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PubMed2005

''If they rape me, I can't blame them": reflections on gender in the social context of child rape in South Africa and Namibia.

The study was based on 77 semi-structured in-depth interviews and 3 small group discussions which were conducted with informants in Windhoek, Namibia and rural Mpumalanga province, South Africa. Children (abuse survivors and others), parents, men and women from the community and a range of key informants (such as police, social workers, health workers, NGO staff and teachers) were asked about their experiences and perceptions of child rape and child rearing. This study has its roots in the recent popular concern about the high prevalence of child rape in Southern Africa. Drawing on the data, we reflect on aspects of the social context of child rape in South Africa and Namibia that at least provide space for, without actually legitimating, these acts. We argue that children are rendered vulnerable to abuse because of a series of ideas which create opportunities, the most important of which is the dominant patriarchal ideology, compounded by the pronounced age hierarchies found in these societies. The high status of men, with respect to particularly girl children, leads to vulnerability through reducing girls' ability to refuse sexual advances and generating expectations in men that they should control women and children. Rape is often an act of punishment, used to demonstrate power over girl children and manufacture control. Rape is also used as an instrument of communication with oneself (the rapist) about masculinity and powerfulness. This ability to avoid being caught was important in some rapes. Some children are rendered vulnerable by coming from backgrounds where the likelihood of cases being pursued was low. Whilst it is often said that communities abhor child rape, responses to cases show that often strong action is not taken against perpetrators and the girls may be equally, or predominantly, blamed. In cases close to home, perpetrators are often protected. Thus the dominant message is that much as child rape is abhorred, responses are highly inadequate. Advances in gender equity are central to positive change.

Child↗

PubMed2005

Trends and racial differences in infant mortality in South Africa.

Racial differences in infant mortality in South Africa are studied using household-level data from 1987 to 1989 and 1998. Logistic regression models are estimated to explore the determinants of the overall trend in infant mortality and racial disparities in infants' survival chances. We do not find evidence for reduced overall risk of infant death among births that occurred from 1993 to 1998 when compared to those that occurred from 1982 to 1989, despite policy and action directed toward this goal by the new government that was elected in early 1994. We also find that persistent inequalities in the personal and household resources of South Africa's four main racial groups substantially account for racial differences in infant survival rates in both periods. These findings are discussed in light of contemporary social and health issues in South Africa.

Female↗

PubMed2005

Travelling to Africa: health risks reviewed.

Africa's varied ecology presents a wide range of travel health threats: infections; accidents; envenomations; an uncertain drug supply; problematic access to competent medical care outside South Africa. Important vaccine preventable diseases include yellow fever, meningococcal disease, typhoid, polio, rabies, and hepatitis A and B; routine vaccinations should be up to date. Much, but not all, of sub-Saharan Africa is malarious with chloroquine resistant falciparum dominating; chemoprophylaxis and personal protection measures will often be indicated. Other threats are less obvious, e.g. helminth and protozoal infections. The immunocompromised and other high-risk groups may require special attention. Risk mitigation strategies may include education, vaccination, chemoprophylaxis, personal protection measures, provision of treatment and equipment packs, behaviour modification, and evacuation insurance.

Accident Prevention↗

PubMed2004

Confirmation of occurrence of Babesia canis vogeli in domestic dogs in South Africa.

The prevalence of Babesia infections in domestic dogs in South Africa was studied using reverse line blot hybridization and 18S sequence analysis. Babesia canis vogeli was confirmed for the first time in domestic dogs in South Africa. Out of a total of 297 blood samples collected from domestic dogs in Bloemfontein, East London, Johannesburg, Durban and from the Onderstepoort Veterinary Academic Hospital, 31 were positive for Babesia canis rossi, whereas B. c. vogeli was detected in 13 dogs. None of the dogs carried both parasites. The detection of B. c. vogeli has implications with regard to prevalence and varied clinical manifestation of canine babesiosis in South Africa.

Animals↗

PubMed2006

Infectious hypodermal and hematopoietic necrosis virus (IHHNV)-related sequences in the genome of the black tiger prawn Penaeus monodon from Africa and Australia.

We found an infectious hypodermal and hematopoietic necrosis virus (IHHNV)-related sequence within the shrimp genome in populations of Penaeus monodon from Africa and Australia. IHHNV is a single-stranded DNA virus that has caused severe mortality and stunted growth in penaeid shrimp. Recently, IHHNV-related sequences were found in samples of P. monodon from Madagascar and Tanzania. These sequences vary considerably (14 and 8%, respectively) from that of IHHNV found in association with viral epidemics. Laboratory bioassays were carried out with P. monodon and Litopenaeus vannamei to determine if either of these IHHNV-related sequences is infectious. We used juvenile and adult P. monodon containing the virus-related sequences from four geographic regions to generate inocula and tissues for feeding. Specific pathogen free P. monodon and L. vannamei were used as indicator shrimp. During the 2-4 week bioassays, none of the indicator shrimp showed signs of infection or disease. Results of both PCR assays and histological examination of the indicator shrimp were negative for IHHNV infection, indicating that the Africa type IHHNV-related sequences are not infectious. With the shrimp containing the Madagascar type IHHNV-related sequence (designated as type A), we performed genome walking at the 3' end of the virus-related sequence and found that this virus-related sequence is part of the P. monodon genome. A fragment of 1.9 kb flanking sequence was cloned and sequenced. Sequence analysis showed that this flanking sequence contains shrimp microsatellite DNA. Also, its translated amino acid sequence was highly similar to a retrotransposon. This result provides molecular evidence that the type A IHHNV-related sequence is shrimp DNA. This sequence was found in the P. monodon collected from Africa and Australia.

Africa↗

PubMed2006

Veterinary waste disposal: practice and policy in Durban, South Africa (2001-2003).

In South Africa, until recently, veterinary waste has not been included in definitions of health care waste, and so has been neglected as a contributor to the hazardous waste stream. Despite the application of, for example, the "Polluter Pays" principle in South African environmental legislation, to generators of waste, which would include veterinarians, there appears to be little awareness of and even less enforcement of the legislation in this regard. This paper reports on a 2001-2003 survey of management practices of the five waste contractors servicing just over half of the veterinarians in Durban, South Africa's second largest city. Some of their activities, when evaluated in terms of the legislation, guidelines and policies relating to waste handling and disposal, were found to be non-compliant. Since any discussion on waste management should take cognisance of waste from generation to final disposal, the responsibility of veterinarians as waste generators is also discussed in the light of the recent developments in health care waste management in South Africa. This study presents a review of past and current policies, legislation and guidelines that have application to veterinary waste. This is the first study to address veterinary waste disposal in any South African city.

Animals↗

PubMed2004

Pleistocene and pre-Pleistocene Begonia speciation in Africa.

This paper presents a historical biogeographic analysis of African Begonia based on combined internal transcribed spacer (ITS) and trnL intron sequences. Age range estimates for Begonia in Africa ranged from only 1.5 Ma for some terminal nodes to 27 Ma for basal nodes when the ages of Réunion (2 Ma) andMayotte (5.4 Ma) were used to date the split between Begonia salaziensis and Begonia comorensis. Assuming a more recent origin age for Begonia salaziensis (2 Ma) provided age estimates in other parts of the phylogeny which agreed with patterns observed in other African organisms. A large proportion of the Begonia diversity seen today in Africa is of pre-Pleistocene origin. Species of Pleistocene origin are concentrated in species-rich groups such as sections Loasibegonia, Scutobegonia, and Tetraphila, which have their centre of diversity in western Central Africa. Phylogenetically isolated taxa such as Begonia longipetiolata, Begonia iucunda, and Begonia thomeana date to the late Miocene, a period of extended aridification on the African continent that had severe effects on African rain forest species. A general pattern is identified where phylogenetically isolated species occur outside the main identified rain forest refuges. Endemic species on the island of São Tomé such as Begonia baccata, Begonia molleri, and Begonia subalpestris appear to be palaeoendemics. Of these species, the most recent age estimate is for B. baccata, which is dated at ca. 3 Ma. Therefore, São Tomé appears to have functioned as an important (if previously unrecognised) pre-Pleistocene refuge. On the mainland, areas such as the Massif of Chaillu in Gabon, southern Congo (Brazzaville), and far western areas of Congo (Kinshasa) have played similar roles to São Tomé.

Africa↗

PubMed2006

Phylogenetic systematics and tempo of evolution of the Viverrinae (Mammalia, Carnivora, Viverridae) within feliformians: implications for faunal exchanges between Asia and Africa.

We reconstructed the phylogeny of the subfamily Viverrinae (Mammalia, Carnivora, Viverridae) using a approximately 3kb data set in order to reassess timing and patterns of faunal exchanges between Asia and Africa. Maximum parsimony, maximum likelihood, and Bayesian analyses of separated and combined matrices (cytochrome b, transthyretin intron I and IRBP exon 1 [IRBP1]) recovered all the well-supported relationships within feliformian lineages. In addition, IRBP1 supported paraphyly of genus Herpestes and contributed to the resolution of equivocal hypotheses within Viverridae, including (1) the monophyly of Viverrinae, and (2) Viverricula sister-group of the other terrestrial civets (Civettictis and Viverra). The combined analysis yielded a robust phylogeny, recovering monophyly of Prionodontidae and yielding high posterior probabilities for nodes (1) (Prionodontidae, Felidae) and (2) ((Felidae, Prionodontidae), ((Hyaenidae, (Herpestidae, Eupleridae)), Viverridae)). Using a fossil cross-validation method, we estimated the emergence of Viverridae at 34.29Myr, with a separation between the three traditional subfamilies Hemigalinae, Paradoxurinae, and Viverrinae during the Late Oligocene-Early Miocene. The terrestrial civets and the splits between (1) Civettictis and Viverra and (2) Poiana and Genetta were estimated to appear during the Middle Miocene. Parsimony- and maximum likelihood-based methods yielded unambiguous ancestral area reconstructions, including the Asian origin of the family Viverridae, the subfamily Viverrinae, the terrestrial civets and the clade (Civettictis, Viverra). On the grounds of genetic distances, morphological divergence, and divergence time estimates, we propose the erection of the subfamily Genettinae (including Genetta and Poiana). Our analyses suggested two independent migration events from Asia to Africa, during the Middle Miocene (Civettictis) and between the Late Oligocene and Middle Miocene (Genettinae). These results are in agreement with the hypothesis of Miocene routes from Asia to Africa-via the Arabian microplate-that would have involved several independent events of migrations. Couched in the context of the viverrid fossil record, our study calls for a revision of the paleontological data in order to fully appreciate the complexity of Afro-Asian faunal exchanges.

Africa↗

PubMed2004

A re-examination of the potential impact of preventive therapy on the public health problem of tuberculosis in contemporary sub-Saharan Africa.

BACKGROUND: To estimate the effect size of tuberculosis preventive therapy (PT) on the public health problem of tuberculosis in contemporary sub-Saharan Africa. METHODS: A compartmental flow model that considers high levels of tuberculosis and human immunodeficiency virus (HIV) infection in contemporary sub-Saharan Africa was used to assess the impact of PT on the prevalence of tuberculosis and tuberculosis-associated mortality. RESULTS: Model implementation shows that giving PT to 25% of HIV-positive individuals with latent tuberculosis infection (LTBI) leads to a 3.9% reduction in the prevalence of tuberculosis in 10 years and a 5.1% reduction in 20 years. This intervention also prevents a cumulative total of 3.0% of tuberculosis-associated deaths in a decade and 5.5% in two decades. Doubling PT coverage to 50% approximately doubles the effect size, suggesting a linear relationship within the 20-year period. The effect size is slightly sensitive to changes in level of HIV transmission, level of tuberculosis transmission, and level of case detection and treatment cure rates in the population. CONCLUSIONS: Contrary to suggestions by previous authors that PT can significantly reduce the public health problem of tuberculosis in sub-Saharan Africa, this model-based analysis suggests that the impact of PT on tuberculosis in the population is likely to be small.

Africa South of the Sahara↗

PubMed2003

Quantification of clinical morbidity associated with schistosome infection in sub-Saharan Africa.

Health policy making in developing countries requires estimates of the (global) burden of disease. At present, most of the available data on schistosomiasis is limited to numbers of individuals harbouring the infection. We explored the relationship between the presence of schistosome infection and clinical morbidity, in order to estimate numbers of individuals with disease-specific morbidity for Schistosoma haematobium and Schistosoma mansoni infection in sub-Saharan Africa. We searched the literature for cross-sectional data from field studies reporting both schistosome infection and morbidity. This was used to derive a functional relationship between morbidity and infection. After standardisation for diagnostic method, the number of individuals with specific types of clinical morbidity or pathology was predicted. As only aggregated prevalences of infection were available for countries or areas, we adjusted for heterogeneity in infection levels within communities in those countries. In total, 70 million individuals out of 682 million (2000 estimate) in sub-Saharan Africa were estimated to experience haematuria in the last 2 weeks associated with S. haematobium infection, and 32 million dysuria. Ultrasound detected serious consequences of S. haematobium, major bladder wall pathology and major hydronephrosis, were predicted at 18 and 10 million, respectively. Infection with S. mansoni was estimated to cause diarrhoea in 0.78 million individuals, blood in stool in 4.4 million and hepatomegaly in 8.5 million. As the associations between prevalence of S. mansoni infection and prevalence of diarrhoea and blood in stool were not very clear, the resulting estimates may be underestimations. Using the very limited data available, we estimated the mortality rates due to non-functioning kidney (from S. haematobium) and haematemesis (from S. mansoni) at 150000 and 130000 per year. Given the overall high number of cases with schistosomiasis-related disease and associated death, we conclude that schistosomiasis remains an important public health problem in sub-Saharan Africa.

Africa South of the Sahara↗

PubMed2003

Malaria vaccines in Africa.

Besides being a leading cause of morbidity and mortality, malaria is also a cause and consequence of rampant poverty in Africa, where current control efforts are mainly frustrated by antimalaria drug and insecticide resistance. The development of malaria vaccines is therefore a priority for Africa. The paper examines the still limited role played by African institutions in trials of malaria vaccines. The process of antigen discovery and validation is mainly restricted to universities and public research institutions in the north, and relies on public funding. Industry is generally uninterested in malaria vaccine development; travellers' vaccines are attracting limited industrial interest. Public funding of neglected phases (asexual and transmission blocking) of malaria vaccine candidates is very recent. Malaria vaccine trials in Africa favour sites with historical affiliations to Europe (UK and France); recently the USA entered the race. Trials at neutral or African led, or African owned sites are rare, although they are essential for multi-centre Phase III trials. The selection of new trial sites should consider epidemiological, ownership and leadership criteria. Establishment of new sites should be guided by needs assessment, followed by capacity strengthening to fill the gaps in personnel, equipment, transport and infrastructure. All systems (e.g. financial, management, ethics and regulatory review) should be strengthened. Given the enormity of the challenges involved public-private partnerships are essential.

Academies and Institutes↗

PubMed2001

[Pheochromocytoma in Africa: rarity, gravity and ectopy].

Pheochromocytoma is one of the main curable etiologies of high blood pressure, although its diagnosis and therapeutic management can be problematical: an incorrect diagnosis or inappropriate treatment may lead to fatal complications. This disease was exceptionally uncommon in the 1950s, and 30 years later about 30 cases had been reported; however, since 1981 there has been a progressive increase in the incidence of pheochromocytoma (48 documented cases in Africa). In Africa, this disease has two particular characteristics: the gravity of the clinical symptoms, mainly due to the physiological and pharmacological effects of catecholamines which as a result of this disease are stored and liberated at very high rates; and the ectopic site in a number of cases. To facilitate the diagnosis of pheochromocytoma improved clinical investigation is therefore advocated, but the necessary medical equipment is not always available in Africa. On this continent, the ectopic factor confirms the observations made in the early 1980s, and should be taken into consideration in the diagnosis and management of this disease.

Adolescent↗

PubMed2003

The functional status of people with epilepsy in rural sub-Saharan Africa.

PURPOSE: Little data is available regarding the impact of epilepsy on the functional status of people with epilepsy (PWE) in developing countries. In sub-Saharan Africa, limited medical services and social stigmatization subject PWE to substantial physical, psychological and social deprivation. To better delineate the overall burden and distribution of epilepsy-associated disability in sub-Saharan Africa, we assessed the functional status of PWE in a rural, population-based sample and made comparisons to published reports from urban Zimbabwe. METHODS: A population-based survey of PWE with epilepsy in rural Zambia utilizing WHO questionnaires. RESULTS: Among 86 PWE in 3 rural Zambian communities, 67% participated in the interviews. Only 62% of PWE were receiving treatment. Five to seven percent of rural PWE reported problems with basic hygiene and 9-14% were unable to fulfill work demands, attend social events or enjoy leisure activities. In contrast, 95% of urban PWE denied any problems with social functioning, work performance or relationships. Compared to the urban population, rural PWE had a greater seizure burden (2.3/month vs. 1/month, p=0.007) and reported more difficulties with activities of daily living, including problem solving (70% vs. 54%, p=0.02), speed of thinking (70% vs. 59%, p=0.02) and relationships with co-workers (68% vs. 26%, p< or =0.005). CONCLUSIONS: A significant proportion of PWE in rural sub-Saharan Africa report problems fulfilling both social and professional functions. These results also suggest that rural PWE may have poorer functional status than their urban counterparts.

Activities of Daily Living↗

PubMedDate not supplied

Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa.

Although randomized controlled trials of interventions to reduce malaria in pregnancy have demonstrated an increase in the birthweight of the newborn in primigravidae, the subsequent impact on infant mortality in all-parities has not been assessed. The aim of this paper was to model the possible impact of placental malarial infection on infant mortality through reduced birthweight. An extensive literature search was undertaken to define a series of parameters describing the associations between placental infection, birthweight and premature mortality in sub-Saharan Africa. It was shown that a baby is twice as likely to be born of low birthweight if the mother has an infected placenta at the time of delivery (all-parities: 23% vs 11%, primigravidae only: 32% vs 16%), and that the probability of premature mortality of African newborns in the first year of life is 3 times higher in babies of low birthweight than in those of normal birthweight (16% vs 4.6%). Assuming 25% of pregnant women in malaria-endemic areas of Africa harbour placental malarial infection, it is suggested that 5.7% of infant deaths in malarious areas could be an indirect cause of malaria in pregnancy. This would imply that, in 1997, malaria in pregnancy could have been responsible for around 3700 infant deaths under the diverse epidemiological conditions in Kenya. Placental infection with Plasmodium falciparum appears to have a more significant role in infant survival in Africa than has been previously assumed. This may explain the high reduction in infant mortality rates from interventions aimed at reducing transmission, over and above that expected from a decline in direct malaria-specific mortality alone.

Africa South of the Sahara↗

PubMedDate not supplied

An economic comparison of chloroquine and sulfadoxine-pyrimethamine as first-line treatment for malaria in South Africa: development of a model for estimating recurrent direct costs.

The relative cost-effectiveness of chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) as first-line antimalarial therapy in southern Africa is of great interest to policymakers, clinicians and researchers in the subregion. A model was developed to access the cost-effectiveness of replacing CQ with SP as first-line treatment in Mpumalanga, South Africa, where malaria is seasonal and the population is non-immune. In-vivo drug resistance levels were used to derive a 'resistance variable' for each drug, which was used to compare the costs to the public healthcare provider associated with either therapeutic option. Costs including drugs, staff time, transport, maintenance, utilities, training and consumables were determined and subjected to Monte Carlo simulation and subsequent analysis to generate an average cost-effectiveness ratio (ACER) with confidence intervals for each drug. SP was found to be 4.8 (95% CI 3.3-6.7) times more cost-effective than CQ in Mpumalanga at 1997 resistance levels and costs, despite the far greater cost per treatment course of SP (US$ 4.02 as opposed to US$ 0.22 for CQ) in South Africa. At the price of SP in Kenya and Uganda (US$ 0.47-4.80 per treatment course), the ACER for SP does not change materially, increasing to between 5.1 and 5.6. Resistance emerged as the factor that most influenced the ACER of a specific drug. Indirect costs, compliance, changes in effectiveness and costs over time and costs of adverse events were not included in the model owing to paucity of data and logistical difficulties. Since most of these are likely to be similar in both drug models, the relative ACER is unlikely to be significantly altered by their inclusion.

Adult↗

PubMedDate not supplied

Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London, 20 March 1997. Epidemiology and control of rabies. The growing problem of rabies in Africa.

Although rabies in Africa is relatively insignificant in terms of human mortality, the disease is still relevant because of the high costs of rabies prevention. Over the past 2 decades, demographic, economic and sociopolitical trends in Africa have increasingly favoured the persistence and spread of rabies, while limiting the effectiveness of control measures. Dog rabies predominates throughout most of Africa; the domestic dog is the principal reservoir host as well as the most important source of infection for people. However, wild-life rabies is increasingly a concern, both as a threat to endangered wildlife populations and because of the possible emergence of new maintenance hosts.

Africa↗

PubMed2002

The consequences of reducing transmission of Plasmodium falciparum in Africa.

Malaria transmission intensity in Africa varies over several log orders, from less than one infected bite per year to more than one thousand. In this review we examine the consequences in terms of age pattern, clinical spectrum and overall burden of disease and discuss the possible implications for interventions that reduce exposure to infected bites. With very low transmission intensity, all age groups are susceptible to severe malaria. With increasing transmission intensities, older children and adults suffer less severe disease and with high transmission rates the majority of severe cases occur in infants under one year of age. This pattern reflects the increasingly rapid acquisition of immune responses that limit the life-threatening effects of malaria with increasing exposure to the parasite. The clinical spectrum of severe malaria varies with transmission: with high transmission, severe malarial anaemia dominates and cerebral malaria is rare. As one moves towards lower transmission rates, cerebral malaria accounts for an increasingly large proportion of cases. Although the population risk of severe disease falls with age, the risk of death at an individual level may rise with age after an initial fall from very high case fatality rates in children aged under 6 months. Of central interest to malaria control is how the overall amount of disease in childhood varies with transmission. Data from a number of sources suggest that, with low transmission, the amount of malarial disease rises with increasing exposure but that this saturates relatively early. A key issue is whether the same pattern obtains for deaths, both those directly due to malaria and those from all causes. The methodological limitations of ecological comparisons between different areas are discussed before presenting a review of attempts to use this approach in Africa. This suggests that children living in areas of low malarial endemicity have all-cause mortality rates about half of those of children living in areas of moderate to high transmission. Deaths in the first year of life rise linearly with increasing exposure to malaria over a wide range of transmission intensities; by contrast all-cause mortality in children aged 0-4 years appears to saturate at relatively low transmission intensities. These data suggest that interventions that reduce exposure to malaria parasites, such as insecticide-treated bed nets (ITNs), will have the greatest chance of a sustained effect when used in areas where disease burdens are high but the frequency of parasite exposure is low-to-moderate. In conditions of high transmission, initial reductions in mortality may prove difficult to sustain as the reduced level of transmission may still lie on the part of the curve where mortality has saturated. However, at all levels of transmission the overall balance of benefits, including reduced load on families and health services from non-life-threatening malaria, favours the widespread introduction of ITNs in endemic areas of Africa.

Adult↗

PubMed2001

Systemic lupus erythematosus in migrants from west Africa compared with Afro-Caribbean people in the UK.

SLE has a high prevalence in Afro-Caribbean populations but has been reported to be rare in west Africa. We assessed prevalence (per 100000) of SLE in women in an area of south London and estimated it to be 177 (95% CI 135-220) in Afro-Caribbeans, 110 (58-163) in west Africans, and 35 (26-43) in Europeans. The high prevalence of SLE in recent migrants from west Africa suggests that the disease is not rare in west Africa, and that there is a genetic basis for the high risk of SLE in people of west African descent compared with other groups.

Adolescent↗