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PubMed1992

A theoretical perspective on population policy in South Africa.

The author describes the goals of South Africa's Population Development Programme, which works to enact the government's population policy. The primary objective is to achieve a balance between population size and natural and socioeconomic resources in the country. "The Population Development Programme promotes specific fertility-inhibiting programmes, projects and actions in the socio-economic fields of education, manpower training, health, the economy and housing. Population information, education and communication programmes are also directed at people with high fertility to facilitate the change of fertility perceptions in favour of a small family norm."

Africa↗
PubMed1996

Urbanization and apartheid in South Africa: influx controls and their abolition.

"This study will take up the particular aspects and characteristics of urbanization [in South Africa] from the standpoint of the effects exerted by the apartheid system. It will then examine the trends which have taken place since abolition of the pass laws and restrictions on the influx of blacks into urban areas....[The author considers] the relationship between restrictions on the movement of blacks into urban areas on the one hand and the maintenance of low-wage migrant labor and retention of farmland in home districts on the other."

Africa↗
PubMed1988

South Africa's urban policy: a new form of influx control.

"The South African government has repealed influx control for blacks living in the 'non-independent homelands.' Although the urban shift of the black population is increasingly accepted, controls on the supply of housing and land for housing blacks have been retained. The emphasis is now on alternative restrictions on black urbanization. The restrictions, however, contrast with the wishes of South Africa's business leadership. The 1986 'reforms' are explained by exploring the relationship between government policy and business interests. Finally, the urban policies are contrasted with the new metropolitan government, the Regional Services Councils, through which blacks are being brought into multiracial governmental structures but on unequal terms."

Africa↗
PubMed1993

A simple questionnaire survey method for studying migration and residential displacement in informal settlements in South Africa.

"My aim in this article is to describe a cheap and reliable questionnaire survey method which can be used to identify patterns in migration and residential displacement." The method is described in the context of measuring migration in informal settlements in South Africa. "The merit of the method which I have described...lies in the fact that it allows questions of residential movement to be addressed in a routine manner, in much the same way that questions are used concerning, for example, household income."

Africa↗
PubMed1998

Migration dynamics and development in rural South Africa: demographic and socioeconomic perspectives.

"This paper addresses five key questions related to migration dynamics and development in rural South Africa: (1) Which individual and household level factors are particularly important in understanding migration patterns? (2) Taken together, are sociodemographic or socioeconomic factors more influential? (3) Do present patterns of migration and remittance flows reflect strategies that connote survival, or do they represent household efforts to advance their well-being and their position in society? (4) Which segments of the population appear to gain or lose from contemporary patterns of migration and remittance flows? and (5) How might remittances shape trends in local level development and equality, or inequality?... The data source is the nationwide representative sample survey ¿Project for Statistics on Living Standards and Development' undertaken in the latter part of 1993."

Africa↗
PubMed2005

Respiratory syncytial virus infection: denominator-based studies in Indonesia, Mozambique, Nigeria and South Africa.

OBJECTIVE: To assess the burden of respiratory syncytial virus (RSV)-associated lower respiratory infections (LRI) in children in four developing countries. METHODS: A WHO protocol for prospective population-based surveillance of acute respiratory infections in children aged less than 5 years was used at sites in Indonesia, Mozambique, Nigeria and South Africa. RSV antigen was identified by enzyme-linked immunosorbent assay performed on nasopharyngeal specimens from children meeting clinical case definitions. FINDINGS: Among children aged < 5 years, the incidence of RSV-associated LRI per 1000 child-years was 34 in Indonesia and 94 in Nigeria. The incidence of RSV-associated severe LRI per 1000 child-years was 5 in Mozambique, 10 in Indonesia, and 9 in South Africa. At all study sites, the majority of RSV cases occurred in infants. CONCLUSION: These studies demonstrate that RSV contributes to a substantial but quite variable burden of LRI in children aged < 5 years in four developing countries. The possible explanations for this variation include social factors, such as family size and patterns of seeking health care; the proportion of children infected by human immunodeficiency syndrome (HIV); and differences in clinical definitions used for obtaining samples. The age distribution of cases indicates the need for an RSV vaccine that can protect children early in life.

Age Distribution↗
PubMed2005

Re-evaluating the burden of rabies in Africa and Asia.

OBJECTIVE: To quantify the public health and economic burden of endemic canine rabies in Africa and Asia. METHODS: Data from these regions were applied to a set of linked epidemiological and economic models. The human population at risk from endemic canine rabies was predicted using data on dog density, and human rabies deaths were estimated using a series of probability steps to determine the likelihood of clinical rabies developing in a person after being bitten by a dog suspected of having rabies. Model outputs on mortality and morbidity associated with rabies were used to calculate an improved disability-adjusted life year (DALY) score for the disease. The total societal cost incurred by the disease is presented. FINDINGS: Human mortality from endemic canine rabies was estimated to be 55 000 deaths per year (90% confidence interval (CI) = 24 000-93 000). Deaths due to rabies are responsible for 1.74 million DALYs lost each year (90% CI = 0.75-2.93). An additional 0.04 million DALYs are lost through morbidity and mortality following side-effects of nerve-tissue vaccines. The estimated annual cost of rabies is USD 583.5 million (90% CI = USD 540.1-626.3 million). Patient-borne costs for post-exposure treatment form the bulk of expenditure, accounting for nearly half the total costs of rabies. CONCLUSION: Rabies remains an important yet neglected disease in Africa and Asia. Disparities in the affordability and accessibility of post-exposure treatment and risks of exposure to rabid dogs result in a skewed distribution of the disease burden across society, with the major impact falling on those living in poor rural communities, in particular children.

Africa↗
PubMed1996

Surgery in South Africa.

The practice of surgery in South Africa ranges from full-time service in state-funded and academic hospitals serving a largely indigent population to a private sector for medically insured patients. Surgical training occurs at eight medical schools, and specialist registration is obtained after 4 to 5 years with either a university-conferred degree or a fellowship from the College of Surgeons of South Africa. The wide spectrum of First- to Third-World diseases and the high incidence of trauma provide comprehensive experience for practical training. Surgical standards are uniformly high, matching and sometimes pioneering the very best of Western medicine. The health care system is undergoing radical change to correct the imbalances of the apartheid era. Academic institutions are under pressure, and with incipient major financial cutbacks, there is concern that the proud record of service, teaching, and research excellence may be compromised. To facilitate the mission of broadening health care services, diploma training in surgery for rural practitioners is being developed. Outreach programs and closer liaisons with surgical societies in sub-Saharan African countries have also been initiated.

Academic Medical Centers↗
PubMedDate not supplied

Apartheid medicine. Health and human rights in South Africa.

Human rights and health care under apartheid in South Africa were studied. Human rights violations, such as detention without charge or trial, assault and torture in police custody, and restriction orders, have had devastating effects on the health of persons experiencing them. These violations have occurred in the context of a deliberate policy of discriminatory health care favoring the white minority over the black majority. South Africa's medical societies have had mixed responses to the health problems raised by human rights violations and inequities in the health care system. The amelioration of health care for all and prevention of human rights violations depend on ending apartheid and discrimination and greater government attention to these problems.

Delivery of Health Care↗
PubMed1997

The sword of Damocles: the psychosocial impact of familial spinocerebellar ataxia in South Africa.

A survey was conducted on 30 unaffected individuals from a family with autosomal dominant late onset spinocerebellar ataxia in South Africa. The psychological impact of the disorder on individual lives, risk awareness, attitudes towards affected kin and reproduction were evaluated. Respondents employed various psychological strategies to deal with the threat of developing the disorder. In a comparison of "assigned" risk with "perceived" risk, 80% of unaffected persons reported incorrect perceptions of personal risk status. The disorder had little impact on attitudes concerning reproduction; the majority of individuals at risk wanted more children. These issues need to be addressed in the genetic and predictive testing service for familial ataxia in South Africa.

Adolescent↗
PubMed1998

HTLV-Is in Argentina are phylogenetically similar to those of other South American countries, but different from HTLV-Is in Africa.

To understand the origin and past dissemination of human T-cell leukemia/lymphotropic virus type I (HTLV-I) in Latin America, we conducted a phylogenetic study of five new HTLV-I isolates from Argentina. We sequenced partial fragments of long terminal repeats (LTR) of the new HTLV-Is, and then the sequences were subjected to a phylogenetic analysis for comparison with other HTLV-Is of various geographical origins. Our results indicated that all the isolates were members of the Cosmopolitan group. Furthermore, most (four out of five isolates) of the new HTLV-Is belonged to the Transcontinental (A) subgroup, the most widespread subgroup of the four subgroups in the Cosmopolitan group. In this subgroup, they were closely related to HTLV-Is found in other South American countries including those of Amerindians, and were different from those found in Africa. In contrast, the remaining one HTLV-I (ARGMF) did not show any clear similarity to known HTLV-I isolates belonging to the Cosmopolitan group. The close similarity of South American HTLV-Is strongly suggests a common origin of the virus in this continent. Our results do not support the proposed idea of recent introduction of HTLV-I into South America as a consequence of the slave trade from Africa, where phylogenetically different HTLV-Is predominate.

Africa↗
PubMed1998

Prevalence of occupational lung disease in a random sample of former mineworkers, Libode District, Eastern Cape Province, South Africa.

BACKGROUND: Gold mineworkers in South Africa are exposed to high levels of silica dust as a result of which they are at risk of developing silicosis, which is a compensable disease. The incidence of tuberculosis is also high. METHODS: To determine the prevalence of occupational lung disease and the previous compensation history in former migrant mineworkers, a study was undertaken in a random sample of men living in Libode, a rural district of Eastern Cape Province, South Africa. Two hundred thirty-eight ex-mineworkers were examined according to a protocol that included chest radiography and spirometry. Chest radiographs were read into the International Labour Organisation (ILO) classification for pneumoconioses by two readers. RESULTS: The mean age was 52.8 years, and the mean length of service was 12.15 years. The prevalence of pneumoconiosis (> or = ILO 1/0) was 22% and 36% (variation by reader). For both readers, a significant association between length of service and pneumoconiosis and between pneumoconiosis and reduction in FVC and FEV was found. Twenty-four percent of study subjects were eligible for compensation. CONCLUSION: There is a high prevalence of previously undiagnosed, uncompensated pneumoconiosis in the study group. As a result of the failure to diagnose and compensate occupational lung disease, the social and economic burden of such disease is being borne by individuals, households, and the migrant labor-sending communities as a whole.

Adult↗
PubMed1999

Case-control study of mesothelioma in South Africa.

BACKGROUND: South Africa has, uniquely, mined, transported, and used crocidolite, amosite, and chrysotile. A multicenter case-control study was done in South Africa to examine the details of asbestos exposure in cases and controls, and to calculate relative risks for level of certainty of asbestos exposure, nature of exposure (e.g., environmental, occupational) and fiber type. METHODS: Cases and controls (one cancer and one medical per case) were collected by six study centers from referral hospitals, and exposure information was collected by interviewing cases and controls in life. RESULTS: One hundred and twenty-three cases were accepted into the study. None had purely chrysotile exposure. Twenty-three cases had mined Cape crocidolite; three had mined amosite; and three Transvaal crocidolite plus amosite. A minimum of 22 of the cases had exclusively environmental exposure, 20 were from the NW Cape crocidolite mining area. The relative risks associated with environmental exposure in the NW Cape (crocidolite) were larger than for environmental exposure in the NE Transvaal (amosite and crocidolite): 21.9 vs. 7.1 and 50.9 vs. 12.0 for the cancer control and medical control datasets, respectively. CONCLUSIONS: The results confirm the importance of environmental exposure in the Cape crocidolite mining area, the relative paucity of cases linked to amosite, the rarity of chrysotile cases and are consistent with a fiber gradient in mesotheliomagenic potential for South African asbestos with crocidolite > amosite > chrysotile.

Asbestos↗
PubMed1998

Private sector health reform in South Africa.

This paper discusses some of the trends, debates and policy proposals in relation to the financing of the private health sector in South Africa. The public and private sectors in South Africa are of equivalent size in terms of overall expenditure, but cover substantially different population sizes. Within this context the government has reached the unavoidable conclusion that the private sector has to play some role in ensuring that equity, access and efficiency objectives are achieved for the health system as a whole. However, the private sector is some way off from taking on this responsibility. Substantial increases in per capita costs over the past 15 years, coupled with a degree of deregulation by the former government, have resulted in increasing instability and volatility. The development of a very competitive medical scheme (health insurance) market reinforced by intermediaries with commercial interests has accelerated trends toward excluding high health risks from cover. The approach taken by the government has been to define a new environment which leaves the market open for extensive competition, but removes from schemes the ability to compete by discriminating against high health risks. The only alternatives left to the private market, policy makers hope, will be to go out of business, or to survive through productivity improvements.

Costs and Cost Analysis↗
PubMedDate not supplied

Indigence and access to health care in sub-Saharan Africa.

Access to health care services for the poor and indigent is hampered by current policies of health care financing in sub-Saharan Africa. This paper reviews the issue as it is discussed in the international literature. No real strategies seem to exist for covering the health care of the indigent. Frequently, definitions of poverty and indigence are imprecise, the assessment of indigence is difficult for conceptual and technical reasons, and, therefore, the actual extent of indigence in Africa is not well known. Explicit policies rarely exist, and systematic evaluation of experiences is scarce. Results in terms of adequately identifying the indigent, and of mechanisms to improve indigents' access to health care, are rather deceiving. Policies to reduce poverty, and improve indigents' access to health care, seem to pursue strategies of depoliticizing the issue of social injustice and inequities. The problem is treated in a 'technical' manner, identifying and implementing 'operational' measures of social assistance. This approach, however, cannot resolve the problem of social exclusion, and, consequently, the problem of excluding large parts of African populations from modern health care. Therefore, this approach has to be integrated into a more 'political' approach which is interested in the process of impoverishment, and which addresses the macro-economic and social causes of poverty and inequity.

Africa South of the Sahara↗
PubMed1999

DNA profiling of Mycobacterium tuberculosis from the Eastern Cape Province of South Africa and the detection of a high level of genetic diversity.

The genetic diversity in 502 isolates of Mycobacterium tuberculosis from the Eastern Cape Province of South Africa was DNA-profiled using random amplified polymorphic DNA sequences generated by four primers, and analyzed using the Dice similarity coefficient and the Ward cluster algorithm. Three major cluster groups and ten clusters were detected and shown to be significant at the five percent level using analysis of molecular variance (AMOVA). It is proposed that the three major cluster groups may represent three different entries of M. tuberculosis into South Africa during colonial times. No significant genetic differences could be detected between the urban and rural populations, suggesting that migration may play an important role in the wide transmission of all strains of the organism found in this province. However, a genetic distinction (p = 0.10) could be detected between rural individuals from the southern, more prosperous, region and the northern, less prosperous, regions of the province, which may represent either a limited migration between distant rural communities or a difference in health treatment historically in the two areas. AMOVA indicates the existence of a higher degree of population structure between drug sensitive and drug-resistant individuals than between urban and rural individuals (p = 0.05). Two clusters, C1 and C3, contained a large proportion of the isolates resistant to between one and three first-line drugs. Isolates resistant to more than three antibiotics were genetically diverse, suggesting that they are as yet not being transmitted at a high rate between individuals.

Antitubercular Agents↗
PubMed1998

The epidemiology of tuberculosis in South Africa.

Reports by reliable observers indicate that tuberculous disease did not occur to any great extent amongst South Africa's indigenous peoples prior to European colonization. Colonization introduced sources of infection and caused rapid urbanization for purposes of commerce and trade. By the start of the 20th century tuberculosis was recognized as a common health problem amongst the Black and Coloured peoples of South Africa. National notification commenced in 1921 and an incidence of 43 per 100,000 rose to 365 per 100,000 in 1958 and declined to 162 per 100,000 in 1986 before rising again to 221 per 100,000 in 1993. High incidences have been consistently recorded amongst the Coloured population of the Western Cape Province: in 1993 713 per 100,000 compared to the national incidence of 225 per 100,000. Using a computerized geographical information system the precise distribution of tuberculosis in two adjacent underprivileged, mainly Coloured communities, with a combined population of 34,000, is being studied. From 1985 to 1994 4044 notified tuberculosis cases gave an incidence of about 1200 per 100,000, varying from 78 to 3150 per 100,000 for the 39 enumerator subdistricts used for census purposes, and was highest in those with the lowest income. Of 5345 housing units 1835 (34%) housed at least one case of tuberculosis and 483 (9%) three or more cases. IS6110 DNA fingerprinting of strains from this community has shown a high degree of strain diversity (209 out of 334 strains evaluated). Clustering, indicative of recent transmission, was found in only 30% of isolates in this high tuberculosis incidence community.

Age Factors↗
PubMed1988

Atypical haplotypes linked to the beta S gene in Africa are likely to be the product of recombination.

We report here the haplotypes of 10 MstII-defined SS patients and a S/beta o thalassemia from the Central African Republic, exhibiting 7 different atypical haplotypes that are different from the typical Bantu haplotype that characterize over 93% of the beta s bearing chromosomes in that region of Africa. Of the seven atypical haplotypes, six can be easily interpreted as the result of recombination around the "hot spot" 5' of the beta gene, between a typical Bantu haplotype and other haplotypes available in the normal population. Except for one case that requires further study, this result demonstrates that the main mutational event leading to sickle hemoglobin in Bantu-speaking Africa was the mutation of the beta gene in a Bantu haplotype background.

Africa↗