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PubMedDate not supplied

Population policy in South Africa.

This report examines the current state and likely future directions of population policy in South Africa with particular reference to family planning activities set against the background of apartheid and its demise. In the apartheid era, population policy was perceived by most blacks as an instrument for the control of their number and movements. Recently, policy has been adjusted by the national Population Development Program in response to the changing sociopolitical situations in the country. A national post-apartheid population policy is likely to retain many of the components of this new program. However, a future nonracist and democratic society would probably invite a review of population activities in the country and raise wider issues concerning rationales, organization, and strategies for the delivery of family planning in South Africa.

Adolescent↗
PubMed1994

The public health implications of AIDS research in Africa.

The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic has led to greatly increased international collaboration for medical research, mainly epidemiologic in nature, in Africa. Greater understanding of HIV/AIDS has resulted, and considerable training and technology transfer have occurred. However, analytic and descriptive research in countries heavily affected by AIDS has been slow to turn to assessment of interventions, and practical benefits to those countries' public health and policies have lagged behind scientific knowledge. This article considers the public health implications of selected HIV/AIDS research in sub-Saharan Africa and discusses opportunities for interventions and more applied research. Topics covered include HIV testing and its role, surveillance, control of sexually transmitted diseases, the vulnerability of youth and women, tuberculosis, HIV/AIDS care, and the inadequacy of resources currently committed to HIV/AIDS prevention and control in resource-poor countries. Research on HIV/AIDS in Africa has yielded crucial information but now should prioritize interventions and their evaluation. Specific goals that might limit the effects of the HIV/AIDS epidemic in resource-poor countries are achievable given vision, commitment, and resources.

AIDS Serodiagnosis↗
PubMed2001

Do patents for antiretroviral drugs constrain access to AIDS treatment in Africa?

Public attention and debate recently have focused on access to treatment of acquired immunodeficiency syndrome (AIDS) in poor, severely affected countries, such as those in Africa. Whether patents on antiretroviral drugs in Africa are impeding access to lifesaving treatment for the 25 million Africans with human immunodeficiency virus infection is unknown. We studied the patent statuses of 15 antiretroviral drugs in 53 African countries. Using a survey method, we found that these antiretroviral drugs are patented in few African countries (median, 3; mode, 0) and that in countries where antiretroviral drug patents exist, generally only a small subset of antiretroviral drugs are patented (median and mode, 4). The observed scarcity of patents cannot be simply explained by a lack of patent laws because most African countries have offered patent protection for pharmaceuticals for many years. Furthermore, in this particular case, geographic patent coverage does not appear to correlate with antiretroviral treatment access in Africa, suggesting that patents and patent law are not a major barrier to treatment access in and of themselves. We conclude that a variety of de facto barriers are more responsible for impeding access to antiretroviral treatment, including but not limited to the poverty of African countries, the high cost of antiretroviral treatment, national regulatory requirements for medicines, tariffs and sales taxes, and, above all, a lack of sufficient international financial aid to fund antiretroviral treatment. We consider these findings in light of policies for enhancing antiretroviral treatment access in poor countries.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Clinical trials in sub-Saharan Africa and established standards of care: a systematic review of HIV, tuberculosis, and malaria trials.

CONTEXT: The minimum standard of care required for participants in clinical trials conducted in resource-poor settings is a matter of controversy; international documents offer contradictory guidance. OBJECTIVE: To determine whether recently published trials conducted in sub-Saharan Africa met standards of care consistent with best current clinical standards for human immunodeficiency virus (HIV) treatment, tuberculosis treatment, and malaria prevention. DATA SOURCES: Trials published during or after January 1998 that were indexed at the time of the MEDLINE and Cochrane Controlled Trials Register Search (November 20, 2003). STUDY SELECTION: All randomized clinical trials that were conducted in sub-Saharan Africa in 3 clinical domains: HIV disease, tuberculosis treatment, and malaria prophylaxis. DATA EXTRACTION: To establish criteria for best current standards of care, evidence from the literature and published guidelines accepted for well-resourced settings were analyzed; the actual care offered in the trial was then compared with these standards. DATA SYNTHESIS: A total of 128 eligible articles described data from 73 different randomized clinical trials. Only 12 trials (16%) provided care that met guidelines to both intervention and control patients. Only 1 of the 34 trials that enrolled patients with HIV disease provided antiretroviral treatment that conformed to guidelines. Conversely, all tuberculosis treatment trials (n = 13, including 3 for HIV-infected patients) provided tuberculosis therapy that conformed to guidelines. Twenty-one (72%) of 29 malaria prophylaxis trials tested interventions that met guidelines, but only 3 (10%) used any active prophylactic intervention in the control group. Of the 59 trials (81%) that reported on the process of ethical review, all were reviewed by a host African institution and 64% were additionally reviewed by an institution in a developed country. CONCLUSIONS: Rates of adherence to established clinical guidelines of care in randomized clinical trials of HIV treatment, tuberculosis treatment, and malaria prophylaxis varied considerably between disease categories. In determining clinical standards for trials in sub-Saharan Africa, researchers and ethics committees appear to take the local level of care into account.

Africa South of the Sahara↗
PubMed1996

Lymphocyte responses to human cytomegalovirus in different groups of patients in Britain and in adults from west Africa and the Middle East.

Antibody prevalence and lymphocyte proliferation responses to cytomegalovirus (CMV) and herpes simplex virus (HSV) were compared in several different groups of patients: genitourinary medical (GUM) patients, hemophiliacs, men with clinical acquired immunodeficiency syndrome (AIDS) and cases of primary CMV mononucleosis, and also in adults in the general population (control subjects) comprising separate groups native to Britain, West Africa, and the Middle East. Among the British control subjects who were positive for CMV IgG, all were also positive against CMV antigen by the lymphocyte transformation test (LTT). However, among those who were CMV IgG-positive in the various groups of patients, 20-86.9% gave positive responses to CMV antigen by the LTT; moreover, 75.7% and 55.5% of the CMV IgG-positive healthy control subjects from West Africa and the Middle East, respectively, gave positive LTT responses to CMV antigen. When the same groups of patients were tested for responsiveness to HSV antigen by the LTT, there was good agreement between a positive result by this test and by serology in all except those with primary CMV mononucleosis (42.8%). Overall, lymphocyte responses to CMV were significantly impaired in healthy, CMV antibody-positive subjects from West Africa and the Middle East compared to similar subjects from Britain.

Adult↗
PubMed1999

Impact of the introduction of A/Sydney/5/97 H3N2 influenza virus into South Africa.

In 1998 South Africa experienced a major influenza epidemic that was characterized by extensive illness and an unusually early season. The impact of the epidemic was charted by measuring proxy indexes of influenza activity such as school absenteeism and excess mortality in persons older than 65 years. Viruses isolated from patients of all age groups were analyzed both antigenically and at the molecular level to determine the characteristics of the influenza strain responsible for the outbreaks. The study revealed that influenza activity was detected as early as the middle of April and peaked toward the end of May and early June. School absenteeism correlated with a sharp rise in virus isolation during this period. Consumption of influenza-related pharmaceuticals, as well as mortality figures, also corresponded to the increased absenteeism and virus isolation. Characterization of the viruses isolated during 1997 and 1998 showed clearly that the epidemic was caused by the introduction of the A/Sydney/5/97-like H3N2 influenza strain into South Africa in 1998. With no prior exposure to this virus strain, which is antigenically distinct from the viruses that had been present in this country in 1997, the population was highly susceptible, resulting in an early, rapid spread of influenza. This epidemic has highlighted the importance of having an influenza vaccine specifically formulated for the Southern Hemisphere. If the 1998 vaccine had not contained the A/Sydney/5/97 strain, the widespread outbreaks in South Africa would have been far worse in terms of morbidity, mortality, and economic loss. This, in turn, emphasizes the need for increased influenza surveillance and international cooperation.

Absenteeism↗
PubMed2000

Cadaver profile at university of Stellenbosch Medical School, South Africa, 1956-1996.

Data on 1,698 cadavers donated during the period 1956-1996 were obtained from files of the Department of Anatomy and Histology at the University of Stellenbosch Medical School, Tygerberg Hospital, South Africa, to project a profile of the characteristics of those accepted on the program for dissection. A breakdown of the data also provided information on the profile of donors belonging to different population groups. Donors to our program were predominantly male (68%) and predominantly colored, which in South Africa identifies those of mixed heritage (63%). The average age of death was 55 years (range 15-98). Donors belonging to the white population group had the highest female : male ratio. Circulatory disorders accounted for most deaths in the white population group (48%), whereas cancer was the leading cause of death in the colored and black population groups ( approximately 25%). Pulmonary tuberculosis accounted for 13% deaths in the colored population group, 14% of deaths in the black population group, but only 0.5% of deaths in the white population group. Cervical cancer and breast cancer accounted for approximately one-third of cancer deaths in women, with cervical cancer more common in colored and black female donors and breast cancer more common in white female donors. The cadaver profile in general reflects the health status of the different population groups in South Africa. The profiles of the colored and black groups reflect that of disadvantaged population groups (a high prevalence of infectious disease; relatively young populations), whereas the white donor profile is that of a privileged population group (a high prevalence of degenerative disease; aging population).

Adolescent↗
PubMed2000

The spectrum of HIV-1 related cancers in South Africa.

Despite the high prevalence of infection by the Human Immunodeficiency Virus (HIV) in South Africa, information on its association with cancer is sparse. Our study was carried out to examine the relationship between HIV and a number of cancer types or sites that are common in South Africa. A total of 4,883 subjects, presenting with a cancer or cardiovascular disease at the 3 tertiary referral hospitals in Johannesburg, were interviewed and had blood tested for HIV. Odds ratios associated with HIV infection were calculated by using unconditional logistic regression models for 16 major cancer types where data was available for 50 or more patients. In the comparison group, the prevalence of HIV infection was 8.3% in males and 9.1% in females. Significant excess risks associated with HIV infection were found for Kaposi's sarcoma (OR=21.9, 95% CI=12.5-38.6), non-Hodgkin lymphoma (OR=5.0, 95%CI=2.7-9.5), vulval cancer (OR=4.8, 95%CI= 1.9-12.2) and cervical cancer (OR= 1.6, 95%CI= 1.1-2.3) but not for any of the other major cancer types examined, including Hodgkin disease, multiple myeloma and lung cancer. In Johannesburg, South Africa, HIV infection was associated with significantly increased risks of Kaposi's sarcoma, non-Hodgkin lymphoma and cancers of the cervix and the vulva. The relative risks for Kaposi's sarcoma and non-Hodgkin lymphoma associated with HIV infection were substantially lower than those found in the West.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Critical issues for agrichemical safety in South Africa.

A review is made of the potential for environmental and occupational exposure to agrichemicals in South Africa. Data from the farming industry in the Western and Southern Cape regions of South Africa confirm substantial use of a range of insecticides, fungicides, and other agrichemicals. The potential for worker exposure to hazardous agrichemicals is also substantial but, to date, such exposures have been poorly characterized. Further data identify important deficiencies in industrial hygiene measures with regard to safekeeping of chemicals on farms, disposal of empty containers, use of protective equipment, and levels of safety training among farm workers. Evidence is presented for widespread underreporting of agrichemical morbidity and mortality. Surveys investigating acute health effects among farm workers with occupational exposure to agrichemicals in South Africa have produced conflicting results. The possibility of chronic health sequelae from low-dose long-term exposure is an underresearched area that is only now being investigated. A number of important obstacles to agrichemical safety are identified: the multiplicity of laws relating to pesticides administered by different departments resulting in poor coordination; the failure of existing occupational health legislation to address the agricultural workplace adequately; the unavailability and incoordination of safety training; the absence of adequate surveillance data; and inadequacies in statutory requirements with regard to waste disposal on farms. Drawing on experiences of local initiatives, possible solutions are identified that address the public health context of the problem.

Chemistry, Agricultural↗
PubMed2004

On the reliability of recent tests of the Out of Africa hypothesis for modern human origins.

In this paper we critique two recent studies that have been claimed to disprove the Out of Africa hypothesis for modern human origins (Hawks et al., 2000; Wolpoff et al., 2001). We show that the test prediction employed by Hawks et al. (2000) and Wolpff et al. (2001) is not relevant to many versions of the Out of Africa hypothesis, and that the key specimens they used are problematic in terms of morphological representativeness. We also show that there are significant problems with the character state datasets employed in the studies. Lastly, we highlight evidence that the main method used in the studies (pairwise difference analysis) is not reliable when applied to the type of data employed by Hawks et al. (2000) and Wolpoff et al. (2001). In view of the foregoing, we contend that Hawks et al.'s (2000) and Wolpoff et al.'s (2001) claim to have disproved the Out of Africa hypothesis cannot be sustained.

Africa↗
PubMed2002

Out of Africa with regional interbreeding? Modern human origins.

A central issue in paleoanthropology is whether modern humans emerged in a single geographic area and subsequently replaced the preexisting people in other areas. Although the study of human mitochondrial DNAs supported this single-origin and complete-replacement model, a recent paper(1) argues that humans expanded out of Africa more than once and regionally interbred. However, both the genetic antiquity and the impact of the African contribution to modern Homo sapiens are so great as to view Africa as a central place of human evolution. Despite the possibility that out-of-Africa H. sapiens interbred with other populations, this evidence is more consistent with the uniregional hypothesis than the multiregional hypothesis of modern human origins.

Africa↗
PubMedDate not supplied

Diabetes trends in Africa.

Diabetes is an important cause of morbidity and mortality in Africa. Although a dramatic increase in disease burden is projected, it remains to be seen what effect the ongoing devastation of HIV disease will have on the epidemiology of such chronic diseases as diabetes. Recent data on type 2 diabetes prevalence indicate low rates in some rural populations, moderate rates similar to those in developed areas in some countries, and alarmingly high rates in others. The frequent observation of moderate to high prevalence of impaired glucose tolerance, particularly in populations with a low prevalence of diabetes, may indicate the early stage of a diabetes epidemic. Risk factors include urbanization, age, and family history of disease, as well as such modifiable risk factors as adiposity and physical inactivity. For type 1 diabetes, limited data indicate that the prevalence is low in sub-Saharan Africa and that onset occurs later in life there than in other parts of the world. Mortality associated with diabetes is unacceptably high and is disproportionately due to preventable acute metabolic and infective causes. With long duration of disease, there is a high frequency of hypertension and microvascular complications. The apparent low frequency of chronic macrovascular complications needs fuller documentation - as does the apparent high frequency of hypertension even in the non-diabetic population. Efforts to prevent this disease and its complications in Africa are impeded by inadequate health care infrastructure, inadequate supply of medications, absence of educational programs, and lack of available health care facilities and providers.

Africa↗
PubMedDate not supplied

A shared mission? Changing relationships between government and church health services in Africa.

This article reviews the relationships between government and church health providers within sub-Saharan Africa with a particular focus on East and Southern Africa. This is of particular interest at this time, given the changing configuration of the health sector in many countries as a result of health sector reform policies. The article provides a historical overview of the development and emerging role of the church health services within this changing environment. The factors affecting the relationship between the government and church sector are identified. These include differences in objectives, types of service provided, and the organizational culture and management styles. The paper then explores key issues seen to affect the future pattern of relationships including the changing scene, and identifies different models for relationships and implications for key actors including the Ministry of Health, church health agencies and coordinating bodies. The article concludes that church health services will continue to play a key role in health care in sub-Saharan Africa; however, there are challenges facing them and both parties need to develop a response to these.

Africa South of the Sahara↗
PubMed2002

Measles virus strains circulating in Central and West Africa: Geographical distribution of two B3 genotypes.

Africa remains one of the major reservoirs of measles infection. Molecular epidemiological studies have permitted different measles virus isolates to be grouped into clades and genotypes; the major group, which has been identified as indigenous to Africa, is clade B. The viruses from epidemics in the Gambia (1993) and in the Cameroon (2001) were examined. In both studies, the homogeneity of the virus isolates within the epidemic as shown by sequence analysis revealed less than 0.2% variation of nucleotides between isolates. The measles viruses isolated in 1983 in Yaoundé, Cameroon, were designated as the B1 genotype. However, in 2001 only viruses belonging to the B3 genotype were found in this city. The viruses in the Gambia (1993) were also of the B3 genotype. However, these viruses could be distinguished from each other at the antigenic level and by comparative sequence analysis. The B3 Cameroon (2001) viruses were related to the proposed B3.1 subgroup, whereas the Gambian (1993) isolates corresponded to the B3.2 subgroup. The geographical distribution for the period 1993-2001 of these two viruses shows that B3.1 is found from the Sudan to Nigeria and Ghana extending south to the Cameroon, whereas the B3.2 genotype is found in West Africa. In Nigeria and Ghana, the viruses co-circulate. The identification of these viruses will permit more meaningful epidemiological studies after the proposed increase in measles vaccination coverage.

Africa, Western↗
PubMed2004

Antigenic and genetic characterization of serotype G2 human rotavirus strains from South Africa from 1984 to 1998.

Within South Africa, cyclic peaks of serotype G2P[4] rotavirus infection have been observed and these strains were prevalent in some locations. To examine the cyclic phenomenon of serotype G2 rotaviruses, historical stool collections from South Africa spanning 15 years were screened for G2 strains. Subgroup (VP6) ELISA, polyacrylamide gel electrophoresis (PAGE), and P genotyping were performed on 43 G2 strains to investigate the associated DS-1 genogroup characteristics. Antigenic variation of the gene encoding the major neutralization glycoprotein (VP7) was also investigated using G2-specific monoclonal antibodies. In addition, the VP7 gene of 14 serotype G2 strains was sequenced to examine genetic variation. Serotype G2 strains from South Africa displayed a 10 year cyclic pattern with major epidemics occurring in 1987 and 1997. Serotype G2 strains were also found co-dominant with G(1) strains in 1984, 1990, and 1993. The G2 strains from the major epidemics appeared to have emerged from community strains in a manner similar to that suggested for G(1) strains The serotype G2 strains displayed subgroup I specificity and short electropherotypes characteristic of DS-1 genogroup rotavirus strains but appeared to differ in the VP4 gene. Genetic analyses revealed three major serotype G2 lineages, i.e., strains isolated prior to 1987, strains isolated between 1988 and 1994, and strains isolated from 1995. The use of monoclonal antibodies and PCR primers designed against older G2 strains has resulted in the failure to serotype G2 strains circulating currently.

Amino Acid Sequence↗
PubMed1991

Molecular epidemiology of an outbreak of poliomyelitis in South Africa in 1987/1988.

An outbreak of paralytic poliomyelitis occurred in the Republic of South Africa in 1987/88. The epidemic took place in the Natal/KwaZulu region of South Africa and was due to type 1 poliovirus. Twenty-four isolates were characterised by 1- and 2-dimensional oligonucleotide mapping and a single strain of wild-type poliovirus was identified. The same strain of virus was also isolated in other areas of South Africa at the time of the outbreak and has persisted into 1989.

Disease Outbreaks↗
PubMed2005

Measles virus genotype B2 is not inactive: evidence of continued circulation in Africa.

This study describes two measles outbreaks--one in Cape Town, South Africa in November 2002, and the other in Luanda, Angola in March 2003. The outbreaks were notable because they were caused by closely related genotype B2 viruses. This genotype was first described in an outbreak in Libreville, Gabon in the 1980s and was labeled as inactive by the World Health Organization in 2003 because it had not been detected for over 15 years. As the first three cases in the Cape Town outbreak were Angolan citizens who recently arrived from Angola, it appears likely that the source of the virus was Angola. Molecular analysis of specimens collected during the outbreak in Luanda provided direct evidence for the circulation of genotype B2 measles virus (MV) in Angola. This study clearly demonstrates that there is still active circulation of genotype B2 in Africa, and we propose that its apparent inactivity is merely the result of insufficient virologic/molecular surveillance in the region. These findings highlight the need for expanded molecular surveillance in Africa.

Africa↗
PubMed2006

Serotyping and genotyping of HIV-1 infection in residents of Khayelitsha, Cape Town, South Africa.

It is estimated that between 5.5 and 6.1 million people are infected with HIV/acquired immunodeficiency syndrome (AIDS) in South Africa, with subtype C responsible for the majority of these infections. The Khayelitsha suburb of Cape Town has one of the highest HIV prevalence rates in South Africa. Overcrowding combined with unemployment and crime in parts of the area perpetuates high-risk sexual behavior, which increases exposure to infection by HIV. Against this background, the objective of this study was to characterize HIV-1 in residents confirmed to be seropositive. Serotyping was performed through a competitive enzyme-linked immunosorbent assay (cPEIA). Genotyping methods included RNA isolation followed by RT-PCR and sequencing of the gag p24, env gp41 immunodominant region (IDR), and env gp120 V3 genome regions of HIV-1. With the exception of a possible C/D recombinant strain, all HIV-1 strains were characterized as HIV-1 group M subtype C. One individual was shown to harbor multiple strains of HIV-1 subtype C. In Southern Africa, the focus has been to develop a subtype C candidate vaccine, as this is the major subtype found in this geographical area. Therefore, the spread of HIV-1 and its recombinant strains needs to be monitored closely.

Adult↗