billion. This does not include the cost of rehabilitation and follow-up of CVD patients since the necessary data were not available to estimate it. About three-quarters of the direct health care costs were carried by the private sector. The direct health care costs were estimated to be approximately 42% of the total cost. The rest reflects the indirect cost of earnings foregone as a result of premature morbidity and mortality. CONCLUSION: To determine accurately the total economic burden of CVD on the South African economy, additional data will have to be collected. The estimated economic burden of CVD in South Africa clearly highlights the need for a broad-based population strategy, part of an overall national effort to prevent, diagnose and cost-effectively treat CVD.

Cardiovascular Diseases↗
PubMed1996

Changes in the incidences of the different serovars of Haemophilus paragallinarum in South Africa: a possible explanation for vaccination failures.

Infectious coryza remains an important disease in the poultry industry despite the long-term and widespread use of vaccines against its causative agent, Haemophilus paragallinarum, in South Africa. In order to detect antigenic changes between populations of H. paragallinarum isolated before the use of vaccines against infectious coryza in this country, and field isolates obtained after the introduction of infectious coryza vaccines, 106 different NAD-dependent isolates (of which 93 were identified as H. paragallinarum) from 63 different farms, and dating from 1972 to March 1995, were identified by means of rabbit antisera against serogroups A, B and C. Serogroup C isolates show weaker cross-protection, requiring the further subdivision of this serogroup into its four different serovars. The percentages of the different serovars obtained in the 1970s, confirmed previously published data on South African isolates. A tendency towards a decrease in the number of serogroup A and serovar C-2 isolates, and an increase in the percentage of serovar C-3 isolates, was noted among isolates of the 1980s. These changes were markedly enhanced in the isolates obtained from 1990 to March 1995. The percentage of serogroup A isolates decreased significantly from 34% in the 1970s to only 5% in the 1990s, and that of serovar C-2 isolates, from 31-18%, while the abundance of serovar C-3 isolates increased significantly from 31% in the 1970s to 73% in the 1990s. Serogroup B remained more or less constant and never reached more than 10% of the population. These results indicate the need for the incorporation of serovar C-3 in a vaccine for use in South Africa, particularly in those areas of the country from which isolates were collected during this study. Some of the NAD-dependent isolates obtained from poultry in South Africa between 1970 and 1995, were biochemically identified as Pasteurella avium and P. volantium. As H. avium has been subdivided and reclassified into the genus Pasteurella, this represents the first report of the identification of P. avium and P. volantium in South Africa.

Agglutination Tests↗
PubMed1996

Bartonella (Rochalimaea) henselae in southern Africa--evidence for infections in domestic cats and implications for veterinarians.

Substantial evidence has recently accumulated showing domestic cats to be the principal reservoirs of Bartonella henselae, the aetiological agent of human diseases including cat-scratch disease, bacillary angiomatosis, bacillary peliosis and a febrile bacteraemia syndrome. To determine the prevalence of antibodies reactive with Bartonella henselae in cats from southern Africa, indirect fluorescent antibody assays were carried out on feline sera from South Africa and Zimbabwe. Overall, 23% (39/171) of cats had antibody titres > or = 1/64, with cats from Zimbabwe (24%; 28/119) having higher seroprevalences than those from South Africa (21%; 11/52) although this difference was not statistically significant. The implications of these findings for veterinarians in southern Africa are discussed.

Adolescent↗
PubMed1997

Natural history and spectrum of disease in adults with HIV/AIDS in Africa.

Progression from seroconversion to the development of AIDS in Africa may be shorter than in industrialized countries, but there are insufficient data to be certain. Although the data are not always directly comparable, survival after an AIDS diagnosis appears to be substantially shorter in African countries and this may be partly because of later diagnosis of AIDS in Africa, but may also be because of environmental factors such as increased exposure to pathogens of high virulence and lack of access to care. Tuberculosis and bacterial infections are the most important causes of morbidity and mortality among hospitalized patients. Bacteraemia is frequent, particularly due to non-typhoid salmonellae and S. pneumoniae. Cryptosporidia and I. belli are the most frequently isolated pathogens in patients with diarrhoea; non-typhoid salmonellae and Shigella species are also commonly isolated when stool cultures are performed. Cerebral toxoplasmosis, and meningitis due to Cryptococcus, tuberculosis and bacterial pathogens are the most frequent neurological infections and cognitive changes are frequently identified when specifically looked for. Infections with atypical mycobacteria and Pneumocystis carinii are rare, as is CMV retinitis. In women, HIV infection is associated with cervical human papillomavirus and with SIL, although there is currently no evidence for an association with invasive cervical cancer. Individuals infected with HIV-2 progress to AIDS and to death more slowly than those infected with HIV-1, but seem to experience the same spectrum of opportunistic disease when they reach the stage of advanced disease. The limited data available suggest that HIV-infected individuals in Africa develop opportunistic disease at broadly the same level of immunosuppression as do individuals in industrialized countries, but death occurs at a higher range of CD4 counts, although still in the range consistent with advanced disease. Data are still lacking concerning the aetiology of common clinical presentations of HIV disease and the relative frequencies of specific opportunistic diseases in different regions, particularly from southern Africa. Tuberculosis is the single most important HIV-related opportunistic infection in African countries, but diagnosis, particularly of extrapulmonary disease, remains difficult. The lack of laboratory facilities makes the diagnosis of bacterial infections difficult in many parts of the continent and, since this situation is unlikely to change in the near future, clinical algorithms for syndromic management need to be evaluated. More information is needed about gynaecological disease in HIV-infected women. The most important research questions concern the development and evaluation of cost-effective regimes for prophylaxis and treatment of opportunistic disease in order to prolong healthy life in HIV-infected individuals.

AIDS-Related Opportunistic Infections↗
PubMed1998

Family practice in the new South Africa.

Remarkable changes are taking place in the new South Africa. Planned changes in the health care arena present the new, relatively small discipline* of family practice with great opportunity for development and growth. With established generalist roots and recent formal recognition in South Africa, family practice should be well suited for a lead role in the government's efforts to extend health care access to those denied it under apartheid. Whether family practice moves into that role will depend on whether as a discipline it can project a vision of how it can meet the country's health care needs. Close examination of family practice in South Africa shows how the field reflects many of the societal problems of the past and the challenges of the future. With a clear vision of its role in the new South Africa, family practice could overcome these challenges, as well as answer a broader question about the place of family practice outside of the first world setting.

Family Practice↗
PubMed1998

[Depression in Sub-Saharan Africa].

We now have a better knowledge of the specific features of depression in sub-Saharan Africa. Anthropologically speaking, the Western model is irrelevant. Depression in sub-Saharan Africa involves the relationship of the subject to himself or others in a mode specific to African cultures. Ignoring this fact can lead to simplistic ethnocentrism. From a clinical standpoint, depressive illness characterized by somatic manifestations, delusions of persecution, and anxiety are increasingly uncommon. As African societies modernize, these traditional forms are being gradually supplanted by states with symptoms and prognoses more like those observed in industrialized countries. Hybrid depressive syndromes are now the most widespread. Epidemiologically the notion widely held only a few decades ago that depression is a rare occurrence in Africa has now been dispelled. Many studies have been conducted to determine the exact incidence, age distribution, and sex ratio but more precise data is still needed. This investigation will require improvement in screening and diagnostic methods which must be not only suitable for clinical use but also adaptable to local conditions. This is also true with regard to management which has the same goals as anywhere else in the world. Treatment facilities are different in urban and rural areas but care is often dispensed in unconventional settings and may be combined with traditional methods. Drug availability is limited by problems involving supply and cost. This explains why electro-convulsive therapy which was introduced into sub-Saharan Africa long ago still plays a major role in the treatment of depression.

Adult↗
PubMed1998

National HIV surveillance in South Africa--1993-1995.

OBJECTIVE: To determine the point prevalence of HIV infection by serological examination which, performed consistently over several years, serves to monitor the distribution and trend of the HIV epidemic in South Africa. DESIGN: Annual cross-sectional surveys conducted nationally, in October/November. SETTING: South Africa, including areas that used to be known as self-governing and independent national states. SUBJECTS: Pregnant women in the age group 15-49 years who attend antenatal clinic services provided by the public health services. OUTCOME MEASURES: HIV positivity as determined serologically. RESULTS: The rising trend found previously continues: HIV positivity in South Africa was found to be 4.25% in 1993, 7.57% in 1994 and 10.44% in 1995. In 1995 the highest rate was recorded in KwaZulu-Natal (18.23%) and the lowest in the Western Cape (1.66%). On the basis of certain assumptions it is estimated that these rates are indicative of 1.7 million sexually active adults having been infected with HIV by October/November 1995, plus a cumulative total of 40,000 infants. Women in their 20s had the highest age-specific prevalence rates, viz. 13.12% (20-24 years) and 11.03% (25-29 years). HIV positivity in pregnant teenagers was 9.5%. CONCLUSIONS: The HIV epidemic is firmly established in South Africa with a wide variation in provincial prevalence rates. Of particular public health significance is the finding of a high and rising prevalence rate in pregnant teenagers. The observed prevalence rate for 1995 is lower than expected, giving rise to guarded hope that provinces with the highest recorded rates are moving away from the exponential growth found hitherto.

Adolescent↗