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PubMed2005

Stroke prevention, treatment, and rehabilitation in sub-saharan Africa.

Stroke is emerging as a leading cause of preventable death and disability in adults in many developing nations. In Sub-Saharan Africa (SSA), stroke mortality and case fatality in some countries exceed those in the developed world. Stroke also occurs at much earlier ages in SSA, resulting in a greater number of years of potential life lost. The high social and economic burden of stroke calls for effective strategies for prevention, treatment, and rehabilitation in SSA. High blood pressure is the most powerful predictor of stroke, and its treatment can reduce the risk of stroke by > or = 40%. Effective stroke prevention calls for comprehensive risk reduction including blood pressure control. Population-based health education programs and appropriate public health policy coupled with high-risk strategies targeting hypertensive persons and stroke patients must be developed. A broad partnership of key players, innovative funding mechanisms, and increased national and international commitment for the prevention and control of stroke in sub-Saharan Africa and other developing countries is needed.

Africa South of the Sahara↗
PubMed2005

[Role of Musca domestica in the transmission of multiresistant bacteria in the centres of intensive care setting in sub-Saharan Africa].

OBJECTIVE: The houseflies (Musca domestica -MD) are involved in the transmission of the diseases of the faecal danger in subsaharan Africa. What is their role in the transmission of multiresistant bacteria in an intensive care setting in Dakar? TYPE OF STUDY: Descriptive, forward-looking. MATERIALS AND METHODS: The study was conducted from May 1 to September 30, 2003. During this period a flytrap was put above every patient carrier of BMR (methicillin resistant Staphylococcus, extended spectrum beta-lactamases-enterobacteria, ticarcillin resistant Pseudomonas). Caught MD were carried to the microbiology laboratory and incubated in heart-brain broth at 37 degrees C for 18 hours. Then selective gelose platers were used for identification of bacteria. Comparison of antibiotic sensitivities of bacteria isolated from MD and from the patients was made. RESULTS: Out of 441 hospitalized patients, 26 were colonised or infected by BMR. Human pathogenic microorganisms were obtained from 99 out of 120 flies. Seventeen of those flies were carried of BMR. Six among these 17 flies had BMR with sensitivity profile and phenotype of resistance identical to those of the patients under the trap with birdlime. More 3 MD carried BMR BLSE not found on our patients. CONCLUSION: This study shows that the MD can carry BMR. Their participation in the crossed transmission, between patients, of multiresistant bacteria in intensive care setting, must be discussed. The eradication of the MD in our Africa subsaharan services must be looked for.

Adolescent↗
PubMed2006

A systematic literature review of tobacco use among adults 15 years and older in sub-Saharan Africa.

BACKGROUND: Given that developing countries (and particularly women in these countries) are at increasing risk for tobacco use, the need for hard data to accurately monitor tobacco use in developing countries is needed. The purpose of this review is to synthesize the available prevalence data on current tobacco use among adults in sub-Saharan Africa (SSA). METHODS: Several databases were systematically searched for articles published in peer-reviewed journals at any time during the last century to mid-2005. The search resulted in the retrieval of 54 articles in which the current use of tobacco, cigarettes, cigars and snuff were reported. They were conducted in 14 of the 48 SSA countries. RESULTS: Cross-country comparisons revealed that the prevalence, and intensity (frequency and/or quantity) of tobacco use was higher among males compared to females across all countries. Certain racially classified social groups in South Africa were at increased risk for tobacco use. Males aged between 30 and 49 years used tobacco at higher rates than those younger or older than this age range. Among females, prevalence rates of smoked tobacco use increased steadily with age. There was no clear pattern regarding socio-economic status (SES) or urban/rural differences. The onset of tobacco use mostly occurs in late adolescence or early adulthood. CONCLUSIONS: While in many SSA countries the prevalence of tobacco use among adults is relatively low compared to developed and other developing countries, prevention, interventions and policies should work towards reducing these levels by targeting the at risk populations identified from this review.

Adolescent↗
PubMed2005

Reductions in blood lead levels among school children following the introduction of unleaded petrol in South Africa.

Epidemiological studies have indicated that in the 1980s and early 1990s (a period in which petrol lead concentrations in South Africa ranged from 0.836 to 0.4 g/L), large proportions of urban South African children were at risk of excessive exposure to environmental lead. In 1991, when the maximum permissible petrol lead concentration in the country equaled 0.4 g/L, a study determined that the mean blood lead level among children attending inner city schools in the Cape Peninsula equaled 16 microg/dL, with well over 90% of children having blood lead levels equaling or exceeding the internationally accepted guideline level of 10 microg/dL. Socio economic status, housing conditions, and proximity of children's schools and homes to heavily trafficked roads were among the factors significantly associated with blood lead concentrations. In 1996, unleaded petrol was introduced in South Africa. A study undertaken in 2002 (at the same schools as in 1991), when unleaded petrol constituted around 30% of the market share of petrol in the country, has shown significant reductions in the mean blood lead concentration among Cape Peninsula inner city children and in the proportion of children with elevated blood lead levels. The mean blood lead level for the total sample (n = 429) of children whose mean age equaled 7 years (range: 5-11 years) was 6.4 microg/dL (range: 1.0-24.5 microg/dL) and 10% of children had blood lead levels equalling or exceeding 10 microg/dL. The mean blood lead levels among children attending schools in an inner city and in a less heavily trafficked periurban suburb were 6.9 and 4.8 microg/dL, respectively.

Child↗
PubMed2004

Nine-locus Y-chromosome STR profiling of Caucasian and Xhosa populations from Cape Town, South Africa.

Y-chromosome STR markers are not widely used in forensic case work in South Africa. To begin assessing the forensic value of these markers in South Africa, samples were collected from 100 English-speaking Caucasian males and 99 Xhosa males, living in the Cape Town metropolitan area. Allele and haplotype frequencies were determined for nine Y-chromosome STR loci (DYS19, DYS389-I, DYS389-II, DYS390, DYS391, DYS392, DYS393, and the duplicated locus DYS385). Unique haplotypes were obtained for 47 Xhosa males and 66 Caucasians.

Chromosomes, Human, Y↗
PubMed2006

Population data on the AmpF/STR Identifiler loci in Africans and Europeans from South Africa.

Allele frequencies of 15 short tandem repeat (STR) loci, D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA, were determined for 98 unrelated Africans from South Africa and 98 unrelated Europeans from South Africa using the AmpFlSTR Identifiler PCR amplification kit. The genotype frequency distributions of the 15 STR loci were in the Hardy-Weinberg equilibrium for both populations.

Black People↗
PubMed2006

CTX-M-37 in Salmonella enterica serotype Isangi from Durban, South Africa.

Beta-lactamase-mediated resistance was investigated in 59 putative extended-spectrum beta-lactamase (ESBL)-positive Salmonella spp. from the paediatric ward of a tertiary hospital in Durban, South Africa. Three Salmonella enterica serotype Isangi cultured from stool samples were multidrug resistant, with susceptibility only to meropenem, piperacillin/tazobactam and cefoxitin. Isoelectric focusing revealed beta-lactamases with isoelectric points of pI 5.8, 6.8 and 7.2. Sequencing identified beta-lactamases CTX-M-37 and TEM-1. To our knowledge, this is the first report of CTX-M-37 from S. enterica serotype Isangi in South Africa.

Anti-Bacterial Agents↗
PubMed2006

Mapping the emergence of heart disease in a black, urban population in Africa: the Heart of Soweto Study.

BACKGROUND: There is increasing evidence that many populations in the developing world are in "epidemiologic transition" with the subsequent emergence of more "affluent" disease states. The "Heart of Soweto Study" will systematically investigate the emergence of heart disease (HD) in a large urban population in South Africa. METHODS: Part of the conurbation of Johannesburg, South Africa, Soweto is a predominantly Black African community of 1 million individuals. During an initial two year period, all individuals presenting to the local Baragwanath Hospital (3500 beds) with any form of HD will be studied. Demographic and diagnostic coding data in those with pre-established HD will form an abbreviated clinical registry of >12,000 "prevalent" cases. Similarly, socio-demographic, clinical and diagnostic data (e.g. echocardiography and ECG) in newly diagnosed patients will form a more detailed clinical registry of >5000 "incident" cases. Sub-studies of the relationship between HIV status and HD and the optimal management of chronic heart failure will also be performed. RESULTS: These data will provide a unique insight into the causes and consequences of a broad spectrum of HD-related conditions in a "developing world" community in epidemiologic transition. Initially documented population rates, in addition to detailed examinations of the underlying risk factors and causes of HD-related morbidity/mortality will provide an important platform for future stages of the study: a community-based, population screening program and culturally specific primary and secondary programs of care. CONCLUSION: There is an urgent need to systematically track the emergence of HD in the developing world. Initially involving more than 15,000 individuals, the unique Heart of Soweto Study has the potential to provide a wealth of information in this regard.

Black People↗
PubMed2006

Orthopaedic trauma workload in the former homeland of the Transkei, South Africa.

The Bedford Orthopaedic Centre is situated in Umtata at the heart of the former homeland of the Transkei in the Eastern Cape of South Africa. It acts as an orthopaedic and trauma referral hospital for a mainly rural population approaching 4 million. This article focuses on the workload of the hospital over a 4-month period and like many hospitals in South Africa we highlight the difficulties it faces with the trauma epidemic.

Accidents, Traffic↗
PubMedDate not supplied

Children's rights in the context of HIV/AIDS in Southern Africa.

Children in Southern Africa are living under extreme, difficult circumstances because of the spread of HIV/AIDS. Protecting and enhancing the rights of children can be regarded as an investment in the future. The principles identified in the World Fit for Children document from the United Nations International Children's Emergency Fund, within the context of HIV/AIDS, were used as a theoretical framework for a study conducted in one of the provinces of South Africa. A survey was conducted as a collaborative research project to map out critical trends regarding the fulfillment of children's rights, patterns, and structures of services available and the identification of capacity gaps. Right holders and duty bearers were interviewed, area surveys were conducted, and field observations were performed to determine data. Recommendations were made to raise the awareness of children's rights and to mobilize the community into action. To realize children's rights, emphasis must be placed on physical survival, development, and protection. Duty bearers should recognize and accept their responsibilities to establish, facilitate, manage, and/or control plans of action to address the devastating consequences of HIV/AIDS. Children should be empowered with knowledge, skills, and awareness to engage in and claim their rights.

Adolescent↗
PubMed2006

Changes in fuelwood use and selection following electrification in the Bushbuckridge lowveld, South Africa.

Fuelwood is the primary energy source for domestic purposes throughout the developing world, in both urban and rural environments. Due to the detrimental impacts of biomass use on human and environmental health, many governments have sought to reduce its use through provision of potentially cleaner energies, of which electricity is the dominant form. Yet there are surprisingly few studies of changes in fuelwood use following the introduction of electricity, especially in rural areas of Africa. This paper reports on a longitudinal study of fuelwood use, using identical approaches, in five rural villages in the Bushbuckridge region of South Africa, spanning the period over which electricity became widely available. Almost a decade after the introduction of electricity, over 90% of households still used fuelwood for thermal purposes, especially cooking, and the mean household consumption rates over the 11-year period had not changed, even with a policy of 6 kWh per month of free electricity. The proportion of households purchasing fuelwood had increased, probably in response to a number of factors, including (i) increased fuelwood scarcity in the local environment as reflected by increased fuelwood collection times, changes in fuelwood species preferences, and ranking of scarcity by local collectors, and (ii) increases in the price of fuelwood well below that of other fuels and the prevailing inflation rate. Overall, there was an increase in the number of species harvested over the 11-year period. The implications of these findings for rural energy provision are discussed.

Cooking↗
PubMed2005

Riding the wave: South Africa's contribution to ethnopharmacological research over the last 25 years.

South Africa is a country with both rich floral biodiversity and cultural diversity. Traditional herbal medicines form an important part of the healthcare of most South Africans, and relies heavily on the use of indigenous plants. This article briefly describes the role South Africa has played in recent years, in contributing to the worldwide increase in research in the field of ethnopharmacology.

Ethnopharmacology↗
PubMed2005

The commercial harvest of devil's claw (Harpagophytum spp.) in southern Africa: the devil's in the details.

Devil's claw is the common name for two species in the genus Harpagophytum. Their root extracts contain the iridoid glycoside, harpagoside, which has been found to be effective in the treatment of degenerative rheumatoid arthritis, osteoarthritis, tendonitis, kidney inflammation, and heart disease. Most of the world's supply comes from Namibia, with lesser amounts from South Africa and Botswana. In 2002, the peak year of export, 1018 tonnes of dried tubers were exported from southern Africa, representing the harvest of millions of plants. In 2001, sales in Germany were estimated at 30 M euros, accounting for 74% of the prescriptions for rheumatism. Harvest has improved income levels in marginalized communities but it has also raised questions of sustainability. In 2000, recommendations were made to the Convention on the International Trade in Endangered Species (CITES) to add devil's claw to Appendix II. In 2004, the proposal was formally withdrawn due to the efforts of the range states to address sustainability issues. Replacing wild collection with cultivation has generated a debate on the positive and negative effects on harvester income and rural farmers. Successful cultivation efforts have involved micropropagation techniques and growing the plant without water or fertilizers. The governments of the main range states are working with local communities to develop policies and regulations to protect the species and to determine a sustainable harvest.

Africa↗
PubMed2005

Medicinal plant use in the Bredasdorp/Elim region of the Southern Overberg in the Western Cape Province of South Africa.

There are many individuals in the Bredasdorp/Elim area who still use plants as medicines to treat many conditions. This study aimed to document some of this knowledge and present an inventory of all the plants in use in the area. Over 40 individuals were interviewed from old age homes, community centres for the elderly as well as people who were known for their knowledge in this matter. The information was gathered by means of questionnaires. In total, 36 plant species from 19 families were found to be in general use in the area. Only 58% of these plants are indigenous to South Africa, 33% are introduced species and 9% are naturalized species. The dominant families were Asteraceae, Lamiaceae, Alliaceae and the Solanaceae. Many of the plants in use are commonly used in traditional medicine around South Africa and share many of the same uses. Some uses, which have not been seen in the consulted literature, have also been documented. A more structured questionnaire was used to determine which plants were most popular for particular ailments. It was found that Artemisia afra and Ruta graveolens were the most popular.

Aged↗
PubMed2004

Occurrence of Theropithecus sp. in the Late Villafranchian of Southern Italy and implication for Early Pleistocene "out of Africa" dispersals.

Three cervical vertebrae of a large primate have been identified in the revision of the faunal assemblage collected during the late '70s from fissure fillings in the area known as Pirro Nord in southern Italy. By size the three vertebrae are comparable to the large fossil species Theropithecus oswaldi, however we prefer here to attribute the remains to Theropithecus sp. The Pirro Nord Theropithecus represents the second finding outside of Africa of this genus in association with Megantereon whitei, after the site of 'Ubeidiya. The biochronology of Pirro Nord faunal assemblage demonstrates that the arrival into Europe of Theropithecus occurred earlier than thought: in the range of approx 1.6-1.3 Ma. The identification of an European "African assemblage" (Theropithecus associated with Megantereon whitei) has consequences for interpretation of an "out of Africa" (genus Homo) event around the Plio-Pleistocene transition.

Africa↗
PubMed2006

Plio-Pleistocene climatic change in the Turkana Basin (East Africa): evidence from large mammal faunas.

We investigated palaeoclimatic change in the Turkana Basin during the Pliocene climatic shift toward increased aridity in Africa. We analyzed the palaeoecology of this area using mammal faunas as environmental indicators. Twenty Plio-Pleistocene fossil assemblages and a comparative dataset of 16 modern localities covering a wide range of climatic and ecological conditions across Africa were analyzed. We constructed community profiles using taxonomic variables which reflect ecological information. Principal component analysis and bivariate correlation were used to study changes in the community structure of these mammalian faunas and to draw palaeoenvironmental inferences. Subsequently, least-squares regressions yielded climatic estimates (annual rainfall and drought length) for the studied period. An additional set of 8 modern faunas was used to validate these regression models. The climatic estimates showed a drying trend throughout the sequence. The biomes in the Turkana Basin changed from semi-evergreen rain forest to deciduous woodland and savanna during the middle-late Pliocene. This was the most important climatic shift detected in our study. Evidence suggests a continuous presence of savannas from 2.5 million years ago onwards. This pattern of climatic change is consistent with isotopic evidence on global climate, and with independently derived regional palaeoenvironmental evidence (i.e., micromammals, palaeovegetation, soil carbonates and palaeosols).

Africa, Eastern↗
PubMed2006

The mammalian fauna associated with an archaic hominin skullcap and later Acheulean artifacts at Elandsfontein, Western Cape Province, South Africa.

The Elandsfontein site, Western Cape Province, South Africa, is well known for an archaic hominin skullcap associated with later Acheulean artifacts. The site has also provided nearly 13,000 mammalian bones that can be identified to skeletal part and taxon. The assemblage derives from 49 species, 15 of which have no historic descendants. Comparisons to radiometrically dated faunas in eastern Africa indicate an age between 1 million and 600 thousand years ago. Unique features of the fauna, including the late occurrence of a dirk-toothed cat and a sivathere, may reflect its geographic origin in a region that was notable historically for its distinctive climate and high degree of biotic endemism. Together, taxonomic composition, geomorphic setting, and pollen extracted from coprolites indicate the proximity of a large marsh or pond, maintained by a higher water table. The small average size of the black-backed jackals implies relatively mild temperatures. The sum of the evidence places bone accumulation during one of the mid-Pleistocene interglacials that were longer and cooler than later ones, including the Holocene. The geomorphic context of the fauna presents no evidence for catastrophe, and most deaths probably resulted from attritional factors that disproportionately killed the young and old. However, only the dental-age profile of long-horned buffalo supports this directly. Field collection methods biased skeletal-part representation, but originally, it probably resembled the pattern in the younger, marsh-edge Acheulean occurrence at Duinefontein 2, 45 km to the south. Excavation there exposed multiple vertebral spreads, which probably mark carcasses from which hominins or large carnivores removed the meatier elements. Bone damage at both sites suggests that, despite abundant artifacts, hominins were much less important than carnivores in the bone accumulation. Together with limited observations from other sites, Elandsfontein and Duinefontein provisionally suggest that Acheulean-age hominins obtained few large mammals, whether by hunting or scavenging.

Animals↗
PubMedDate not supplied

Mothers, midwives, and HIV/AIDS in Sub-Saharan Africa.

This article reviews clinical and program issues in the prevention of mother to child transmission (PMTCT) of HIV in sub-Saharan Africa. Topics include prevention of infection, voluntary counseling and testing, prenatal care, labor and birth, postpartum, family planning, infant feeding, and the role of traditional birth attendants. Programs providing short-course antiretroviral therapy to prevent infant infection are contrasted with comprehensive programs offering antiretroviral therapy and medical care to mothers, children, and families. Feminization of the epidemic is related to gender inequalities that facilitate the spread of HIV and make pregnant women an especially vulnerable group. Nurses and midwives are the primary health care providers for most of the population in sub-Saharan Africa. They are the backbone of the new PMTCT programs and will be the largest group of health workers available to diagnose and treat opportunistic infections and dispense antiretroviral therapy. But they have received little training and support to provide AIDS care and treatment and are rarely consulted when plans are made about workforce issues and capacity development in the health sector. Clinical training, leadership skills, salary support, expansion of the nursing workforce, and development of expanded roles for nurses and midwives in AIDS care are needed to help them turn the tide of the epidemic.

Adolescent↗