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At least 19 recordsLinked to original sources
PubMed1989

The Tuberculosis Control Programme, 1985-1986. Results of the data-capturing programme instituted by the Department of National Health and Population Development and the Standing Committee on Epidemiology of the Regional Health Organisation for southern Africa.

The Tuberculosis Control Programme during 1985 and 1986 in the seven health regions of the RSA is described. This information has not previously been available. In 1986 the total tuberculosis case load exceeded 90,000. Of about 56,000 patients in whom the outcome was known, nearly 44,000 were discharged from the programme cured, about 9,500 absconded from therapy and 3,000 died. About 222,000 suspects or contacts of cases were investigated. Analysis of the data by health region revealed regional differences of prevalence rates, predominance of inpatient or outpatient treatment, cure rates, the ratio of new tuberculosis suspects or contacts found for every new confirmed case, and the cost of the programme per case and per capita of the population. Although these data must be interpreted cautiously, it is hoped that they will be valuable to all health workers fighting this major infectious disease in South Africa.

Data Collection↗
PubMed1992

Distribution of health personnel in the Republic of South Africa with special reference to medical practitioners.

Data from various sources indicate that there is no shortage of medical practitioners in the RSA. This was confirmed in a 1990 survey by the Department of National Health and Population Development. The perceived shortage is relative in nature and due to a geographical and functional maldistribution. The majority (77%) of medical practitioners reside in metropolitan areas in the RSA; the ratio of doctors to members of the population is 1:696. Only 23% of medical practitioners practise in non-metropolitan areas; the calculated ratio is 1:1 920. The overall ratio in the self-governing territories is 1:15 272 and compares unfavourably with the ratios in non-metropolitan magisterial districts in the RSA. The medical practitioner/population ratio varies fifty-fold between the metropolitan areas in the RSA and the essentially rural self-governing territory of Lebowa (1:30 449). The registered medical practitioner/population ratios for the various development regions vary from 1:672 to 1:7 642. Failure to address these imbalances will have serious implications for the future rendering of acceptable and equitable health care.

Demography↗
PubMed1992

No need for needs norms--why central planning cannot work for health care.

It is widely recognised that South Africa, like other countries, has inequities in health and in access to health care. Centralised formal planning is used by the Department of National Health and Population Development and advocated by others as the approach to social justice and equitable distribution of health care resources. This approach is typical of the central planning of command economies. The reasons why central planning cannot work for health care are explained and an alternative approach is suggested which emphasises decentralised management. This is in line with recent policy statements by the Minister of Health that place a high priority on decentralisation and democratisation. The proposal has important implications for the way in which information systems are developed and used. Much information that central planners say they need is also required for effective management, but with some crucial differences. Planners use ad hoc historical information with little understanding of the local context. Managers, in contrast, regularly need current information for use within the local context. It is therefore recommended that efforts by central planners to acquire information be redirected towards building the capabilities of the health care services to provide and use information for management at all levels.

Health Planning↗
PubMed1991

Denture requirements of indigents in the Western Cape region.

This study was undertaken to determine the denture requirements of indigents who make application to the Department of National Health and Population Development for prostheses. An analysis of 4573 denture application forms for the period 1 January 1983 to 31 December 1984 was undertaken in the Western Cape region in order to obtain the relevant information. The general profile of applicants was that of a middle-aged coloured female who was unemployed with a monthly income of R144.51. Almost 60 per cent of applicants had been edentulous for a period of 1-10 years and the greatest demand was for full upper and lower dentures. The mean period of wearning dentures ranged between 15.9 and 21.7 years. A disturbing finding was that a high percentage of applicants (48.6%) had no motivational reasons for wanting dentures.

Adult↗
PubMed1987

Notifiable malignant lesions in the RSA, 1979-1983--trends and mortality. I. Malignant neoplasms of the bronchus and lung.

Primary malignant tumours of the bronchus, lung and pleura were introduced as notifiable medical conditions in August 1979. The western Cape, Natal and eastern Cape have been the regions with the highest notification rates. Small numbers of cases and deaths were notified from other areas (Orange Free State, southern Transvaal, northern Transvaal and northern Cape). During the period 1979-1983 one-fifth of deaths registered at Central Statistical Services were notified to the Department of National Health and Population Development. Mortality due to lung cancer, as registered, increased by 39.3% in coloured females; from 24.2/100,000 to 33.7/100,000.

Adult↗
PubMed1987

Notifiable malignant lesions in the RSA, 1979-1983--trends and mortality. II. Primary malignant neoplasms of the pleura.

From August 1979 to December 1983, 22 cases of and 17 deaths due to primary malignant neoplasms of the pleura were notified to the Department of National Health and Population Development. Correspondingly, 458 deaths due to mesothelioma and malignant neoplasms of the pleura were registered at Central Statistical Services; 4% of these deaths were notified. Most of the deaths due to mesothelioma and malignant neoplasms of the pleura registered were in white males, who showed a mortality rate of 15.8/1,000,000.

Adult↗
PubMed1987

Differences in trends of measles notifications by age and race in the western Cape, 1982-1986.

Measles remains a major health problem in the Cape Western Region of the Department of National Health and Population Development. During the 5-year period 1982-1986, 5,089 notifications were received and analysed for the Cape Town Metropolitan area and for the rest of the region. Of the 3,682 notifications for Cape Town, 60.6% of the patients were under 2 years old, compared with 15.4% of the 1,407 notifications for the rest of the region. The black population in Cape Town accounted for 58.3% of the notifications, and the coloured population in the rest of the region for 51.5%. White notifications for both areas were low, except in the latter half of 1986, when widespread outbreaks affected mainly the white population. Age-adjusted notification rates varied between the two areas, the highest being for blacks in Cape Town, ranging up to 302.3/100,000, and the lowest being for whites, at 1.6/100,000 in the rest of the region. The implications of these different trends are discussed, and a possible reason for the outbreaks in whites is postulated. The most effective way of dealing with the problem is for every effort and available resource to be put into immunising every child at 9 months of age, and any older children who have not yet been immunised.

Black or African American↗
PubMed1995

Phenylketonuria in South Africa. A report on the status quo.

During the 1980s a pilot newborn screening programme for the early detection (and treatment) of amino acidopathies, especially phenylketonuria (PKU), was conducted by the Department of National Health and Population Development. The motivation for this pilot programme was the high priority accorded PKU screening in Europe and North America and the presumed similarly high incidence of this condition among South Africans of European origin. From a cohort of 59,600 newborns screened in the Pretoria area over a period of 8 consecutive years (1979-1986), only 1 case of PKU (and 1 of tyrosinaemia) was found. Statistically this result is compatible (Poisson distribution, 95% confidence interval) with a 'true' incidence of not more than 3/59,600 (or about 1/20,000) newborns. It is concluded from this result and other relevant information that newborn screening for PKU and other amino acidopathies is not cost-effective and justifiable, especially against the background of prevailing demographic conditions and more pressing health priorities in South Africa. This particular screening programme was discontinued in 1986. The results and conclusions are presented here for the record.

Cost-Benefit Analysis↗
PubMed1994

Notification of pesticide poisoning in the western Cape, 1987-1991.

There is a paucity of data on pesticide-related morbidity and mortality in South Africa. A review of notifications to the western Cape office of the Department of National Health and Population Development from 1987 to 1991 was undertaken to describe the epidemiological profile of pesticide poisoning in the region. Two hundred and twenty-five cases of pesticide poisoning were identified, of which the majority were from rural areas. Farmers, farm workers and their families were most frequently involved in poisoning events, which included accidents arising outside of workplace production (44%), self-inflicted injury (35%) and direct occupational contamination (11%). Farm pesticide stores were the most frequent source of pesticide and a seasonal variation in the trend of poisoning events could be discerned; this corresponded to agricultural spraying practices in the region. The mortality rate was significantly higher among those with self-inflicted injury, particularly farm workers. A concurrent review of hospital admissions for 1991 found that 78% of cases had not been notified. In view of the key role of surveillance in reducing pesticide-related morbidity and mortality, a call is made to improve notification of pesticide poisoning so as to facilitate control of an important potential public health problem.

Adolescent↗
PubMed1993

Malaria prophylaxis--the South African viewpoint.

A consensus meeting was held under the auspices of the Department of National Health and Population Development in September 1991 in order to establish local, current consensus on malaria prophylaxis for the South African traveller within South Africa and neighbouring African countries. The meeting was attended by malaria experts and others interested in malaria. The consensus reached took into consideration not only the international literature, but also local clinical experience and viewpoints. As a result, it was decided that prevention of mosquito bites is the mainstay of malaria prophylaxis and that chemoprophylaxis should be individualised. Malaria may still be contracted despite good compliance with the recommended prophylactic regimen.

Adult↗
PubMed1996

Effect of an immunisation campaign in Natal and KwaZulu on vaccinaton coverage rates, 1990-1991.

In 1990 the Department of National Health and Population Development of South Africa launched a nationwide immunisation campaign targeted mainly at measles. In order to measure the effect of the campaign on vaccination coverage rates for children, pre- and post- campaign vaccination coverage surveys were undertaken using a modified Expanded Programme for Immunisation technique, stratified for race and urban/rural residence. The results in KwaZulu-Natal showed no significant increase in measles vaccination coverage for any race rates after the campaign (as documented by Road-to-Health cards). There was a decrease in coverage of the black population. However, when a history of measles vaccination was accepted, the results showed an increase in coverage. The results call into question the effectiveness of immunisation campaigns as a strategy for raising vaccination coverage levels, as well as their having a sustained impact on the incidence of measles. Alternative strategies, such as the strengthening and expansion of existing primary health care services, should be considered.

Child, Preschool↗
PubMed1988

The Mount Sinai Medical Center, New York.

Aging is the third great antecedent to all disease, along with genetic factors and the environment. Yet, the role of aging in the genesis of the conditions of old age constitutes relatively new territory that has not been adequately explored in terms of education, the health care system, and research. A commitment to these areas was made in 1982 when the Mount Sinai Medical Center established the nation's first and only medical school department of geriatrics--the Gerald and May Ellen Ritter Department of Geriatrics and Adult Development. Recognizing that aging of the population constituted a major global public health challenge, leaders of the medical center turned to Robert N. Butler, MD, who was then director of the National Institute on Aging, for guidance in setting up an institute of gerontology and geriatrics. Because only a full-fledged academic department would have a claim on resources, curriculum, and clerkship time, Dr Butler recommended that such a department be developed at Mount Sinai. The Ritter Department of Geriatrics and Adult Development emphasized the wide scope of this new discipline through educational programs, clinical services, health policy studies, and research projects.

Aged↗
PubMedDate not supplied

A screening survey to assess local public health performance.

Current studies are attempting to develop a national surveillance system to measure the extent that populations are served by local departments carrying out the core functions of public health. Early phases of the study featured observations on 14 health departments that have been subjects of a longitudinal study. These departments were surveyed using a protocol with 81 different indicators. The results permitted distinctions to be made among the departments on levels of performance according to core functions and their associated practices. To simplify the survey protocol so that it might be suitable for use with a large number of local public health jurisdictions, a subset of 26 indicators was selected from the previously developed protocol. Each indicator in the subset was linked with one of the three core functions of public health and with one of the associated practices. In an effort to display correlation between scores on the simplified survey and those in the full survey, scatter plots were prepared for overall scores and for those pertaining to each function and practice. Stepwise regressions were done to determine which queries or groups of queries were most predictive of variations in the screening responses. Four questions accounted for 96 percent of the variance in responses for overall performance. Results suggest that a three-tiered approach to the evaluation of local public health performance might be feasible. For the study departments, responses to four questions could be used to screen overall public health performance; responses to 26 questions could be used to yield information about performance of each of the three core public health functions; and responses to 84 questions could be used to yield more detailed information about performance for each of 10 public health practices. Experience with a larger set of departments might revise the number and nature of the screening queries.

Community Health Services↗
PubMedDate not supplied

Local health department effectiveness in addressing the core functions of public health.

Objective 8.14 of the Year 2000 National Health Objectives calls for 90 percent of the population to be served by a local health department effectively carrying out the three core functions of public health--assessment, policy development, and assurance. To provide a benchmark of local health department effectiveness in addressing the core functions and to assess implications for achieving the year 2000 target, a random national sample (stratified by jurisdiction and population base) of local health departments was surveyed to determine self-reported compliance with 10 public health practice performance measures that operationalize the core functions. Overall compliance with the 10 performance measures was 50 percent, based on weighted responses of 208 responding health departments. Compliance was highest for the practices related to the assurance function and least for practices related to the policy development function. Compliance was also high for departments serving a population of 50,000 or more and those smaller departments organized at the city and city-county levels. Using two different definitions developed by the investigators, 19 and 31 percent of the health departments were judged to be effective in addressing the core functions of public health. These data suggest that less than 40 percent of the U.S. population was served by a health department effectively addressing the core functions of public health in 1993. It appears that considerable capacity building within the public health system will be needed to achieve the year 2000 target of 90 percent.

Community Health Services↗
PubMedDate not supplied

Health-care expenditures for tuberculosis in the United States.

BACKGROUND: The resurgence of tuberculosis (TB) and the increase in multidrug-resistant TB prompted this study, which estimates direct expenditures for TB treatment and public health activities in the United States. METHODS: This retrospective cost of illness study estimated 1991 direct expenditures for TB-related outpatient and inpatient diagnosis and treatment, screening, preventive therapy, contact investigations, surveillance, and outbreak investigations. Existing databases at the Centers for Disease Control and Prevention (Atlanta, Ga) and the Codman Research Group, Lebanon, NH, were supplemented by surveys of state and local TB programs and interviews of organizations that conduct large-scale screening. No estimates of indirect costs were made. RESULTS: The direct medical expenditures for TB in 1991 were estimated at $703.1 million. This cost includes $423.8 million for inpatient care, $182.3 million for outpatient care, $72.1 million for screening, $3.4 million for contact investigations, $17.9 for preventive therapy, and $3.6 million for surveillance and outbreak investigations. Sensitivity analyses yielded a range of expenditures between $515.7 million and $934.5 million. CONCLUSIONS: Treatment accounted for more than 86% of all TB-related expenditures; inpatient treatment accounted for 60% of the total. Prevention activities made up only 14% of all costs. Direct medical expenditures may be underestimated because of limitations in the database on hospital expenditures and health department cost-accounting systems and because of the lack of a national database on screening activities. Greater emphasis should be placed on outpatient treatment and prevention in high-risk populations, and improved cost-accounting systems should be developed in state and local health department TB control programs to facilitate economic evaluation and improve the allocation of health dollars.

Cost of Illness↗