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PubMed1995

Expenditure on health research in South Africa, 1991/1992.

OBJECTIVE: To determine expenditure on health research in South Africa in 1991/1992. DESIGN: Data from the financial statements of large statutory councils conducting research in South Africa, as well as other relevant reports, particularly the Department of National Education's (NATED) survey of research institutions, were analysed. RESULTS: A total of R198.7 million was spent on health research in 1991/1992, 56.1% by the tertiary education sector and 20.7% by the Medical Research Council. Only 1.1% of expenditure on health was spent on research. Less than 9% of health research expenditure by tertiary educational institutions is classified within the category of 'comprehensive medicine' (which includes community health, epidemiology and nutrition), whereas 82% of expenditure by autonomous government institutions is so classified. CONCLUSIONS: Given that expenditure on health research in South Africa is relatively low by international standards, an increase in expenditure by both the public and private sectors should be considered. Given the scarcity of research resources, there should be adequate planning, co-ordination, and particularly prioritisation of resource allocations, so that research can be directed towards addressing the country's health needs.

Health Expenditures↗
PubMed1994

[The midwife in South Africa. Part I--The practice of the midwife].

Part 1, of a two part series on the dilemma of the midwife in South Africa, deals with the practice of the midwife. It is difficult to estimate the number of practicing midwives, as they form part of the general nursing register. Also midwifery is part of the basic nurse training and is not taught as a separate entity. The midwife in South Africa practices in the areas of primary health care, hospitals, clinics, mobile clinics, homes and MOU's. The governments commitment to PHC will likely result in most midwives practicing in this area. Problems are high maternal deaths, shortages and maldistribution of midwives in an urban/rural context and the fragmentation and poor coordination of the health services. The safe motherhood initiative of the WHO has been adopted, there are recommendations that midwifery education be separated from general nurse education, and that clinical skills be strengthened. Midwifery services in South Africa do not fulfill the basic criteria for a PHC service.

Humans↗
PubMed1994

Monogenic primary hypercholesterolaemia in South Africa.

Familial hypercholesterolaemia (FH) and familial defective apolipoprotein B-100 (FDB) are the two major causes of monogenic primary hypercholesterolaemia. In this review, FH and FDB are defined in relation to normal lipoprotein metabolism. In South Africa FH affects about 1% of Afrikaners, Jews and Indians, while FDB is probably a much rarer disorder. In Afrikaners, three 'founder' mutations are responsible for more than 80% of FH. The population genetics that created the exceptionally high frequency of FH and comparatively low frequency of FDB in various South African populations are described. The genetic organisation and itinerary of the normal low-density lipoprotein (LDL) receptor are reviewed, with particular emphasis on the structure-function relationships in the LDL receptor that have been clarified by the mutations found in South Africa. Finally, the clinical relevance of research into FH in South Africa is discussed.

Apolipoprotein B-100↗
PubMed1993

Canid and viverrid rabies viruses in South Africa.

Historical records suggest that in South Africa rabies was present in viverrids in the early 1800s. In the early 1950s a wave of canine rabies spread from Namibia through Botswana into the northern Transvaal and by 1961 a second front had penetrated south from Mozambique into Swaziland and northern Natal. Today, rabies is regularly confirmed in a number of canid and viverrid species in most regions of South Africa. A panel of anti-nucleoprotein monoclonal antibodies was used to examine 83 virus isolates from these species. Two major reaction patterns, one chiefly confined to viruses from canids and the other to viruses from viverrids, were obtained. In addition, some variation in the reaction patterns of viverrid viruses was observed and spill-over of viverrid virus into canids and vice versa was recorded. Rabies in South Africa appears to behave as two distinct disease entities.

Animals↗
PubMed1993

[Plasmodium falciparum malaria in urban zones of high endemic regions in black Africa. Potential seriousness and possible preventive measures].

By the year 2000, 40% of the population of sub-Saharan Africa (western and middle Africa) will live in urban areas. It is obvious that urbanization reduces the transmission of malaria and make treatment easier. However, excessive optimism is inappropriate in regions where malaria transmission remains intense and where it is unfortunately illusory to hope for any major or geographically extensive reduction in transmission outside urban and suburban areas. In this context, the benefit of a reduction in malarial morbidity could be compromised by the increased risk of severe forms in town-dwellers, who now have little or no immunity, when they venture into the surrounding rural zone. The prevention of malaria during trips to endemic areas has become a reality for sub-Saharan African town-dwellers. We have to conceive and propose specific protective measures. This version of the advice to travellers about malaria, intended for use in Africa, is fairly similar, in theory, to the advice we give in Europe to travellers going to tropical areas: 1) at most, chemoprophylaxis throughout the exposure period plus 2 or 4 weeks after their return; 2) in all cases, protection against anopheles (take and travel with an impregnated mosquito net) and: 3) above all, the systematic and rapid treatment of any suspected attack of malaria (take and travel with a medicine pack containing antimalarials). If it seems vain to hope to be able to apply these measures in the current socio-economic situation in sub-Saharan African, they are nonetheless justified.

Africa South of the Sahara↗
PubMed1994

Spectrum of hypertensive target organ damage in Africa: a review of published studies.

This paper reviews the evidence of hypertensive target organ damage (HTOD) in Africa, and the difficulties of its assessment, with a focus on implications for further research and prevention. Specific examples of HTOD reviewed include left ventricular hypertrophy, heart failure, ischaemic heart disease, arrhythmias and sudden death, kidney failure, cerebrovascular accidents, retinopathy and central as well as peripheral vascular disease. There is evidence that the prevalence of hypertension is increasing in some parts of Africa, thus increasing the number of people who suffer from fatal and nonfatal complications. Analysis of the type, frequency and distribution of HTOD is critical to the design of interventions to prevent and manage hypertension, and in the design of future clinical research. As would be expected, the frequency of atherosclerotic complications, particularly involving the heart, is lower in Africa than in developed countries. Stroke, renal failure and heart failure appear to be the principal adverse outcomes and are likely to be associated with a high case fatality rate. Community-based data on these issues are limited, however, and hospital series cannot estimate the population burden and may be unreliable in describing the case mix. Improved data on HTOD will more accurately reflect the health impact of hypertension, provide the basis for aggressive efforts at prevention, detection and control of high BP and establish their relevance in the overall scheme of resource allocation during fiscal austerity and limited healthcare spending. Additionally, knowledge of the prevalence and relative frequencies of HTOD has direct and important implications for clinical outcomes research in hypertension.

Africa↗
PubMed1994

Malarial immunities in nineteenth-century west Africa and the Caribbean.

Military records make it possible to study the cause of death of British and French soldiers in West Africa and the Caribbean between about 1819 and 1914. These records are significant because they trace the quantitative pattern of immunity, or lack of it, among soldiers recruited in one region and serving in another. In the Caribbean, a childhood Caribbean disease environment produced no greater immunity to malaria than childhood in the British isles did. Childhood in West Africa, however, produced a degree of immunity to malaria is the Caribbean. For soldiers whose childhood disease environment was in Europe, increased deaths in the tropics were greater in West Africa than they were in the West Indies. The relative importance of malaria as a cause of death increased over this century, largely because death from other causes in the tropics declined faster than malaria deaths did. The greatest improvement in malaria death rates took place between the 1840s and 1870s as a result of empirical public health measures-not after the discovery of the mosquito vector at the end of the century.

Africa, Western↗
PubMedDate not supplied

[Epidemiological and control aspects of meningococcal meningitis epidemics in Africa].

Meningococcal meningitis epidemics are a major health problem in sub-saharan Africa where they account for thousands of deaths and cause morbidity in hundreds of thousands of people. Meningitis is caused by Neisseria meningitidis. In Africa, epidemic meningitis is primarily due to strains of serogroup A which are responsible for the largest and most recent epidemics. N. meningitidis serotype 4, serosubtype P1.9, clonal complex III-1 was introduced into Africa in 1987. Since then, epidemics spread through the Lapeyssonnie's meningitis belt to the south. Classically, the 6 months-30 years old age group is the group at highest risk of disease. Nevertheless, in recent epidemics caused by clonal complex III-1, high age-specific attack rate occurred in those aged 30 years and over. The objectives of epidemic control are the reduction of mortality and morbidity. Early detection of an emerging epidemic is based on the observation of an incidence rate above a cutoff value. Recently, the WHO has proposed a cutoff of 15 cases/100,000/week averaged over two weeks. Epidemic investigation must be as rapid as possible after detection. The different steps are: confirmation of the epidemic and the meningococcal aetiology, standard case definition and determination of the high risk population. During epidemics, in developing countries, simplified treatment protocols are justified and a single dose of long-acting chloramphenicol is a useful first-line treatment. The strategy most frequently used for the control of epidemics is mass vaccination after the start of the epidemic. This must be done as quickly as possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Rabies and bats in a rabies-endemic area of southern Africa: application of two commercial test kits for antigen and antibody detection.

In southern Africa, isolates of rabies-related viruses (i.e. Duvenhage virus and Lagos bat virus) have been made from insectivorous and frugivorous bats. As no recent formal bat virus survey has been reported in southern Africa, a survey of bats in rabies-endemic areas was undertaken. Five hundred and forty-seven bats (13 species) were collected from 21 localities in the Orange Free State, Lesotho and the northern Cape Province. None of the 190 bat sera tested using the "Trousse Platelia Rage" ELISA kit (Diagnostic Pasteur), had antibodies to rabies virus glycoprotein G. Rabies virus nucleocapsid antigen was also sought for in the brains of 530 bats (13 species) by means of the "Rapid rabies enzyme immunodiagnosis" (RREID) test (Diagnostics Pasteur). No positive results were obtained. These results show that bats are unlikely to play an important role as hosts of rabies in these parts of Africa, although a low rate of infection cannot be excluded.

Africa, Southern↗
PubMed1994

Forensic medicine in South Africa--time for change?

Forensic medical services in South Africa are rendered by state-employed district surgeons and forensic pathologists, who are obliged to utilize the physical infrastructure and personnel of the South African Police in their examinations. Recent highly publicized incidents have (again) highlighted the alleged involvement of the South African Police and/or state security forces in political killings and deaths in custody. The perception has arisen that the South African Police is often a party to a dispute and yet may have virtually unlimited access to evidence and findings, thereby gaining unfair advantage and opportunity for prejudicing the eventual outcome of the investigation. Furthermore, the perceived allegiance (and even possible subservience) of doctors to the South African Police has tarnished the reputation of forensic medical practitioners in this country. It is imperative that the public and the courts perceive the rendering of medicolegal services to be independent and scientifically objective. A model is proposed for the restructuring of medicolegal services in South Africa so as to be autonomous and without the integral involvement of the South African Police. Regard should be had to the opportunity for change now presenting itself in South Africa.

Ethics, Professional↗
PubMedDate not supplied

[Epidemiologic distribution of HIV2 human immunodeficiency virus infection in sub-Saharan Africa].

This text presents the results of an analysis of the distribution and evolution of the HIV2 infection in Africa South of Sahara. The serological data collected in selected groups of the population suggest that the virus is very rare in the East and the South of the continent, except in Mozambic where it is found everywhere, but on a low level. The infection is also rarely depisted in West-Central Africa; however an epidemic could affect the North of angola. HIV2 is probably an old host of some West African collectivities. Now the infection is often sporadic in the general population except in a little regional foci in Guinea-Bissau. On the contrary, high prevalences are observed in many groups of prostitutes. The epidemiological situation has been stable since 1985-86. At least in West Africa, the only new fact of the recent past could be that the infection became apparent to the physicians.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Blood transfusions in Africa during the AIDS epidemic. Condition of localities and perspectives in the Ivory Coast].

HIV is transmitted essentially by the heterosexual route in Africa. As part of an international mobilization against the Aids epidemic, information, education and communication strategies should continue to reduce the frequency of the infection. In this paper, we underline the high risk of HIV infection from blood transfusion in Africa. Although few epidemiological data are available, we feel that this problem should be made a priority, and that blood transfusion in Africa can be made reasonably safe by rational use of limited resources. We first report how the Ivory Coast health ministry, with funding from the European Community, has organized blood transfusion services in the main urban areas. Despite routine screening tests, the risk of HIV transmission through blood products remains high because of the large number of infected donors who are antibody-negative. The accent must thus be placed on alternatives to blood transfusions, while the use of transfusions must be minimized, especially in pediatric and general medical wards. As malaria, undernutrition and obstetric surgery are leading causes of anemia, health programs should be aimed at controlling these factors with the ultimate goal of limiting the spread of HIV.

Adult↗
PubMed1994

[Eye trauma in southern Africa].

The population of southern Africa living in South Africa, Swaziland, Lesotho and Mozambique is 50 million. Because of intertribal hostility, the particular family structure, and the widespread use of alcohol and cannabinoid drugs, violence is very common. Trauma results mainly from "cold" weapons, which are an essential part of the traditional accoutrements of the African male. 202 patients (31.86% of those who underwent eye surgery in 2 years) needed surgery for severe ocular trauma in Mbabane, Swaziland. In a similar period, 100 patients (19.49%) required similar surgery in Boksburg, South Africa.

Civil Disorders↗
PubMed1995

Socio-economic aspects of animal diseases in southern Africa: research priorities in veterinary science.

During May 1995, members of organisations with a vested interest in the socio-economic aspects of animal diseases in southern Africa met for a one-day workshop. This was the first activity of a proposed three-year Forum and programme in this area under discussion. The workshop was sponsored by the Foundation for Research Development, the Agricultural Research Council and the University of Pretoria. The individuals who attended were representatives of academic and government institutions and included veterinarians, veterinary scientists, animal health officers, administrators from the region and abroad, economists, sociologists and animal welfare experts. The aims of the workshop were fourfold: 1. to define what is meant by socio-economic aspects of animal diseases in southern Africa; 2. to identify the socio-economic factors which influence occurrence and consequences of animal diseases; 3. to learn of methods which are used to assess socio-economic needs, and 4. to initiate an ongoing network and research programme in this area. Two key questions were considered and discussed by the participants, and a consensus reached for each. The first question considered the link between community development and socio-economic aspects of animal diseases. This included the role of production animals, companion animals and game in developing communities and factors influencing these roles, as well as constraints to this development. The second question concerned the gaps in our understanding of the socio-economic aspects of animal diseases in southern Africa which would lead to research opportunities. Six areas identified were were the collection of disease information, education and communication, policy, economics, community needs and technology.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa, Southern↗
PubMed1996

The defined daily dose as a measure of drug consumption in South Africa. A preliminary study.

OBJECTIVE: To perform a preliminary investigation into the us e of the defined daily dose (DDD) as a unit to measure drug utilisation in South Africa. The DDD methodology has been applied in many countries in Western Europe and in other parts of the world. However, research using the DDD method is still lacking in South Africa despite the important role that it can play in economic planning and the improvement of prescribing practices. DESIGN: A retrospective drug utilisation study using da ta from a medical aid. Consumption of selected central nervous system drugs in a formulary system was determined. SETTING: Doctors and patients located in an area of Port Elizabeth. PARTICIPANTS: The prescribing behavior of 50 dispensing doctors serving a homogeneous demographic and socioeconomic patient population was analysed. OUTCOME MEASUREMENTS: The DDD/1,000 registered patients/day, the cost per DDD and the relationship between the two units. RESULTS: Values for the DDD/1,000 registered patients/day were on average lower than international values, but similar trends were observed. The cost per DDD for antipsychotic and antidepressant drugs was on average higher than for hypnotic and anxiolytic drugs. There was an inverse relationship between the DDD/1,000 registered patients/day and the cost per DDD. CONCLUSIONS: The DDD methodology is a useful technique to enable drug consumption data to be measured and compared both nationally and internationally. It can be regarded as a valuable tool for the promotion of rational and cost-effective use of medicine in a future health care system for South Africa.

Central Nervous System Depressants↗
PubMed1996

Geographical distribution and relative abundance of stock-associated Culicoides species (Diptera: Ceratopogonidae) in southern Africa in relation to their potential as viral vectors.

To determine the geographical distribution and relative abundance of Culicoides species associated with livestock, 220-V down-draught light-traps equipped with 8-W blacklight tubes were operated at 34 sites in different climatic regions in South Africa and Lesotho. From January 1984 to September 1986, 3 041 631 Culicoides, belonging to at least 50 species, were collected in a total of 959 collections. Of these, 572 412 individuals were identified and sexed. Culicoides species were found to be widespread in South Africa and were collected in varying numbers at all the sites sampled. The average catch size, however, was larger in frost-free areas than in areas with extreme winters. The more abundant and widespread species, which have the potential to be vectors of stock-associated viruses such as bluetongue and African horsesickness, were C. imicola, C. leucostictus, C. schultzei s.l., C. pycnostictus, C. nivosus, C. similis, C. zuluensis, C. magnus, C. bedfordi, C. neavei, C. brucei, C. tropicalis, C. exspectator, C. gulbenkiani, C. bolitinos, C. ravus, C. coarctatus and C. onderstepoortensis. Of these, C. imicola was the most abundant species, being dominant at 17 of the 34 sites sampled and accounting for 71.4% of the specimens collected. As C. imicola is relatively uncommon in hot and dry as well as cool and wet areas, this species cannot be regarded as the only vector of stock-associated viruses in southern Africa. Further laboratory vector-competence studies, i.e. determination of viral-infection and -transmission rates, should first concentrate on the above-mentioned Culicoides species, especially those known to feed on livestock.

African Horse Sickness↗
PubMed1996

The distribution, diagnoses and estimated economic impact of plant poisonings and mycotoxicoses in South Africa.

Maps are provided showing the national and provincial distributions of many plant poisonings and mycotoxicoses in South Africa. The various poisonings are briefly described and criteria for their diagnoses are given. The annual mortalities of cattle from plant poisonings/mycotoxicoses in South Africa were calculated as c. 37 665 head with a current cash value of c. R57 627 450, and that of small stock as c. 264851 head with a value of c. R46 878 627. The annual total cost of plant poisonings/mycotoxicoses to the livestock industry of South Africa is conservatively estimated at R104 506 077. These figures do not include hidden losses such as diminished production, reproductive failure, the cost of not utilizing toxic pastures and the fall in price of infested land.

Animals↗
PubMed1996

Desegregating health statistics and health research in South Africa.

OBJECTIVE: This article aims: (i) to re-examine the use and usefulness of categorisation based on 'race', ethnicity and 'population group' membership in public health research; and (ii) to assess the consequences of using these categories for describing, analysing and redressing disparities in health within South Africa. The utility of categorisation based on 'race', ethnicity and 'population group'. Categorising populations and comparing patterns of disease between different groups of people can be a useful technique for identifying potential causes of disease. In this context, ethnicity is a valid social concept that could be used to investigate the consequences of self-ascribed identity on health. Likewise, 'population group', as defined during apartheid in South Africa, represents a valid political concept that could be used for assessing the impact of social discrimination on health. However, both these concepts are often seen, and used, as euphemisms for 'race', even though there are no genetically distinct human subspecies that can be identified and categorised as discrete 'races'. Indeed, 'race' as a biological concept has no validity in human biology. Nevertheless, categories based on 'race', ethnicity and 'population group; continue to be used in health research, and reinforce the perception that differences in disease between different 'racial', ethnic and 'population' groups are the result of heritable biological characteristics. In so doing, they undermine support for health interventions that would otherwise address the social and political origins of 'racial' and ethnic disparities in health. The utility of 'population group' for redressing the consequences of apartheid. Despite these problems, 'population group' classification provides important information for assessing the impact of apartheid on disparities in health within South Africa. Yet, the abolition of apartheid legislation is likely to result in extensive socio-economic and geographical migration that will weaken the sensitivity and specificity of 'population group' as an indicator for identifying inequalities in health. For this reason, targeting corrective action at specific population groups in order to tackle disparities in health, runs the risk of ignoring alternative social causes of inequalities in health, and ignoring disadvantaged individuals from elsewhere in the population. The continued use of 'population group' classification might also perpetuate the root cause of disparities in health, by maintaining the process used to formalise discrimination. CONCLUSION: If the purpose of health research is to monitor inequalities in health and to help target resources aimed at reducing these inequalities, then it should seek, in its language, concepts and methods to undermine the root cause of disadvantage. Health research aimed at monitoring and redressing the consequences of social disadvantage on health should therefore focus on non-biological determinants of social disparities in health. As a general rule, health researchers should avoid using categories based on 'race', ethnicity and 'population group' when collecting and analysing health data; journal editors should not accept articles that use these categories without justification; and health authorities should not collect data routinely segregated by 'race', ethnicity or 'population group'.

Bias↗