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PubMed2002

The epidemiology of rape and sexual coercion in South Africa: an overview.

During 1999 the issue of rape in South Africa was debated at the highest levels. The epidemiology of rape has become an issue of considerable political importance and sensitivity, with President Mbeki demanding an answer to the question: how much rape is there in South Africa? The purpose of this paper is both to summarise and synthesise the findings of research to provide an overview of the epidemiology of rape of women in South Africa and to show how difficult it is to answer the President's question. The review begins by considering why rape is so difficult to research. Data available shows that rape reported to the police (240 incidents of rape and attempted rape per 100,000 women each year) represents the tip of an ice berg of sexual coercion. Representative community-based surveys have found, for example, that in the 17-48 age group there are 2070 such incidents per 100,000 women per year. Non-consensual sex in marriage and dating relationships is believed to be very common but is usually not well reported in surveys. Forced sexual initiation is reported by almost a third of adolescent girls. In addition coerced consensual sex is a common problem in schools, workplaces and amongst peers. Knowledge of causal and contributory factors influencing the high levels of rape are also discussed. We conclude that the rape statistic for the country is currently elusive but levels of non-consensual and coerced sex are clearly very high. International comparison needs to be approached with caution because most developing countries lack the infrastructure for accurate crime reporting and do not have such a substantial body of survey data.

Adolescent↗
PubMed1998

Perceptions and priorities in disease eradication: dracunculiasis eradication in Africa.

Dracunculiasis, guinea worm disease, is an incapacitating disease affecting people in poor, remote areas of Africa, in Yemen, and a few remaining areas of the Indian subcontinent where there is poor access to protected water sources. The neglect of this preventable disease and its belated recognition are analyzed within the context of changing priorities for health since the 1870s, especially the shift from the paradigm of Imperial Medicine to Primary Health Care. A global eradication effort took off during the 1980s, and, although the original target date of December 1995 has passed, the program has achieved a remarkable recent diminution in the number of recorded cases, over 99% of which are now found in Africa. Eradication policies in Africa are briefly explored in relation to current concerns such as the incorporation of dracunculiasis eradication measures in cash-starved primary health care programs. The wider implications of an eradication campaign which is on the verge of success are also considered.

Africa↗
PubMed1999

The 'dop' system, alcohol abuse and social control amongst farm workers in South Africa: a public health challenge.

Many farm workers in South Africa continue to live and work under adverse conditions that are the legacy of apartheid policies. Despite its official prohibition, the arrangement by which workers are given alcohol' as a benefit of employment, known as the 'dop' system, appears to persist. Even though it is a minority of farms that currently actively practice the dop system, the ramifications of the historical 'institutionalisation of massive alcohol consumption are widespread. Heavy alcohol consumption is not only directly injurious to the health of farm workers and their families, but places them at risk to various social and environmental hazards. This is illustrated in a case of pesticide poisoning in which 24 workers were poisoned when given wine contaminated with the carbamate insecticide aldicarb. The case illustrates (i) the ongoing application of the dop system on farms in South Africa and (ii) the interaction between social factors and chemical exposures amongst farm workers. Public perceptions about the natural tendencies of 'coloured' people to drink heavily have much to do with perpetuating the dop system, and reinforcing a system geared towards the social control of rural farm workers and their families. The dop system poses a major challenge to the public health authorities in South Africa who are charged with the task of restructuring health services to address the human rights and health needs of marginal farming communities within a primary health care framework.

Agriculture↗
PubMed2000

Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility?

While the vision for restructuring health care in South Africa is based on a comprehensive primary health care system, care at the primary level remains largely biomedical in orientation. Given this, I argue that whilst adding mental health care to primary level care may increase accessibility of psychiatric care. it will not, however, provide for comprehensive integrated primary mental health care as planned. This would require a paradigm shift towards a comprehensive discourse of care which includes mental health care. While efforts towards reorienting health care personnel in South Africa towards the primary health care approach have been initiated, an examination of the primary health care system in one sub-district in South Africa, reveals that the delivery of biomedical care is sustained by a number of factors within the primary health care system as well as within the macro-context. A shift in the paradigm of care provided would therefore require the transformation of the system on many fronts. Of central importance would be the restructuring of the primary health care system to be supportive of emotional labour, health promotion, empowerment of service users and of care which takes the subjectivity of the illness experience for the patient into account.

Culture↗
PubMed2001

Testing for clinical anaemia caused by Haemonchus spp. in goats farmed under resource-poor conditions in South Africa using an eye colour chart developed for sheep.

A novel clinical assay for the assessment and subsequent treatment of Haemonchus infection in sheep to slow down the development of anthelmintic resistance--the FAMACHA system--has been developed, tested and validated in South Africa. The system is based on a colour chart with five colour categories depicting varying degrees of anaemia that are compared with the colour of the mucous membranes of the eyes of sheep. The animal is then scored from severely anaemic (pale) through anaemic to non-anaemic (red) and those animals considered in danger of succumbing to the effects of haemonchosis are treated. This method was tested in goats farmed under resource-poor conditions in South Africa. Analyses in goats performed during the summers of 1998/1999 and 1999/2000 show a test sensitivity of 76 and 85%, respectively, meaning that the system may be used to identify correctly 76-85% of those animals in need of treatment with an anthelmintic. However, the test specificity remains low at 52-55%. This means that a large proportion of those animals that would not require treatment would in fact be treated. However, when the use of the FAMACHA system is compared with conventional dosing practices where all the animals are treated, using the FAMACHA system would result in a large proportion of the animals being left untreated. The untreated animals are then able to deposit the eggs of anthelmintic-susceptible worms on the pasture, while the treated ones should pass very few ova, given an effective anthelmintic. This maintains a reservoir of susceptible larvae in refugia, and should slow down the development of anthelmintic resistance. The validation of the FAMACHA system for goats for use by resource-poor farmers, which this paper describes, may have wide application in the tropics and subtropics of sub-Saharan Africa and elsewhere.

Anemia↗
PubMed2002

Brucellosis in sub-Saharan Africa: epidemiology, control and impact.

Brucellosis is an important disease among livestock and people in sub-Saharan Africa. In general, the incidence is the highest in pastoral production systems and decreases as herd size and size of landholding decreases. The prevalence of risk factors for infections are best understood for bovine brucellosis and to a lesser extent for ovine and caprine brucellosis. The occurrence and epidemiology of brucellosis in pigs is poorly understood. This species bias is also reflected in control activities. As with other public-sector animal health services, the surveillance and control of brucellosis in sub-Saharan Africa is rarely implemented outside southern Africa. Brucellosis is even more ignored in humans and most cases go undiagnosed and untreated, leading to considerable suffering for those affected. Decision-making to determine the importance of brucellosis control relative to other public concerns and what brucellosis control strategies should be applied is urgently required. A strategy for how brucellosis decision-making might be considered and applied in future is outlined.

Africa South of the Sahara↗
PubMedDate not supplied

Primate evolution - in and out of Africa.

A synthetic analysis of molecular, fossil and biogeographical data gives a remarkably consistent scenario for the evolution of the catarrhine primates - the hominoids and Old World monkeys. This analysis supports the African location of the common ancestor of the Old World monkeys, and suggests that the Asian colobine monkeys and macaques dispersed out of Africa into Eurasia within the past ten million years. More interestingly and controversially, this analysis further suggests that the lineage leading to the living hominoids dispersed out of Africa about twenty million years ago, and that the common ancestor of the living African apes, including humans, migrated back into Africa from Eurasia within about the past ten million years.

Africa↗
PubMed2006

Trends in protective behaviour among single vs. married young women in sub-Saharan Africa: the big picture.

The trends in contraceptive uptake and condom use among single and married young women show distinct patterns in sub-Saharan Africa. A large median increase of 1.4 percentage points per year in condom use by single young women for pregnancy prevention was witnessed in 18 countries based on Demographic and Health Survey data from 1993 to 2001. In contrast, a modest increase in condom use was noted for married or cohabiting young women. Condom promotion in Africa has been, therefore, a success for single women. Its promotion for pregnancy prevention offers even greater potential, as pregnancy prevention is the main or partial motive of most single women who use condoms. While a myriad of research studies on condom use among young single people have been conducted and published, the needs of the married and cohabiting population have been neglected by researchers and programme staff alike, despite the fact that more than half of HIV infections in the severe epidemics of Southern and East Africa are occurring in this group. The barriers to condom adoption by married couples may not be as severe as is often assumed.

Adolescent↗
PubMed2000

Trends in antimicrobial resistance and serotype distribution of blood and cerebrospinal fluid isolates of Streptococcus pneumoniae in South Africa, 1991-1998.

OBJECTIVE: Since 1979, the South African Institute for Medical Research (SAIMR) has served as the national reference center for pneumococcal serotyping and monitoring of antibiotic resistance trends. This study documents trends in antimicrobial resistance in pneumococci isolated from blood or cerebrospinal fluid (CSF) between 1991 and 1998 in South Africa. METHODS: Pneumococcal isolates (n = 7406) from either blood or CSF were sent to the SAIMR reference laboratory for serotyping. The isolates were evaluated for resistance to penicillin, chloramphenicol, tetracycline, erythromycin, clindamycin, and rifampicin. RESULTS: Resistance to one or more antibiotics increased significantly from 19% in 1991 to 1994 to 25% in 1995 to 1998 in all ages, and in children from 32% to 38% (P < 10[-6]). Although penicillin resistance did not increase in children (28.1% vs. 28.9%), penicillin resistance in all ages increased from 9.6% to 18.0%. Significant increases in resistance to chloramphenicol, tetracycline, erythromycin, and rifampicin also were seen in both groups. Multiple resistance increased significantly, from 2.2% to 3.8%. The proportion of isolates with intermediate or high-level penicillin resistance remained constant during the surveillance period. Erythromycin resistance, predominantly expressed as simultaneous resistance to erythromycin and clindamycin, increased from 1.6% to 2.6%. The percentage of erythromycin-resistant isolates that were resistance to erythromycin alone increased from 10.6% to 28.7%, suggesting the emergence of mefE-mediated resistance. In children 2 years of age and younger, although serogroup 6 remained the most common, there were significant increases in serogroups 19, 18, and 13. The percentage of the total invasive pneumococcal disease in this population that is caused by serogroups found in the nonavalent pneumococcal conjugate vaccine (serogroups 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F) increased from 72% to 91%. CONCLUSIONS: Antibiotic resistance in the pneumococcus is increasing in South Africa, although the proportion of strains with high-level penicillin resistance has not increased. New conjugate vaccines may not only decrease the burden of all pneumococcal disease but, in addition, lower the incidence of antibiotic-resistant disease in South Africa.

Adolescent↗
PubMed2001

The past, present and future of childhood malaria mortality in Africa.

During the past few years, there has been a historic series of declarations of renewed commitment to malaria control in Africa. Whether the burden of malaria is increasing in Africa is a moot point. This article attempts to re-construct the evidence for the trends in childhood mortality as a result of Plasmodium falciparum infection over the last century in Africa.

Africa↗
PubMed2003

Estimating the needs for artesunate-based combination therapy for malaria case-management in Africa.

Because of inadequacies in national health information systems, the volumes of drugs required to support an effective policy transition toward artesunate-based combination therapy (ACT) are unknown for most African countries. A series of national surveys and population projections have been used to estimate the age-structured fever burden among 41 malaria endemic countries in Africa. Under present fever-management guidelines, commodity costs and internationally agreed coverage targets, the financial resources to meet the needs of ACT in most African countries are huge. Between US$1.6 billion and US$3.4 billion per annum must be found to give Africa the chance to consider a drug policy based on ACT. Substantial reductions in these costs would be achieved through more effective targeting of resources--only 20% of drugs would be required to manage fevers among the most at-risk pediatric patient populations. Better diagnostics would also be an important consideration for a new ACT policy in Africa.

Adolescent↗
PubMed2005

Epidemiology and aetiology of epilepsy in sub-Saharan Africa.

Data on the incidence of and prognosis for epilepsy in sub-Saharan Africa are scarce, but prevalence data show that epilepsy is two or three times more common than in industrialised countries in non-tropical areas. The high prevalence of epilepsy and low life expectancy indicate that incidence is high. Relative contributions of each cause of epilepsy are difficult to determine. Only a few case-control studies have been done in sub-Saharan Africa. Infections, in particular cysticercosis in its endemic areas, cause most cases of epilepsy. The implementation of studies to accurately determine the causes of epilepsy in sub-Saharan Africa is urgently required. Such studies will help to lower the incidence of epilepsy in this region and better understand the aetiology of epilepsy in other areas.

Adolescent↗
PubMed2005

Socioeconomic status as a risk factor for HIV infection in women in East, Central and Southern Africa: a systematic review.

This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women's access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female's SES and fourteen also included a measurement of partner's SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner's SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES.

Adult↗
PubMed2005

Sexual risk behaviour among the youth in the era of HIV/AIDS in South Africa.

The paper discusses factors associated with sexual risk behaviour, i.e. failure to use condoms consistently during sexual intercourse, among unmarried sexually experienced youths in South Africa. Data from the 'Transitions to Adulthood in the Context of AIDS in South Africa' surveys of 1999 and 2001 were analysed to identify factors associated with high sexual risk behaviour among the youth. The multinomial regression models for male and female youths were fitted separately for the 1999 and 2001 data sets. The results show increasingly consistent use of condoms during sexual intercourse and that high sexual risk behaviour among youths is predominantly determined by social factors such as 'ever-pregnant' or 'ever made pregnant', 'ever given something for sex', age of sexual partner, currently in school, pressured by friends to have sex, peer influence on safe sex and education level for males. There is evidence that availability of contraception information is important in strategic interventions that seek to change the sexual behaviour of the youth in South Africa.

Adolescent↗
PubMed2003

Transmission ecology of Echinococcus in wild-life in Australia and Africa.

Following the introduction of E. granulosus into Australia with domestic animals during European settlement, the parasite quickly became established in the E. granulosus-naive native animals of the continent. The distribution of E. granulosus in wildlife in Australia is restricted by rainfall, but nevertheless the parasite is currently widespread and highly prevalent in many areas including numerous national parks and privately owned farms. The human population of Africa is rapidly increasing resulting in ever more pressure on wild-life populations and habitat. National parks, reserves and conservation areas now provide important tracts of preserved habitat for maintaining populations of wildlife that are also important in the maintenance of E. granulosus. In some parts of Africa, hydatid-infected humans provide a source of E. granulosus infection to wildlife definitive hosts. In many areas felids may also act as important definitive hosts for E. granulosus with the parasite being maintained in a prey/predator relationship between lions and a range of intermediate hosts. Populations of E. granulosus-infected wild-life both in Australia and Africa act as important reservoirs in perpetuating the transmission of E. granulosus to both domestic animals and humans. In Australia, E. granulosus-infected wild-life is infiltrating urban areas and currently represents a potentially important new public health problem.

Africa↗
PubMed2003

New species of Anthostomella on fynbos, with a key to the genus in South Africa.

A study of saprobic fungi occurring on the fynbos of the Western Cape Province of South Africa yielded four unknown Anthostomella species. A. proteae from Protea nitida, A. cynaroides from P. cynaroides, A. leucospermi from Leucospermum oleifolium, and A. brabeji from Brabejum stellatifolium are described as new. New records for South Africa include A. conorum from Leucadendron sp., Protea magnifica and P. neriifolia, and A. clypeata from Ischyrolepis subverticellata, Cannomois virgata, Restio egregius, and R. cfr confusus. A dichotomous key to the Anthostomella species in South Africa is also provided.

Ecosystem↗
PubMed2005

Morphological and molecular characterization of Endophyllum species on perennial asteraceous plants in South Africa.

Endophyllum osteospermi is an autoecious, endocyclic rust fungus, which has only been recorded on Chrysanthemoides monilifera ssp. monilifera (Asteraceae, Calendulae), a perennial woody shrub. Both organisms are indigenous to South Africa. Because E. osteospermi is being considered for release in Australia as a biocontrol agent against C. monilifera ssp. monilifera, it was necessary to determine its host range and natural distribution in South Africa. To address this, natural stands of Chrysanthemoides species, as well as other South African asteraceous plants, were monitored for E. osteospermi between 1992 and 2003. A morphological and molecular comparison of specimens referable to Endophyllum was undertaken. Based on these results, E. osteospermi was recorded on C. monilifera sspp. monilifera, pisifera, rotundata, canescens, and subcanescens, C. incana, and an undescribed taxon. E. osteospermi was also recorded on Osteospermum ciliatum, O. pollgaloides, and O. potbergense. Furthermore, a closely related but previously undescribed species, E. dimorphothecae sp. nov. is described on Dimorphotheca cuneata. Aecidium elytropappi is transferred to Endophyllum as E. elytropappi comb. nov., being recorded on Elytropappus rhinocerostis and Stoebe plumosa. This study shows that in South Africa E. osteospermi is restricted to a small group of related plant species in the Calenduleae. This rust is therefore considered suitable as a candidate agent for the biocontrol of C. monilifera ssp. monilifera, and pending the results of host specificity testing, would most likely be safe to introduce into Australia.

Asteraceae↗
PubMed2005

Phylogenetic analyses of DNA sequences reveal species partitions amongst isolates of Armillaria from Africa.

The basidiomycete genus Armillaria causes root rot and death to woody plants in boreal, temperate and tropical regions of the world. Armillaria root rot has been described from various parts of Africa on many different hosts. However, very little is known regarding the evolutionary relationships among Armillaria species in Africa. The aim of this study was to determine the phylogenetic relationships between isolates originating from different regions in Africa using nDNA sequences from two non-coding gene regions. The ITS and the IGS-1 regions of the ribosomal DNA operon were sequenced and analysed using different phylogenetic tree searching methods. Phylogenetic trees grouped the African taxa in two strongly supported clades. One of these represented A. fuscipes and the other an undescribed but distinct species.

Africa↗