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PubMed2002

Does race matter? Children's height in Brazil and South Africa.

I examine racial differences in child stunting in mid-1990s South Africa and Brazil, two multiracial societies with different histories of legal support for racial discrimination. Using data from nationally representative household samples linked to community-level measures, the analysis shows that racial inequality in the distribution of socioeconomic resources across households and communities explains much of the racial difference in stunting in both countries. Even after these factors are controlled, however, the results indicate that in South Africa, nonwhite children are still at greater risk of growth faltering than are white children. The nature of socioeconomic and racial differences in children's growth is examined, and major determinants are discussed. These findings suggest that although state-sanctioned racism may help to explain the greater racial inequality in stunting in South Africa than in Brazil, the eradication of a disadvantage for nonwhites will depend on changes in the same fundamental socioeconomic inequalities that characterize both nations.

Black or African American↗
PubMed2002

In the high court of South Africa, case no. 4138/98: the global politics of access to low-cost AIDS drugs in poor countries.

In 1998, 39 pharmaceutical manufacturers sued the government of South Africa to prevent the implementation of a law designed to facilitate access to AIDS drugs at low cost. The companies accused South Africa, the country with the largest population of individuals living with HIV/AIDS in the world, of circumventing patent protections guaranteed by the intellectual property rules that were included in the latest round of world trade agreements. The pharmaceutical companies dropped their lawsuit in the spring of 2001 after an avalanche of negative publicity. Yet, despite the government's victory, AIDS drugs remain very expensive in South Africa, and the government still refuses to provide antiretroviral therapy to adults. These events have shone a spotlight, not only on the possibilities for coordinated political activism in the era of instant global communications, but also on the tangled social, economic, and political dimensions of AIDS treatment in poor countries.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Pharmacists' knowledge and perceptions of emergency contraceptive pills in Soweto and the Johannesburg Central Business District, South Africa.

CONTEXT: In South Africa, emergency contraceptive pills are available directly from pharmacies without a prescription, yet few studies have assessed pharmacists' knowledge of and attitudes toward the medication. METHODS: In-person interviews were conducted with 34 pharmacists practicing in Soweto and the Johannesburg Central Business District, from February through April 2003. The pharmacists provided data on their knowledge of emergency contraceptive pills and their attitudes toward providing the medication to women in specific situations. RESULTS: Nearly all pharmacists sold at least one of the two types of dedicated emergency contraceptive pills available in South Africa. Although most had accurate knowledge about the method's dosing schedule, side effects and mechanism(s) of action, more than half erroneously believed that repeated use posed health risks. A large majority of pharmacists believed the pills should be available to rape victims, to single or married women and to women who had never given birth, but almost half did not think the pills should be given to women younger than 18, and a fourth said they would not give them to women with a late menstrual period. About one-third to half of pharmacists supported advance provision of the medication under certain circumstances. Most were willing to display promotional materials on emergency contraceptives in their pharmacies. CONCLUSIONS: Interventions aimed at educating pharmacists about the benefits of emergency contraceptive pills, especially for adolescents, are needed. Government and medical authorities should take advantage of pharmacists' willingness to display educational materials as a way to increase women's knowledge and use of the medication in South Africa.

Adult↗
PubMed2005

Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-Natal, South Africa.

BACKGROUND: Between 1995 and 2000, KwaZulu-Natal province, South Africa, experienced a marked increase in Plasmodium falciparum malaria, fuelled by pyrethroid and sulfadoxine-pyrimethamine resistance. In response, vector control was strengthened and artemether-lumefantrine (AL) was deployed in the first Ministry of Health artemisinin-based combination treatment policy in Africa. In South Africa, effective vector and parasite control had historically ensured low-intensity malaria transmission. Malaria is diagnosed definitively and treatment is provided free of charge in reasonably accessible public-sector health-care facilities. METHODS AND FINDINGS: We reviewed four years of malaria morbidity and mortality data at four sentinel health-care facilities within KwaZulu-Natal's malaria-endemic area. In the year following improved vector control and implementation of AL treatment, malaria-related admissions and deaths both declined by 89%, and outpatient visits decreased by 85% at the sentinel facilities. By 2003, malaria-related outpatient cases and admissions had fallen by 99%, and malaria-related deaths had decreased by 97%. There was a concomitant marked and sustained decline in notified malaria throughout the province. No serious adverse events were associated causally with AL treatment in an active sentinel pharmacovigilance survey. In a prospective study with 42 d follow up, AL cured 97/98 (99%) and prevented gametocyte developing in all patients. Consistent with the findings of focus group discussions, a household survey found self-reported adherence to the six-dose AL regimen was 96%. CONCLUSION: Together with concurrent strengthening of vector control measures, the antimalarial treatment policy change to AL in KwaZulu-Natal contributed to a marked and sustained decrease in malaria cases, admissions, and deaths, by greatly improving clinical and parasitological cure rates and reducing gametocyte carriage.

Adolescent↗
PubMed2003

Differences in extent of genetic introgression between sympatric Culex pipiens and Culex quinquefasciatus (Diptera: Culicidae) in California and South Africa.

Comparisons of five morphological characters, 12 enzyme electrophoresis profiles, and Wolbachia pipientis infection rates were used to characterize populations of members of the Culex pipiens L. complex in California and South Africa. In South Africa, male phallosome DV/D ratio, male maxillary palp index, branching of siphonal seta 1a, the enzyme locus Mdhp-1, and W. pipientis infection rates proved highly diagnostic for separating Culex quinquefasciatus from Cx. pipiens phenotypes. In Johannesburg, where sympatric members of the Cx. pipiens complex were analyzed as one population, a significant Wahlund Effect was observed in the enzyme loci such as Ao, 6-Pgdh, Mdh-2, and Pgm. In California, all populations of the Cx. pipiens complex were in Hardy Weinberg equilibrium at all polymorphic enzyme loci examined. Additionally, in California, all populations had similar W. pipientis infection rates and appeared morphologically identical (except for DV/D ratio, in extreme north and south). These findings indicate that in South Africa, Cx. pipiens and Cx. quinquefasciatus remain as genetically distinct populations and behave as separate species. Conversely, in California, there is considerable genetic introgression between Cx. pipiens and Cx. quinquefasciatus, and they behave as a single species.

Animals↗
PubMed2001

Babesia leo n. sp. from lions in the Kruger National Park, South Africa, and its relation to other small piroplasms.

Babesia leo, a small piroplasm isolated from lions in South Africa is described as a distinct species based on a phylogenetic analysis of the 18S rRNA gene. Intraerythrocytic trophozoite and merozoite stages of B. leo are morphologically indistinguishable from other small piroplasms of felids. Previous studies showed that B. leo was biologically and antigenically distinct from B. felis, which is known to infect wild and domestic felids in South Africa. Molecular characterization showed strong support for the phylogenetic seperation of B. leo as a distinct species from B. felis and other felid piroplasms. Phylogenetic analysis also showed that Babesia microti and all of the felid piroplasms from Africa with known 18S rRNA gene sequences available, including B. leo, formed a single, separate clade, sister to the other babesial and theilerial piroplasm parasites.

Animals↗
PubMed1992

Organisation of veterinary public health in Africa.

Veterinary public health (VPH) is not integrated into the mainstream of public health services in Africa. There are no formal mechanisms within government public health services through which veterinary skills and resources can be effectively harnessed to bear upon community health. There is no conscious, overt or substantial effort by public authorities to incorporate VPH services in the overall approach to public health. VPH activities cover mainly the control of the major animal diseases transmissible to man (zoonoses), meat inspection and, to a limited degree, the quality control of milk, fish and their products. These services are carried out by the Veterinary Services of the Ministry of Agriculture in each country. Concerning education, only 7 of the 28 schools of veterinary medicine in Africa have separate departments where VPH subjects such as epidemiology, food hygiene, zoonoses, biostatistics, community health, public administration, preventive medicine and other related fields are taught by public health-trained and oriented staff. Elsewhere the teaching of VPH subjects is delegated to staff whose foremost interests are in pathology, microbiology and clinical medicine. Postgraduate training in VPH is fast developing in the veterinary schools of Nigeria, Kenya and Uganda. Political instability, war, famine and poverty which deplete human and material resources, lack of intersectorial cooperation in matters of public health and lack of vigour on the part of the veterinary profession as a whole to assert its broader role in the community also contribute to the poor organisation of VPH in Africa. International collaboration in VPH is spearheaded by the Food and Agriculture Organisation (FAO) and the World Health Organisation (WHO). These agencies, along with the Office International des Epizooties (OIE) and other international organisations or groups, are active in promoting the development of VPH programmes by setting guidelines on the organisation and management of VPH, coordinating control programmes for the major zoonoses and providing financial and technical expertise.

Africa↗
PubMed1993

Economics and planning in the veterinary undergraduate programme: a model for sub-Saharan Africa.

Veterinarians in sub-Saharan Africa work in resource-deficient environments. Decisions taken by veterinarians in this sub-region, on animal health, animal husbandry and public health issues, are therefore influenced by economic factors including macro-economic considerations related to the current structural adjustment programmes being implemented in the sub-region. In turn, decisions or advice given by veterinarians have socio-economic consequences on clients, on the effectiveness of the delivery systems for veterinary services and on the growth of national economies. For these reasons, economics and planning should be essential components of all modern veterinary undergraduate programmes in sub-Saharan Africa, in order to give veterinarians a basis for making decisions and giving advice which is both technically and economically sound. The authors argue that principles of livestock economics, livestock enterprise management, livestock investment analysis and economics of animal health care are necessary elements in economics and planning courses. They propose a division of these elements into discrete course units to allow for flexibility and adaptability to the different curriculum structures of schools in sub-Saharan Africa and, possibly, continuing professional development courses. The resource requirement for teaching the courses, the integration of the units in the undergraduate programme and the problems which are likely to be encountered in developing the courses are discussed.

Africa↗
PubMed1994

Systems approach to animal health services delivery in sub-Saharan Africa: the case of privatisation.

The theory of privatisation is first reviewed with respect to animal health care in sub-Saharan Africa. Then, using the systems approach advocated in an accompanying paper, the authors argue that the nature of animal production systems obtaining in any economy is of central importance in determining the type and mixture of animal health services delivery systems present. These are influenced, in turn, by the demand placed on the production system by consumers, the levels of consumer income and the policies enacted by governments. The authors compare the situation in sub-Saharan Africa with that in developed countries, especially the United States of America. Theory would predict that privatisation of veterinary services in sub-Saharan Africa will be evolutionary rather than revolutionary, even with deliberate policies to encourage privatisation. In regard to personnel, private services would be much easier to develop on the basis of auxiliaries and technicians, rather than self-employed veterinarians and their associates. Hasty or wholesale privatisation, involving the creation of a cadre of self-employed veterinarians will, in the face of market failure, result in a reduction in the services available to low input/low output production systems. The general level of animal health care provided to certain types of producers will thus be lower than currently available. These theoretical predictions are borne out in practice.

Africa South of the Sahara↗
PubMed1995

African horse sickness surveillance systems and regionalisation/zoning: the case of South Africa.

Central and Southern Africa are generally regarded as being endemic areas for African horse sickness (AHS). With the advent of the concepts of risk analysis and regionalisation/zoning, however, the possibility has now arisen of establishing 'zones' within South Africa for AHS surveillance purposes. In 1993, a protocol was submitted to the European Community (now European Union: EU), proposing the establishment of an AHS-free zone in the Cape peninsula. The proposal is based on historical evidence that AHS virus overwinters (in zebra) only in the Kruger National Park, from where it spreads westwards and southwards every year. The infection only extends to the Western Cape Province once every fifteen years. A ban on vaccination in the proposed AHS-free zone has been suggested, together with strict control of the movement of horses into and through this zone. The entire equine population of this zone (some 8,000 animals) would serve as sentinels. All equine mortalities would be notifiable, with mandatory post-mortem examinations. The establishment of an insect-free quarantine station in this zone would enable the movement of certified AHS virus-free horses from South Africa to the EU and the rest of the world.

African Horse Sickness↗
PubMed1995

Overview and epidemiology of contagious bovine pleuropneumonia in Africa.

Contagious bovine pleuropneumonia (CBPP) is widespread in Africa and in other regions of the world. This disease is particularly important in the semi-arid, sub-humid and arid zones of tropical Africa, but CBPP incidence seems to be increasing in some parts of East Africa. The epidemiology of CBPP is characterised by the occurrence of sub-acute and symptomless infections, and the persistence of chronic carriers. Spread of the disease is associated with cattle movement. The major obstacles to eradication of CBPP are the difficulties in controlling cattle movement and applying quarantine and slaughter policies. Other difficulties arise due to the absence of a field test for diagnosis, the relatively short duration of post-vaccinal immunity and the lack of data on the economic impact of the disease. The Pan-African Rinderpest Campaign strategy for CBPP control and eradication conforms with national control programmes, which include cost/benefit analysis. It is planned to perform blanket vaccination against the disease for three to five years, depending on the economic situation of each country. Stringent control of cattle movement will complement vaccination campaigns. The eradication phase, including slaughter measures, will be instituted following reduction of CBPP incidence. Regional and international coordination will be instituted to control international cattle movement and harmonise control strategies.

Africa↗
PubMed1999

The circumstances surrounding the outbreak and spread of equine influenza in South Africa.

Equine-2 influenza A virus (H3N8) infection first occurred among naïve horses in South Africa in December 1986. The virus was introduced following the importation of six horses from the United States of America. While the release of in-contact horses from quarantine three days after the arrival of these six horses played a role in the rapid spread of the disease in South Africa, other outbreaks of disease were associated with viral introduction by personnel or contaminated instruments. The control measures and implications of the introduction of equine influenza to South Africa are also discussed.

Animals↗
PubMed2001

Tracing movement of African buffalo in southern Africa.

Genetic characterisation of two pathogens, namely foot and mouth disease (FMD) virus and Mycobacterium bovis, isolated from African buffalo (Syncerus caffer) in southern Africa was used to determine the origin of buffalo in situations where the source of infection was obscure. By determining the phylogenetic relatedness of various FMD virus isolates using partial sequencing of the main antigenic determinant, VP1, the origin of buffalo moved illegally to the non-endemic region of South Africa was traced to the Kruger National Park (KNP) where FMD is endemic in the buffalo population. Comparative analysis of the 'genetic fingerprints' of bovine tuberculosis isolates from buffalo and cattle has aided in tracing the original source of infection of buffalo populations in the KNP. Furthermore, these analyses have assisted in tracing the origin of infected animals that have been moved to other parts of South Africa.

Africa, Southern↗
PubMed2002

Regional status and approaches to control and eradication of foot and mouth disease in the Middle East and North Africa.

The Middle East is regarded as the region of the world most heavily affected by foot and mouth disease (FMD). The situation in the Middle East and North Africa constitutes a threat to other regions of the world, especially Europe. Risk management differs between North Africa and the Middle East due to different epidemiological situations. In the Middle East, the national cattle population is the principal target of preventive vaccination. Vaccination is used as a tool for preventing economic losses due to the disease, rather than as a means to prevent the spread of the infection. In North Africa, as FMD occurs almost cyclically, management is more focused on emergency preparedness and limitation of the spread of the disease upon diagnosis, as well as on effective control measures based on quarantine and mass vaccination. To reduce future outbreaks of FMD in the countries of the two regions, a common strategic programme should be adopted, based on effective regional co-operation at many levels. This should be complemented by efforts to restructure and consolidate the national Veterinary Services.

Africa, Northern↗
PubMed2003

Managing animal trypanosomosis in Africa: issues and options.

This paper discusses past and present approaches to managing tsetse-transmitted animal trypanosomosis in Africa and describes the three main weaknesses of these approaches, i.e., inappropriate objectives, inadequate links between research and policy-making and a lack of recognition that trypanosomosis should be high up on the social science research agenda. Making progress in managing trypanosomosis has been difficult and the authors argue that the weaknesses of the approaches must be corrected if Africa is to benefit from the few advances made so far, and for the continent to make further sustained efforts to combat the disease. The authors explain that this can be achieved by replacing the current widespread preoccupation among researchers and policymakers with controlling (or eradicating) trypanosomosis with a focus on managing (or coping with) the disease. In addition, ways of achieving greater coherence between research and policy-making must be explored. Finally, the social science issues raised by the question of which practical steps need to be taken to manage trypanosomosis in Africa should be placed at the forefront of research efforts.

Africa↗
PubMed2006

Asbestos-related disease in South Africa: the social production of an invisible epidemic.

South Africa was the third largest exporter of asbestos in the world for more than a century. As a consequence of particularly exploitative social conditions, former workers and residents of mining regions suffered--and continue to suffer--from a serious yet still largely undocumented burden of asbestos-related disease. This epidemic has been invisible both internationally and inside South Africa. We examined the work environment, labor policies, and occupational-health framework of the asbestos industry in South Africa during the 20th century. In a changing local context where the majority of workers were increasingly disenfranchised, unorganized, excluded from skilled work, and predominantly rural, mining operations of the asbestos industry not only exposed workers to high levels of asbestos but also contaminated the environment extensively.

Adolescent↗
PubMed1997

South Africa's early experiment in social medicine: its pioneers and politics.

The election of a democratic, nonracial government in South Africa has moved the health needs of the majority of the population to center stage. In the search for precedents, health policymakers have turned to South Africa's pioneering of health centers and social medicine in the 1940s. This paper looks at the intellectual context in which these ideas were first developed; the particular political circumstances and relationships between doctors and the state in the late 1930s, which facilitated the establishment of health centers; the role that the health centers were intended to play in South Africa's wider postwar health plans; and the reasons for the centers' failure. Contrary to conventional wisdom, it argues that the failure of the health centers and the wider health plans predated the advent of the National Party to power in 1948, and resulted mainly from the marginalization of the centers as a low-cost option for the poor, which was itself a consequence of underfunding and the vested interests of local health authorities and private practitioners.

History, 20th Century↗
PubMed2000

The pursuit of equity in health: reflections on race and public health data in Southern Africa.

The United States shares with Zimbabwe and South Africa a history of racial subjugation. A revision of the US racial classification to allow membership in more than one group means race may no longer be an exclusive characteristic. These issues also have been debated in southern Africa. In this commentary, the author reviews race classification in southern Africa and the use of race-specific public health data. Comparisons of illness and death rates across race groups have shown the health consequences of White privilege and Black disadvantage. But current public health data are not divided by race. The consequences of this policy are discussed.

Censuses↗