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PubMed2000

Sexual behavior, heterosexual transmission, and the spread of HIV in sub-Saharan Africa: a simulation study.

A stochastic simulation model has been used to assess the extent to which variation in sexual behavior and transmission characteristics can explain the striking spatial heterogeneity in the prevalence of HIV among different geographical locations in sub-Saharan Africa. Of the various parameters describing sexual behavior the most important determinant of the spread of HIV is the proportion of men engaging in sexual relationships with people other than spouses, including contacts with sex workers and short-term partners. Considering factors other than sexual behavior the model shows that this heterogeneity in HIV prevalence could be the result of differences in the transmission probability of HIV or in the prevalence of other sexuality transmitted diseases. These factors could play a key role in determining the patterns of spread of HIV in sub-Saharan Africa and should be considered in the design of intervention strategies.

Adult↗
PubMed1997

Re-analysis of the hominid radii from Cave of Hearths and Klasies River Mouth, South Africa.

Two of the few postcranial fragments from the late Early Stone Age and/or the Middle Stone Age of southern Africa are the proximal radii from the Cave of Hearths and Klasies River Mouth. The Cave of Hearths fossil is metrically indistinguishable from both archaic (e.g., Neandertals) and recent humans, and presents a mosaic of primitive and modern features. The primitive include a relatively slender neck and thick cortical bone (the latter of which distinguishes recent humans from archaic, Early Modern, and Upper Paleolithic hominids); the modern includes an anteromedially (rather than medially) facing radial tuberosity. Its extreme collo-diaphyseal angle is unusual, although it can be matched by modern homologues. The neck-shaft angle of some Neandetral and Early Modern radii also appears to match that of the Cave of Hearths specimen. The Klasies River Mouth radius also has thick cortical bone of the neck. It is morphologically indistinguishable from Early Modern and Neandertal homologues. These, and other fossils, suggest a mosaic pattern of evolution in the postcranial skeleton of the late Early Stone Age and/or Middle Stone Age inhabitants of sub-Saharan Africa.

Animals↗
PubMed2001

Human mandibular incisors from the late Middle Pleistocene locality of Hoedjiespunt 1, South Africa.

The Hoedjiespunt 1 locality is an archaeological and palaeontological site located on the Hoedjiespunt Peninsula at Saldanha Bay, South Africa. In 1996 two human teeth, a left central mandibular incisor and a left lateral mandibular incisor, were discovered during excavations in the late Middle Pleistocene palaeontological layers. These teeth are described and are found to belong to a single subadult individual. Despite their developmental stage, these incisors already display early signs of wear. Their crown diameters are larger than modern and archaeological African comparative material and are most closely comparable with crown diameters of an early Middle Pleistocene and late Middle Pleistocene dental sample from Africa, Europe and Asia. In the light of this metrical evidence, data on two previously excavated maxillary molars, most probably belonging to the same individual, were re-examined. It was found that the Hoedjiespunt 1 hominid possessed dental metrical features (large anterior teeth and small molars) comparable with other African and European hominids referred to the Middle Pleistocene.

Biological Evolution↗
PubMed2000

Independent introduction of transmissible F/D recombinant HIV-1 from Africa into Belgium and The Netherlands.

Most HIV-1 subtype F viruses described so far have been isolated from individuals originating in South America, Romania, or Central Africa. Previous studies have shown that subtype F viruses from these three areas can be distinguished by phylogenetic tree analysis of various parts of the HIV genome. Subtype F strains circulating in Central Africa and classified as subgroup F2 and F3 have relatively large nucleotide distances from strains of subgroup F1, which includes some African strains, along with strains from Romania and South America. Subtype F strains have now appeared in Europe. In this study, we analyzed the complete gag gene and a large fragment of the pol gene of seven strains of African origin that represent the three F subgroups. At least five of the seven strains appear to be intersubtype recombinants. Of four strains circulating in Belgium and the Netherlands, three were F/D mosaics and the fourth harboured a G(gag)/GH(pol)/F3(env) recombinant structure. Two of the three F/D mosaics showed identical breakpoints and were independently introduced in Belgium and the Netherlands. At least two of the mosaics were further transmitted. The remaining three strains of the seven we studied were isolated from individuals in Cameroon. Two included large or smaller F1 fragments in gag and pol. The third strain was subtype D along the entire gag and pol fragment. A parental African subtype F that showed no evidence for recombination was not found.

Africa↗
PubMed2001

Molecular and phylogenetic analyses of 16 novel simian T cell leukemia virus type 1 from Africa: close relationship of STLV-1 from Allenopithecus nigroviridis to HTLV-1 subtype B strains.

A serological survey searching for antibodies reacting with human T-cell leukemia virus type 1 (HTLV-1) antigens was performed on a series of 263 sera/plasma obtained from 34 monkey species or subspecies, originating from different parts of Africa. Among them, 34 samples exhibited a typical HTLV-1 Western blot pattern. Polymerase chain reaction was performed with three primer sets specific either to HTLV-1/STLV-1 or HTLV-2 and encompassing gag, pol, and tax sequences, on genomic DNA from peripheral blood mononuclear cells of 31 animals. The presence of HTLV-1/simian T-cell leukemia virus type 1 (STLV-1) related viruses was determined in the 21 HTLV-1 seropositive animals tested but not in the 10 HTLV-1 seronegative individuals. Proviral DNA sequences from the complete LTR (750 bp) and a portion of the env gene (522 bp) were determined for 16 new STLV-1 strains; some of them originating from species for which no STLV-1 molecular data were available as Allenopithecus nigroviridis and Cercopithecus nictitans. Comparative and phylogenetic analyses revealed that these 16 new sequences belong to five different molecular groups. The A. nigroviridis STLV-1 strains exhibited a very strong nucleotide similarity with HTLV-1 of the subtype B. Furthermore, four novel STLV-1, found in Cercocebus torquatus, C. m. mona, C. nictitans, and Chlorocebus aethipos, were identical to each other and to a previously described Papio anubis STLV-1 strain (PAN 503) originating from the same primate center in Cameroon. Our data extend the range of the African primates who could be permissive and/or harbor naturally STLV-1 and provide new evidences of cross-transmission of African STLV-1 between different monkey species living in the same environment and also of STLV-1 transmissions from some monkeys to humans in Central Africa.

Africa↗
PubMed2001

Diabetes in sub-Saharan Africa.

NCDs including diabetes, heart disease and stroke are global epidemics of the 21st century. The greatest burden on health will be in developing countries and sub-Saharan Africa is an area of major challenge: We are concerned with planning for the adult victims of the new epidemic and this includes the development of appropriate treatment. Therapy should be cost effective and evidence on the economics of treating chronic conditions in Africa is urgently required. Finally, health promotion, primary prevention and health screening strategies for chronic diseases such as diabetes, stroke and coronary heart disease are required.

Africa South of the Sahara↗
PubMed2002

The role of birds in the ecology of West Nile virus in Europe and Africa.

Surveys on wild birds conducted during the last two decades in Europe, notably Poland and the Czech Republic, to determine their infection rate with WN virus have revealed endemic foci of infection. Some species of seropositive birds were nonmigrators while others were hatchlings of migrating species. Persistently infected avian reservoirs are potential sources of viruses for mosquitoes that multiply in the temperate European zone in hot, wet summers. In the past, evidence for geographical circulation of WN viruses was based on antigenic analysis of strains from different countries while more recent epidemiological studies have relied on analysis of nucleotide sequences of the envelope gene. With the reappearance of epidemic WN fever in European countries, interest has been focused once again on the African origin of the causal agent carried by migrating wild birds. In some epidemics, isolates were made from human cases or mosquitoes and only serologic evidence for infection was available from domestic and wild bird populations. In this respect the unusual findings of anti-WN virus antibodies in a population of storks maintained in northern Germany could be interpreted as evidence for local infection. The unique susceptibility of young domestic geese in Israel in 1997-2000 to WN virus and the isolation of similar strains from migrating White storks in Israel and Egypt suggest that the recent isolates are more pathogenic for certain avain species and that migrating birds do play a crucial role in geographical spread of the virus. Knowledge of the routes taken by birds migrating between Africa and Europe will therefore help in selecting sites where attempts to isolate viruses will be most fruitful. The appearance of the disease in western European equine populations (Italy and France) requires that other birds and their migratory routes be investigated once more. It remains to be determined whether the European endemic foci of WN virus are in themselves sources of infection for other birds that migrate across Europe and do not necessarily reach sub-Saharan Africa. If this is the case it will be necessary to define the strategies for detection of virus overwintering in the European temperate climate.

Africa↗
PubMed1987

Primary eye care in rural sub-Saharan Africa.

Primary eye care in rural sub-Saharan Africa is reviewed. In the context of eye care delivered by village health workers (VHW's) living in and supported by the community, such a system of health care does not exist in Africa today. There are no VHW's, and primary health care is currently a matter of experimentation and conjecture only. However, most basic eye care is rendered by non-ophthalmologists; such care consists of screening, treatment of infections and inflammations, and in some cases, cataract surgery. Lower levels of non-ophthalmic general health workers are being tasked to promote measures to prevent trachoma and xerophthalmia/nutritional blindness by intervention at the village level. Preliminary results of such programs are encouraging, and warrant further evaluation and expansion.

Africa↗
PubMedDate not supplied

Health care provision and surgical education in South Africa.

Apartheid policies have led to inequalities in the delivery of health care and the training of surgeons in South Africa. The nation's population of 33 million is comprised of 73.6% Blacks, 14.8% Whites, 8.8% Coloureds, and 2.7% Asians. Only 17% of the population are covered by medical insurance (78% of Whites, 28% of Asians, 26% of Coloureds, 4% of Blacks) that funds the private sector which accounts for 46% of the nation's total health care expenditure of 9.2156 million rand. The remainder receive care from curative state hospital based services, which consume 77% of the public expenditure on health. Preventive and promotive health services account for 23%. Only 3.2% of South Africa's gross national product is spent on health care provision for 80% of the population--well short of the World Health Organization's recommendation of 5.8%. This figure translates into a per capita expenditure of 138, 340, 356, and 597 rands for Blacks, Coloureds, Asians, and Whites, respectively. Eight medical schools produce just over 900 graduates per year, 80% of whom are white. The medium of instruction is English at five (Cape Town, Witwatersrand, Natal, MEDUNSA, and Transkei) and Afrikaans at three (Pretoria, Stellenbosch, and Bloemfontein). Natal and MEDUNSA are creations of apartheid and have graduated almost all the Black South African doctors, of whom only 15 are practicing surgeons. Many universities are cognizant that dramatic change is needed to redress such imbalances, and admission policies are changing.(ABSTRACT TRUNCATED AT 250 WORDS)

Delivery of Health Care↗
PubMed1988

Diabetic eye disease in Central Africa.

Six hundred African diabetic patients were examined using a standardised technique based on the World Health Organisation Multinational Study, in which no country from Africa was represented. Thirty-four percent of patients had retinopathy and 13% were affected by cataract. They were older and the duration of diabetes was longer than patients without retinopathy or cataract. There was no association with glycaemic control. Systolic blood pressure was higher in patients with retinopathy but there was no association with diastolic pressure. Only one patient had proliferative retinopathy and blindness compared to 25 (4.2%) patients blinded by cataract. In Central Africa cataract is a more important cause of blindness and visual disability than retinopathy.

Adult↗
PubMed1989

Origin of the hemagglutinin on A/Equine/Johannesburg/86 (H3N8): the first known equine influenza outbreak in South Africa.

A severe influenza outbreak occurred in horses in South Africa in 1986. The causative agent was identified as an influenza virus [A/Equine/Johannesburg/86 (H3N8)]. Antigenic analyses of the hemagglutinin (HA) with ferret antisera and monoclonal antibodies showed that the Eq/Johannesburg/86 virus is similar to recent equine H3 viruses. The nucleotide sequence analysis on the HA genes of Eq/Johannesburg/86 and other equine H3 influenza viruses, together with the epidemiological data, clearly demonstrated that the Eq/Johannesburg/86 virus was derived from a virus that had been circulating in horses in the United States in 1986-87. The epidemiological information suggests that the unusually severe influenza outbreak in South Africa may be due to the lack of immunity to these viruses in the horse population.

Amino Acids↗
PubMed1979

Scaling sex attitudes and behavior in South Africa.

Sex attitudes and behavior were scaled according to Guttman scale criteria among 300 members of the public, students, and nurses in Johannesburg, South Africa, replicating the central features of earlier studies conducted in the United States. The study presents an initial attempt to establish norms of sex attitudes and behavior in South Africa. The scales are shown to provide reliable tools for sex research and clinical practice.

Attitude↗
PubMed1994

Serologic evidence for human ehrlichiosis in Africa.

Human ehrlichiosis is a recently recognized rickettsial disease. It is caused by Ehrlichia chaffeensis, an intraleucocytic Gram-negative, obligate intracellular bacterium, grouped within the genus Ehrlichiae. Most human cases of ehrlichiosis have been diagnosed in the USA. Two cases have been reported outside of the USA, one in Europe and one in Africa. From 1 January to 30 June 1992, 765 sera from blood donors or other asymptomatic subjects in 8 African countries, including Ivory Coast, Burkina Faso, Mali, Central African Republic, Angola, Zimbabwe, Mozambique and Commores Islands, were tested by indirect immunofluorescence for the presence of E. chaffeensis antibodies. Positive sera were confirmed by Western immunoblotting. Only two of 765 sera tested were positive. One serum obtained from Burkina Faso had an IgG titer of 1:200 and one from Mozambique had an IgG titer of 1:80. Human ehrlichiosis seems to occur infrequently in Africa, although many more sera from additional African countries need to be evaluated.

Africa↗
PubMed1987

Control of cattle mange in southern Africa using ivermectin.

Seven trials including 768 cattle were conducted in South Africa and Namibia to evaluate the efficacy of the systemic parasiticide ivermectin when administered subcutaneously at a dose rate of 200 micrograms/kg against sarcoptic (Sarcoptes scabiei var. bovis), chorioptic (Chorioptes bovis) and psoroptic (Psoroptes ovis var. bovis) mange mites. The efficacy of a single treatment against Psoroptes and Sarcoptes was greater than against Chorioptes. There was marked clinical cure in all treated cases with loss of crusts and hair regrowth. The number of cases of psoroptic mange in two large herds, of which 42.4% of 724 animals were clinically affected prior to mass treatment, was reduced by 99.3% following a single subcutaneous treatment with ivermectin; a single animal from which mites were recovered may not have been treated. The apparent prevalence and prospects for control and eradication of cattle mange in South Africa and Namibia are discussed.

Administration, Oral↗
PubMed1996

The control of heartwater in west Africa--present and future.

Heartwater (HW) is the name given to the acute, febrile disease of ruminants caused by infection with the obligate intra-cellular rickettsia Cowdria ruminantium. The effect of losses associated with HW and dermatophilosis are an important constraint to the sustainable use of non-indigenous breeds, but recent advances in heartwater and dermatophilosis research provide optimism that integrated control of these conditions can be achieved in west Africa. The relevant advances in HW research are in methods for monitoring the status of animals at risk of developing heartwater, which allow the veterinarian and owner to identify control strategies for herds and individual animals, and developments in the field of vaccination. This paper seeks to provide information that may assist the veterinary services in west Africa in assessing and identifying opportunities for HW control. Recommendations for the activities of key institutions place an emphasis upon the isolation and identification of west African strains of Cowdria for inclusion in inactivated or live vaccines, and the need for donor support to enable field trials of integrated control methods for HW and dermatophilosis.

Africa, Western↗
PubMed2003

Genetic diversity of oil palm (Elaeis guineensis Jacq.) germplasm collections from Africa: implications for improvement and conservation of genetic resources.

A total of 723 accessions of oil palm ( Elaeis guineensis Jacq.) from 26 populations representing ten countries in Africa and one Deli dura family were screened for allelic variation at seven enzyme loci from six enzyme systems using starch gel electrophoresis. On average, 54.5% of the loci were polymorphic (0.99 criterion). The average and effective number of alleles per locus was 1.80 and 1.35, respectively. Mean expected heterozygosity was 0.184, with values ranging from 0.109 (population 8, Senegal) to 0.261 (population 29, Cameroon). The genetic differentiation among populations was high (F(ST)=0.301), indicating high genetic divergence. The calculation of F(ST) by geographic zones revealed that the high F(ST) was largely due to F(ST) among populations in West Africa, suggesting diversifying selection in this region. The mean genetic distance across populations was 0.113. The lowest genetic distance (D) was observed between population 5 from Tanzania and population 7 from the Democratic Republic of the Congo (0.000) and the highest was found between population 4 from Madagascar and population 13 from Sierra Leone (0.568). The total gene flow across oil palm populations was low, with an Nm of 0.576, enhancing genetic structuring, as evident from the high F(ST) values. UPGMA cluster analysis revealed three main clusters; the western outlying populations from Senegal and Sierra Leone were in one cluster but separated into two distinct sub-clusters; the eastern outlying populations from Madagascar were in one cluster; the populations from Angola, Cameroon, The Democratic Republic of the Congo, Ghana, Tanzania, Nigeria and Guinea were in one cluster. The Deli dura family seems to be closely related to population 6 from Guinea. Oil palm populations with high genetic diversity-i.e. all of the populations from Nigeria, Cameroon and Sierra Leone, population 6 of Guinea, population 1 of Madagascar and population 2 of Senegal should be used in improvement programmes, whereas for conservation purposes, oil palm populations with high allelic diversity (A(e)), which include populations 22 and 29 from Cameroon, populations 39 and 45 from Nigeria, population 6 from Guinea, populations 5 and 13 from Sierra Leone and population 1 from Madagascar should be selected for capturing as much genetic variation as possible.

Africa↗
PubMed2006

Suicide mortality in South Africa: a city-level comparison across socio-demographic groups.

BACKGROUND: South Africa offers a valuable study environment to assess the impact of political and social changes on health. Increasing urbanisation has led to a focus on city development and its effect on its residents. The study assesses whether sex- and race-specific suicide rates differ across six of South Africa's major cities. Regional differences may reflect varying contextual and individual underlying mechanisms. Those need to be understood for appropriately targeted prevention efforts. METHODS: Suicide mortality data (n=4,946) for the six cities between 2001 and 2003 were used to assess whether there are differences in rates for age-standardised race and sex groups across cities and whether these differences are constant across cities. The overall age-standardised rates for the six cities was 25.3/100,000 for men and 5.6/100,000 for women. RESULTS: Suicide rates are most often highest among whites and men, but both the magnitude and distribution of suicide vary considerably for different race and sex groups within and across cities. There is a strong association between the method of suicide used and the city. CONCLUSIONS: Despite some common trends in the suicide profile across South African cities, city does matter for the magnitude and distribution of suicide mortality across race and sex groups and for the method of suicide used. The need for locally based suicide research investigating possible reasons for these differences is highlighted.

Adult↗
PubMed2006

Norms for mental health services in South Africa.

BACKGROUND: In the aftermath of apartheid, South Africa has inherited a fragmented, under-resourced and inequitable public sector mental health service. Attempts are being made to reform mental health services, in keeping with new health policy, which proposes the downscaling of psychiatric institutions and the development of community-based services. This study set out to develop a set of service norms for the care of people with severe psychiatric conditions (SPC) in South Africa, to assist the implementation of the new policy. METHODS: A national situation analysis of current public sector mental health services was conducted. A model was developed for estimating the mental health service resource needs of people with SPC. Following consultation with provincial stakeholders, a set of service norms were developed taking into account national indicators from the situation analysis (as a baseline level) and proposals of the model (as a target level). RESULTS: The study recommends an increase in the number of acute psychiatric beds in general hospitals; development of community-based residential care; redistribution of staff from hospital to community services, particularly in rural areas; and the development of information systems to monitor the transitions to community-based care. CONCLUSIONS: The norms proposals presented in this study express mental health service needs in terms of quantifiable service resource and utilisation levels. In doing so, the study attempts to make explicit the assumptions and values on which planning is based.

Community Mental Health Services↗