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At least 775 records · Page 43Linked to original sources
PubMed1997

Trial of labour after caesarean section in sub-Saharan Africa: a meta-analysis.

OBJECTIVE: To evaluate the safety and effectiveness of a policy of trial of labour for women with a previous caesarean section, delivering in hospitals in sub-Saharan Africa. DESIGN: A meta-analysis of 17 published reports. SETTING: Hospitals located in sub-Saharan Africa. MAIN OUTCOME MEASURES: The probability of vaginal delivery, the risk of mortality and morbidity, and the risk difference for specific obstetrical conditions were computed using an approach equivalent to a random effects model. RESULTS: The proportion of women who were allowed a trial of labour ranged from 37% to 97% across reports. The probability of a vaginal delivery among these women was 69% (95% CI 63-75%). Maternal mortality among all women with a previous caesarean section was 1.9/1000 (95% CI 0-4.3). Uterine rupture and scar dehiscence occurred in 2.1% (95% CI 1.0-3.2). Criteria used to select women for a trial of labour appeared to have a limited impact on the probability of vaginal delivery. CONCLUSIONS: In hospitals in sub-Saharan Africa a selective policy of trial of labour after a previous caesarean section has a success rate comparable to that observed in developed countries. The policy appears to be relatively safe and applicable in this context.

Africa South of the Sahara↗
PubMed1995

Interventional cardiology in South Africa.

South Africa is a country in political and cultural flux. Because of the iniquitous system of apartheid, inequalities have been perpetuated at all levels including health care. Due to the high prevalence of ischemic heart disease and rheumatic heart disease, coronary angiography, PTCA, intracoronary stenting, and balloon valvuloplasty have become established cardiological procedures in South Africa. However, a new political dispensation promises changes to health care, which will impact on interventional cardiology. With a proposed emphasis on primary health care, resources for tertiary health care will probably be curtailed. Thus consideration will have to be given to reducing expenditure by careful review of indications for expensive interventional procedures and developing new ideas to contain costs. This will be the challenge facing cardiologists in a "New South Africa".

Adolescent↗
PubMed2005

Quality of life and the concept of "living well" with HIV/AIDS in sub-Saharan Africa.

PURPOSE: To increase understanding of the meaning of quality of life for people living with HIV/AIDS in four countries in sub-Saharan Africa: Botswana, Lesotho, South Africa, and Swaziland. METHODS: Using a cross-sectional design and convenience sample, we administered a survey and collected data on demographic characteristics, measures of severity of illness, and perceptions of quality of life. The purposefully selected sample (N=743) consisted of community-based people living with HIV/AIDS in 2002. Based on the Wilson and Cleary framework for organizing variables related to quality of life, a hierarchical multiple regression was conducted with quality of life as the dependent variable. RESULTS: The sample of 743 persons was 61.2% female with a mean age of 34 years. Approximately 62 % of the sample reported having received an AIDS diagnosis. Ten predictor variables explained 53.2 % of the variance in life satisfaction. Those participants with higher life satisfaction scores were less educated, had worries about disclosure and finances, did not have an AIDS diagnosis or other comorbid conditions, had lower symptom intensity, had greater functioning, and had fewer health worries. None of these participants was taking antiretroviral medications at the time of this study. CONCLUSIONS: Several dimensions of the Wilson and Cleary model of quality of life were significantly related to life satisfaction for people living with HIV/AIDS in sub-Saharan Africa. Quality of life for this sample was primarily defined as overall functional ability and control over symptom intensity. These findings are similar to studies in developed countries that have shown the significant relationships among functional abilities, symptom control, and perceived quality of life. As antiretroviral medications become more available in these areas, community members and care providers can help clients realize the possibility of living well with HIV/AIDS, and can work with clients to improve functional ability and control symptom intensity to make living well a reality.

Adaptation, Psychological↗
PubMed1989

Personal violence (suicide and homicide) in South Africa.

An examination of recent suicide and homicide rates in the United States and South Africa showed quite similar patterns, with whites having higher rates of suicide and nonwhites having higher rates of homicide. In recent years, suicide rates for white males have risen in South Africa while remaining stable in the United States. In contrast, homicide rates have risen for nonwhites in South Africa.

Black or African American↗
PubMed1998

Risk of malaria in visitors to the Kruger National Park, South Africa.

BACKGROUND: The risk of malaria to visitors to South Africa's nature reserves is unknown. Current recommendations for travelers are based on malaria incidence rates in local communities. These rates may well overestimate travelers' malaria risk and lead to unnecessary use of antimalarial prophylaxis with associated drug-related adverse events. This study investigated the incidence of malaria in visitors to South Africa's Kruger National Park (KNP). METHODS: Postal questionnaires were sent to the cohort of visitors staying in the KNP during April 1996, 6 to 8 weeks after they returned to their homes. Nonrespondents received duplicate questionnaires 8 weeks later. Responses from 3267 groups, representing 11,107 visitors (56. 8%) allowed determination of the malaria attack rate in this group of travelers and assessment of associations between malaria risk and a number of factors, including type of accommodation used during the visit; duration of stay; use of chemoprophylaxis; and use of personal protection measures. All travelers indicating that they had suffered an episode of malaria following their visit were telephonically contacted and their health providers traced to determine the basis of diagnosis and clinical outcome. RESULTS: One clinically suspected and four confirmed cases of Plasmodium falciparum malaria among the visitors suggest a low attack rate of 4. 5 cases per 10,000 visitors during April, the highest risk month for malaria in South Africa. No association was found between malaria risk and accommodation type, duration of stay, use and type of chemoprophylaxis, and use and number of personal protection measures. CONCLUSIONS: These findings confirm the importance of careful assessment of local malaria risk before individualized advice is provided to travelers.

Adult↗
PubMed2003

Cost-effectiveness of USAID's regional program for family planning in West Africa.

Between 1994 and 1996, the United States Agency for International Development (USAID) closed 23 country missions worldwide, of which eight were in West and Central Africa. To preserve United States support for family planning and reproductive health in four countries in that region, USAID created a subregional program through a consortium of US-based groups that hired mainly African managers and African organizations. This study assesses cost-effectiveness of the program through an interrupted time-series design spanning the 1990s and compares cost-effectiveness in four similar countries in which mission-based programs continued. Key indicators include costs, contraceptive prevalence rates, and imputed "women-years of protection." The study found that, taking into account all external financing for population and family planning, the USAID West Africa regional approach generated women-years of protection at one-third the cost of the mission-based programs. This regional approach delivered family planning assistance in West Africa cost-effectively, and the findings suggest that regional models may work well for many health and population services in small countries.

Adolescent↗
PubMed2006

Medical student education in emergency medicine: new model from South Africa.

Emergency medicine is a new specialty in South Africa. Postgraduate training, degrees and diplomas have been introduced and this should make a significant difference, in due course, to emergency care in the country. The University of the Witwatersrand, Johannesburg, South Africa, like many universities in Australia, embarked upon a Graduate Entry Medical Programme. This implied significant curriculum change and gave opportunity for the development of formal emergency medicine training for students, for the first time. After considerable debate over the needs of the graduate in South Africa a new block was developed, called the Acute and Perioperative Care block. This encompasses forensic medicine, emergency medicine, trauma and anaesthetics. The training is integrated and progressive. No similar programme has been detected elsewhere. At the end of the first year there is considerable satisfaction on the part of both teachers and students and many of the students, finding the module exciting, have indicated a wish to become involved in emergency medicine in the future. The structure of the course is laid out and might be of relevance to colleagues with an interest in medical education.

Anesthesia↗
PubMed2004

Oral health in South Africa.

This study describes the oral health status of the inhabitants of, and reflects on possible trends in oral diseases in South Africa. During the past 20 years, three national oral health surveys were conducted in South Africa, the most recent, a national Children's Oral Health Survey, was conducted between 1999 and 2002. The results of this study show that 39.7% of the 6-year-old children were caries free, which is below the goal of 50% set by the Department of Health (DoH) for the year 2000. The DMFT of 1.1 for the 12-year-old group, however, was below the 1.5 set by the DoH for this group for the year 2000. Based on the Unmet Treatment Need Index more than 80% of caries in children is not treated. The greatest need for the treatment of dental caries in South African children was for preventive services, restorations and extractions. The DMFT for the 12 year-old-group in South Africa decreased from 2.5 in 1982 to 1.1 for the current survey. Of the same group, 20.2% of the children presented with definite signs of dental fluorosis. The Dental Aesthetic Index was used to assess the prevalence of malocclusion and 32.3% of 12-year-old children needed definitive orthodontic treatment. The results of national surveys showed a reduction in dental caries severity of the permanent dentition of 12-year-old South African children.

Adolescent↗
PubMed1998

[Two cases of spotted fever group rickettsiosis contracted in southern parts of Africa].

A 40-year-old Japanese male stayed in Zimbabwe and developed a fever above 38 degrees C during which he noted a typical eschar in the lumbar region and also regional inguinal lymphadenopathy. Although not conspicuous, erythematous eruptions accompanied by itching were observed on the face, trunk and lower extremities. After returning to Japan and visiting our hospital, he was suspected of rickettsiosis and put on minocycline which gradually led to the improvement of the symptoms. Immunofluorescence antibody determinations disclosed rising titers against Rickettsia conorii (R. conorii) for both IgM and IgG classes. The second patient, a 34-year-old Japanese male, developed fever, generalized erythema and a typical eschar while staying in South Africa. The first blood sample showed positive IgM and IgG antibodies against R. conorii, and the second sample a decline in IgM but not in IgG class antibodies. Both cases were diagnosed as spotted fever group rickettsiosis based on their clinical manifestations including typical eschar and also the results of antibody determinations. Most of the previous cases of spotted fever group rickettsiosis in Africa have been regarded as Mediterranean spotted fever which is caused by R. conorii and transmitted by Rhipicephalus sanguineus. However, recently, the presence of another type of spotted fever group rickettsiosis, African tick-bite fever, caused by Rickettsia africae and transmitted by Amblyomma hebraeum has been proposed. Although clinical features of the two rickettsiosis are reported to be separable, apparent cross reaction between the two organisms hampers the use of conventional antibody determinations for their differentiation. For the two cases presented here identification of the causative rickettsia species was impossible, because they were not isolated. With ever increasing numbers of international travel, physicians should be alert to the possibility of spotted fever group rickettsiosis when encountering febrile patients returning from endemic countries. This is particularly important considering that beta-lactam antibiotics commonly used as an empiric therapy are not effective, and the disease has a potential to develop into severe forms.

Adult↗
PubMed1999

History of sleeping sickness in East Africa.

The history of human sleeping sickness in East Africa is characterized by the appearance of disease epidemics interspersed by long periods of endemicity. Despite the presence of the tsetse fly in large areas of East Africa, these epidemics tend to occur multiply in specific regions or foci rather than spreading over vast areas. Many theories have been proposed to explain this phenomenon, but recent molecular approaches and detailed analyses of epidemics have highlighted the stability of human-infective trypanosome strains within these foci. The new molecular data, taken alongside the history and biology of human sleeping sickness, are beginning to highlight the important factors involved in the generation of epidemics. Specific, human-infective trypanosome strains may be associated with each focus, which, in the presence of the right conditions, can be responsible for the generation of an epidemic. Changes in agricultural practice, favoring the presence of tsetse flies, and the important contribution of domestic animals as a reservoir for the parasite are key factors in the maintenance of such epidemics. This review examines the contribution of molecular and genetic data to our understanding of the epidemiology and history of human sleeping sickness in East Africa.

Africa, Eastern↗
PubMed2004

Therapy of falciparum malaria in sub-saharan Africa: from molecule to policy.

The burden of falciparum malaria remains as great as ever, and, as has probably always been the case, it is carried mainly by tropical Africa. Of the various means available for the control of malaria, the use of effective drugs remains the most important and is likely to remain so for a considerable time to come. Unfortunately, the extensive development of resistance by the parasite threatens the utility of most of the affordable classes of drug: the development of novel antimalarials has never been more urgently needed. Any attempt to understand the vast complexities of falciparum malaria in Africa requires an ability to think "from molecule to policy." In consequence, the review ambitiously tries to examine the current pharmacopeia, the process by which new drugs are developed and the ways in which drugs are actually used, in both the formal and informal health sectors. The informal sector is particularly important in Africa, where around half of all antimalarial treatments are bought from informal outlets and taken at home without supervision by health care professionals: the potential impact of adherence on clinical outcome is discussed. Given that the full costs are carried by the patient in a large proportion of cases, the importance of drug affordability is explored. The review also discusses the splicing of new drugs into national policy. The various parameters that feed into deliberations on changes in drug policy are discussed.

Adolescent↗
PubMed2004

Evidence of unique genotypes of beak and feather disease virus in southern Africa.

Psittacine beak and feather disease (PBFD), caused by Beak and feather disease virus (BFDV), is the most significant infectious disease in psittacines. PBFD is thought to have originated in Australia but is now found worldwide; in Africa, it threatens the survival of the indigenous endangered Cape parrot and the vulnerable black-cheeked lovebird. We investigated the genetic diversity of putative BFDVs from southern Africa. Feathers and heparinized blood samples were collected from 27 birds representing 9 psittacine species, all showing clinical signs of PBFD. DNA extracted from these samples was used for PCR amplification of the putative BFDV coat protein (CP) gene. The nucleotide sequences of the CP genes of 19 unique BFDV isolates were determined and compared with the 24 previously described sequences of BFDV isolates from Australasia and America. Phylogenetic analysis revealed eight BFDV lineages, with the southern African isolates representing at least three distinctly unique genotypes; 10 complete genome sequences were determined, representing at least one of every distinct lineage. The nucleotide diversity of the southern African isolates was calculated to be 6.4% and is comparable to that found in Australia and New Zealand. BFDVs in southern Africa have, however, diverged substantially from viruses found in other parts of the world, as the average distance between the southern African isolates and BFDV isolates from Australia ranged from 8.3 to 10.8%. In addition to point mutations, recombination was found to contribute substantially to the level of genetic variation among BFDVs, with evidence of recombination in all but one of the genomes analyzed.

Africa, Southern↗
PubMed1977

Rheumatoid arthritis in a tribal Xhosa population in the Transkei, Southern Africa.

An epidemiological survey of rheumatoid arthritis (RA) was undertaken in a tribal Xhosa community in the Transkei of Southern Africa. 577 respondents aged 18 and over were examined clinically and of these, 549 were investigated radiologically and 482 serologically. The presence of RA was then assessed by means of a modification of the Rome criteria, as used in previous comparable surveys. The prevalence of 'definite' RA in the adults aged 18 and over in this population was 0-68% and of 'probable' RA, 1-6%. The combined 'definite' and 'probable' prevalence was 2-2%. The relatively low prevalence of RA in this population is consistent with the results of other surveys in unsophisticated African Negro populations in West Africa and South Africa, and contrasts with the higher prevalence encountered in an urbanized South African Negro community and in populations in Europe and the USA.

Adolescent↗
PubMed1998

Teaching medical students on the ethical dimensions of human rights: meeting the challenge in South Africa.

SETTING: Previous health policies in South Africa neglected the teaching of ethics and human rights to health professionals. In April 1995, a pilot course was run at the University of Cape Town in which the ethical dimensions of human rights issues in South Africa were explored. OBJECTIVES: To compare knowledge and attitudes of participating students with a group of control students. DESIGN: Retrospective cohort study. SUBJECTS: Seventeen fourth-year medical students who participated in the course and 13 control students from the same class, matched for gender. INTERVENTIONS: Students participated in a one-week module on ethics and human rights. Five months after the course had been run, students completed a semi-structured questionnaire exploring their knowledge and attitudes with regards to ethics and human rights issues. MAIN OUTCOME MEASURES: Knowledge scores, attitude scores and various individual indicators of attitude. RESULTS: Clear benefits for overall knowledge score, for four out of five individual knowledge questions and for one of the attitude questions, were demonstrated. Participating students also appeared to be more convinced of the need for teaching on the ethical dimensions of human rights at postgraduate level and that such teaching should also be integrated in the curriculum. The low response rate amongst controls may have selected students who were more socially conscious, thereby leading to an underestimate of the true impact of the course. CONCLUSION: The evaluation indicates clear benefits of the course for undergraduate students, and supports arguments for the inclusion of such courses in the training of health professionals. This is particularly important given the challenges posed by the Truth and Reconciliation Commission to the health professions to address past complicity in human rights abuses through reorientation of medical training in South Africa.

Adult↗
PubMed1979

Gaucher's disease in South Africa.

The adult non-neuropathic form of Gaucher's disease has been identified in 32 patients in 25 Ashkenazi Jewish kindreds in South Africa. The minimum prevalence in this population is 1 in 5000, with a gene frequency of 0.014 and a carrier rate of 1 in 36. On correction for bias resulting from possible under-ascertainment, these minimum figures become 1 in 4000, 0.0166, and 1 in 30, respectively. Confirmation of autosomal recessive inheritance was obtained by segregation analysis by the 'a priori' and 'simple sib' methods. The Ashkenazin of South Africa have their origins in Lithuania and it is evident that the high gene frequency in South Africa is a reflection of the genetic constitution of the immigrant population. The localisation of the Gaucher gene to Lithuania represents a further step in the determination of the early geographic distribution of the genetic disorders of the Jewish race.

Gaucher Disease↗
PubMed1977

Sero-genetic studies on the San of South West Africa.

The San, a physically, culturally and linguistically distinctive people, have been shown by archaeological records anciently to have inhabited the whole of Eastern and Southern Africa. They, in common with the Khoi, the other members of the Khoisan race, are confined now to Southern Africa and principally to Botswana and South West Africa, though a number are also found in Angola. Sero-genetic data concerning seven South West African groups are presented in this study, and confirm a shared overall genetic profile characteristic of the San in general, slightly different from that of the Khoi and in significant contrast with that of the Negroes.

ABO Blood-Group System↗
PubMed2005

Cardiovascular complications of diabetes mellitus in sub-Saharan Africa.

BACKGROUND: Cardiovascular disease, the major cause of mortality and morbidity in modern societies, is set to overtake infectious diseases in the developing world as the most common cause of death. The increasing prevalence of major and emerging cardiovascular risk factors accounts for the growing burden of cardiovascular disease in the world. Diabetes in all its forms is one of the main cardiovascular risk factors. Two of 3 diabetic patients will die as a result of cardiovascular complications, and approximately 30% of patients treated in cardiovascular intensive care units have diabetes. METHODS AND RESULTS: This review on the cardiovascular complications of diabetes in sub-Saharan Africa is a bibliographical MEDLINE search of published data over the past 2 decades. Diabetes-related cardiovascular disease complications are considered to be rare in Africa but are on the rise and are regularly associated with classic cardiovascular risk factors. Coronary heart disease may affect 5% to 8% of type 2 diabetic patients and cardiomyopathy, up to 50% of all patients. Close to 15% of patients with stroke have diabetes, and up to 5% of diabetic patients present with cerebrovascular accidents at diagnosis. Peripheral vascular disease prevalence varies across sites from 4% to 28%. CONCLUSIONS: It is obvious that diabetes mellitus and related cardiovascular complications are gaining more importance in sub-Saharan Africa. The relative contribution of putative risk factors is not well defined, and further research is therefore needed.

Africa South of the Sahara↗
PubMed1989

Psychiatry in Africa: an overview.

The authors review the practice of psychiatry in Africa today. They describe the similarities as well as the differences between psychiatry in Africa and in the Western world in the rates, presentations, and treatment of neurosis, depression, schizophrenia, and suicide and drug- and alcohol-related problems. Child psychiatric services and research in biological psychiatry are rare in Africa, and sociocultural problems confront epidemiologic studies and the use of psychotherapy. The authors conclude that to achieve the goal of mental health care for all Africans, psychiatry should be included in the primary health care program, regional postgraduate medical centers are needed, and a means of gathering statistics and funding research should be fostered.

Africa↗