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PubMedDate not supplied

HIV/AIDS care in KwaZulu-Natal, South Africa: an interview with Dr. Leana Uys. Interviewed by Ellen Giarelli and Linda A. Jacobs.

Human suffering from the HIV/AIDS epidemic in Africa has reached unprecedented proportions. In 1998, an estimated 50% of all new infections in sub-Saharan Africa occurred in South Africa; and it is predicted that by the year 2003, South Africa will be experiencing a negative population growth. Besides the toll in human lives, the estimated cost for basic care and prevention services in Africa is 10 times the current expenditure. Three unique factors are critical in the South African HIV/AIDS epidemic: HIV transmission patterns, the effect of this disease on women and children, and the role that traditional healers play in the treatment of HIV/AIDS. In a recent interview, Dr. Leana Uys, an educational leader in the School of Nursing at the University of Natal in Durban, Republic of South Africa, provided an insightful perspective on HIV/AIDS policies and related sociocultural issues that have a direct effect on the HIV/AIDS epidemic. She communicated her personal experiences as well as the experiences of South African nurses working as caregivers, educators, and policy makers with AIDS patients and their families in KwaZulu-Natal.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Veterinary waste disposal: practice and policy in Durban, South Africa (2001-2003).

In South Africa, until recently, veterinary waste has not been included in definitions of health care waste, and so has been neglected as a contributor to the hazardous waste stream. Despite the application of, for example, the "Polluter Pays" principle in South African environmental legislation, to generators of waste, which would include veterinarians, there appears to be little awareness of and even less enforcement of the legislation in this regard. This paper reports on a 2001-2003 survey of management practices of the five waste contractors servicing just over half of the veterinarians in Durban, South Africa's second largest city. Some of their activities, when evaluated in terms of the legislation, guidelines and policies relating to waste handling and disposal, were found to be non-compliant. Since any discussion on waste management should take cognisance of waste from generation to final disposal, the responsibility of veterinarians as waste generators is also discussed in the light of the recent developments in health care waste management in South Africa. This study presents a review of past and current policies, legislation and guidelines that have application to veterinary waste. This is the first study to address veterinary waste disposal in any South African city.

Animals↗
PubMed1998

The development of passive health surveillance by a sentinel network of family practitioners in South Africa.

OBJECTIVE: For the South African Sentinel Practitioner Research Network (SASPREN), a volunteer network of family practitioners in South Africa, to develop a health surveillance system through the surveillance of important health events. MOTIVATION: The incidence of important preventable diseases and the burden of disease are not reliably known in South Africa, both in the public and private sector. Incidence rates determined at primary care level could help with planning and delivery of appropriate health services and monitoring of the impact of intervention programmes. METHODS: Altogether 183 sentinel practitioners were recruited in nine provinces, from 2,478 doctors invited to participate. Of these 120 were active in reporting all their new cases of 13 selected health events to the study centre on mailed postcards. After data-capturing, incidence rates were calculated for defined periods. Feedback was given to the sentinels through a newsletter and personalised reports. RESULTS: A network of sentinel family practitioners has been established in South Africa, and can provide incidence rates for both diseases and interventions through a simple and cheap surveillance system. The calculated rates demonstrated periodic trends for certain events, as well as inter-provincial, -gender and -population group differences. CONCLUSIONS: As the validity of the dataset and its generalisation to the whole population is uncertain, its usefulness as point estimates of incidence rates is unknown. This information serves as an important pointer for further research. The trends of these rates may provide a valuable tool for monitoring the impact of public health policies.

Age Distribution↗
PubMed2004

The meaning of 'self-starvation' in impoverished black adolescents in South Africa.

Recent surveys in South Africa have demonstrated that disordered eating is equally common among black and white female students. Self-report measures have been used in these surveys to establish levels of disordered eating. One study in Tanzania, where a two-stage design was implemented, showed that upon interview the majority of participants did not present with disordered eating. The absence of two-stage studies in South Africa brings into question some of the findings from these surveys. In the present study, we surveyed a sample of black and white high school students in South Africa to establish the prevalence of disordered eating. In the second phase of this study, we attempted to interview those black students from one particular school who scored high on the eating disorder measures. This process proved both challenging and elucidating. While a significant number of young black females endorsed eating disorder symptoms on self-report, interviews with some participants showed that self-starvation and related symptoms had a different meaning from what we would typically expect from someone with an eating disorder. Consequently, this study highlights the need to revisit the methods typically employed in cross-cultural research in eating disorders. Careful consideration of a variety of cultural factors that may alter the meaning of standard measures is called for.

Adolescent↗
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↗
PubMed1982

Deaths from destructive lifestyles (largely preventable among economically active Whites in South Africa, 1968--1977.

In South Africa, 60% of the deaths economically active (EA) White males and 40--50% among EA White females in recent years were largely preventable, being a result of destructive lifestyles. The most common cause of death was ischaemic heart disease (IHD), accounting for 30% of deaths among EA males and 20% of deaths among EA females. The next most common cause of death was motor vehicle accidents in males (10%), and cerebrovascular diseases (CVA) in females (10%). However, among males in England, Wales and Scotland, lung cancer was the second most common cause of death, and as from 1974 this was also the case among American males. Age-adjusted mortality rates (MRs) of White South African males were compared with the MRs of males in the USA, Australia, England and Wales, and Scotland over the period 1968--1977. The MRs of White South African males were higher than those males in the other populations for IHD, CVA, motor vehicle accidents and suicides, but not for lung cancer and chronic respiratory diseases (highest MR among Scottish males). Over the period 1968--1977 the MRs for IHD were unchanged among males in South Africa (220-250/00 000), Scotland (190/00 000) and England and Wales (150/00 000), but those of males in the USA and Australia fell by 25% and 21% respectively to around 150/00 000 by 1977. MRs for motor vehicle accidents in White males in South Africa fell by 33% in 1974 due to the strict enforcement of lowered speed limits at the start of the oil crisis.

Accidents, Traffic↗
PubMed1999

Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. South African Vitamin A Study Group.

BACKGROUND: The observation that mother-to-child transmission of HIV-1 can occur through breastfeeding has resulted in policies that recommend avoidance of breastfeeding by HIV-1-infected women in the developed world and under specific circumstances in developing countries. We compared transmission rates in exclusively breastfed, mixed-fed, and formula-fed (never breastfed) infants to assess whether the pattern of breastfeeding is a critical determinant of early mother-to-child transmission of HIV-1. METHODS: We prospectively assessed infant-feeding practices of 549 HIV-1-infected women who were part of a vitamin A intervention trial in Durban, South Africa. The proportions of HIV-1-infected infants at 3 months (estimated by use of Kaplan-Meier life tables) were compared in the three different feeding groups. HIV-1 infection was defined by a positive RNA-PCR test. FINDINGS: At 3 months, 18.8% (95% CI 12.6-24.9) of 156 never-breastfed children were estimated to be HIV-1 infected compared with 21.3% (17.2-25.5) of 393 breastfed children (p=0.5). The estimated proportion (Kaplan-Meier) of infants HIV-1 infected by 3 months was significantly lower for those exclusively breastfed to 3 months than in those who received mixed feeding before 3 months (14.6% [7.7-21.4] vs 24.1% [19.0-29.2], p=0.03). After adjustment for potential confounders (maternal CD4-cell/CD8-cell ratio, syphilis screening test results, and preterm delivery), exclusive breastfeeding carried a significantly lower risk of HIV-1 transmission than mixed feeding (hazard ratio 0.52 [0.28-0.98]) and a similar risk to no breastfeeding (0.85 [0.51-1.42]). INTERPRETATIONS: Our findings have important implications for prevention of HIV-1 infection and infant-feeding policies in developing countries and further research is essential. In the meantime, breastfeeding policies for HIV-1-infected women require urgent review. If our findings are confirmed, exclusive breastfeeding may offer HIV-1-infected women in developing countries an affordable, culturally acceptable, and effective means of reducing mother-to-child transmission of HIV-1 while maintaining the overwhelming benefits of breastfeeding.

Adult↗
PubMed2003

Evidence to support a food-based dietary guideline on sugar consumption in South Africa.

Since 1997, South Africa has been developing and implementing food-based dietary guidelines for people aged >6 years. The complexity of the population, which contains different ethnic groups, as well as the rapid urbanization that is taking place, means that food-based dietary guidelines need to consider both overnutrition and undernutrition. The initial guidelines did not include guidance on sugar, and the Department of Health was not prepared to approve them until appropriate guidance on sugar was included. This paper summarizes the evidence available for such a guideline and the nature of that evidence. Other low- and middle-income countries, particularly those in Africa, may face a similar dilemma and might learn from our experience.

Dental Caries↗
PubMed1996

The direct and indirect costs of cardiovascular disease in South Africa in 1991.

BACKGROUND: In South Africa, cardiovascular disease (CVD) is the leading cause of death among all population groups, other than blacks, among whom it ranks third. CVD therefore has a severe impact on the South African economy. OBJECTIVES: To ascertain the availability and quality of South African data on the cost of CVD and to estimate the impact of CVD on the South African economy during 1991. METHODS: The direct health care costs and the indirect costs related to loss of productivity were estimated. Where no direct or complete detailed South African data were available, projections were made based on reasonable assumptions of data and models developed in other countries; these were applied to the limited available South African data. The major disease outcomes considered for this cost estimation were: expenditure on ischaemic heart disease, cerebrovascular disease (stroke), venous thrombosis and embolism, and peripheral vascular diseases and related conditions. These diseases are responsible for the majority of fatal cases of CVD reported in South Africa. RESULTS: The estimated total cost of CVD in South Africa in 1991 was between R4.135 billion and R5.035 billion. This does not include the cost of rehabilitation and follow-up of CVD patients since the necessary data were not available to estimate it. About three-quarters of the direct health care costs were carried by the private sector. The direct health care costs were estimated to be approximately 42% of the total cost. The rest reflects the indirect cost of earnings foregone as a result of premature morbidity and mortality. CONCLUSION: To determine accurately the total economic burden of CVD on the South African economy, additional data will have to be collected. The estimated economic burden of CVD in South Africa clearly highlights the need for a broad-based population strategy, part of an overall national effort to prevent, diagnose and cost-effectively treat CVD.

Cardiovascular Diseases↗
PubMed2006

Prevalence of HIV-1 in blood donations following implementation of a structured blood safety policy in South Africa.

CONTEXT: The South African National Blood Service collects more than 700,000 units of blood annually from a population in which 11.4% is infected with human immunodeficiency virus 1 (HIV-1). The prevalence of HIV-1 in blood donations increased to 0.26% (1:385) in 1998, indicating that a significant number of window-period infective units were entering the blood supply (risk 3.4/100,000). OBJECTIVES: To determine whether the implementation of a new donor selection policy and educational program introduced in 1999 was associated with reductions in the incidence and prevalence of HIV-1 in blood donations and the reduced transmission risk. DESIGN: We compared the prevalence of HIV-1 in 880,534 blood donations collected from 1999 through 2000 with the 791,639 blood donations collected from 2001 through 2002. We estimated the incidence of HIV-1 in 93,378 (1999-2000) and 67,231 (2001-2002) first-time donations and the residual risk for all donations in 2001-2002 using the less-sensitive enzyme-linked immunoassay and incidence-window period model. SETTING: All blood donors in the Inland region of the South African National Blood Service were analyzed. INTERVENTION: Donor clinics in high HIV prevalence areas were closed. Programs targeting repeat donors and youth were initiated and HIV risk behavior education programs were developed. Structured donor interviews and an enhanced donor self-exclusion questionnaire were institutionalized. RESULTS: The prevalence of HIV-1 in blood donations declined from 0.17% in 1999-2000 to 0.08% in 2001-2002 after the implementation of the new donor selection and education policy. The number of high-risk donations collected decreased from 2.6% to 1.7% (P<.001), and the likelihood of these donations being infected decreased from 4.8% to 3.25%. The likelihood of first-time donors being recently infected with HIV-1 decreased from 18% to 14% (P = .07) and respective incidence of high-risk donations collected decreased from 2.6% to 1.7%. Donations from the majority black population declined from 6.6% to 4.2% (P<.001). Analysis of HIV-1 incidence in 2001-2002 suggests a residual risk of collecting a window period infectious unit of 2.6/100,000. CONCLUSION: The implementation of enhanced education and selection policies in South Africa was associated with decreased prevalence of HIV-1 in blood donations.

Adolescent↗
PubMed2006

U-Pb isotopic age of the StW 573 hominid from Sterkfontein, South Africa.

Sterkfontein cave, South Africa, has yielded an australopith skeleton, StW 573, whose completeness has excited great interest in paleoanthropology. StW 573, or "Little Foot," was found 25 meters below the surface in the Silberberg Grotto. 238U-206Pb measurements on speleothems immediately above and below the fossil remains, corrected for initial 234U disequilibrium, yield ages of 2.17 +/- 0.17 million years ago (Ma) and 2.24(-0.07)(+0.09) Ma, respectively, indicating an age for StW 573 of close to 2.2 Ma. This age is in contrast to an age of approximately 3.3 Ma suggested by magnetochronology and ages of approximately 4 Ma based on 10Be and 26Al, but it is compatible with a faunal age range of 4 to 2 Ma.

Animals↗
PubMed2004

Factors associated with contraceptive use in late- and post-apartheid South Africa.

In 1994, South Africa underwent a transition from the institutionalized racism of an apartheid state to a nonracial democracy. This study uses data from two surveys conducted in the style of the Demographic and Health Surveys to compare patterns and predictors of racial differences in modern contraceptive use in the late- and post-apartheid periods. Age-group-specific logistic regression models show that despite strong state family planning programs targeting black women, these women were less likely than nonblacks to practice modern contraception both before and after the political transition, even after controlling for large racial-group differences in sociodemographic characteristics and the distribution of socioeconomic resources. Black, colored, Indian, and white women show different patterns of contraceptive use across their reproductive careers; in particular, young, unmarried black and colored women show high levels of use. Use of injectable contraceptives is also high among black and colored women, whereas injectables are not the primary method used by Indian or white women. These findings are discussed in light of their research and policy implications.

Adolescent↗
PubMed2003

Adolescent mothers' utilization of contraceptive services in South Africa.

BACKGROUND: In South Africa, contraceptives, as well as emergency contraceptives, are available free of charge. Since 1996, changed legislation has enabled women of all ages to choose whether they wish their pregnancies to be terminated during the first 12 weeks of pregnancy. Therefore, adolescent mothers, 19 years or younger at the time of their babies' birth, were investigated regarding why they failed to use contraceptive, emergency contraceptive or termination of pregnancy services. AIM: To explore the knowledge of young mothers regarding contraception. METHOD: An exploratory descriptive survey, utilizing questionnaires and convenience sampling. FINDINGS: The majority of the participating 250 adolescent mothers lacked knowledge about contraceptives, emergency contraceptives and termination of pregnancy services. Merely legalizing the termination of pregnancies, and providing free contraceptive and emergency contraceptive services, did not affect the utilization of these services by the 250 adolescent mothers investigated. CONCLUSION: Young mothers require more knowledge to enable them to make better informed decisions, and the services need to become more readily accessible and user friendly to adolescents. Reproductive health services provided specifically to adolescents could enhance the utilization of such services.

Adolescent↗
PubMed1991

Policy and strategy for occupational health services in South Africa.

Recent events in South Africa have spurred policy thinking in many areas, including occupational health. Strategic thinking needs to take account of current and likely future economic and political conditions in the new South Africa. The present occupational health system, considered as a network of health services, educational and research facilities along with a mechanism of legal regulation of workplace conditions, and compensation for occupationally-related disability, is reviewed and found to be inadequate in several respects. A possible structure for an integrated occupational health system is outlined at national, regional and local levels. Both service provision and financing arrangements are addressed. The interrelation between occupational health services and general health services for workers and their dependants is approached from the point of view of the desirability of comprehensive primary health care services catering to all health needs of all workers and their dependants. Appropriate linkages between levels of care (primary, secondary and tertiary), and between relevant institutions required for an efficient occupational health system are outlined.

Health Policy↗
PubMed1995

Guidelines for the management of hypertension at primary health care level. Hypertension Society of Southern Africa, endorsed by the Medical Association of South Africa and the Medical Research Council.

OBJECTIVE: To outline rational and cost-effective comprehensive management of hypertension by health care professionals in a primary care setting. OUTCOMES: Control of hypertension with a target blood pressure (BP) of systolic 140 - 159 mmHg, diastolic 90 - 94 mmHg, with minimal or no drug side-effects. Reduce BP in the elderly and those with severe hypertension gradually. Stricter BP control is required for patients with end-organ damage, coexisting risk factors, diabetes mellitus. Extensive data including many randomised controlled trials showed the benefit of controlling hypertension. This evidence is reported in Opie L. H. and Steyn K., Rationale for the hypertension guidelines for primary care in South Africa, S Afr Med J 1995; 85: 1325-1338. VALUES: To treat as many of the untreated hypertensive patients as possible, using rational and cost-effective care. Cost-effectiveness and access to therapy are major issues. BENEFITS, HARMS AND COSTS: Reduction in stroke, cardiac failure, renal failure and coronary artery disease. The major precautions and contraindications to each antihypertensive drug recommended are listed. The financial costs of the drugs are considered. RECOMMENDATIONS: Correct BP measurement procedure. identification of blood pressure levels for appropriate management. Evaluation of other cardiovascular risk factors and their influence on when to treat hypertension. Lifestyle modification and patient education for all patients. Drug therapy: first line--low-dose diuretics; second line--reserpine or beta-blockers or ACE inhibitors or calcium channel blockers; third line--hydralazine or prazosin or another second-line drug. Drug treatment and referral or specific cases (pregnancy, diabetes mellitus, severe hypertension). VALIDATION: Developed by the Hypertension Society of Southern Africa Executive Committee and co-opted persons during 1995, with added input from HSSA members at the National Congress. Endorsed by the Medical Association of South Africa.

Adult↗
PubMed1997

Development of an HIV clinical and research database for South Africa.

Health service restructuring in South Africa provides an opportunity to introduce appropriate Health Information System (HIS) technology. This is particularly relevant given the emerging HIV epidemic and the need to capture, translate and disseminate new experiences in HIV/AIDS care, support and clinical research. In 1994, a number of clinicians and health-care providers working in South Africa had begun to establish basic computerized databases to assist in research on HIV, but no standardized nomenclature or framework for collaboration was created. This paper describes a clinical and research database that could be used as an example for a standardized system by clinicians working in South Africa. The authors, with assistance from the National AIDS Research Programme of the Medical Research Council, created a prototype relational database using Microsoft Access. To test the prototype, 1057 HIV-positive patients from the infectious Disease Clinic at Johannesburg General Hospital were entered.

Databases, Factual↗
PubMed2003

A re-examination of levels and differential in fertility in South Africa from recent evidence.

The final estimate of South Africa's population as of October 1996 from the first post-apartheid census by Statistics South Africa was lower (40.6 million) than expected (42 million). The expectation of a total population of 42 million was largely based on results of apartheid projections of South Africa's population. The results of the last apartheid census in South Africa in 1991 had been adjusted such that it was consistent with results modelling the population size of South Africa. The discrepancy between the final estimate of the 1996 census and that expected from the modelling described above, and the departure by Statistics South Africa from previous practice of adjusting the census results to be consistent with demographic models, has generated controversies regarding the accuracy of the final results from the 1996 census. This study re-examines levels and differential in fertility in South Africa from recent evidence in order to assess whether or not the fertility inputs in projections of South Africa's population during the apartheid era overestimated fertility.

Adolescent↗