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PubMed2006

Maize meal predisposes to endemic squamous cancer of the oesophagus in Africa: breakdown of esterified linoleic acid to the free form in stored meal leads to increased intragastric PGE2 production and a low-acid reflux.

Endemic cancer of the oesophagus in Africa is associated with the use of maize as the staple. In one African community endemic cancer of the oesophagus has been shown to have a strong statistical association with the consumption of foods based on maize in the meal form. A strong association with consumption of maize meal has also been shown in a region of Italy. It has been argued in the past that the association with maize consumption is due to a fortuitous association; or due to the nutritional deficiencies of maize meal; or due to fungal contamination. We argue that maize meal is a distinctly different food from whole maize, and that nutritional content as much as deficiency is responsible for predisposition of the oesophagus to carcinogenesis. An important factor is the breakdown of esterified linoleic acid to the free form in stored maize meal. This leads to excess production of prostaglandin E2 in the stomach. The excess Prostaglandin E2 causes a low-acid duodenogastro-oesophageal reflux, which predisposes to carcinogenesis. Supporting evidence is available that the steps of this mechanism occur in endemic areas, and that they are associated with the carcinogenic process. Health measures including poverty alleviation, health education, and monitoring and control of maize meal storage and content may be required to reduce the incidence of this disease in Africa.

Africa↗
PubMed2004

Evidence for relatively greater subcutaneous fat deposition in stunted girls in the North West Province, South Africa, as compared with non-stunted girls.

OBJECTIVE: We examined differences in body composition between stunted and non-stunted girls, with adjustments for confounding factors. METHODS: A cross-sectional study was conducted in a representative sample of 478 African school girls, ages 10 to 15 y, in the North West Province, South Africa. Height, weight, skinfold thicknesses, and waist and mid upper arm circumferences were measured by trained biokineticists using standard methods. Trained field workers measured dietary intakes by 24-h recall, and physical activity was measured by using the physical activity recall of the previous day. Body mass index and physical activity category were calculated. RESULTS: Stunted girls had significantly lower weight and skinfold thicknesses than did non-stunted ones. After including the covariates: age, years since menarche, school, type of housing, dietary energy and fat intakes, physical activity category, body weight, and stratum of urbanization in analysis of variance, the mean sum of triceps skinfold and subscapular skinfold thicknesses of stunted girls was greater than that of the non-stunted girls (P < 0.002). Stunted subjects were less active than non-stunted ones. CONCLUSION: This manifestation of relatively more subcutaneous fat and greater waist circumference in stunted girls may be involved in the development of obesity among black women in South Africa.

Adipose Tissue↗
PubMed2005

Secondary anthropometric data analysis of the National Food Consumption Survey in South Africa: the double burden.

OBJECTIVE: There is an increase in the prevalence of overweight and obesity in children worldwide, including South Africa. We investigated the prevalences of overweight, obesity, and stunting in a current generation of children (ages 12 to 108 mo), which has a high prevalence of stunting, and evaluated the determinants of both nutritional disorders. METHODS: Secondary data analysis of the weight and height measurements of 12- to 108-mo-old children (weighted n = 2200, non-weighted n = 2894) during the 1999 National Food Consumption Survey in South Africa is reported. The body mass index reference percentiles recommended for use in children by the International Obesity Task Force were used to determine the prevalence of overweight and obesity, and the National Center for Health Statistics (NCHS) percentiles were used to determine the prevalence of stunting. RESULTS: Nationally, the prevalence of stunting (height-for-age < or = -2 standard deviations, NCHS 50th percentile) in these children was 19.3% (95% confidence interval [CI] = 17.49 to 21.16) and was highest in 1- to 3-y-old children (24.4%) and in children of farm workers on commercial farms (25.6%). The prevalence of combined overweight and obesity (body mass index > or = 25 kg/m(2) in 17.1%, 95% CI = 15.00 to 19.23) at the national level was nearly as high as that for stunting. Further, the types of determinants for stunting and overweight were generally similar (although directionally opposite in degree of risk conferred) and included type of housing, type of toilet in the home, fuel used in cooking, presence of a refrigerator or stove, presence of a television in the house, educational level of the caregiver, and maternal education level. An example of the directionally opposite degree of risk is exemplified by the use of paraffin as a fuel being protective against being overweight (odds ratio = 0.78, 95% CI = 0.63 to 0.97) but predictive of an increased risk for stunting (odds ratio = 1.24, 95% CI = 1.04 to 1.48). Stunting itself conferred an increased risk (odds ratio = 1.80, 95% CI = 1.48 to 2.20) of being overweight. CONCLUSION: Certain defined determinants appear to play important roles in children's nutritional outcomes in relation to stunting and to overweight and obesity.

Anthropometry↗
PubMedDate not supplied

Early cardiovascular changes in 10- to 15-year-old stunted children: the Transition and Health during Urbanization in South Africa in Children study.

OBJECTIVE: Early changes in vascular function could be associated with stunting, which may contribute to the development of cardiovascular diseases in later life. In this study we tested the hypothesis that stunting may be related to changes in cardiovascular function in African children ages 10 to 15 y. METHODS: In the Transition and Health during Urbanization in South Africa in Children study, the health status of children in the North-West Province of South Africa was studied. It was an epidemiologic, cross-sectional study in which 583 black non-stunted and 192 stunted children (stature below the fifth percentile for age) of both sexes ages 10 to 15 y were recruited from 44 schools. Blood pressure was monitored with the Finapres (finger-arterial pressure) apparatus and by means of the Fast Modelflo software program; measurements for systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, heart rate, cardiac output, stroke volume, total peripheral resistance, and arterial compliance were obtained. Dietary intake data were collected with a 24-h dietary recall questionnaire. Nutrient coding was the same for all recalls and macro- and micronutrients were calculated. Anthropometric measurements were done according to standard methods. RESULTS: There were no significant differences in systolic blood pressure and diastolic blood pressure between stunted and non-stunted children after correction for body mass index and heart rate. Stroke volume, arterial compliance, and cardiac output were significantly lower and total peripheral resistance was significantly higher in stunted children than in non-stunted children. No significant differences in dietary intake could be detected, although dietary intakes were slightly lower in the stunted children. CONCLUSIONS: We found that compliance, a marker of vascular function, is significantly lower in stunted children. Stunting was related to early changes in cardiovascular function in African children ages 10 to 15 y.

Adolescent↗
PubMed2006

Epidemiology and control of echinococcosis in sub-Saharan Africa.

Cystic echinococcosis (CE) is highly endemic among the nomadic pastoral tribes of East Africa, but is rare amongst the agriculturally based communities. Echinococcus granulosus infections are common in dogs from all countries in sub-Saharan Africa where they have been examined. Transmission of E. granulosus to humans is affected by such factors as prevalence of the parasite in domestic dogs, behaviors of humans towards dogs, and heterogenicity of the parasite and susceptibility of humans to infection. Sheep and goats appear to be the most common domestic intermediate hosts, but recent studies suggest that camels are equally important intermediate host, especially in Sudan and Turkana. At least five of ten E. granulosus genotypes are infective to humans in sub-Saharan African. Most human cases of CE are caused by the sheep strain (GI) and camel strain (G6) of E. granulosus. Other strains occurring in the area may include a lion strain, the horse strain (G4 or Echinococcus equinus) and the cattle strain (G5 or Echinococcus ortleppi).

Africa South of the Sahara↗
PubMed2005

A model of contagious bovine pleuropneumonia transmission dynamics in East Africa.

The dynamics of contagious bovine pleuropneumonia (CBPP) transmission vary widely between livestock production systems. This paper describes the development of a homogeneous, stochastic, compartmental model for CBPP transmission in pastoral herds of East Africa. The model was built using parameter estimates based on data published in the literature and on observations of livestock owners obtained through participatory research. The basic reproduction number for CBPP in southern Sudan was estimated to range from 3.2 to 4.6. The homogeneous model indicates that the critical community size for the persistence of CBPP falls within the typical herd sizes for pastoral communities in East Africa suggesting that individual isolated herds are capable of maintaining infection indefinitely. Vaccination alone with currently available vaccines was unlikely to eradicate the disease.

Africa, Eastern↗
PubMed2006

Re-infection of wildlife populations with rinderpest virus on the periphery of the Somali ecosystem in East Africa.

We report surveillance for rinderpest virus in wildlife populations in three major ecosystems of East Africa: Great Rift Valley, Somali and Tsavo from 1994 to 2003. Three hundred and eighty wild animals were sampled for detection of rinderpest virus, antigen or genome and 1133 sampled for antibody in sera from Kenya, Uganda, Ethiopia and Tanzania from 20 species. This was done modifying for wildlife the internationally recommended standards for rinderpest investigation and diagnosis in livestock. The animals were selected according to susceptibility and preference given to gregarious species, and populations were selected according to abundance, availability and association with livestock. Rinderpest virus, antigen and/or genome were detected in Kenya; within Tsavo, Nairobi and Meru National Parks. Serological results from 864 animals (of which 65% were buffalo) from the region were selected as unequivocal; showing the temporal and spatial aspects of past epidemics. Recent infection has been only in or peripheral to the Somali ecosystem (in Kenya). Our evidence supports the hypothesis that wildlife is not important in the long-term maintenance of rinderpest and that wildlife are infected sporadically most likely from a cattle source, although this needs to be proven in the Somali ecosystem. Wildlife will continue to be a key to monitoring the remaining virus circulation in Africa.

Africa, Eastern↗
PubMed2006

Global paediatric pulmonology: out of Africa.

Respiratory illness is the major cause of mortality and morbidity in African children. The spectrum of disease includes acute and chronic respiratory illness. As a result of the HIV epidemic currently occurring in sub-Saharan Africa, HIV-associated acute and chronic respiratory disease has emerged as a major factor in the epidemiology of childhood respiratory illness. Pneumonia is the leading causes of childhood mortality responsible for approximately 21% of deaths in African children under five years of age each year. The HIV pandemic has increased the incidence, severity and pneumonia mortality in African children. Pulmonary tuberculosis (TB) is an important cause of morbidity and death. Globally, the highest TB incidence rates occur in sub-Saharan African countries; many of these countries are also experiencing a dual HIV epidemic, resulting in an exponential increase in TB cases. The burden of childhood respiratory illness has necessitated novel and improved ways of diagnosis, treatment and prevention, particularly in the context of limited resources. Improved diagnosis, treatment and prevention of pneumonia have been a research focus, particularly in HIV-infected children. African studies have provided information on the epidemiology, aetiology and outcome from pneumonia in HIV-infected and uninfected children. The efficacy of trimethoprim-sulphamethoxazole prophylaxis in reducing mortality and morbidity in HIV-infected African children was shown in the only randomized controlled trial. Two large studies have shown the efficacy of the pneumococcal conjugate vaccine in an African context. Regarding TB, areas of research include diagnostic studies and improved preventative strategies. Promising diagnostic studies for childhood TB include the use of sputum induction, PCR techniques and blood interferon assays. The immune reconstitution inflammatory syndrome (IRIS) has emerged as a new clinical entity in HIV-infected children with TB associated with use of antiretroviral therapy. New preventative strategies for TB include novel vaccines and primary prophylaxis. Available, effective interventions for prevention and treatment of childhood respiratory disease exist; the challenge is to achieve widespread implementation and high coverage rates in African countries. Greater access to newer vaccines and, in HIV-infected children, to anti-retroviral therapy and prophylaxis is necessary to further reduce the burden of childhood respiratory illness in Africa.

Africa↗
PubMed2004

Present concerns of survivors of human rights violations in South Africa.

Most research on persons subjected to physical torture for political reasons has framed this experience as traumatic, with the sequelae approximating the diagnostic criteria of posttraumatic stress disorder (PTSD). However, responses to checklists, questionnaires, and structured interview schedules may reflect the effect of demand characteristics more than the actual concerns of respondents. Thus semi-structured qualitative interviews were conducted with 20 South Africans who were detained for political reasons during the apartheid era. The interviews were transcribed and analyzed with the assistance of the Atlas.ti 4.5 programme. Results showed that the major concerns expressed by the sample were somatic problems, economic marginalization, non-clinical emotional distress, and dissatisfaction with the present political dispensation in South Africa. Respondents also expressed concerns that reflected symptoms of traumatization, but these were not salient in comparison with the other themes that emerged. These data suggest that a model of trauma and the diagnostic category of PTSD may be less appropriate than suggested by most of the literature in accounting for the concerns of many South African former political detainees. This paper critiques the hegemony of the psychiatric model of traumatization in conceptualizing the needs of this population, and suggests an alternate perspective that is broader and more inclusive than a psychiatric paradigm. It also discusses the research and possible clinical implications of the results in terms of addressing the needs of former detainees in South Africa.

Adult↗
PubMed2004

'White liquor hits black livers': meanings of excessive liquor consumption in South Africa in the second half of the twentieth century.

Four years into South Africa's first democracy, the African National Congress Youth League, with the help of the liquor industry's Social Aspects of Alcohol Committee drafted a policy to prevent substance abuse in black communities. They declared that alcohol was 'often not used in a socially acceptable way'. Concerned not so much with post-apartheid policy as with making sense of what socially acceptable alcohol usage might mean, this article explores narratives of alcohol use and abuse in South Africa in the second half of the twentieth century. It demonstrates that while multiple understandings of excess in alcohol consumption were articulated, those notions tied to particular constructions of racial difference prevailed. Ideas pairing drinking habits with race were given effect by state institutions. By tying drinking habits to 'race' and by locating 'race' in a social hierarchy, state institutions determined access to liquor and welfare services. By naturalising Africans as heavy drinkers, the state justified its sale of liquor to African men while denying the need for rehabilitation in the event of alcoholic dependence. By placing 'coloured' closer to 'white' in its racial order, the apartheid state found cause to extend limited rehabilitation services to those designated 'coloured'. By tying liquor revenues to apartheid administration, the ruling regime exonerated its policy of excluding blacks from the retail liquor trade even after lifting prohibition in 1962. This policy encouraged rampant illicit liquor dealing, created a social environment in which alcoholic excess, particularly after 1976, reached new proportions and generated new and dangerous meanings of socially acceptable drinking. Against the grain of these dominant discourses of racially designated meanings of drinking, African people forged a more complex set of practices and meanings not rendered any clearer by the ANC Youth League's discourse of acceptable and unacceptable usage.

Alcohol Drinking↗
PubMed2005

Community-based participatory research (CBPR) in South Africa: engaging multiple constituents to shape the research question.

Community engagement is an on-going, arduous, and necessary process for developing effective health promotion programs. The challenges are amplified when the particular health issue or research question is not prominent in the consciousness of the targeted community. In this paper, we explore the community-based participatory research (CBPR) model as a means to negotiate a mutual agenda between communities and researchers. The paper is focused on the (perceived) need for cervical cancer screening in an under-resourced community in Cape Town, South Africa. Cervical cancer is a significant health problem in this community and elsewhere in South Africa. Unlike HIV-AIDS, however, many Black South Africans have not been educated about cervical cancer and the importance of obtaining screening. Many may not consider screening a priority in their lives. Our research included extensive consultations and informal interviews with diverse community and regional stakeholders. Following these, we conducted 27 focus groups and 106 demographic surveys with randomly selected youth, parents, local health care personnel, educators and school staff. Focus group data were summarized and analyzed cross-sectionally. Community stakeholders were involved throughout this research. Our consultations, interviews, and focus group data were key in identifying the concerns and priorities of the community. By engaging community stakeholders, we developed a research framework that incorporated the community's concerns and priorities, and stressed the intersecting roles of poverty, violence, and other cultural forces in shaping community members' health and wellbeing. Community members helped to refocus our research from cervical cancer to 'cervical health,' a concept that acknowledged the impact on women's bodies and lives of HIV-AIDS and STDs, sexual violence, poverty, and multiple social problems. We conclude that the research agenda and questions in community-based health research should not be considered immutable. They need to be open to negotiation, creativity, and constant reinvention.

Adult↗
PubMed2006

Challenges to microbicide introduction in South Africa.

Qualitative research was conducted in South Africa to determine perceptions about intra-vaginal microbicides in order to better understand the socioeconomic, cultural and structural contexts for the support of future introduction of this new HIV prevention method. Focus group discussions and in-depth interviews were conducted at community, health service, and policy levels of inquiry. The main study site was a black working class urban area close to Cape Town. "Desperation" in response to the HIV/AIDS epidemic, rape, sexual coercion and unplanned consensual sex emerged as major reasons to support microbicides, while concerns about the partial effectiveness of microbicide protection and its hypothetical nature elicited a more cautious approach. Other key findings included the likelihood that microbicides would be "mainstream", the possible impact on sexual practices and gender norms, issues of condom substitution/migration and potential avenues for education and distribution. We found that microbicides have the potential to meet diverse needs beyond that suggested by prior research. This included a desire for products that could protect against HIV infection following rape, sexual coercion and unplanned sex, and the finding that a wider range of people than previously suggested would potentially use microbicides. The challenge for microbicide introduction will be to develop products that can meet diverse needs not only in South Africa, but also in the broader global context.

Adolescent↗
PubMed2006

Hope is the pillar of the universe: health-care providers' experiences of delivering anti-retroviral therapy in primary health-care clinics in the Free State province of South Africa.

South Africa is experiencing one of the largest HIV/AIDS epidemics in the world. A national, publicly funded anti-retroviral therapy (ART) programme has recently been launched. This paper describes the findings from a qualitative study of the views of health-care professionals, especially nurses, regarding the ART roll-out in the Free State province of South Africa, where nurses are responsible for most of the care delivered to AIDS patients. The study highlights the hope provided by the new programme and the motivation it has engendered among nurses. Apart from long waiting lists for ART, these professionals saw the main programme challenge as the integration of a holistic model of patient-centred care, inclusive of psycho-social support, into an under-resourced primary health-care system. By comparison, neither the increasing clinical responsibilities borne by nurses, nor the ability of patients to adhere to ART, were seen as key problems. This study suggests that the ART programme has mobilised health workers to assume responsibility for providing high-quality care in an under-resourced setting.

Ambulatory Care Facilities↗
PubMed2006

A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: evidence from Demographic and Health Surveys (DHS).

This paper uses Demographic and Health Surveys data from 21 countries in sub-Saharan Africa to examine the use of maternal health services by teenagers. A comparison of maternal health care between teenagers and older women, based on bivariate analysis shows little variation in maternal health care by age. However, after controlling for the effect of background factors such as parity, premarital births, educational attainment and urban/rural residence in a multivariate analysis, there is evidence that teenagers have poorer maternal health care than older women with similar background characteristics. The results from multilevel logistic models applied to pooled data across countries show that teenagers are generally more likely to receive inadequate antenatal care and have non-professional deliveries. An examination of country-level variations shows significant differences in the levels of maternal health care across countries. However, there is no evidence of significant variations across countries in the observed patterns of maternal health care by maternal age. This suggests that the observed patterns by maternal age are generalizable across the sub-Saharan Africa region.

Adolescent↗
PubMed2005

Africa's present and future needs in toxicology education: Southern African perspective.

Degrees and diplomas as well as certificates that are granted by universities and technikons in South Africa in scientific disciplines, such as forensic medicine, pharmacology, marine and veterinary sciences, environmental health, and occupational hygiene, include toxicology as one of the subjects in their overall syllabus. However, aspects of toxicology included in each of these courses are biased towards that particular subdiscipline and basic level of toxicology may be taught. Educational needs in toxicology in South Africa can be summarized as follows: (a) recognition of toxicology as a discipline in its own right at these tertiary education institutions and (b) creation of opportunities to study and obtain higher degrees in one or more of the many subdisciplines of toxicology. The results from a survey conducted on the toxicology syllabi offered at these tertiary education institutions are used to substantiate these needs.

Education↗
PubMed2005

Report of the 2nd International Conference on Envenomations in Africa (Deuxième Colloque International sur les Envenomations en Afrique).

An international meeting on envenomations in Africa was held in Cotonou, Republic of Benin, the 19th and 20th of September, 2004, to gather clinical practitioners, epidemiologists, health authorities and antivenom producers to present and discuss the most recent available data on the prevalence of snake envenomations in Africa. The meeting concluded with a round table which had the objective of evaluating the problems facing the epidemiology and therapy of envenomations by African snakes and making some general recommendations at the level of national health authorities, researchers, medical practitioners, and international antivenom producers.

Africa↗
PubMed2005

Why has the dihydrofolate reductase 164 mutation not consistently been found in Africa yet?

Resistance to the antifolate sulfadoxine-pyrimethamine (SP), the current mass-treatment antimalarial drug, is associated with selection of point mutations in dihydrofolate reductase and dihydropteroate synthase. Among these mutations, the leucine 164 dihydrofolate reductase mutation (Leu-164) is associated with higher levels of SP resistance; this mutation is also associated with a decrease in the efficacy of chlorproguanil/dapsone, a newly developed antifolate antimalarial drug. Leu-164 has been detected in Southeast Asia and South America, regions where SP is no longer effective. Surprisingly, this mutation has not yet been detected in Africa, using the standard protocol based on PCR-RFLP, despite high SP resistance. In this paper, we discuss briefly the reasons why Leu-164 has not yet been selected in Africa and we propose a means that may slow down the selection of this mutation.

Africa↗
PubMed2006

El Niño Southern Oscillation (ENSO) and annual malaria incidence in Southern Africa.

We evaluated the association between annual malaria incidence and El Niño Southern Oscillation (ENSO) as measured by the Southern Oscillation Index (SOI) in five countries in Southern Africa from 1988 to 1999. Below normal incidence of malaria synchronised with a negative SOI (El Niño) and above normal incidence with a positive SOI (La Niña), which lead to dry and wet weather conditions, respectively. In most countries there was a positive relationship between SOI and annual malaria incidence, especially where Anopheles arabiensis is a major vector. This mosquito breeds in temporary rain pools and is highly sensitive to fluctuations in weather conditions. South Africa and Swaziland have the most reliable data and showed the strongest associations, but the picture there may also be compounded by the moderating effect of other oscillatory systems in the Indian Ocean. The impact of ENSO also varies over time within countries, depending on existing malaria control efforts and response capacity. There remains a need for quantitative studies that at the same time consider both ENSO-driven climate anomalies and non-ENSO factors influencing epidemic risk potential to assess their relative importance in order to provide an empirical basis for malaria epidemic forecasting models.

Africa, Southern↗