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PubMed2006

The cost-effectiveness of alternative polio immunization policies in South Africa.

AIMS: To assess the cost-effectiveness of switching from oral polio vaccine (OPV) to inactivated poliovirus vaccine (IPV), or to cease polio vaccination in routine immunization services in South Africa at the time of OPV cessation globally following polio eradication. METHODS: The cost-effectiveness of nine different polio immunization alternatives were evaluated. The costs of introducing IPV in a separate vial as well as in different combination vaccines were estimated, and IPV schedules with 2, 3 and 4 doses were compared with the current 6-dose OPV schedule. Assumptions about IPV prices were based on indications from vaccine manufacturers. The health impact of OPV cessation was measured in terms of vaccine associated paralytic paralysis (VAPP) cases and disability adjusted life years (DALYs) averted. CONCLUSIONS: The use of OPV in routine immunization services is predicted to result in 2.96 VAPP cases in the 2005 cohort. The cost-effectiveness of the different IPV alternatives varies between US$ 740,000 and US$ 7.2 million per VAPP case averted. The costs per discounted DALY averted amount to between US$ 61,000 and US$ 594,000. Among the IPV strategies evaluated, the 2-dose schedule in a 10-dose vial is the most cost-effective option. At the assumed vaccine prices, all IPV options do not appear to be cost-effective in the South African situation. OPV cessation without IPV replacement would result in cost savings of US$ 1.6 million per year compared to the current situation. This is approximately a 9% decrease in the budget for vaccine delivery in South Africa. However, with this option there is a risk (albeit small) of vaccine-derived poliovirus circulating in a progressively susceptible population. For IPV in a single dose vial, the break-even price, at which the costs of IPV delivery equal the current OPV delivery costs, is US$ 0.39.

Child, Preschool↗
PubMed2004

Different approaches to the vaccination of free ranging village chickens against Newcastle disease in Qwa-Qwa, South Africa.

The aim of this study was to develop a strategy to control Newcastle disease (ND) in free ranging village chickens using the Nobilis ND Inkukhu vaccine (Intervet South Africa). The study was conducted at Thibella village in Qwa-Qwa, South Africa from April 2001 to October 2002. Three different routes of vaccination (administration via eye-drop, drinking water and feed) were investigated. The haemagglutination inhibition (HI) test was conducted monthly in order to measure the antibody response of village chickens after immunization against Newcastle disease. Using a South African isolate of velogenic ND virus, challenge trials were conducted to determine the efficacy of the vaccine. A questionnaire was provided to evaluate perceptions of farmers on vaccinations. The eye-drop vaccination route produced the highest HI titres ranging between 2.7 and 4.4, followed by the drinking water vaccination route with titres ranging between 2.3 and 4.0. The lowest titres were from the feed vaccination route which ranged between 1.6 and 3.0. Following the challenge, the entire control group died on the third and fourth day after infection. However, 70% of the chickens immunized by using either the eye-drop or drinking water route survived the challenge. Only 20% of the chickens from the group immunized through the feed route survived. Evidently both the eye-drop and drinking water routes were efficient in preventing disease. Necropsies showed that vaccinated chickens had mild lesions whilst control chickens had severe lesions compatible with Newcastle disease. The efficacy of the vaccine using either of the routes can be enhanced by administration of booster vaccinations at 3-month intervals during the first year of a vaccination campaign and then at 6-month intervals from the second year onwards. The majority of the owners indicated that they would prefer to vaccinate their flocks using the drinking water route.

Animals↗
PubMed2006

Genetic characterisation of African swine fever viruses from outbreaks in southern Africa (1973-1999).

African swine fever (ASF) is a highly lethal and economically significant disease of domestic pigs in the southern African sub-region, where outbreaks regularly occur. There is anecdotal evidence suggesting that trans-boundary movement of infected animals may have played a role in precipitating widespread outbreaks in the past, however, since the 1970s outbreaks have generally been more localised, particularly in those countries where control of animal movement is strictly regulated. The origin and relatedness of regional ASF outbreaks was investigated here by means of a two-step genetic characterisation approach whereby p72 gene sequencing was used to delineate genotypes, prior to intra-genotypic resolution of viral relationships by central variable region (CVR) characterisation of the 9RL ORF. In this manner, regional virus heterogeneity and epidemiological links between outbreaks could be assessed for the first time through phylogenetic analysis of the C-terminal end of the p72 gene of viruses recovered from domestic pig outbreaks in southern Africa between 1973 and 1999. The phylogeny revealed the presence of 14 distinct p72 genotypes of which 6 (genotypes XVII-XXII) were considered novel. Eight of these were country-specific with the remaining six having a trans-boundary distribution. CVR products were heterogeneous in size ranging from 377bp to 533bp across the 14 southern African genotypes. Within-genotype CVR comparisons revealed the presence of a genotype XIX virus with an extended field presence in South Africa (1985-1996) and permitted discrimination between three genotype VII viruses that were identical across the p72 gene.

Africa, Southern↗
PubMed2004

Control strategies for sweet potato virus disease in Africa.

Sweet potato virus disease (SPVD), caused by dual infection with the whitefly-borne Sweet potato chlorotic stunt virus (SPCSV) and the aphid-borne Sweet potato feathery mottle virus (SPFMV), is the most serious disease of sweet potato in Africa. SPVD has been known there since at least the 1940s, although it took several decades to elucidate its aetiology. It occurs throughout Africa and is particularly prevalent in the Great Lakes region. Production of sweet potato is largely by resource-poor farmers, growing mostly local landraces and for home consumption and so control strategies need to be appropriate to these circumstances. Most high yielding and/or early maturing landraces in Uganda are susceptible to SPVD and most resistant landraces are low-yielding, forcing farmers to compromise between the conflicting requirements of large and/or early yields, and food security. Accordingly, two strategies were tested to avoid the disadvantages associated with such compromises. These were deploying high-yielding SPVD-resistant cultivars and phytosanitation practices to enable susceptible landraces to be grown successfully. In on-farm trials in Masaka and Rakai Districts of Uganda, some SPVD-resistant cultivars bred at Namulonge Agricultural and Animal Research Station (NAARI), in Wakiso District, out-yielded local landraces. Other trials at NAARI and at nearby farms showed that roguing diseased cuttings within 1 month of planting and isolation from diseased crops, even by as little as 15m, can considerably decrease spread of SPVD to susceptible cultivars. This indicates that phytosanitation can protect desirable susceptible cultivars, even if adopted only locally. A dual approach of deploying both resistant varieties and phytosanitation provides farmers with a valuable increase in their choice of control strategies for SPVD.

Africa↗
PubMed2004

The occurrence of campylobacters in water sources in South Africa.

Campylobacter spp., mainly C. jejuni and C. coli, are recognized as significant human bacterial pathogens, being responsible for increasing numbers of gastroenteritis cases worldwide. Several reports have indicated that environmental waters are potential reservoirs and transmitting vehicles for these bacteria. The purpose of this study was thus to examine the occurrence of campylobacters in drinking and environmental water sources of South Africa, a country with a warmer climate and higher microbial pollution levels than those previously addressed in the Northern Hemisphere where similar investigations have been undertaken. Various types of water samples (five drinking water, four ground water, 11 surface water and four raw sewage) were collected from different parts of South Africa. Detection was by enrichment in Bolton broth prior to plating on both selective mCCDA or through a 0.6microm membrane filter on non-selective blood agar isolation media. Out of 100 initially selected Campylobacter-like isolates, only 22 did not grow aerobically and were subsequently identified as Campylobacter spp. by biochemical tests. However, the results obtained by 16S rRNA sequence analysis indicated that only three of these strains (13.6%) were Campylobacter jejuni and the remaining 19 strains were identified as Arcobacter butzleri. The spread of Arcobacter via water warrants further investigation, especially in view of the higher levels of detection and pathogenic nature of these bacteria.

Campylobacter↗
PubMed2005

Epilepsy-associated stigma in sub-Saharan Africa: the social landscape of a disease.

Many studies in developed regions of the world have confirmed that stigma contributes substantially to the psychological and social burden of epilepsy. Relatively few studies of epilepsy-associated stigma have been conducted in Africa, where much of the world's burden of epilepsy exists. In sub-Saharan Africa (SSA), particularly in rural regions, close family ties, communal living situations, and traditional belief systems undoubtedly influence the expression of stigmatization. A review of the epidemiologic, anthropologic, and sociologic studies of epilepsy in SSA provides significant insights into how people with epilepsy (PWE) are perceived by their communities and families and how these perceptions translate into limited social and economic opportunities and possibly worsen the physical vulnerability of PWE in this region. The medical community is not exempt from the social process of stigmatization, and poor public health infrastructure and medical services undoubtedly contribute to the cycle of epilepsy-associated stigma through wide treatment gaps, poor seizure control, and high rates of seizure-related injury. In this review, we extrapolate data from existing studies of epilepsy in SSA coupled with our own experience providing epilepsy care in the region to give an overview of the social landscape of this common, devastating condition.

Africa South of the Sahara↗
PubMed2005

Mitochondrial phylogeny reveals differential modes of chromosomal evolution in the genus Tatera (Rodentia: Gerbillinae) in Africa.

The African gerbils of the genus Tatera are widespread and abundant throughout sub-Saharan Africa. There is still today a certain controversy concerning the taxonomy of these rodents and very few attempts have been made to assess their systematic relationships. The present paper introduces findings based on the partial sequences of cytochrome b (495 bp) and the 16S rRNA (469 bp) mitochondrial genes of six (T. robusta, T. nigricauda, T. vicina, T. leucogaster, T. valida, and T. kempi) species together with two additional taxa. We also report the karyotypes of T. vicina and T. leucogaster. We propose that T. vicina should be considered as a valid species and show the monophyly of the robusta species group, with the exclusion of T. leucogaster. Our results show there is a different chromosomal evolutionary pattern within the two major lineages, which is recognizable through molecular phylogenetics. One is characterized by karyotype stability and the other by a considerable number of chromosomal rearrangements. The lineage divergence coincides with the formation of the East African Rift. The processes that led to the origin of the East African species seem to be related to the subsequent climatic changes, which caused cyclic contraction and expansion of the savannah biomes. Furthermore, geological activities that characterized East Africa during Plio-Pleistocene may also have contributed to lineage divergence.

Africa↗
PubMed2005

A previously unrecognized radiation of ranid frogs in Southern Africa revealed by nuclear and mitochondrial DNA sequences.

In sub-Saharan Africa, amphibians are represented by a large number of endemic frog genera and species of incompletely clarified phylogenetic relationships. This applies especially to African frogs of the family Ranidae. We provide a molecular phylogenetic hypothesis for ranids, including 11 of the 12 African endemic genera. Analysis of nuclear (rag-1, rag-2, and rhodopsin genes) and mitochondrial markers (12S and 16S ribosomal RNA genes) provide evidence for an endemic clade of African genera of high morphological and ecological diversity thus far assigned to up to five different subfamilies: Afrana, Cacosternum, Natalobatrachus, Pyxicephalus, Strongylopus, and Tomopterna. This clade has its highest species diversity in southern Africa, suggesting a possible biogeographic connection with the Cape Floral Region. Bayesian estimates of divergence times place the initial diversification of the southern African ranid clade at approximately 62-85 million years ago, concurrent with the onset of the radiation of Afrotherian mammals. These and other African ranids (Conraua, Petropedetes, Phrynobatrachus, and Ptychadena) are placed basally within the Ranoidae with respect to the Eurasian groups, which suggests an African origin for this whole epifamily.

Africa South of the Sahara↗
PubMed2006

Convergent evolution of gigantism in damselflies of Africa and South America? Evidence from nuclear and mitochondrial sequence data.

Extreme large body size is rare in modern Zygoptera (damselflies). Only the South and Central American damselfly family Pseudostigmatidae and one African species, Coryphagrion grandis, share the morphological trait of gigantism. By means of phylogenetic analyses using two mitochondrial markers (16S rDNA and ND1) and one nuclear marker (EF1) in combination with an existing morphological data set, we trace the evolution of gigantism in damselflies. Individual and combined data sets were analyzed using the maximum parsimony, minimum evolution and maximum likelihood algorithms. Regardless of the algorithm used and the data set analyzed all principal tree topologies support a monophyly of the damselfly taxa displaying giant body size. This supports the view that the evolution of gigantism in damselflies from Africa and South America is not the result of convergent evolution due to strikingly similar habitat preferences, but rather the result of close genealogical relationship. Because modern odonates evolved before the split of Africa from Gondwanaland, the proposed phylogeny suggests that C. grandis represents a Gondwana relict.

Africa↗
PubMed2001

Mechanical failures as a contributing cause to motor vehicle accidents South Africa.

Over the past decades motor vehicles became the primary mode of transportation in developing countries. At the same time an improvement in automotive engineering and manufacturing as well as the phenomena of urbanisation have resulted in more vehicles spending more time on the road at higher speeds. Invariably this leads to driving scenarios where safety critical manoeuvres have to be performed that rely on the mechanical condition of the vehicles. In developing countries, where economic realities force the population to make use of older and less reliable vehicles, the risk of accidents caused by some sort of mechanical failure increases. The casualty rate (events causing death and/or serious injuries) for road traffic accidents in South Africa is amongst the highest in the world. This trend has persisted with little variation over the years, despite the efforts of local road safety organisations and research institutes to decrease them. The main goal of this study was to establish the contribution of mechanical failures to motor vehicle accidents, and furthermore, to compare it with international trends. Data obtained from accident response units (ARU) indicate that tyres and brakes were the main contributors to mechanical failures resulting in accidents in the Pretoria region (Gauteng Province). However, the reported percentage of approximately 3% is comparable to similar statistics from developed countries. Detailed information on the condition of road-going vehicles was then collected in this area. The roadside survey (potential mechanical defect tests (PMDT)) indicated that 40% of the vehicles surveyed on the suburban road and 29% of the vehicles surveyed on the highway had mechanical defects that contravened current road and traffic regulations in South Africa and may, therefore, be at risk of causing an accident due to a mechanical failure. In the Minibus (taxi) survey, large irregularities in tyre inflation pressure were identified as a cause of concern. The main conclusion from this work is that tyres and brakes are the two most dominant components that contribute to the mechanical defects causing accidents, with overloading an additional factor to consider. It is important to acknowledge that these three factors can easily be monitored during simple roadside inspections.

Accidents, Traffic↗
PubMed2001

Use of satellite remote sensing and geographic information systems to model the distribution and abundance of snail intermediate hosts in Africa: a preliminary model for Biomphalaria pfeifferi in Ethiopia.

Geographic information system (GIS) risk models for the snail-borne diseases caused by Schistosoma spp. and Fasciola spp. have recently been developed based on climate and satellite-retrieved data on temperature and vegetation coverage. By using these models, it was possible to describe a relationship between vegetation index (Normalized Differences Vegetation Index (NDVI)), land surface temperature (T(max)) and disease prevalence, but little reference was made to the distribution of the corresponding intermediate host snail. Presence of the intermediate host snail is a key factor determining distribution of the disease in sub-Saharan Africa and a good snail distribution mode would probably mirror the endemic area of schistosomiasis. In the present analysis, it was shown that snail distribution data corresponds with schistosomiasis prevalence data in relation to a forecast model based on NDVI and T(max) data derived from the Advanced Very High Resolution Radiometer (AVHRR) onboard the National Oceanic and Atmospheric Administration satellite series. The 'best fit' model included NDVI values from 125 to 145 and a T(max) data range of 10-32 degrees C. This model included 92.3, 90.4 and 94.6% of the positive snail sample sites in GIS query overlay areas extracted from annual, dry season and wet season composite maps, respectively. For other sites in Africa, other NDVI and T(max) ranges may be more appropriate, depending on the species of snail present, a topic that will be examined in further studies.

Africa↗
PubMed2003

Trauma care systems in South Africa.

AIM: To provide an overview of the provision of trauma care in South Africa, a middle income country emerging into a democratic state. METHODS: Literature review. CONCLUSIONS: South Africa is gripped by an almost hidden epidemic of intentional and non-intentional injury, largely driven by alcohol and substance abuse, against a background of poverty and rapid urbanisation. Gross inequities exist in the provision of trauma care. Access to pre-hospital care and overloading of tertiary facilities are the major inefficiencies to be addressed. The burden of disease due to trauma presents unique opportunities for reconstruction and clinical research.

Accidents↗
PubMed2001

Some general aspects of the distribution and epidemiology of bovine trypanosomosis in southern Africa.

Bovine trypanosomosis occurs in vast areas of southern Africa. Its epidemiology and impact on cattle production is determined largely by the level of interaction between tsetse and cattle. Four situations can be distinguished. First, areas where cattle are absent. Second, zones where cattle have been introduced in game areas but where game is still abundant and constitutes the major source of food for tsetse. Third, areas where, often because of human interference, the density of game animals is low and cattle constitute the main source of food and finally, areas where cattle occur at the edge of tsetse-infested zones. In southern Africa, the impact of the disease on cattle production varies according to the epidemiological circumstances. The disease has an epidemic character with significant impacts on production in areas where cattle have been introduced recently or along the interface between tsetse-infested game areas and tsetse-free cultivated areas. Bovine trypanosomosis has an endemic character, with little impact on production, in areas where tsetse mainly feed on cattle and where the invasion of tsetse is low. Options for the control of bovine trypanosomosis will vary according to the epidemiological circumstance. In particular, the control of tsetse with insecticide-treated cattle will only be effective when a large proportion of feeds are taken from cattle over a large area and when the invasion of tsetse can be reduced sufficiently.

Africa South of the Sahara↗
PubMed1999

Antegrade continence enema and its application in Africa.

BACKGROUND: Antegrade continent enema (ACE) procedure has been accepted worldwide as the salvage procedure for intractable constipation and faecal incontinence after anorectal malformation surgery. Its application only has been reported from the developed countries. METHODS: The authors performed four such operations on incontinent children in a poor socioeconomic group in South Africa. RESULTS: Three patients had previous surgery for anorectal malformation, and one had intractable encopresis. The patients kept clean with water washouts only, starting 1 week after the operation. CONCLUSIONS: The ACE procedure can be used easily by patients in disadvantaged communities of Africa, and its use requires minimal but sympathetic supervision only. The authors recommend that all pediatric surgeons dealing with these unfortunate children should perform this procedure after a trial period of medical treatment. This is also the first report of the ACE procedure performed for an encopretic child.

Anal Canal↗
PubMed2003

Melanin and HIV in sub-Saharan Africa.

HIV is common in sub-Saharan Africa. Sexually transmitted bacterial and fungal infections increase the chance of HIV infection. Melanin can prevent the penetration of skin and mucus membranes by microorganisms, and soluble melanin can inhibit HIV replication. We suggest that melanin may reduce the incidence of HIV infection through venereally acquired skin lesions, thus reducing the risk of sero-conversion and slow the progress to AIDS. Indigenous sub-Saharan peoples are highly melanized, but there is pigment variation between populations. We show that skin reflectance, a negative correlate of melanin, is positively associated with adult rate of HIV in sub-Saharan countries. There is no such relationship in populations outside sub-Saharan Africa. We suggest that melanin concentration in black people may correlate with resistance to HIV infection.

Africa South of the Sahara↗
PubMedDate not supplied

Annual Plasmodium falciparum entomological inoculation rates (EIR) across Africa: literature survey, Internet access and review.

This paper presents the results of an extensive search of the formal and informal literature on annual Plasmodium falciparum entomological inoculation rates (EIR) across Africa from 1980 onwards. It first describes how the annual EIR data were collated, summarized, geo-referenced and staged for public access on the internet. Problems of data standardization, reporting accuracy and the subsequent publishing of information on the internet follow. The review was conducted primarily to investigate the spatial heterogeneity of malaria exposure in Africa and supports the idea of highly heterogeneous risk at the continental, regional and country levels. The implications for malaria control of the significant spatial (and seasonal) variation in exposure to infected mosquito bites are discussed.

Africa↗
PubMedDate not supplied

Where is the meningitis belt? Defining an area at risk of epidemic meningitis in Africa.

Mapping an area at risk of epidemics of meningococcal meningitis in Africa has significant implications for their prevention and case treatment, through the targeted development of improved surveillance systems and control policies. Such an area was described using information obtained from published and unpublished reports of meningitis epidemics between 1980 and 1999 and cases of meningococcal disease reported by surveillance systems to WHO. The Sahel bore the greatest epidemic burden, with over two-thirds of documented outbreaks and high attack rates. In addition to those already in the Meningitis Belt, countries affected included Guinea-Bissau, Guinea, Côte d'Ivoire, Togo, the Central African Republic and Eritrea. Elsewhere epidemics were reported from a band of countries around the Rift Valley and Great Lakes regions extending as far south as Mozambique and from here west to Angola and Namibia in southern Africa. The cumulative pan-continental analysis provided evidence of an epidemic-susceptible area which extends beyond the region accepted as the Meningitis Belt and which, moreover, may be partially determined by the physical environment, as shown by a striking correspondence to the 300-1100-mm mean annual rainfall isohyets.

Africa↗
PubMedDate not supplied

Primary HIV infection diagnosed in South Africa masquerading as another tropical disease.

Eleven patients referred to a hospital in South Africa with suspected tropical diseases such as malaria, typhoid fever and South African tick bite fever were found to be suffering from primary human immunodeficiency virus (HIV) infection. Hospital records were reviewed retrospectively in those acutely ill, febrile patients where a clinical suspicion of HIV seroconversion existed and no other diagnosis could be found. A history of recent travel, particularly to malarious areas, was given by most of these patients. The clinical presentation was dominated by high fevers and headaches. The most helpful pointers to primary HIV infection included a characteristic palatal enanthem, leucopenia and thrombocytopenia. Ironically, the history of recent travel appeared to have confounded the diagnosis despite the fact that travel has often been associated with the acquisition of HIV in Africa. Recognition of primary HIV infection masquerading as a tropical disease may result in more frequent diagnosis of this serious condition.

Adult↗