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PubMedDate not supplied

Poliomyelitis outbreak in Natal/KwaZulu, South Africa, 1987-1988. 2. Immunity aspects.

An extensive poliomyelitis outbreak due to type 1 poliovirus took place in Natal/KwaZulu, South Africa, in 1987-1988, causing 412 paralytic cases. This epidemic differed from a previously described outbreak in Gazankulu, South Africa, in 1982 in that it occurred against a background of relatively good immunity. Thus, only 12% of patients lacked antibodies to types 2 and 3, indicating lack of previous immunization, and 76% of healthy children sampled in the epidemic area had serological immunity to all 3 types of poliovirus. The occurrence of extensive outbreaks in relatively well-immunized communities emphasizes the need to maximize herd immunity and reduce reservoirs of infection in the gut and in the environment, which can be achieved only with oral polio vaccine.

Antibodies, Viral↗
PubMedDate not supplied

Modelling the efficacy of prophylactic and curative therapies for preventing the spread of tuberculosis in Africa.

Concerns have been raised about whether the interaction between tuberculosis and human immunodeficiency virus (HIV) may lead worldwide to a recrudescent tuberculosis pandemic. These concerns are particularly grave in Africa which has a high prevalence of both tuberculosis and HIV. This study used a computer simulation model to examine the effect of tuberculosis-HIV interactions on tuberculosis prevalence and mortality in Africa. The model then assessed the impact of expanding treatment and chemoprophylaxis programmes on tuberculosis prevalence and mortality over the next decade. In communities where 20% of the population is infected with HIV and 25% receive treatment for tuberculosis, deaths from tuberculosis would be 100% higher than in communities where none of the population is HIV-infected. In a population the size of Uganda's, during one decade there would be approximately an additional 530,000 deaths from tuberculosis. When 50% of patients with active tuberculosis receive treatment, one death will be averted for every 2.5 people who receive treatment. The prevalence of active tuberculosis could be cut by over 90% in a decade by providing effective chemoprophylaxis to 30% of individuals with inactive TB. In conclusion, TB is only one example of a preventable and treatable infectious disease which can be spread through casual contact and which, because of its higher prevalence among the HIV positive population, may lead to a preventable increase in incidence of infection among the general population.

AIDS-Related Opportunistic Infections↗
PubMed1993

No reason for complacency about the potential demographic impact of AIDS in Africa.

Much uncertainty surrounds the likely demographic impact of AIDS in the worst afflicted regions of the developing world such as sub-Saharan Africa. Various research groups have published projections of future trends but these differ widely with respect to potential impact on net population growth rates. Pessimistic forecasts suggest that AIDS may reverse the sign of a 3% to 4% population growth rate before the establishment of HIV, over time periods of a few to many decades. Optimistic forecasts suggest a decline in population growth rates, but predict that a 3% growth rate before AIDS may be reduced by only about 50% over a period of a few decades. This paper reports new analyses of the demographic impact of AIDS, based on observed age-stratified prevalences of HIV-1 infection amongst women of child bearing age. It is assumed that the observed patterns reflect the final endemic state and the implications of this assumption for adult and infant mortality and female reproductive life expectancy are assessed. It is concluded that a variety of scenarios is possible, depending on the detail of assumptions concerning life expectancy before the arrival of AIDS, the incubation period of the disease, and the rate of vertical transmission. Realistic assumptions do suggest, however, that the observed prevalences of infection in the worst afflicted regions of sub-Saharan Africa are sufficient to reduce current population growth rates to close to, or below, zero in the coming decades.

Adolescent↗
PubMed1994

Persistent organochlorine residues in small cetaceans from the east and west coasts of southern Africa.

Organochlorine pollutant levels in the blubber of small cetaceans and ratios between concentrations of compounds, such as DDE/tDDT and tDDT/PCB, were used to identify the chronology of input of DDT and PCB into the coastal waters along the west and east coasts of southern Africa. Although regression analyses, with time as the only independent variable, do not show a statistically significant decline in tDDT from 1980 to 1987 in the common dolphin from the east coast of South Africa, there is a fairly strong indication that tDDT concentrations did not increase or even stay constant with time. tDDT concentrations in the bottlenose dolphin declined significantly from 1980 to 1987 (P < 0.05). The regression analyses for PCB in the bottlenose dolphin from the east coast show no decline (P > 0.05). The data from this study illustrate that it would take a long time in the coastal waters and open ocean before the restriction and prohibition on the production and use of organochlorines will take effect.

Africa, Southern↗
PubMed1991

Cholera in Africa: lessons on transmission and control for Latin America.

In January, 1991, epidemic cholera emerged in Peru and spread to 7 other countries of Latin America. Cholera was introduced 20 years ago to Africa, where it spread rapidly to 30 of the 46 countries of the region and by 1990 accounted for 90% of all cases reported to the World Health Organisation. Many lessons from the cholera epidemic in Africa are relevant to efforts to control the disease in Latin America. Public health practices from the past--quarantine and cordon sanitaire to halt introduction of cholera by travellers, and vaccination and mass chemoprophylaxis to control epidemics--are ineffective in preventing spread of the disease. Cholera can be transmitted not only by contaminated water but also by food. Social phenomena such as mass migrations and burial practices may play a greater role than previously understood. While efforts to prevent the spread of cholera have been ineffective, cholera-associated mortality can be decreased with rehydration therapy. Since the current pandemic is unlikely to retreat soon, new strategies are urgently needed to control the spread of cholera through sanitary and behavioural interventions or improved vaccines.

Africa↗
PubMed1991

Who will operate on Africa's 3 million curably blind people?

About half the 6 million blind people in sub-Saharan Africa have surgically curable cataract. The available manpower and resources can only provide services for less than 10% of the new blind cataract patients each year, and little is being done for the estimated 3 million "cataract backlog". A serious limiting factor to the development of prevention of blindness programmes is lack of trained manpower. Despite an increase in the number of ophthalmologists trained in cataract surgery (which varies greatly from country to country), this number is not keeping pace with increased demand for eye-care services, especially in large rural populations. Initiatives that will help to overcome this dilemma are specific post-graduate courses in community ophthalmology in Africa, plans to develop a one-year diploma in ophthalmology course for English-speaking West African countries, and a proposal to upgrade a similar course in Zimbabwe. Additionally there is a need for the training of more ophthalmic assistants, cataract surgeons, and nurses in the diagnosis and management of common ophthalmic disorders. Experienced expatriate ophthalmologists also have an important role in the teaching of doctors and ophthalmic assistants how to select patients and carry out successful inexpensive cataract surgery with appropriate technology and limited facilities.

Africa↗
PubMed1982

A study of deafness in West Africa.

Some 800 profoundly deaf children from 4 Yoruba states in Nigeria were assessed and examined in an attempt to identify the causes of deafness in this part of West Africa. It was found that measles, meningitis and rubella were the three major preventible diseases causing deafness. Genetic abnormalities, in contradistinction to other tropical countries, do not seem to be very important and chronic ear infections show different manifestations in this area to the situation reported in East Africa. The overwhelming problems that face the deaf and any possible extension of services for the deaf are detailed. In view of these it seems that the most cost-effective way of helping the deaf in Nigeria is by immunizing the population against those infectious diseases that cause the disability. This policy would accord with the recent initiatives by the United Nations: the International Year of the Child (I.Y.C.) and the International Year of the Disabled Person (I.Y.D.P.) as well as The Expanded Programme of Immunization (E.P.I.) of the World Health Organization.

Acoustic Impedance Tests↗
PubMed1989

Liver cell dysplasia accompanying hepatocellular carcinoma in southern Africa. Differences between urban and rural populations.

Liver cell dysplasia (LCD) has been recognised for many years in association with hepatocellular carcinoma (HCC). The presence of LCD relates to cirrhosis, particularly macronodular, as well as HBsAg positivity in many countries. These relationships have not previously been recognised in southern Africa. This study of LCD in 160 rural and urban black patients with proven HCC records a significant difference between the prevalence of dysplasia in rural HBsAg-positive and -negative cases: 75.6% in HBsAg+ individuals vs. 29.4% of those negative for HBsAg (P less than 0.01). Furthermore a significant relationship is reported between dysplasia and macronodular cirrhosis, LCD being observed in 62.9% of those with macronodular cirrhosis vs. 29.5% of non-cirrhotics (P less than 0.001). In addition there was evidence for a relationship between severity of dysplasia and domicile (rural greater than urban), age (being more extensive in younger patients), and ongoing viral replication (82.3% of patients showing the highest grade of dysplasia were found to be serum HBeAg+ and/or tissue HBcAg+ cf. 3.7% with absent or low-grade dysplasia). It is apparent that in southern Africa the presence of dysplasia in HBsAg+ individuals implies that HCC should be actively excluded in these patients and that they should thereafter be carefully monitored for the development of a tumour.

Adult↗
PubMed1983

Health care financing: recent experience in Africa.

The economic realities of health sector development in Africa has been analyzed in this paper. Both the global and national macroeconomic context has been defined. Given the available data, it is clear that most African countries face increasingly serious economic realities, such as slow or even declining economic growth (per capita), a depressed food production situation, severe balance of payments crises, and increasing dependence on external financial assistance. Given the limited but increasingly available 1981 and 1982 data, the economic situation in many countries is more constrained than those indicated by the data contained in this paper. In this context, the potential competitive situation facing governmental health care systems was reviewed. In addition, the diversity in the sources of health expenditures between countries in Africa was highlighted. These data provide clear evidence that governments clearly do not finance the entire health care system and that individual payment for service in many countries represent an important source of revenue for many care providers in various health care systems operating in any given country. The potential for governments to finance either an expansion of or improvements to the government component of their health care systems is then reviewed. The highlights of this analysis include the following points. First, the tax structure in many African countries is highly dependent on export and import duties, which in turn creates dependency on sustained foreign demand for exports.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1983

Ocular needs in Africa: increasing priorities and shrinking resources.

Current demands for ophthalmic treatment services in Africa far outstrip available resources, especially in terms of ophthalmic surgeons. With a few exceptions, the gross national product per capita in African countries is less than US $500. Even in those petroleum economies where the figure is considerably higher, the wealth is grossly inequitably distributed. In a continent whose population is expected to double within 20 years, this means that the ratio of trained health worker to population is expected to become much greater rapidly. The money needed to expand the corps of specially trained health workers at a rate matching the expected population growth rate is non-existent. About 1% of the African population is blind. The three major causes are cataract, trachoma and glaucoma. These involve specific age groups of the population. Cataract, which causes roughly 40% of all blindness, mostly affects the over-60s. This group comprises 5% of the population. Glaucoma occurs mostly over the age of 40, i.e. in about 20% of the population. The trachoma 'reservoir', from which chronic re-infections arise, is the under-15 group, an alarming 42% of the population. The prevalence of trachoma is inversely related to access to safe water, a commodity generally available to less than half of the people in Africa, and especially limited in rural areas. Finally, nutritional blindness and its associated high-mortality protein energy malnutrition (PEM) affects the under-five segment, about 18% of the population.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1983

Surgical treatment of open angle glaucoma is preferable to medical management in Africa.

Primary open angle glaucoma is the third leading cause of blindness in Africa, causing roughly 16% of all blindness and thereby involving approx. 800,000 people on the continent. The overall prevalence and age-group breakdown of the disease is similar to that in industrialized countries, involving almost exclusively people over 40, and rising steadily thereafter with age. Factors such as a generally asymptomatic disease, definitely symptomatic medical treatment, the high cost of drugs and their irregular availability, difficulties in obtaining adequate long term chronic follow-up, and poor patient understanding of the disease all combine to make medical therapy of this condition unacceptable in Africa. Modern surgical techniques are safe, effective, and comparatively cost effective in the treatment of glaucoma. Early surgery is therefore recommended whenever possible.

Africa↗
PubMed1984

Hypothesis of leprosy, tuberculosis and urbanization in Africa.

Leprosy today is a problem of global magnitude affecting possibly up to 15 million people. Its rise and fall in medieval Europe is an historically fascinating enigma. Partial cross-immunization by epidemic tuberculosis, reinforced by the growth of cities, has been proposed as a mechanism in leprosy's European disappearance, but evidence is lacking. In the case of Africa in recent decades, analysis of leprosy and tuberculosis rates, and of levels of urbanization, albeit with imperfect data, suggests a possible environmental health for leprosy, the existence of some cross-interference between tuberculosis and the milder, paucibacillary form of leprosy, and a negative correlation between leprosy and urbanization. It is argued that the rise of the city in Africa, acting through a combination of influences, including tuberculosis, is leading to a decline of leprosy.

Africa↗
PubMed1987

The magnitude of the maternal mortality problem in sub-Saharan Africa.

Estimates of national levels of maternal mortality in sub-Saharan Africa are based on limited and defective data and subject to considerable discussion. In this paper, existing data from several sources are reviewed. The attempt has been made to assess the level of maternal mortality by studying the relative importance of maternal death, health services coverage data, perinatal mortality, causes of maternal death and traditional birth practices. It is concluded that national levels of maternal mortality in sub-Saharan Africa most likely vary from 250 to 700 per 100,000 live births, in proportion to the variation in overall levels of mortality in the countries. There is a need for more studies either based on data from peripheral hospitals or on community surveys. Such studies should analyse coverage of deliveries, coverage of maternal deaths, causes of maternal deaths, socioeconomic differentials, perinatal mortality and should pay special attention to the increasing problem of abortion-related mortality.

Abortion, Induced↗
PubMed1989

Women's health in east Africa.

The MCH/FP services for women in Africa offer today limited services that do not cater to the multiple and complex problems that women face during their long productive lives. Many women are infertile, many suffer and die from abortions, many cannot get access to safe contraceptive technology or safe and sterile delivery services. At the same time women are more stressed than ever before with a proletarianisation process that has left them very often as the sole providers for their households, and with an intensified role in agricultural production. The health needs of women have thus intensified and become increasingly shaped by their growing role in production and in the social reproduction of the household. The paper examines the changing health needs of women in East Africa, why MCH/FP health services have failed to meet these needs, and identifies the types of services that women increasingly require.

Africa, Eastern↗
PubMed1989

Availability of pharmaceuticals in sub-Saharan Africa: roles of the public, private and church mission sectors.

Although the availability of pharmaceuticals is critical for both curative and preventive health care, drugs are, at best, sporadically available in governmental facilities in sub-Saharan Africa. The religious missions and private sectors are more successful than the public sector in obtaining and distributing drugs. The public sector operates under a myriad of constraints inherent in a bureaucracy; the religious missions have the advantages of better management and access to foreign currency; the private sector is innately efficient. Donor assistance to increase the availability of drugs in the public sector has included support for revolving drug funds, national drug services, the improvement of management techniques, and the local production of pharmaceuticals. None of these interventions has been notably successful. In 1987, UNICEF presented The Bamako Initiative--a proposal to launch an internationally-financed fund for essential drugs for sub-Saharan Africa. However, the proposal is unrealistic in anticipating that the requisite resources and/or hard currency can be raised to support the proposal. As the private sector is a more efficient distributor, it is recommended that the private sector be given responsibility for the distribution of drugs. Nonetheless, some governmental controls will be necessary to ensure that essential drugs are available at the least cost to the consumer.

Africa↗
PubMed1989

Violence, conflict and health in Africa.

This study attempts to examine the impact of incessant violence and political conflicts on the development of health services in Africa. Specifically, how do violent activities and conflicts, such as wars, affect health care infrastructures and health policies in Africa? The paper further examines the consequences of violence and conflicts on the health of refugees. The paper concludes that African states would develop better health policies for their citizens in the absence of violence and conflicts.

Africa↗
PubMed1989

Political repression and children in South Africa: the social construction of damaging effects.

This article discusses some dilemmas facing mental health and social service workers studying and providing services for children affected by political repression in South Africa. We argue that it is almost inevitable that progressive care providers are affected by an image of childhood as one of passive innocence and vulnerability, an image which is both outmoded in terms of modern developmental psychology and potentially destructive if the aim of intervention is empowerment. Practical experience with children affected by repression has led us to question commonly held views on the nature of psychological damage, and to recognise that our views on stress tend to be class-bound. Questions of partiality and credibility affect both practical work and the way that social service workers conceive of their role. Without an approach to the understanding of repression which takes account of underlying ideological factors, the social construction of illness and symptoms, and the historical antecedents of current abuses of children in South Africa, we are unable adequately to situate and evaluate critically the work we are doing. Even the focus on children as particular victims of apartheid needs to be thoroughly examined.

Child↗
PubMed1990

Debt crisis, health and health services in Africa.

In the early 1960s when most of Africa became independent, the hope for the resolution of the related problems of poverty, illiteracy and disease became the primary agenda of its sovereign states. There were indeed initial gains in various aspects of social infrastructure, especially education and medical services. Beginning from the mid 1970s, but particularly since 1980, this initial progress is, however, being reversed as Africa totters under an excruciating debt burden and accompanying austerity programmes. This essay provides a kaleidoscope of this ominous decay with particular reference to health and health services. Several proposals for the way forward are discussed.

Africa↗