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PubMed2004

Theory-based HIV risk reduction counseling for sexually transmitted infection clinic patients in Cape Town, South Africa.

BACKGROUND: South Africa has the world's fastest growing AIDS epidemic. There is an urgent need for effective HIV risk reduction interventions in South Africa. OBJECTIVE: The objective of this study was to develop and test the potential efficacy of a brief theory-based HIV prevention counseling intervention for sexually transmitted infection (STI) clinic patients in South Africa. METHOD: STI clinic patients in Cape Town (N=228) were assessed at baseline and randomized to receive either: 1) a single 60-minute session motivational/skills-building HIV risk reduction counseling intervention or 2) a 20-minute HIV information/education session. Participants completed 1- and 3-month follow ups with 80% retention. RESULTS: The 60-minute motivational/skills risk reduction counseling demonstrated significantly greater risk reduction practices, lower rates of unprotected intercourse, and greater likelihood of receiving HIV testing after the intervention. CONCLUSIONS: Brief theory-based HIV prevention counseling may significantly reduce HIV risk behaviors for STI clinic patients in South Africa.

Adult↗
PubMed2006

Coital bleeding and HIV risks among men and women in Cape Town, South Africa.

BACKGROUND: South Africa has one of the world's fastest growing HIV epidemics. Genital bleeding during sexual intercourse may play a role in facilitating HIV transmission in South Africa. PURPOSE: The purpose of this study was to examine the prevalence and sources of coital bleeding among men and women living in a Cape Town South Africa township. METHODS: A purposive sample of 464 men and 531 women completed anonymous street intercept surveys of HIV risk history and sexual behaviors. RESULTS: Thirty-one percent of men and 26% of women had a lifetime history of engaging in sexual intercourse that involved genital bleeding, and 21% of men and 16% of women reported coital bleeding in the previous 3 months. Over 75% of coital bleeding was attributed to menses. Across genders and controlling for demographic, sexual behavior, and life history factors, coital bleeding in the previous 3 months was associated with being an indigenous African, having multiple sexual partners, and higher rates of unprotected intercourse during that time period. People who reported coital bleeding were over 3 times more likely to have been diagnosed with a sexually transmitted infection even after controlling for having had genital ulcers. CONCLUSIONS: Coital bleeding may be common in South Africa. Prevention messages that promote condom use or refraining from sex when there is genital bleeding are therefore needed.

Adolescent↗
PubMed1979

The role played by wildlife in the epizootiology of rabies in South Africa and South-West Africa.

The role played by wildlife in the perpetuation of rabies is discussed in the light of information obtained during a routine examination of specimens at the Veterinary Research Institute, Onderstepoort, during the 10-year period, 1967-1976. In the course of the investigation, 9 additional hosts of rabies were confirmed and 4 rabies areas identified. The chief disseminators in 2 of these areas were found to be the dog (Canis familiaris) and the black-backed jackal (C. mesomelas); in the third area, the yellow mongoose (Cynictis penicillata), and in the fourth Genetta and Felis spp., including the domestic cat (Felis catis). It was noted that the domestic cat is of less importance in those areas where dogs and jackals are the chief disseminators.

Animal Population Groups↗
PubMed2003

Rape and HIV post-exposure prophylaxis: addressing the dual epidemics in South Africa.

In South Africa, a country notable for both a rapidly escalating AIDS epidemic and high levels of sexual violence, the issue of HIV post-exposure prophylaxis (PEP) following rape has recently come to the fore, and a policy supporting provision of PEP has been approved by the national government. This paper compares the conditions for providing PEP in Europe and North America with the conditions faced by two initiatives in South Africa, one serving a primarily rural base, and one urban. It is based on a review of the literature on sexual violence in South Africa and use of PEP following occupational and non-occupational exposure. It incorporates perspectives from in-depth interviews in 2000 with 18 key informants, including survivors of sexual violence, gender and HIV activists, domestic violence NGOs, rape crisis centres, physicians, lawyers, researchers and HIV/AIDS advisors in the Department of Health. The paper argues that given the scientific evidence for PEP, and the nature of the dual epidemics of HIV and sexual violence in South Africa, the public health and social justice rationale for implementing PEP equals and indeed exceeds that put forward in industrialised countries. However, delays in accessing PEP caused by the public justice system and lack of training for service providers constitute significant obstacles to effective implementation. In this respect, provision of PEP presents an opportunity to reform and strengthen existing services for post-rape care and to link attention to the epidemic of sexual violence to HIV/AIDS prevention.

Anti-HIV Agents↗
PubMed2003

Determinants of suicide in the Transkei sub-region of South Africa.

BACKGROUND: South Africa has a history of traumatized citizens and is a society in transition. Suicidal behavior among the black population group in South Africa appears to be on the increase. Under the post-apartheid dispensation they are undergoing a lot of stresses especially in relation to their as yet unmet expectations and demands from the government. OBJECTIVE: To identify the possible determinants of suicide in the Transkei sub-region of South Africa. METHODS: Interviews with relatives of suicide victims, and analysis of victims' demographic, socioeconomic, and psychosocial data. RESULTS: Rural people (> 90%) were much more likely to commit suicide than urban dwellers (< 10%). Suicide notes were left by 13% of the victims. Hanging was the method of choice in 57%, gunshot in 30%, and poisoning in 13%. Among those who died by hanging and by gunshot injuries, males far outnumbered the females (82% and 89%, respectively). By contrast, females constituted the greater proportion of deaths by poisoning (75%). Apparent precipitating factors included economic hardship (87%), alcohol abuse (23%), health related issues (17%), marital problems (13%), and social disputes (10%). The uneducated (70%) and unemployed (64%) used hanging as the method of choice. The highly educated 5 (17%) were all employed, and used a firearm in committing suicide. Family disputes 5 (17%) and separation of parents from teenage children were recorded in 17% of the cases. CONCLUSION: Financial hardship was the main underlying reason, identified in 87% victims of suicide. To break this vicious cycle of unemployment, alcohol abuse, and poor health, a comprehensive poverty alleviation program along with community education could be an important step towards reducing suicides in the Transkei sub-region of South Africa.

Journal Article↗
PubMed2003

Adequacy and efficiency of nursing staff in a child-welfare-clinic at Umtata General Hospital, South Africa.

BACKGROUND: South Africa has a serious shortage of human and financial resources to provide primary healthcare services especially in the historically under-served areas. It is a tedious task to carry out healthcare delivery for the masses without rationalizing human resources in the form of re-allocation and re-deployment of healthcare personnel. This study aimed to establish the level of adequacy and efficiency of nursing staff in the former Transkei region. The study was carried out in the child and family welfare clinic of the Umtata General Hospital. OBJECTIVE: To assess adequacy and efficiency of nursing staff in a child welfare clinic. METHOD: This was a retrospective study. The workload of two nurses allocated to the child welfare clinic at Umtata General Hospital South Africa was calculated based on the patient numbers and hours of work per week. Calculations excluded time breaks for tea, lunch and annual leave. This work load was compared to the norms of standard examination time that is 12 minutes per patient obtained from the sub directorate of Natalia Office of the Department of Health. Information regarding number of patients attended to by the nurses and their disease conditions was obtained from retrospective review of hospital records. RESULTS: While each nurse was on duty for 8 hours per day each had only 6 reproductive hours. The two nurses examined only 310 patients giving staff utilization of 2.46% (i.e. 310/12600) and adequacy of staff of 0.0492 or 310/6300. CONCLUSION: There is under-utilization of the staff in Umtata General Hospital, South Africa. RECOMMENDATION: To increase utilization of the nurses a process of sharing and merging with a clinic or a ward with similar type of work is recommended.

Child↗
PubMed1997

Lead poisoning of children in Africa, II. Kwazulu/Natal, South Africa.

The prevalence of elevated blood lead (PbB) levels in rural and semi-urban areas of Kwazulu/Natal (KZN) as well as the risk factors for elevation of PbB among children in informal settlements are examined. The study involved over 1200 children in two age groups: 3-5 and 8-10 years old. Average PbB level in Besters, an informal settlement in the Durban metropolitan region, was 10 micrograms/dl with 5% of the children showing PbB level of greater than 25 micrograms/dl. By comparison, average PbB value in Vulamehlo, a rural area located 90-120 km from Durban, was 3.8 micrograms/dl and 2% of the PbB was greater than 10 micrograms/dl. The results show that many children in KZN are at risk of being lead poisoned. Household factors that were significantly associated with PbB levels in children included distance from tarred roads, overcrowding, hygienic habits in the household and the burning of solid wastes for heating or cooking. Lack of significant association with child risk behaviors is attributed to the over-riding influence of high levels of contaminated dusts both indoor and outdoor. With recent introduction of unleaded gasoline in South Africa, a number of unique socio-ecological factors are expected to slow the change in PbB levels of children in some townships.

Child↗
PubMed1999

Case-control study of mesothelioma in South Africa.

BACKGROUND: South Africa has, uniquely, mined, transported, and used crocidolite, amosite, and chrysotile. A multicenter case-control study was done in South Africa to examine the details of asbestos exposure in cases and controls, and to calculate relative risks for level of certainty of asbestos exposure, nature of exposure (e.g., environmental, occupational) and fiber type. METHODS: Cases and controls (one cancer and one medical per case) were collected by six study centers from referral hospitals, and exposure information was collected by interviewing cases and controls in life. RESULTS: One hundred and twenty-three cases were accepted into the study. None had purely chrysotile exposure. Twenty-three cases had mined Cape crocidolite; three had mined amosite; and three Transvaal crocidolite plus amosite. A minimum of 22 of the cases had exclusively environmental exposure, 20 were from the NW Cape crocidolite mining area. The relative risks associated with environmental exposure in the NW Cape (crocidolite) were larger than for environmental exposure in the NE Transvaal (amosite and crocidolite): 21.9 vs. 7.1 and 50.9 vs. 12.0 for the cancer control and medical control datasets, respectively. CONCLUSIONS: The results confirm the importance of environmental exposure in the Cape crocidolite mining area, the relative paucity of cases linked to amosite, the rarity of chrysotile cases and are consistent with a fiber gradient in mesotheliomagenic potential for South African asbestos with crocidolite > amosite > chrysotile.

Asbestos↗
PubMed1992

Viewing primary mental health care at a time of social transition in South Africa.

As South Africa shifts from a social structure based on the principles of apartheid to a democratic society, social policies must be developed that are consonant with the ideals of the "new" society. These must, however, take into account the current realities of the South African context. This article suggests that the application of the principles of primary mental health care is the approach most likely to meet mental health needs in the future South Africa, but that difficulties are likely to arise in the transition to this approach. These difficulties must be identified and dealt with. The authors discuss the problems in providing competent curative care to all and in shifting emphasis to prevention and promotion in mental health care. The discussion covers both practical and political complications. The authors conclude that though the process to primary mental health care will be a long one, the problems are unlikely to be insurmountable.

Health Planning↗
PubMed1997

Cleaning the womb: constructions of cervical screening and womb cancer among rural black women in South Africa.

In South Africa problems with current cervical screening uptake, including low coverage and loss of screened women to follow-up, have been identified. This paper presents the findings of an anthropological study of rural Black women's perceptions and understandings of cervical symptomatology, screening and cancer conducted among three different language groups in South Africa. The data collected indicate that women were screened when presenting with symptoms of reproductive tract infection, with the result that for many the smear came to be associated with the diagnosis and treatment of sexually transmitted diseases (STDs). In some cases the smear was said itself to "clean" the womb. The results were often interpreted by women as signifying womb "dirtiness" and confirming the presence of symptomatic reproductive disease for which they had initially presented to the biomedical facility. Several barriers to screening were identified including fear of vaginal exposure, expectation of pain, being asymptomatic, and gender of the practitioner. In addition women perceived womb cancer to be invariably terminal, knowledge which was constructed from personal and community experience of the illness. The illness was closely associated with (usually female) "promiscuity". The authors discuss the implications of the data for healthworkers and health promotion specialists, in particular the association of the smear with STDs, the way in which women are recruited for screening, the perceived terminality of womb cancer, and the processes by which local knowledge about illness is constructed. The findings demonstrate the importance of medical anthropology in contributing towards the provision of effective and locally appropriate healthcare.

Adult↗
PubMed2004

Ecstasy use in South Africa: findings from the South African Community Epidemiology Network on Drug Use (SACENDU) project (January 1997-December 2001).

This article provides descriptive surveillance information about the extent and consequences of Ecstasy use for five sentinel sites in South Africa. From January 1997 to December 2001, data were gathered on a biannual basis from multiple sources, including specialist treatment centers, trauma units, school students, rave party attendees, and from police and arrestees. Indicators point to relatively low levels of Ecstasy use in South Africa. Demographic characteristics of Ecstasy consumers in South Africa were identified. Ecstasy is predominantly used among White South African youth of both genders, with the age of users decreasing over recent years. The use of Ecstasy is, however, increasing among other population groups. Some emerging health risks associated with club drug use were identified, including the use of Ecstasy in combination with other substances. On the basis of this information, a number of policy recommendations are made. These are targeted at both Ecstasy demand reduction and harm minimization. The study points to the need for continued monitoring of Ecstasy use and its associated consequences in this country.

Adolescent↗
PubMed2004

The use of a spatial information system in the management of HIV/AIDS in South Africa.

BACKGROUND: South Africa is experiencing an HIV/AIDS pandemic of shattering dimensions. The availability and provision of antiretroviral (ARV) drugs could bring relief to the situation, but the treatment is unfortunately complex with each patient being assigned a different antiretroviral therapy varying in diet-medication regiment. The context of South Africa, its variety of urban and rural settings adds to the challenge of administering and monitoring the HIV+ person throughout the treatment, which will last for the rest of their lives. The lack of physical infrastructure, reliable statistics and adequate resources hinder the efficient management of HIV/AIDS. RESULTS: The collection of reliable data will be a first step to assess the status of HIV/AIDS in communities. A number of hospitals have started this process using the conventional approach to collect information about their patients using a paper-based system. Since time is of essence in the fight against the pandemic, data exchange between various hospitals, municipalities and decision-making bodies is becoming more and more important. The logical response to such a need is a computerised system, which will collect and administer HIV/AIDS related information within the local context and allow a monitored access to the data from a number of stakeholders. CONCLUSIONS: The purpose of this study was to design and develop an HIV/AIDS database, which is embedded in a Spatial Information Management System. The pilot study area is the Gugulethu township in Cape Town where more than 27% of the 325 000 residents are HIV+. It is shown that the implementation of the HIV/AIDS database and the Spatial Information Management System can play a critical role in determining where and when to intervene, improving the quality of care for HIV+ patients, increasing accessibility of service and delivering a cost-effective mode of information.

Journal Article↗
PubMed1983

Primary health care provision in terms of community need in South Africa.

In South Africa, early lessons in primary health care were lost to sight and have been rediscovered only recently. Priorities need to be reassessed in order to better allocate resources to community needs. Developing and developed communities require different primary care services. Simple and effective epidemiological methods should be used to gather information required for planning and evaluation of services. In developing communities, where there is a shortage of doctors, trained nurses operate local clinics with the help of community workers. Community participation and the cooperation of the traditional healers are necessary. Appropriate training of personnel for an effective role in public health care is essential.

Community Health Services↗
PubMed2004

A Survey of the quality of nursing care in several health districts in South Africa.

BACKGROUND: South Africa is currently focusing strongly on human resource development. The purpose of this study was to describe and compare the quality of nursing service and care in three health districts in the KwaZulu Natal Province. To identify deficiencies which could be addressed by education and training, it might be useful to measure the quality of care given by nurses. METHODS: From March to August 2002 a survey was done in six hospitals and six clinics in three health districts of the KwaZulu-Natal province of South Africa. Five different aspects of care was evaluated; hand-over from one nursing shift to another, implementation of universal precautions, patient satisfaction, nursing records, management of chronic illnesses. All these aspects were evaluated using checklists based on record reviews or direct observation, except for patient satisfaction, which was evaluated by questionnaires. RESULTS: The average scores on the different aspects varied from 11% (for nursing records) to 73% (for management of chronic diseases). Specific problems became evident. In one district three out of four hand-overs between shifts of nurses scored less than 50%. In all three districts the use of protective gear scored low (43%). While the average score for management of chronic illnesses were high at 73%, the blood pressures of only 23% was within the target range, and the blood sugar of only 38% of patients were controlled. Patient satisfaction averaged 72% across the three districts. CONCLUSION: The quality of care measurements identified specific training needs, but other management strategies are probably also indicated.

Journal Article↗
PubMed1996

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

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

Adolescent↗
PubMed1990

A methodology for resource allocation in health care for South Africa. Part II. The British experience and its relevance to South Africa.

This second article in the series on resource allocation in health care, argues for a formula-based method of resource allocation in South Africa. The model employed in England since 1976 and its application in a number of developed and developing countries is reviewed. The international experience is related to South African conditions and the principal elements necessary for a formula to achieve greater spatial equity in South African health-resource distribution are discussed.

Delivery of Health Care↗
PubMed2002

Physical inactivity is the major determinant of obesity in black women in the North West Province, South Africa: the THUSA study. Transition and Health During Urbanisation of South Africa.

OBJECTIVE: We investigated the association between measures and determinants of obesity in African women. METHODS: For a cross-sectional study of adult black women in the North West Province, South Africa, we used a stratified sample of 1040 volunteers from 37 randomly selected sites in the province according to the level of urbanization. We analyzed the association between measures of obesity, namely body mass index (BMI), waist circumference, waist-to-hip ratio, triceps and subscapular skinfolds, and socioeconomic factors, dietary intakes, and physical activity. RESULTS: The rate of obesity (BMI > 30) in the sample was 28.6%. We found a significant positive association between household income and measures of obesity. After exclusion of underreporters and adjustments for age, smoking, and household income, we found significant positive correlations between total energy intake, fat intake, and BMI. Physical activity index (derived from a subset of 530 subjects) correlated negatively with BMI and waist circumference. Subjects in the highest third of physical activity were less likely to be obese (odds ratio-0.38, 95% confidence interval-0.22-0.66). CONCLUSIONS: Women with higher incomes and lower physical activity were at the greatest risk of increased BMI. Physical inactivity showed the strongest association with measures of obesity in this study.

Adolescent↗
PubMed1996

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

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

Carrier State↗