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PubMed2002

Roots, shoots, but too little fruit: assessing the contribution of COPC in South Africa.

Community-oriented primary care (COPC) originated in South Africa during the 1940s and 1950s, where it served to inform local church-based and nongovernmental organization-based initiatives during the apartheid years. During the 1990s, COPC played an inspirational role in the process of national health policy formulation. Yet COPC's contribution to current health practice remains more symbolic than substantive. Despite a policy framework that favors the widespread introduction of COPC, various political, structural, managerial, and human resource obstacles constrain its effective implementation. Notwithstanding a rapidly changing health care environment and well-established health transition from infections and nutritional disorders to non-communicable diseases and injury, COPC and its variants remain abidingly relevant to South Africa's-and Africa's-health care reality.

Community Health Centers↗
PubMed2001

The economics of HIV vaccines: projecting the impact of HIV vaccination of infants in sub-Saharan Africa.

OBJECTIVES: (i) To project vaccine parameters, economic consequences and market size associated with HIV-1 vaccination of infants in sub-Saharan Africa through the Expanded Program on Immunisation (EPI); and (ii) to assess threshold values for price and effectiveness. STUDY DESIGN AND METHODS: Cost-effectiveness analysis using a decision-analysis model linking epidemiological data with economic information. Epidemiological data on the burden of disease of HIV were obtained from the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS. The decision analysis model was constructed using estimates of lifetime chances of HIV infection. To assess threshold values for price and effectiveness, a maximum value for cost effectiveness in developing countries of $US100 was used in the base case. One-way and multivariate sensitivity analysis was performed on relevant parameters, assessing the impact of these parameters on the results of our analysis. In the base case, health benefits and consequences were discounted at a rate of 3%. STUDY PERSPECTIVE: Societal. RESULTS: According to our model, introduction of an HIV-1 vaccine in the EPI would result in the vaccination of 8717112 infants in sub-Saharan Africa per year. This corresponds to the prevention of 1839355 cases of HIV per year, gaining 16461800 disability-adjusted life years (DALYs). The cost-effectiveness ratio of the intervention would be $US3.4 per DALY gained (1998 values) at a vaccine price in the base case of $US5. At the same price the estimated size of the market would be approximately $US44536111 per year. CONCLUSION: If technological and financial problems associated with the development of an HIV vaccine can be solved, HIV vaccination in Africa could be both cost effective and potentially profitable.

AIDS Vaccines↗
PubMedDate not supplied

Trends in malaria chemoprophylaxis prescription in South Africa 1994 to 2000.

The World Health Organization estimates that more than 300 million cases of malaria exist worldwide each year, resulting in more than 3 million deaths, with more than 1 million deaths of children in sub-Saharan Africa alone. Malaria is also a reemerging disease in some parts of Africa, including South Africa. Malaria prevention is multi-faceted with no single precaution offering complete protection. Taking chemoprophylaxis decreases the severity and frequency of death from malaria due to Plasmodium falciparum when compared with taking no chemoprophylaxis.

Antimalarials↗
PubMed2006

Cause-specific mortality rates in sub-Saharan Africa and Bangladesh.

OBJECTIVE: To provide internationally comparable data on the frequencies of different causes of death. METHODS: We analysed verbal autopsies obtained during 1999 -2002 from 12 demographic surveillance sites in sub-Saharan Africa and Bangladesh to find cause-specific and age-specific mortality rates. The cause-of-death codes used by the sites were harmonized to conform to the ICD-10 system, and summarized with the classification system of the Global Burden of Disease 2000 (Version 2). FINDINGS: Causes of death in the African sites differ strongly from those in Bangladesh, where there is some evidence of a health transition from communicable to noncommunicable diseases, and little malaria. HIV dominates in causes of mortality in the South African sites, which contrast with those in highly malaria endemic sites elsewhere in sub-Saharan Africa (even in neighbouring Mozambique). The contributions of measles and diarrhoeal diseases to mortality in sub-Saharan Africa are lower than has been previously suggested, while malaria is of relatively greater importance. CONCLUSION: The different patterns of mortality we identified may be a result of recent changes in the availability and effectiveness of health interventions against childhood cluster diseases.

Adolescent↗
PubMed1996

AIDS in Africa.

HIV has infected more than 10 million people in sub-Saharan Africa with prevalence rates of up to 30% reported from some countries. Adult transmission of HIV in Africa is mainly heterosexual and over half of new infections are in women. About 40% of infants born to HIV-positive mothers are themselves infected. Diarrhoea occurs in 90% of African AIDS patients and 'slim disease' (prolonged diarrhoea and wasting usually due to coccidian parasites) is pathognomic of AIDS in Central Africa. Dual infection with HIV and tuberculosis is a major problem. African AIDS patients appear to succumb to virulent pathogens, especially Mycobacterium tuberculosis, before they become sufficiently immunosuppressed to develop the opportunistic infections typically associated with advanced HIV disease in developed countries.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Malaria: a reemerging disease in Africa.

A recent upsurge of malaria in endemic-disease areas with explosive epidemics in many parts of Africa is probably caused by many factors, including rapidly spreading resistance to antimalarial drugs, climatic changes, and population movements. In Africa, malaria is caused by Plasmodium falciparum and is transmitted by Anopheles gambiae complex. Control efforts have been piecemeal and not coordinated. Strategies for control should have a solid research base both for developing antimalarial drugs and vaccines and for better understanding the pathogenesis, vector dynamics, epidemiology, and socioeconomic aspects of the disease. An international collaborative approach is needed to build appropriate research in a national context and to effectively translate research results into practical applications in the field. The Multilateral Initiative for Malaria in Africa can combine all of the above strategies to plan and coordinate partnerships, networking, and innovative approaches between African scientists and their Northern partners.

Africa↗
PubMed2026

Mobilome-driven antimicrobial resistance in a one health context: evidence and lessons from Africa.

Antimicrobial resistance (AMR) is one of the most urgent global health threats and is increasingly recognized as a One Health challenge driven by interactions among human, animal, and environmental reservoirs. Central to the emergence and dissemination of AMR across these interfaces are mobile genetic elements (MGEs), which form an interconnected mobilome capable of transferring resistance genes across bacterial taxa and ecological niches. These elements facilitate the accumulation and spread of multidrug resistance determinants and are shaped by co-selective pressures operating at the animal-environment-human interface. Despite their critical role, genomic surveillance of MGEs remains limited, particularly in high-burden regions such as Africa. This narrative review synthesizes evidence from published genomic surveillance studies, primarily whole-genome sequencing-based analyses, to examine the distribution and dynamics of AMR genes and MGEs across One Health interfaces. We highlight animal-environmental systems as major hotspots for mobilome-driven resistance dissemination and also evaluate key advances, methodological approaches, and persistent surveillance challenges and gaps specific across Africa. By integrating findings from diverse genomic studies, and highlighting key lessons and implementation gaps from One Health studies across Africa, this review underscores the need for coordinated One Health surveillance strategies to better capture mobilome dynamics and inform sustainable AMR control efforts.

Africa↗
PubMed2004

The competence of nursing graduates from problem-based programs in South Africa.

Although a significant body of research regarding problem-based learning (PBL) programs has been conducted during the past 2 decades, most of it relates to medical students and their curricula. There has also been very little research in the context of developing countries. In South Africa, most of the students who are admitted into nursing programs are from disadvantaged backgrounds, and it is important to assess the extent to which process-based curricula are appropriate for this group. The purpose of this study was to describe and evaluate the outcomes of PBL programs in nursing schools in South Africa in terms of the actual clinical practice and competence of graduates, and to compare these outcomes with those of graduates from conventional programs. The objectives of the study were to identify the characteristics of practice of graduates from PBL and conventional schools of nursing in South Africa, as described by the graduates and their supervisors, and secondly, to compare the practice characteristics of the two groups.

Clinical Competence↗
PubMed2000

The composition of old age homes in South Africa in relation to the residents and nursing personnel.

This research project is the first phase of a larger study aimed at describing and exploring the cost-effective utilisation of nursing personnel in old age homes in South Africa. The aim in the first phase was to describe the composition of the residents and nursing personnel of old age homes in South Africa. An exploratory and descriptive survey was conducted and the data was collected by means of a questionnaire. The questionnaire also included data on the financial implications of utilising professional nursing personnel to manage the care of the frail residents/older persons in old age homes in South Africa. The questionnaires were mailed to 612 old age homes published in the Hospital and Nursing Yearbook of 1997 (100% sample). A total of 145 (23.69%) questionnaires were returned and included in the descriptive data analysis. The residents are mainly female (77%), older than 85 years of age, belong to the white race group (83.74%) and are highly dependent on nursing care and supervision (69.7%). Old age homes are mainly managed/controlled by welfare organisations and lay health care workers are utilised to a large extent (42.22% of the nursing workforce) to render nursing care to the frail residents. The cost-effective utilisation of nursing personnel (registered and enrolled), as well as the utilisation of lay health workers in old age homes, needs to be critically examined.

Age Distribution↗
PubMed2003

"To know or not to know": service-related barriers to voluntary HIV counseling and testing (VCT) in South Africa.

Voluntary HIV Counselling and Testing (VCT) is still in its infancy in South Africa, and although the necessary infrastructure in terms of clinics and hospitals exists, a VCT culture is not yet established in the country. The purpose of this study was to determine the needs, attitudes and beliefs of a sample of South Africans towards VCT, and to investigate possible barriers affecting participation in VCT programs in South Africa. A semi-structured questionnaire was used to survey the views of 1422 people. Results indicate that while subjects were not opposed to VCT in principle, 33% would go to clinics where nobody would know them. The following problems with VCT services were mentioned: Logistical problems (not enough counsellors, long lines, lack of privacy); no trust in the health care system or fearing a breach of confidentiality; fear of rejection; and a lack of follow-up support after diagnosis. Suggestions are made on how to improve VCT services in South Africa.

Adult↗
PubMed2004

An analysis of opinions from veterinarians in South Africa regarding business management skills.

The changing role of veterinarians in the global market is a current topic of debate and discussion. Few countries including South Africa have formally examined the changing dynamics of this profession. Therefore, the present study addressed 2 objectives. The 1st was to examine basic information about veterinarians in South Africa including their age, gender and distribution across provinces, the percentage whose practice was urban, rural or periurban, the numbers working with specific animal species, and the extent of business management and skills previously gained. The 2nd objective was to obtain opinions and insights from veterinarians in South Africa about the challenges and opportunities facing their business practices to better understand what they considered important dynamics to their businesses today. Several areas of business on which they were questioned and which were included in this study were: marketing, vision, human resources, leadership, financial management, ethics, competition, day-to-day operations, interpersonal skills and information management. This is the 1st known survey to employ a questionnaire to gain insights and opinions from veterinarians about business management skills.

Demography↗
PubMed2005

Ulcerative balanitis and vulvitis of Dorper sheep in South Africa: a study on its aetiology and clinical features.

Ovine ulcerative balanitis and vulvitis in sheep of the Dorper breed has been observed in South Africa since 1979. Its aetiology has not been conclusively resolved, and there is some discrepancy in descriptions of its clinical features. In order to identify the pathogenic micro-organism/s that contribute to the occurrence of the disease, the microflora in the genital tracts of both clinically healthy and affected sheep were isolated and compared. Bacteriological examination of materials from affected and unaffected sheep resulted in the isolation of Arcanobacterium pyogenes from 44.2% and 17.2% of them respectively. This difference is statistically significant (P < 0.01). Seventy-four per cent of the isolates originated from severe clinical cases. Mycoplasmas were isolated from 49.3% of 116 clinically normal sheep and 78.2% of 104 affected sheep. There were significant differences in their rates of isolation in clinical groups (P < 0.05). Of all the mycoplasma isolates, Mycoplasma mycoides mycoides large colony variant (MmmLC) was isolated from 61.5% of clinically diseased sheep while 6.0% of the isolates were from apparently healthy animals (P < 0.05). The study threw light on the prevalence of mycoplasmas in the genital tract of apparently healthy sheep and, at the same time the identity of the mycoplasma pathogen associated with ulcerative balanitis and vulvitis was revealed. The findings of this investigation therefore confirmed the involvement of mycoplasma, particularly that of MmmLC large colony, in the disease in Dorper sheep in South Africa, and it was concluded that this microorganism is an important pathogen of balanitis and vulvitis in them. The study furthermore demonstrated a probable synergism between A. pyogenes and MmmLC. Finding these 2 organisms together occurred 53.4 times more frequently in the affected sheep than in the unaffected, which emphasises the probable multifactorial nature of the disease. The association between age and the presence of clinical signs was statistically significant. It was found that young sheep were more likely to have lesions than adult sheep. Clinical observations showed that the typical ulceration appears to be confined to the glans penis and lips of the vulva; no ulceration was observed on the shaft of the penis and prepuce or vaginal vestibule. In uncomplicated cases inflammation of the prepuce and vaginal vestibule is not a regular feature of the disease. Therefore the names ulcerative balanitis and vulvitis most accurately describe the nature of the disease in South Africa.

Age Factors↗
PubMed2006

Managing anthelmintic resistance in small ruminant livestock of resource-poor farmers in South Africa.

Gastrointestinal parasitism is one of the most important disease complexes of sheep and goats impacting on the resource-poor livestock farmer. Of the responsible nematodes, Haemonchus contortus, a blood-sucking worm of the abomasum, poses possibly the greatest threat. Over the past several decades, the worm has been controlled through the use of anthelmintics, but the emergence of anthelmintic resistance has threatened this chemotherapeutic approach. In Africa, the overall prevalence of anthelmintic resistance has not been extensively investigated, particularly within the resource-poor farming sector, but resistance has been reported from at least 14 countries with most of the reports emanating from Kenya and South Africa and the majority concerning H. contortus. While levels of resistance under commercial sheep farming systems in South Africa is considered to be amongst the worst in the world, resistance has also been reported from the resource-poor farming sector. Increases in productivity and reproduction of livestock and the development of markets for sale of animals are seen by international funding bodies as a way out of poverty for communities that keep livestock. This must lead to the greater need for parasite control. At such times, the risk of levels of anthelmintic resistance escalating is much greater and there is therefore a need to look at alternatives to their use. Proposed strategies include the appropriate, but judicious use of anthelmintics by application of the FAMACHA system and the use of alternatives to anthelmintics such as strategic nutrient supplementation. It is also very clear that there is a strong demand for knowledge about animal diseases, including helminthosis, and their effective management in the resource-poor livestock farming communities. This is an important challenge to meet.

Animals↗
PubMed2004

Characterization of a pigeon paramyxovirus (PPMV-1) isolated from chickens in South Africa.

A paramyxovirus with a thermostability of 60 min (typical of velogenic viruses) and a mean death time of > 90 h (typical of lentogenic viruses) was isolated from layers near Mooi River, South Africa. Our results, based on comparative nucleotide sequence data indicated that the virus is pigeon paramyxovirus 1 (PPMV-1), a variant of Newcastle disease virus. The F0 cleavage site contains a 112RRKKRF117 motif, and the virus had 98% sequence identity with PPMV-1 strains from the Far East. PPMV-1 was last reported in South Africa during the 1980s, with this being the first report of PPMV-1 isolated from chickens in South Africa.

Animals↗
PubMed1987

Dracunculiasis in Africa in 1986: its geographic extent, incidence, and at-risk population.

This paper presents a preliminary assessment of the geographic extent and estimates of the incidence and the population at risk of dracunculiasis in Africa. Nineteen countries are known to be affected, in a belt extending right across the northern part of the continent south of 18 degrees N, and in east Africa extending almost to the equator. Annual incidence is estimated to be 3.32 million, and the at-risk population is approximately 120 million. These data provide an initial baseline on which the success of control measures now being initiated in Africa can be assessed.

Africa↗
PubMed1999

Short report: entomologic inoculation rates and Plasmodium falciparum malaria prevalence in Africa.

Epidemiologic patterns of malaria infection are governed by environmental parameters that regulate vector populations of Anopheles mosquitoes. The intensity of malaria parasite transmission is normally expressed as the entomologic inoculation rate (EIR), the product of the vector biting rate times the proportion of mosquitoes infected with sporozoite-stage malaria parasites. Malaria transmission intensity in Africa is highly variable with annual EIRs ranging from < 1 to > 1,000 infective bites per person per year. Malaria control programs often seek to reduce morbidity and mortality due to malaria by reducing or eliminating malaria parasite transmission by mosquitoes. This report evaluates data from 31 sites throughout Africa to establish fundamental relationships between annual EIRs and the prevalence of Plasmodium falciparum malaria infection. The majority of sites fitted a linear relationship (r2 = 0.71) between malaria prevalence and the logarithm of the annual EIR. Some sites with EIRs < 5 infective bites per year had levels of P. falciparum prevalence exceeding 40%. When transmission exceeded 15 infective bites per year, there were no sites with prevalence rates < 50%. Annual EIRs of 200 or greater were consistently associated with prevalence rates > 80%. The basic relationship between EIR and P. falciparum prevalence, which likely holds in east and west Africa, and across different ecologic zones, shows convincingly that substantial reductions in malaria prevalence are likely to be achieved only when EIRs are reduced to levels less than 1 infective bite per person per year. The analysis also highlights that the EIR is a more direct measure of transmission intensity than traditional measures of malaria prevalence or hospital-based measures of infection or disease incidence. As such, malaria field programs need to consider both entomologic and clinical assessments of the efficacy of transmission control measures.

Africa↗
PubMedDate not supplied

The public health impact of chloroquine resistance in Africa.

Between 1978 and 1988 Plasmodium falciparum resistance to chloroquine has been reported in all countries of tropical Africa. Despite the intensification of resistance during the last 2 decades, chloroquine remains in 2000 the first-line treatment for malaria in most of these countries. Here we review published data on the public health impact of antimalarial drug resistance in Africa. These data show that since the late 1980s convincing evidence of a major public health impact of the spread of chloroquine resistance has been available. Hospital studies in various African countries have documented a 2- or 3-fold increase in malaria deaths and admissions for severe malaria, an increase temporally related to the emergence of chloroquine resistance. Data from sentinel demographic surveillance systems in Senegal indicated that mortality attributable to malaria in children increased by as much as 6-fold among populations where low levels of malaria mortality had been achieved because of efficient health services before the emergence of chloroquine resistance. Increasing incidence of severe malarial anemia also contributed to human immunodeficiency virus dissemination. The dramatic impact of chloroquine resistance on malaria mortality has long been underestimated because only a low proportion of malaria attacks are potentially lethal among persons continuously exposed since birth to high levels of transmission. There is an urgent need to change treatment policies in Africa.

Africa↗
PubMedDate not supplied

The epidemiology and burden of Plasmodium falciparum-related anemia among pregnant women in sub-Saharan Africa.

The paucity of precise information on the burden of malaria among pregnant women has hampered effective lobbying for the inclusion of preventative strategies against malaria in Safe Motherhood Initiatives. This article reviews the evidence on the coincidental risks of malaria and anemia in Africa and attempts to estimate the probable burden of malaria-related severe anemia in this susceptible group. Twenty-six studies on hemoglobin levels in all-parity pregnant women throughout this region could be matched with a malaria parasite ratio in children < 15 yr old (a measure of the intensity of transmission). In areas with no malaria, the mean hemoglobin levels were markedly higher than those found in areas with stable malaria transmission, though changes with increasing intensity of transmission were unclear. Eighteen studies from areas with stable malaria transmission in sub-Saharan Africa suggested that the median prevalence of severe anemia in all-parity pregnant women is approximately 8.2%. Assuming that 26% of these cases are due to malaria, it is suggested that as many as 400,000 pregnant women may have developed severe anemia as a result of infection with malaria in sub-Saharan Africa in 1995.

Africa South of the Sahara↗