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At least 703 records · Page 39Linked to original sources
PubMed2005

The impact of the HIV/AIDS epidemic on hospital nurses in KwaZulu Natal, South Africa: nurses' perspectives and implications for health policy.

During a stay in South Africa in 2002-2003, we learned that public sector nurses dealt with serious community and workplace impacts from the HIV/AIDS epidemic; and were reluctant to report occupational exposures to HIV or take a short-course of antiretroviral post-exposure prophylaxis to prevent HIV infection. In May 2003, in South Africa's KwaZulu Natal province, we explored perspectives of 34 public hospital nurses in nine group interviews on workplace safety; the impact of HIV/AIDS on nurses' work environments; and, hospital and government policy. The information they provided illustrates that the views of nurses are vitally important to policy-making. We conclude that seeking nurses' views and involving them in policy processes could contribute to worker health, to addressing the dramatic shortage of nurses, recently identified as the largest threat to providing HIV/AIDS treatment in sub-Saharan Africa, and to improving quality of care.

Government Regulation↗
PubMedDate not supplied

Trauma in South Africa.

Trauma care in South Africa has a number of unique challenges. South Africa is a large country with an uneven distribution of services; a restrictive infrastructure; severe financial restraints on the entire health system; and an overwhelming incidence of patients with human immunodeficiency virus, acquired immunodeficiency disease syndrome, and tuberculosis. Substance abuse and violence are common cofactors in trauma. A profile of injuries encountered in South Africa is discussed.

Accidents, Traffic↗
PubMed2001

Conservation strategies for Africa's large mammals.

Africa's large mammals are conserved for their aesthetic, scientific and economic values. Many of these species face a gloomy future precipitated by a combination of factors directly and indirectly influenced by the activities of man, including habitat loss, overexploitation, poor management of designated protected areas, and the vulnerability of small isolated populations. Africa's designated protected areas and biodiversity hotspots are also under threat, highlighting the importance of embracing community participation to address accelerating poverty and malnutrition. Innovative strategies are required for the conservation of Africa's mammals, such as the integration of a wide range of species in the production landscape, including the farming community. Transfrontier conservation areas (TFCAs) have been established with the combined objectives of conserving biodiversity, creating new jobs in the tourism and wildlife industry, and promoting a culture of peace. These areas extend far beyond traditional national parks, providing opportunities for integrating large mammals into sustainable land-use practices, at the same time as addressing some of the continent's more pressing socioeconomic needs. Research on African mammals will inevitably have to change direction to accommodate the growing threats and changed circumstances. Priorities will include the identification of corridors associated with TFCA establishment, the determination of the economic value of certain species in consumptive use programmes, research on contraception as a management option in restricted areas, and further work on the indirect use value of species. There will also be worthwhile opportunities to be pursued with ex situ conservation programmes, but these need to be focussed more efficiently.

Africa↗
PubMed2006

The effect of climate variation on agro-pastoral production in Africa.

Using national crop and livestock production records from 1961-2003 and satellite-derived data on pasture greenness from 1982-2003 we show that the productivity of crops, livestock, and pastures in Africa is predictably associated with the El Niño Southern Oscillation and the North Atlantic Oscillation. The causal relations of these results are partly understandable through the associations between the atmospheric fluctuations and African rainfall. The range of the explained among-year variation in crop production in Africa as a whole corresponds to the nutritional requirements for approximately 20 million people. Results suggest reduced African food production if the global climate changes toward more El Niño-like conditions, as most climate models predict. Maize production in southern Africa is most strongly affected by El Niño events. Management measures include annual changes in crop selection and storage strategies in response to El Niño Southern Oscillation-based and North Atlantic Oscillation-based predictions for the next growing season.

Africa↗
PubMed2003

The health impact of environmental pollutants: a special focus on lead exposure in South Africa.

Studies have shown blood lead levels of some children in South Africa at levels of health concern. New studies show even relatively low lead levels to have detrimental effects on cognitive function in young children. Large numbers of South African inner-city and other children have been shown to have unacceptably high blood lead levels. Studies indicate that blood lead levels of children living in South Africa's urban areas are higher than those of children in most developed countries, including Great Britain, Europe, and the United States. Although data and reported studies are very sparse, mean blood lead levels of approximately 15 microg/dl have been reported in children. Elevated blood lead levels were associated with socioeconomic status and housing conditions. Key environmental risk factors for elevated blood levels were contaminated soil and dust in the urban environment, and the still large number of automobiles using leaded gasoline. In view of emerging evidence linking lead at increasingly lower levels to adverse effects in children, the South African government is taking actions to reduce lead exposure among vulnerable groups. Currently, South Africa has no national lead surveillance program. The government, therefore, has developed international and regional partnerships to prevent and address the problem of lead exposure.

Child↗
PubMed2003

Secondary data analyses of dietary surveys undertaken in South Africa to determine usual food consumption of the population.

OBJECTIVE: The primary objective of this study was to generate a reference table of food items and average amounts of these items consumed by South Africans, for the Department of Health. The reference table was required to be representative of foods and beverages eaten frequently by children and adults from all age and ethnic groups in order for the Department of Health to test for contaminants in these foods. DESIGN: The National Food Consumption Survey (NFCS) served as a framework for compiling data on children since this was a national representative survey of 1-9-year-old children undertaken in South Africa in 1999. However, there has never been a national dietary survey on adults in South Africa. Consequently the data had to be extrapolated from existing isolated surveys on adults. Secondary data analysis was conducted on existing dietary databases (raw data) obtained from surveys undertaken on adults in South Africa between 1983 and 2000. Available datasets were regional and independent, and were not individually representative of the South African diet. It was therefore necessary to use different statistical methods, including factor analyses, weighting and correlations, to generate ethnic and geographic representative data for adults. Two methods were used: Method 1, which corresponded with results of the NFCS (over-sampled for low socio-economic status), and Method 2, which was based on ethnic proportions of the population. RESULTS: The secondary data analyses generated food items most commonly consumed by the South African adult population (Method 1) in descending frequency of usage and average (mean) amount per day: maize porridge (78%/848 g), white sugar (77%/27 g), tea (68%/456 g), brown bread (55%/165 g), white bread (28%/163 g), non-dairy creamer (25%/6 g), brick margarine (21%/19 g), chicken meat (19%/111 g), full-cream milk (19%/204 g) and green leaves (17%/182 g). In 6-9-year-olds, maize porridge (72%/426 g), sugar (76%/23 g), tea (51%/258 g), full-cream milk (35%/171 g) and white bread (33%/119 g) were eaten most frequently. Similarly, in 1-5-year-olds, the foods consumed most frequently were maize porridge (80%/426 g), sugar (76%/21 g), tea (44%/224 g), full-cream milk (39%/186 g) and white bread (24%/83 g). In order to evaluate the validity of the adult data generated, kilojoule values of the individual food items (per capita) were compared with food balance sheets (FBSs). The comparison was favourable except that the FBSs had a higher overall energy intake per capita of between 22 and 28%. CONCLUSION: Reference tables of commonly consumed foods and beverages were generated at minimal cost based on secondary data analyses of past dietary surveys in different South African populations.

Adolescent↗
PubMed2005

Nutrition security, livelihoods and HIV/AIDS: implications for research among farm worker households in South Africa.

OBJECTIVE: Previous research on the health transition and nutrition security in black South African households revealed the need for further research among farm workers who belong to the poorest population categories. This article gives an overview of the link between nutrition security, livelihoods and HIV/AIDS in South Africa, drawing conclusions for research among farm worker households. DESIGN AND SETTING: A literature review, observations on farms and interviews with farmers and key informants were carried out in 2003 and 2004. Peer examination was done with South African and German researchers from the natural and social sciences. RESULTS: Farm workers face poverty and nutrition insecurity and continue to be a tragically underserved population group, also in terms of research. There is furthermore a lack of in-depth research on underlying causes for nutrition security in South Africa and on the link with livelihoods, poverty and HIV/AIDS. Micro-social qualitative research from the household and gender perspective is required, as valid data on households, their internal dynamics and therefore the reflection of social realities are missing. A multidisciplinary research approach based on a new conceptual framework was developed to address the situation of farm worker households. CONCLUSION: The outlined research contributes to existing programmes on farms in the North West Province, with the findings being valid also for other parts of southern Africa facing poverty, nutrition insecurity and HIV/AIDS.

Agriculture↗
PubMed2005

The National Food Consumption Survey (NFCS): South Africa, 1999.

OBJECTIVE: The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1-9 years old), as well as factors that influence their dietary intake. DESIGN: This was a cross-sectional survey of a nationally representative sample of all children aged 1-9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information. SUBJECTS: Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%. METHODS: The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a food-frequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference. RESULTS: At the national level, stunting (height-for-age below minus two standard deviations (< -2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age < -2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1-3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure. CONCLUSION: The NFCS indicated that a large majority of households were food-insecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa.

Anthropometry↗
PubMed2002

Threat to ethnic identity: the experience of White Afrikaans-speaking participants in postapartheid South Africa.

The dismantling of apartheid and the postapartheid dispensation had far-reaching implications for all the citizens of South Africa. In an urban sample of White Afrikaans-speaking South Africans (Afrikaners) in postapartheid South Africa, the authors investigated perceptions of threat to ethnic identity, as well as correlates of those perceptions. The respondents experienced threat on 2 levels: The 1st was distinctive continuity, the concern that their ethnic group would not continue as a distinctive group in society. The 2nd was the evaluative dimension of ethnic identity (i.e., well-being), the concern that group membership would no longer contribute to positive self-esteem. The respondents experienced greater threat on the 2nd level, reflecting predominantly negative experiences as White Afrikaans-speaking persons in postapartheid South Africa. A high threat perception on the 2nd level was associated with (a) a perception of other groups' negative evaluations of their ethnic group, (b) negative attitudes toward political changes, and (c) perceptions of illegitimacy and instability of the postapartheid political system. The respondents who felt that Afrikaners would not continue as a distinctive group in society had a more positive attitude toward the sociopolitical changes, did not show strong ethnic identification, and had a negative collective self-esteem. They were also politically more liberal. Those findings are discussed in relation to theoretical expectations.

Adult↗
PubMed2003

The inequality of maternal health care in urban sub-Saharan Africa in the 1990s.

Numerous studies document the disadvantage in child health of the urban poor in African cities. This study uses Demographic and Health Survey data from 23 countries in sub-Saharan Africa to examine whether the urban poor experience comparable disadvantages in maternal health care. The results show that, although on average the urban poor receive better antenatal and delivery care than rural residents, the care of the urban poor is worse than that of the urban non-poor. This suggests that the urban bias in the allocation of health services in Africa does not benefit the urban poor as much as the non-poor. Multilevel analyses reveal significant variations in maternal health in urban areas across countries of sub-Saharan Africa. The dis-advantage of the urban poor is more pronounced in countries where maternal health care is relatively good. In these countries the urban poor tend to be even worse off than rural residents, suggesting that the urban poor have benefited least from improvements in maternal health care.

Africa South of the Sahara↗
PubMed1993

Potential of trypanotolerance as a contribution to sustainable livestock production in tsetse affected Africa.

Tsetse transmitted trypanosomiasis is possibly the major constraint on livestock and agriculture development in Subsaharan Africa. Control of the disease has been based on vector control as well as on the use of trypanocidal drugs to treat or prevent infection in animals. Both control methods are effective but have proven not to be sustainable. Moreover, the development of a vaccine against trypanosomiasis is unlikely to be successful in the near future. On the other hand, trypanotolerant cattle, like the N'Dama can survive and produce in tsetse affected areas without interventions. This taurine breed has been indigenous to Africa for approximately 7,000 years and forms presently about 6% of the bovine population of Africa. Generally the N'Dama are kept in the rural areas by the small-scale farmer as a multi-purpose animal. Recent studies have defined management characteristics and assessed the production potential at the village level and under ranching conditions of N'Dama cattle exposed to various levels of tsetse challenge. Furthermore, experimental infections showed conclusively the superior resistance to the effects of infection of the N'Dama cattle when compared to zebu cattle and have confirmed that trypanotolerance is innate in N'Dama cattle. Studies have been conducted on development of protective humoral and cellular responses, the regulation of parasite multiplication and control of anaemia. These studies provided tools for identifying components of trypanotolerance. The ability to resist the development of anaemia in the face of infection, has shown to be correlated with the capacity to be productive; moreover, PCV values can serve as selection criterium for trypanotolerance. Subsequently, repeatabilities and heritabilities of trypanotolerance and performance traits were estimated.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMedDate not supplied

mtDNA sequences of Chadic-speaking populations from northern Cameroon suggest their affinities with eastern Africa.

BACKGROUND: No mitochondrial DNA (mtDNA) sequences from Chadic-speaking peoples have yet been reported, even though these populations inhabit a vast territory from eastern Nigeria to central Chad. This paper deals with the mtDNA sequences of four Central Chadic populations (Hide, Kotoko, Mafa and Masa) from northern Cameroon, biological samples from which were collected during anthropological research in the area of their homeland. OBJECTIVE: The main goals of this article are to report new mtDNA sequences of Chadic-speaking populations, to analyse their genetic diversity and to establish their relationships within the peri-Saharan area in respect of geography and languages. SUBJECT AND METHODS: The analyses are based on 104 mtDNA haplotypes, which can be localized into four different areas of northern Cameroon. Data collection was based on a strict geographical sampling strategy; the ethnonyms are retained here only for comparative purposes. RESULTS: None of the examined Chadic populations displays a departure from the normal mismatch distribution pattern, and the null hypothesis of the expansion event cannot be rejected. Analyses of molecular variance and F(ST) genetic distances revealed that the Chadic-speaking groups of northern Cameroon share more similarities with the populations of the Upper and Middle Nile Valley and East Africa than with populations from Central Africa. The results show geographical clustering to be more important than the correlation of linguistic affiliations with molecular genetic data. CONCLUSION: The observation that the Chadic group reveals some affinities to East Africans is extremely surprising giving the present-day geographical distance (around 2000 km) between them. These observations complement recent linguistic and archaeological findings, which consider the Chadic branch in the Afro-Asiatic phylum to be of eastern origin. A continuous, well-defined, geographic sampling strategy of the different genetic polymorphisms of the native populations of sub-Saharan Africa is further needed as the only way of understanding the differentiation of the mtDNA sequences at a micro-regional scale.

Africa↗
PubMed2002

The colony as laboratory: German sleeping sickness campaigns in German East Africa and in Togo, 1900-1914.

This paper is on dangerous human experimentations with drugs against trypanosimiasis carried out in the former German colonies of German East Africa and Togo. Victory over trypanosomiasis could not be achieved in Berlin because animals were thought to be unsuitable for therapeutic laboratory research in the field of trypanosomiasis. The colonies themselves were necessarily chosen as laboratories and the patients with sleeping sickness became the objects of therapeutical and pharmacological research. The paper first outlines Robert Koch's trypanosomiasis research in the large sleeping sickness laboratory of German East Africa and then focuses on the escalating human experiments on trypanosomiasis in the German Musterkolonie Togo, which must be interpreted as a reaction to the starting signal given by Robert Koch in East Africa.

Africa, Eastern↗
PubMed2002

Improving the accessibility of condoms in South Africa: the role of informal distribution.

Lack of access to condoms presents a fundamental barrier to HIV prevention across most of sub-Saharan Africa. One strategy to enhance the accessibility of condoms is to promote their informal distribution outside of health facilities through existing social networks. To investigate the prevalence and practices of informal condom distribution, we administered a questionnaire to individuals procuring condoms at 12 public health facilities in four regions of South Africa. Of the 554 individuals interviewed, 269 (48%) reported either giving or receiving condoms informally in the month before the study. In multivariate analysis, reporting informal condom distribution was associated with increased education, male gender, multiple sex partners and recent condom use. The specific practices involved in giving or receiving condoms differed between males and females, with women more likely to involve family members and men more likely to involve friends. These results indicate that informal condom distribution is surprisingly common among individuals procuring public sector condoms in South Africa, and begin to suggest the gendered nature of informal condom distribution networks. While these findings require confirmation in other populations, the practices of informal condom distribution described here provide an excellent opportunity for enhancing condom accessibility and delivering other interventions for HIV prevention.

Adolescent↗
PubMed2006

Epidemiology of health and vulnerability among children orphaned and made vulnerable by HIV/AIDS in sub-Saharan Africa.

The HIV/AIDS epidemic in sub-Saharan Africa has already orphaned a generation of children, and it is projected that by 2010, 18 million African children under the age of 18 are likely to be orphans from this single cause (UNICEF, 2005, The state of the Worlds Children: Childhood under threat. New York: UNICEF). Results from a Kellogg funded OVC project (Skinner et al., 2004, Definition of orphaned and vulnerable children. Cape Town: HSRC) supported the construct that the loss of either or both parents would indicate a situation of likely vulnerability of children. A key problem in the literature on the impact of orphanhood on the well-being of children, families and communities, is that the focus of assertions and predictions is often on the negative impact on 'AIDS orphans', or households. There are hardly any studies that compare the experiences of orphans with non-orphans. This paper thus attempts to fill that gap. It uses epidemiological data to explore the epidemiology of health and vulnerability of children within the context of AIDS in sub-Saharan Africa. Because of data limitations, only the following aspects are examined: (i) orphan status; (ii) household structure (in particular, grandparent headedness and female-headedness); (iii) illness of parents; (iv) poverty; and (v) access to services, especially schooling, health, social services. While recognizing the limitations of the analysis, data presented in this paper indicates that orphans in sub-Saharan Africa are more vulnerable than non-orphans. The authors conclude with some suggestions for policy makers and programme implementers, highlighting the importance of focusing on interventions that will have maximum impact on the health and well-being of children.

Adolescent↗
PubMed2005

Developing a competence framework and evaluation tool for primary care nursing in South Africa.

CONTEXT: Nurses provide the bulk of primary care services in South Africa. Post-apartheid health legislation envisions the provision of comprehensive primary services at all public clinics, which implies the need for a cadre of primary care nurses able to render such services. OBJECTIVES: To identify core competencies of clinic nurses and develop an evaluation tool for primary care nursing in South Africa. METHODS: The descriptive and exploratory techniques used included two meetings of a reference group of South African primary care professionals, followed by a consensus-building exercise. Using the Delphi technique expert opinion was solicited from South Africa, Canada and the USA. FINDINGS: The reference group meetings yielded a list of nine core competencies. Infrastructure issues, such as the supermarket (one-stop shopping) approach to service delivery, communication and transport systems, and the quality of supervision still cause concern. These issues underscore that competence cannot be measured in a vacuum. Input from Delphi participants affirmed the nine core competencies and the need to assess the impact of core competency training. One possible way to measure the nine core competencies would be to use proxy indicators. DISCUSSION/CONCLUSIONS: Identifying core competencies is a complex process. There is a need to process a wide range of views and ideas. Also, balancing academic concerns with service delivery needs and constraints is an ongoing challenge. A potential limitation of the Delphi technique is participant selection bias and fatigue. Accessing a diverse international panel and making numerous follow up attempts via phone, mail and email were used to attempt to ameliorate these inherent limitations. Although the process is cumbersome, providing "experts" with a venue to wrestle with these ideas can be fruitful. Future studies would help to assess the reliability of the findings.

Clinical Competence↗
PubMedDate not supplied

'I am what I am because of who we all are': international perspectives on rehabilitation: South Africa.

This article provides an overview of some of the important factors that impinge on people with cerebral palsy and their families, on medical and rehabilitation personnel, and on systems of healthcare and education in South Africa. Information is provided with regard to the national contextual variables that influence intervention in the country. The incidence of cerebral palsy is related to some of the more prominent aetiological variables including poverty, malaria, HIV/Aids and premature birth. Health care systems available for children with cerebral palsy are discussed, including the role of traditional healers. Access to education, training and care of children with cerebral palsy is described, including a brief history of specialized education in South Africa. An overview of the personnel, approaches and work contexts involved in rehabilitation highlights the unique nature of intervention in South Africa. The article concludes with recommendations for interventionists with reference to lessons that can be learned in terms of adapting skills and knowledge to local needs, in order to work successfully with children with cerebral palsy and to develop the resilience of their families. In addition, it is suggested that the definition of cerebral palsy needs to reflect the context in which the person lives.

Cerebral Palsy↗
PubMed2005

Human immunodeficiency virus (HIV) and suicide in a region of Eastern Province ("Transkei"), South Africa.

HIV/AIDS is an alarming illness worldwide. It is known to have a significant association to suicide, despite a lack of in depth study. Early studies suggested suicide risk 20 to 36 times higher than the general population, but more recent trends in America show a decline. This is not true in Africa, including the region of Eastern Province, South Africa. There is abundant political and health discussion, but little study. This article presents descriptive statistics and case histories. These beginning studies must be augmented by comprehensive study of not only the epidemiology, but also the psychological and social correlates. Regrettably, there are numerous obstacles to such study in South Africa.

Adult↗