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1
Dommisse, John. "WORLD MEDICAL ASSOCIATION AND SOUTH AFRICA." Lancet 334, no. 8674 (November 1989): 1280. http://dx.doi.org/10.1016/s0140-6736(89)91887-4.
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Wynen, André. "WORLD MEDICAL ASSOCIATION AND SOUTH AFRICA." Lancet 334, no. 8667 (October 1989): 866. http://dx.doi.org/10.1016/s0140-6736(89)93030-4.
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Stewart, John. "The Expulsion of South Africa and Rhodesia from the Commonwealth Medical Association, 1947–70." Medical History 61, no. 4 (September 13, 2017): 548–67. http://dx.doi.org/10.1017/mdh.2017.58.
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In 1970 the medical associations of South Africa and Rhodesia (now, Zimbabwe) were expelled from the Commonwealth Medical Association. The latter had been set up, as the British Medical Commonwealth Medical Conference, in the late 1940s by the British Medical Association (BMA). These expulsions, and the events leading up to them, are the central focus of this article. The BMA’s original intention was to establish an organisation bringing together the medical associations of the constituent parts of the expanding Commonwealth. Among the new body’s preoccupations was the relationship between the medical profession and the state in the associations’ respective countries. It thus has to be seen as primarily a medico-political organisation rather than one concerned with medicine per se. Although, there were also tensions from the outset regarding the membership of the Southern African medical associations. Such stresses notwithstanding, these two organisations remained in the BMA-sponsored body even after South Africa and Rhodesia had left the Commonwealth. This was not, however, a situation which could outlast the growing number of African associations which joined in the wake of decolonisation; and hardening attitudes towards apartheid. The article therefore considers: why the BMA set up this Commonwealth body in the first place and what it hoped to achieve; the history of the problems associated with South African and Rhodesian membership; and how their associations came to be expelled.
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Beck, Winfried. "THE WORLD MEDICAL ASSOCIATION AND SOUTH AFRICA." Lancet 333, no. 8652 (June 1989): 1441–42. http://dx.doi.org/10.1016/s0140-6736(89)90137-2.
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Mji, Diliza. "The World Medical Association in South Africa." International Journal of Health Services 15, no. 2 (April 1985): 351–53. http://dx.doi.org/10.2190/4huh-dwvu-mu8j-k0nb.
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Cassim, Shakira. "Symposium 2: COVID-19 Experiences Around the World." International Journal of Human and Health Sciences (IJHHS) 6 (March 13, 2022): 9. http://dx.doi.org/10.31344/ijhhs.v6i0.399.
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The presentation gives an overview of the COVID-19 pandemic in South Africa. It discusses the 1st, 2nd and 3rd waves, including the current new COVID-19 variant B1.1.529 and the 4th predicated wave. It also discusses the South African government's response to the COVID-19 pandemic. Muslims in South Africa make up 3% of South Africa's population of nearly 60 million. It further examines the COVID- 19 statistics in the Muslim community, the Muslim response in the relief efforts, and focusing on the response of the Islamic Medical Association of South Africa (IMASA) in the efforts to combat the virus and improve the survival rates.International Journal of Human and Health Sciences Supplementary Issue: 2022 Page: S9
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Zell, Hans M. "Publishing in Africa." Logos 30, no. 4 (May 8, 2020): 16–36. http://dx.doi.org/10.1163/18784712-03004002.
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This is the second instalment of a two-part article. Part 1 of this article appeared in Logos, 30 (3). Part 2 sets out a number of suggestions to strengthen the book industries in Africa, and the way forward, especially on capacity- and skills-building; training for book industry personnel; strengthening book professional associations, South–South linkages, and knowledge-sharing; encouraging international collaboration; the need for ongoing research and documentation; African books in the global marketplace; and the important but still neglected area of publishing in African indigenous languages. An Appendix provides a summary of the International Publishers Association (IPA) and Association for the Development of Education in Africa (ADEA) meetings on the African book industry, held in Nairobi in June 2019, together with links to a number of articles, reports, and press statements about the meetings.
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Mbali, Mandisa. "‘A Matter of Conscience’: The Moral Authority of the World Medical Association and the Readmission of the South Africans, 1976–1994." Medical History 58, no. 2 (April 2014): 257–77. http://dx.doi.org/10.1017/mdh.2014.8.
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AbstractThis article describes the role of transnational anti-apartheid activism in South Africa, Britain and the United States in generating international moral outrage over the readmission of the Medical Association of South Africa (MASA) to the World Medical Association (WMA), which had taken place in 1981 after it had withdrawn from that body in 1976. It discusses an example of a controversy where an international health organisation (IHO) lost moral authority as a result of being accused of white supremacy and a pro-American engagement in Cold War politics. At the time of its readmission to the WMA, the MASA was controversial because of its failure to strike off its membership roll one of the doctors implicated the death in detention of Black Consciousness leader Steve Biko in 1977. It details how these activists viewed the American Medical Association as having campaigned for the MASA’s readmission. The WMA’s readmission of the MASA cost the former its relationships with the World Health Organisation (WHO) and the British Medical Association – a dispute which continued until South Africa’s democratic transition of 1994. With its focus on transnational activism in relation to the WMA and the effects of activists’ allegations of racism on its internal politics, this article contributes to the literature on the history of IHOs. Ultimately, this controversy shows the deficiency of international medical professional associations as ethical arbitrators of last resort.
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Lawrence, R. A. A. R. "South African Medical Association colluded with apartheid." BMJ 311, no. 7011 (October 14, 1995): 1026. http://dx.doi.org/10.1136/bmj.311.7011.1026.
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Sehularo, Leepile Alfred. "A relevant practical course for mental health care providers in South Africa." International Journal of Scientific Reports 2, no. 8 (August 6, 2016): 210. http://dx.doi.org/10.18203/issn.2454-2156.intjscirep20162811.
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<p>The South African Mental Health Care Actdefines mental health care provider as a person providing mental health care services to mental health care users and includes mental health care practitioners. Mental health care practitioner means a nurse, psychiatrist or registered medical practitioner, psychologist, occupational therapist or social worker who has been trained at an accredited institution to provide prescribed mental health care, treatment and rehabilitation services. For a South African mental health provider to render high-quality mental health care, treatment and rehabilitation services, that mental health care provider should have been exposed to theory and practical teaching and learning in Intellectual Disability (ID). One of the most relevant practical courses for intellectual disability in South Africa is offered by the Sunshine Association.</p>
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Verhoef, Grietjie. "From Friendly Society to Compulsory Medical Aid Association." Social Science History 30, no. 4 (2006): 601–27. http://dx.doi.org/10.1017/s0145553200013602.
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The compulsory medical benefit scheme for white public servants in South Africa grew out of a friendly society founded in 1905. This development diverged from the experience of other members of the British Commonwealth, where universal health insurance schemes developed following the British example. The Civil Servants’ Medical Benefit Association (CSMBA) addressed the needs of white public servants, leaving the non-white communities without any form of government-sponsored medical support, apart from health care provided at government hospitals. The CSMBA was a well-managed medical benefit association, but when it was appointed the compulsory medical benefit association for white public servants, government intervention affected the financial viability of the organization, despite the payment of a state subsidy.
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Esterhuizen, Jm, and Gh Van Rensburg. "The Role of Gender in the History of the Professional Development of South African Nursing and Nursing Organisations." Gender Studies 20, no. 1 (December 1, 2021): 110–27. http://dx.doi.org/10.2478/genst-2022-0008.
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Abstract Historically, female nurse leaders endeavoured to make nursing a profession by establishing nursing organisations that could act as agents of change. They were hampered by sociocultural notions of gender: men dominating society, politics, and the economy. Nurses therefore needed positive working relationships with male leaders. In South Africa, such gender dynamics led to the South African Nursing Association (SANA), being influenced by a political system, that is, apartheid, which had dire consequences for the profession. This article illustrates that historically the emerging nursing profession was intimately connected with a changing society: female nurses strove for economic and professional independence but were confined by a male-dominated (medical) society. South African female nurse leaders never openly challenged the political status quo. It is recommended that current South African nursing organisations advocate for gender equality and clarify how they can foster a health-care environment in which gender diversity is the norm.
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Smith, Wayne P., Vernon Wessels, Diane Naicker, Elizabeth Leuenberger, Peter Fuhri, and Lee A. Wallis. "Development of a Mass-Gathering Medical Resource Matrix for a Developing World Scenario." Prehospital and Disaster Medicine 25, no. 6 (December 2010): 547–52. http://dx.doi.org/10.1017/s1049023x00008748.
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AbstractMass gatherings have a higher patient presentation rate than is found within the general population. Despite this fact, many mass gatherings are occurring without suitable medical coverage. South Africa has had no standard approach or model to determine the number of medical personnel needed to deploy to an event. The awarding of the FIFA (Federation International de Football Association) 2010 World Cup to South Africa has provided the impetus for the development of such a model. The model presented in this paper is based on existing recommendations that originate from the United Kingdom.This paper outlines the modifications that have been made to this model to ensure that adequate medical resources still are provided, albeit in a developing country where medical resources may not be as plentiful.
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Kubjane, Mmamapudi, Natacha Berkowitz, Rene Goliath, Naomi S. Levitt, Robert J. Wilkinson, and Tolu Oni. "Tuberculosis, Human Immunodeficiency Virus, and the Association With Transient Hyperglycemia in Periurban South Africa." Clinical Infectious Diseases 71, no. 4 (September 26, 2019): 1080–88. http://dx.doi.org/10.1093/cid/ciz928.
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Abstract Background Diabetes mellitus (DM) increases tuberculosis (TB) risk. We assessed the prevalence of hyperglycemia (DM and impaired glucose regulation [IGR]) in persons with TB and the association between hyperglycemia and TB at enrollment and 3 months after TB treatment in the context of human immunodeficiency virus (HIV) infection. Methods Adults presenting at a Cape Town TB clinic were enrolled. TB cases were defined by South African guidelines, while non-TB participants were those who presented with respiratory symptoms, negative TB tests, and resolution of symptoms 3 months later without TB treatment. HIV status was ascertained through medical records or HIV testing. All participants were screened for DM using glycated hemoglobin and fasting plasma glucose at TB treatment and after 3 months. The association between TB and DM was assessed. Results Overall DM prevalence was 11.9% (95% confidence interval [CI], 9.1%–15.4%) at enrollment and 9.3% (95% CI, 6.4%–13%) at follow-up; IGR prevalence was 46.9% (95% CI, 42.2%–51.8%) and 21.5% (95% CI, 16.9%–26.3%) at enrollment and follow-up. TB/DM association was significant at enrollment (odds ratio [OR], 2.41 [95% CI, 1.3–4.3]) and follow-up (OR, 3.3 [95% CI, 1.5–7.3]), whereas TB/IGR association was only positive at enrollment (OR, 2.3 [95% CI, 1.6–3.3]). The TB/DM association was significant at enrollment in both new and preexisting DM, but only persisted at follow-up in preexisting DM in patients with HIV-1 infection. Conclusions Our study demonstrated high prevalence of transient hyperglycemia and a significant TB/DM and TB/IGR association at enrollment in newly diagnosed DM, but persistent hyperglycemia and TB/DM association in patients with HIV-1 infection and preexisting DM, despite TB therapy.
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Luyirika, E., and F. Kiyange. "A Regional Palliative Care Entity Working With a Host Government to Facilitate Exchange Visits From Across Africa to Improve Access to Controlled Medicines for Cancer Patients." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 164s. http://dx.doi.org/10.1200/jgo.18.17300.
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Background and context: The African Palliative Care Association (APCA) is a pan-African palliative care organization hosted in Uganda but supporting initiatives to integrate palliative care into national health systems across Africa. Uganda hosts one of the oldest cancer units in Africa and also reconstitutes its own oral liquid morphine to reduce barriers and cost of access to pain control for patients. Aim: The aim of this effort is to expose government officials and other NGOs from other African countries to best practices in oral morphine manufacture, distribution and access to controlled medicines for pain control in cancer and other conditions with a view to benchmark and establish similar or better systems. Strategy/Tactics: APCA working with its funders in consultation with the Ugandan Ministry of Health and Hospice Africa Uganda, facilitates other African ministries of health delegations to conduct study visits in Uganda to benchmark the oral morphine reconstitution, the supply chain mechanisms for its distribution to patients in both public and private hospitals and at home. Program/Policy process: APCA identifies countries with morphine access challenges and makes arrangements for key personnel in those countries in ministries of health, medicines control authority, central medicines stores and national palliative care associations where they exist to spend a study period in Uganda. While in Uganda, the delegations visit the oral morphine manufacturing facility, Hospice Africa Uganda, the Ministry of Health, national medical stores, National Drug Authority, joint medical stores and some of the palliative care providers and training facilities. Once the period with the various stakeholders in the country is completed, the visiting teams draw up plans for implementation and identify required technical assistance from APCA. The costing and sources of funding are identified including contribution from the government in need and then activities are implemented. Outcomes: As a result of this South-to-South approach, Uganda has hosted delegations from 14 African countries. At one instance, it involved the Minister Of Health from Swaziland heading a delegation to Uganda while others sent other high level delegates to the peer learning and bench marking. All these countries have taken steps to establish access to oral liquid morphine as well as policy and capacity building activities for their staff. Some of the countries like Malawi and Swaziland are already having morphine reconstitution and national palliative care policies while others such as Rwanda and Botswana are in the process of changing to the same system. Cancer and palliative care related activities are also being implemented in some of countries. Some countries have graduated to host others like Uganda does. What was learned: The South-to-South learning and bench marking visits are very practical in Africa and have triggered palliative care initiatives at national level.
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Chiba, Sheetal, Warren Lowman, and Gunter Schleicher. "Early complications in adult liver transplant recipients at the Wits Donald Gordon Medical Centre, South Africa." african journal of gastroenterology and hepatology 3, no. 1 (July 12, 2020): 1–24. http://dx.doi.org/10.52378/hmer76393.
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Background Deceased donor liver transplantation (DDLT) is a transplant modality performed routinely in adults at Wits Donald Gordon Medical Centre (WDGMC). Infection, graft dysfunction, surgical and medical complications are common in the early post-transplant period, accounting for early morbidity and mortality. Objectives Provide a descriptive analysis of all complications in the first 30 days post DDLT. To investigate associations between recipient demographic data, comorbid diabetes, MELD score, and subsequent complications. Methods A retrospective review of adult DDLT recipients for the first 30 days post-transplant was performed at WDGMC for the period January 2015 - December 2016. Fischer’s exact test was used to assess relationships between demographic data and infectious complications, whilst an independent sample t-test was used for non-infectious complications. Results Seventy-eight DDLTs were performed, with 6 (8%) mortalities in the first 30 days. The median age was 54 years; 54% were male. In total, 24 recipients (31%) developed infectious complications. Sixteen patients (67% of the infectious cohort) had intra-abdominal sepsis, 6 (25%) developed lower respiratory tract infections, 6 (25%) skin and soft tissue infections, and 3 (13%) urinary tract infections. Of all infectious complications, 7 patients (29%) developed bacteremia. Non-infectious complications were developed in 55 patients (71%) of which renal complications were more common (67%). No significant association between age, gender, ascites, diabetes mellitus, MELD score, and any complications was found. Conclusion Non-infectious complications were more prominent than infectious complications in the first 30 days post-DDLT in adult recipients, with no significant association between recipient demographic data, comorbid diabetes, CMV status, and MELD score.
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O'Farrell, Nigel, Linda Morison, Prashini Moodley, Keshree Pillay, Trusha Vanmali, Maria Quigley, Richard Hayes, and A. Willem Sturm. "Association Between HIV and Subpreputial Penile Wetness in Uncircumcised Men in South Africa." JAIDS Journal of Acquired Immune Deficiency Syndromes 43, no. 1 (September 2006): 69–77. http://dx.doi.org/10.1097/01.qai.0000225014.61192.98.
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Ruffieux, Yann, Mazvita Muchengeti, Matthias Egger, Orestis Efthimiou, Lina Bartels, Victor Olago, Maša Davidović, et al. "Immunodeficiency and Cancer in 3.5 Million People Living With Human Immunodeficiency Virus (HIV): The South African HIV Cancer Match Study." Clinical Infectious Diseases 73, no. 3 (February 2, 2021): e735-e744. http://dx.doi.org/10.1093/cid/ciab087.
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Abstract Background We analyzed associations between immunodeficiency and cancer incidence in a nationwide cohort of people living with human immunodeficiency virus (HIV; PLWH) in South Africa. Methods We used data from the South African HIV Cancer Match Study built on HIV-related laboratory measurements from the National Health Laboratory Services and cancer records from the National Cancer Registry. We evaluated associations between time-updated CD4 cell count and cancer incidence rates using Cox proportional hazards models. We reported adjusted hazard ratios (aHRs) over a grid of CD4 values and estimated the aHR per 100 CD4 cells/µL decrease. Results Of 3 532 266 PLWH, 15 078 developed cancer. The most common cancers were cervical cancer (4150 cases), Kaposi sarcoma (2262 cases), and non-Hodgkin lymphoma (1060 cases). The association between lower CD4 cell count and higher cancer incidence rates was strongest for conjunctival cancer (aHR per 100 CD4 cells/µL decrease: 1.46; 95% confidence interval [CI], 1.38–1.54), Kaposi sarcoma (aHR, 1.23; 95% CI, 1.20–1.26), and non-Hodgkin lymphoma (aHR, 1.18; 95% CI, 1.14–1.22). Among infection-unrelated cancers, lower CD4 cell counts were associated with higher incidence rates of esophageal cancer (aHR, 1.06; 95% CI, 1.00–1.11) but not breast, lung, or prostate cancer. Conclusions Lower CD4 cell counts were associated with an increased risk of developing various infection-related cancers among PLWH. Reducing HIV-induced immunodeficiency may be a potent cancer-prevention strategy among PLWH in sub-Saharan Africa, a region heavily burdened by cancers attributable to infections.
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Caldwell, Robert Ian. "Thieves of the state and the South African Medical Association." South African Medical Journal 103, no. 6 (May 21, 2013): 354. http://dx.doi.org/10.7196/samj.7008.
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Groups, African Pathologists' Summit Working. "Proceedings of the African Pathologists Summit; March 22–23, 2013; Dakar, Senegal: A Summary." Archives of Pathology & Laboratory Medicine 139, no. 1 (June 25, 2014): 126–32. http://dx.doi.org/10.5858/arpa.2013-0732-cc.
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Context This report presents the proceedings of the African Pathologists Summit, held under the auspices of the African Organization for Research and Training in Cancer. Objectives To deliberate on the challenges and constraints of the practice of pathology in Sub-Saharan Africa and the avenues for addressing them. Participants Collaborating organizations included the American Society for Clinical Pathology; Association of Pathologists of Nigeria; British Division of the International Academy of Pathology; College of Pathologists of East, Central and Southern Africa; East African Division of the International Academy of Pathology; Friends of Africa–United States and Canadian Academy of Pathology Initiative; International Academy of Pathology; International Network for Cancer Treatment and Research; National Cancer Institute; National Health and Laboratory Service of South Africa; Nigerian Postgraduate Medical College; Royal College of Pathologists; West African Division of the International Academy of Pathology; and Faculty of Laboratory Medicine of the West African College of Physicians. Evidence Information on the status of the practice of pathology was based on the experience of the participants, who are current or past practitioners of pathology or are involved in pathology education and research in Sub-Saharan Africa. Consensus Process The deliberations were carried out through presentations and working discussion groups. Conclusions The significant lack of professional and technical personnel, inadequate infrastructure, limited training opportunities, poor funding of pathology services in Sub-Saharan Africa, and their significant impact on patient care were noted. The urgency of addressing these issues was recognized, and the recommendations that were made are contained in this report.
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Wassenaar, Trudy M., Benjamin N. Fry, Albert J. Lastovica, Jaap A. Wagenaar, Peter J. Coloe, and Birgitta Duim. "Genetic Characterization of Campylobacter jejuni O:41 Isolates in Relation with Guillain-BarréSyndrome." Journal of Clinical Microbiology 38, no. 2 (2000): 874–76. http://dx.doi.org/10.1128/jcm.38.2.874-876.2000.
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Campylobacter jejuni O:41 strains are found in association with Guillain-Barré syndrome in South Africa. Strains of this serotype collected over 17 years were characterized by amplified fragment length polymorphism and flagellin typing to determine their clonal nature. Despite minor variation in GM1 expression, all of the strains were genetically indistinguishable, indicating that they are representative of a genetically stable clone.
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Groome, Michelle J., Jacqueline E. Tate, Marion Arnold, Milind Chitnis, Sharon Cox, Corné de Vos, Mari Kirsten, et al. "Evaluation of Intussusception After Oral Monovalent Rotavirus Vaccination in South Africa." Clinical Infectious Diseases 70, no. 8 (May 24, 2019): 1606–12. http://dx.doi.org/10.1093/cid/ciz431.
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Abstract Background Postlicensure studies have shown an association between rotavirus vaccination and intussusception. We assessed the risk of intussusception associated with Rotarix (RV1) administration, at 6 and 14 weeks of age, in an upper-middle-income country, South Africa. Methods Active prospective surveillance for intussusception was conducted in 8 hospitals from September 2013 through December 2017. Retrospective case enrollment was done at 1 hospital from July 2012 through August 2013. Demographic characteristics, symptom onset, and rotavirus vaccine status were ascertained. Using the self-controlled case-series method, we estimated age-adjusted incidence rate ratios within 1–7, 8–21, and 1–21 days of rotavirus vaccination in children aged 28–275 days at onset of symptoms. In addition, age-matched controls were enrolled for a subset of cases (n = 169), and a secondary analysis was performed. Results Three hundred forty-six cases were included in the case-series analysis. Post–dose 1, there were zero intussusception cases within 1–7 days, and 5 cases within 8–21 days of vaccination. Post–dose 2, 15 cases occurred within 1–7 days, and 18 cases within 8–21 days of vaccination. There was no increased risk of intussusception 1–7 days after dose 1 (no cases observed) or dose 2 (relative incidence [RI], 1.71 [95% confidence interval {CI} .83–3.01]). Similarly, there was no increased risk 8–21 days after the first (RI, 4.01 [95% CI, .87–10.56]) or second dose (RI, .96 [95% CI, .52–1.60]). Results were similar for the case-control analysis. Conclusions The risk of intussusception in the 21 days after the first or second dose of RV1 was not higher than the background risk among South Africa infants. Clinical Trials Registration South African National Clinical Trial Register (DOH-27-0913-4183).
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Dommisse, John. "Apartheid as a Public Mental Health Issue." International Journal of Health Services 15, no. 3 (July 1985): 501–10. http://dx.doi.org/10.2190/xrwq-r9ma-06wr-09a5.
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The most serious hazard to the physical and mental health of the majority rural poor black population in South Africa is caused by the ruling wealthy white minority's policy of apartheid. Forced removals and dumping of millions of people into small, disconnected, barren, poor reserve areas, bereft of adequate medical, psychiatric and public health services (the ‘final solution’ of the ‘native problem’) causes widespread malnutrition, infectious and other diseases, and high mortality and mental-illness rates. Blacks and progressive whites are banned, terrorized, detained without trial, tortured, and murdered by the state; the Africans are not only disfranchised but are now also being denationalized and deprived of their ancient birthright to this richly-endowed part of Africa. Acceptance of this modern version of Naziism by the World Psychiatric Association and the World Medical Association, in the face of adequate information provided by the United Nations, its agency the World Health Organization, the American Psychiatric Association, and numerous other agencies and reports, needs urgent examination and decisive action.
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MODY, G. M., and M. G. HAMMOND. "DIFFERENCES IN HLA-DR ASSOCIATION WITH RHEUMATOID ARTHRITIS AMONG MIGRANT INDIAN COMMUNITIES IN SOUTH AFRICA." Rheumatology 33, no. 5 (1994): 425–27. http://dx.doi.org/10.1093/rheumatology/33.5.425.
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Roozen, Geert V. T., Ruchika Meel, Joyce Peper, William D. F. Venter, Roos E. Barth, Diederick E. Grobbee, Kerstin Klipstein-Grobusch, and Alinda G. Vos. "Electrocardiographic and echocardiographic abnormalities in urban African people living with HIV in South Africa." PLOS ONE 16, no. 2 (February 2, 2021): e0244742. http://dx.doi.org/10.1371/journal.pone.0244742.
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Background Studies from high income countries report that HIV-positive people have an impaired systolic and diastolic cardiac function compared to HIV-negative people. It is unclear if results can be translated directly to the Sub-Saharan Africa context. This study assesses electro- and echocardiographic characteristics in an urban African population, comparing HIV-positive people (treated and not yet treated) with HIV-negative controls. Methods We conducted a cross-sectional study in Johannesburg, South Africa. We enrolled HIV-positive participants from three randomized controlled trials that had recruited participants from routine HIV testing programs. HIV-negative controls were recruited from the community. Data were collected on demographics, cardiovascular risk factors, medical history and electrocardiographic and echocardiographic characteristics. Results In total, 394 HIV-positive participants and 153 controls were enrolled. The mean age of HIV-positive participants was 40±9 years (controls: 35±10 years), and 34% were male (controls: 50%). Of HIV-positive participants 36% were overweight or obese (controls: 44%), 23% had hypertension (controls: 28%) and 12% were current smoker (controls: 37%). Median time since HIV diagnosis was 6.0 years (IQR 2.3–10.0) and median treatment duration was 4.0 years (IQR 0.0–8.0), 50% had undetectable viral load. The frequency of anatomical cardiac abnormalities was low and did not differ between people with and without HIV. We observed no relation between HIV or anti-retroviral therapy (ART) and systolic or diastolic heart function. There was an association between ART use and corrected QT interval: +11.8 ms compared to HIV-negative controls (p<0.01) and +18.9 ms compared to ART-naïve participants (p = 0.01). We also observed a higher left ventricular mass index in participants on ART (+7.8 g/m2, p<0.01), but this association disappeared after adjusting for CD4 cell count, viral load and HIV-duration. Conclusion The low number of major cardiac abnormalities in this relatively young, well managed urban African HIV-positive population is reassuring. The increase in corrected QT interval and left ventricular mass may contribute to higher cardiac mortality and morbidity in people living with HIV in the long term.
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van VUUREN, A., P. RHEEDER, and E. HAK. "Effectiveness of influenza vaccination in the elderly in South Africa." Epidemiology and Infection 137, no. 7 (October 17, 2008): 994–1002. http://dx.doi.org/10.1017/s0950268808001386.
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SUMMARYThis study primarily aimed to estimate the association between influenza vaccination and the occurrence of hospitalization for acute respiratory or cardiovascular diseases, or all-cause death during the influenza season in an elderly population in South Africa. We conducted a nested case-control study using data from a cohort of 45 522 elderly members of a private medical funding organization during the moderate 2004 influenza season. In 1282 (2·8%) subjects the combined outcome occurred and the influenza vaccination rate in controls was 15·4%. After adjustments for measured confounders, vaccination was associated with a statistically significant reduction of 19% (95% confidence interval 3·1–32·9) in the combined outcome. Post-hoc sensitivity analysis of the potential impact of potential healthy user bias showed that confounding, if present, could have caused this finding. Our data were inconclusive regarding the benefits of influenza vaccination in elderly persons in South Africa and given the low vaccine uptake, long-term follow-up is warranted.
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Dada, Shakila, Kirsty Bastable, and Santoshi Halder. "The Role of Social Support in Participation Perspectives of Caregivers of Children with Intellectual Disabilities in India and South Africa." International Journal of Environmental Research and Public Health 17, no. 18 (September 11, 2020): 6644. http://dx.doi.org/10.3390/ijerph17186644.
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Caregivers are an intrinsic component of the environment of children with intellectual disabilities. However, caregivers’ capacity to support children’s participation may be linked to the social support that they, as caregivers, receive. Social support may increase participation, educational, psychological, medical and financial opportunities. However, there is a lack of information on social support in middle-income countries. The current study described and compared the social support of caregivers of children with intellectual disabilities by using the Family Support Survey (FSS) in India and South Africa. The different types of social support were subsequently considered in relation to participation, using the Children’s Assessment of Participation and Enjoyment (CAPE). One hundred caregiver–child dyads from India and 123 from South Africa participated in this study. The data were analysed using non-parametric measures. Indian caregivers reported greater availability of more helpful support than did the South African caregivers. Social support was associated with children’s participation diversity (India) and intensity (South Africa). The child-/caregiver-reported participation data showed different associations with participation. Results from this study suggest that perceived social support of caregivers differs between countries and is associated with their child’s participation. These factors need to be considered when generalising results from different countries.
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Bussin, Mark. "Factors driving changes to remuneration policies in South Africa." African Journal of Employee Relations 39, no. 2 (February 19, 2019): 43–63. http://dx.doi.org/10.25159/2664-3731/5871.
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This study was conducted in 2012 and replicates Bussin and Huysamen’s (2004) work, conducted in 2003, on remuneration policies. It investigates the factors driving remuneration policy in South Africa and determines whether these factors have changed since 2003. Anonymous e-mail questionnaires were received from 131 senior company representatives. All participating companies were members of the South African Reward Association (SARA) or clients of a large remuneration consulting firm. Data were analysed using a chi-squared test and factor analysis. Results support Bussin and Huysamen’s study, which found that the two main drivers of change in policy were the retention of talented staff and the financial results of the organisation. However, three components of remuneration are receiving greater prominence than they did in 2003: governance in the organisation, merit pay and retention strategies. These findings suggest a greater shareholder expectation that pay should be linked to performance, and that pay acts as a retention strategy for critical staff.
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Allgaier, Rachel L., Nina Shaafi-Kabiri, Carla A. Romney, Lee A. Wallis, John Joseph Burke, Jaspreet Bhangu, and Kevin C. Thomas. "Use of Predictive Modeling to Plan for Special Event Medical Care During Mass Gathering Events." Disaster Medicine and Public Health Preparedness 13, no. 5-6 (June 6, 2019): 874–79. http://dx.doi.org/10.1017/dmp.2019.1.
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ABSTRACTObjectives:In 2010, South Africa (SA) hosted the Fédération Internationale de Football Association (FIFA) World Cup (soccer). Emergency Medical Services (EMS) used the SA mass gathering medicine (MGM) resource model to predict resource allocation. This study analyzed data from the World Cup and compared them with the resource allocation predicted by the SA mass gathering model.Methods:Prospectively, data were collected from patient contacts at 9 venues across the Western Cape province of South Africa. Required resources were based on the number of patients seeking basic life support (BLS), intermediate life support (ILS), and advanced life support (ALS). Overall patient presentation rates (PPRs) and transport to hospital rates (TTHRs) were also calculated.Results:BLS services were required for 78.4% (n = 1279) of patients and were consistently overestimated using the SA mass gathering model. ILS services were required for 14.0% (n = 228), and ALS services were required for 3.1% (n = 51) of patients. Both ILS and ALS services, and TTHR were underestimated at smaller venues.Conclusions:The MGM predictive model overestimated BLS requirements and inconsistently predicted ILS and ALS requirements. MGM resource models, which are heavily based on predicted attendance levels, have inherent limitations, which may be improved by using research-based outcomes.
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Ballard, R. C., Htun Ye, A. Matta, Y. Dangor, and F. Radebe. "Treatment of chancroid with azithromycin." International Journal of STD & AIDS 7, no. 1_suppl (January 1996): 9–12. http://dx.doi.org/10.1258/0956462961917230.
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A randomized, comparative study undertaken in Nairobi, Kenya and a non-comparative evaluation undertaken in Carletonville, South Africa have both shown that a single oral dose of azithromycin 1 g is effective in the treatment of the genital ulcer disease (GUD), chancroid, with cure rates of 89% and 92% recorded respectively. While treatment failure was associated with human immunodeficiency virus seropositivity and lack of circumcision in Kenya, no such association could be found in the South African study. In both series, azithromycin treatment resulted in cure of both Haemophilus ducreyi culture-positive and culture-negative cases of GUD, including two cases subsequently diagnosed as lymphogranuloma venereum. A combination of single-dose azithromycin with single-dose benzathine penicillin may provide effective ‘single-visit’ syndromic treatment for GUD in many developing countries.
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Grootboom, Mzukisi, and Mark Sonderup. "A reflection on the South African Medical Association – past, present and future." South African Medical Journal 104, no. 6 (May 5, 2014): 410. http://dx.doi.org/10.7196/samj.8408.
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Wilde, Michelle I. "The 26th International Pediatric Association Congress of Pediatrics, Johannesburg, South Africa, 4–9 August 2010." Pediatric Drugs 13, no. 2 (April 2011): 125–28. http://dx.doi.org/10.2165/11532630-000000000-00000.
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Gunasekera, K., T. Cohen, W. Gao, H. Ayles, P. Godfrey-Faussett, and M. Claassens. "Smoking and HIV associated with subclinical tuberculosis: analysis of a population-based prevalence survey." International Journal of Tuberculosis and Lung Disease 24, no. 3 (March 1, 2020): 340–46. http://dx.doi.org/10.5588/ijtld.19.0387.
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BACKGROUND: Despite multiple tuberculosis (TB) prevalence surveys reporting a relatively high frequency of bacteriologically confirmed, active TB among individuals reporting no typical symptoms of disease, our understanding of this phenomenon is limited.OBJECTIVE: To quantify the epidemiological burden and estimate associations between individual-level variables and this “subclinical” presentation.METHODS: We performed a secondary analysis of TB prevalence survey data from the South African communities of the Zambia, South Africa Tuberculosis and AIDS Reduction trial. Generalized estimating equations were used to estimate the association between individual-level demographic, behavioral, socio-economic, and medical variables and the risk of bacteriologically positive TB among participants not reporting any symptoms consistent with active TB.RESULTS: The crude prevalence of TB was 2222.1 cases per 100 000 population (95% CI 2053.4–2388.5); 44.7% (295/660) of all documented prevalent cases of TB were subclinical. Current tobacco smoking (OR 2.37, 95% CI 1.41–3.99) and HIV-positive status (OR 3.26, 95% CI 2.31–4.61) were significantly associated with subclinical TB.CONCLUSION: Individuals who smoke or have HIV may be at increased risk of active TB and not report typical symptoms consistent with disease. This suggests possible shortcomings of symptom-based case finding which may need to be addressed in similar settings.
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Mlangeni, L., M. Mabaso, L. Makola, and K. Zuma. "Predictors of Poor Self-rated Health in KwaZulu-Natal, South Africa: Insights from a Cross-sectional Survey." Open Public Health Journal 12, no. 1 (April 30, 2019): 164–71. http://dx.doi.org/10.2174/1874944501912010164.
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Background: The association between Self-Rated Health (SRH) and poor health outcomes is well established. Economically and socially marginalized individuals have been shown to be more likely to have poor SRH. There are few representative studies that assess the factors that influence SRH amongst individuals in KwaZulu-Natal, South Africa. This study assessed factors associated with poor self-rated health amongst individuals from KwaZulu-Natal using data from the 2012 South African national household survey. Methods: The 2012 South African population-based nationally representative household survey employed a multi-stage stratified cluster randomised crossectional design. Multivariate backward stepwise logistic regression models were used to determine whether SRH is significantly influenced by socio-demographic and health-related factors. Results: Out of a total of 5192 participants living in KZN, 18.1% reported having fair/poor SRH. In the multivariate logistic regression model the increased likelihood of reporting fair/poor was significantly associated with being older, HIV positive, being an excessive drinker, and not having medical aid. The decreased likelihood of reporting fair/poor was associated with being educated, not having a chronic condition, being physically active, being employed, and not accessing care regularly. Conclusion: This study has shown that marginalized individuals are more likely to have poorer SRH. Greater efforts need to be made to ensure that these individuals are brought into the fold through education, job opportunities, health insurance, social support services for poor living conditions, and poor well-being including services for substance abusers.
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Mann, T., I. Vlok, R. N. Dunn, S. Miseer, and J. Davis. "Private healthcare sector spine surgery: patient and surgeon profiles from a large open medical scheme in South Africa." South African Medical Journal 113, no. 7 (July 5, 2023): 55–60. http://dx.doi.org/10.7196/samj.2023.v113i7.291.
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Background
It is generally understood that the profile of spine surgery varies by setting, based on factors such as the age profile of the population, the economic context and access to healthcare. Relatively little is known about the profile of spine surgery in South Africa, although one previous report from the public healthcare sector suggested a high burden of trauma and infection-related surgery. To our knowledge, there has been no formal investigation in the private sector. A holistic understanding of spine surgery within our setting may be beneficial for applications such as resource allocation and informing the training needs of future specialists.
Objectives
To provide insight into spinal surgery in the South African private healthcare sector by describing spine surgery characteristics within a large open medical scheme, including both patient and surgeon profiles.
Methods
This retrospective review included adult inpatient spine surgeries funded by the largest open medical scheme in South Africa between 2008 and 2017. An anonymized dataset extracted from the scheme records included patient demographics, ICD-10 codes, procedure codes and surgeon specialization. Descriptive patient and surgery data were presented. Furthermore, the association between patient and surgery factors and surgeon specialization was investigated using univariate and multivariate analyses.
Results
A total of 49,576 index spine surgeries were included. The largest proportion of surgeries involved members 40-59 years old (n=23,543, 48%), approximately half involved female members (n=25,293, 51%) and most were performed by neurosurgeons (n=35,439, 72%). At least 37,755 (76%) surgeries were for degenerative pathology, 2,100 (4%) for trauma and 242 (0.5%) for infection. Adjusted risk ratios (aRR) significantly associated with orthopaedic surgeon specialization included cervical spine region aRR = 0.49 (95% C.I. 0.39-0.61), trauma aRR = 1.50 (95% C.I. 1.20-1.88), deformity aRR = 1.77 (95% C.I. 1.33-2.35) and blood transfusion aRR = 1.46 (95% C.I. 1.12-1.91).
Conclusion
Spine surgery in South Africa’s largest open medical scheme was dominated by surgery for degenerative pathology in older adults and was performed largely by neurosurgeons. This constituted a stark contrast to a previous report from the public sector and highlighted a mismatch between exposure during public sector registrar training and private practice post-specialization. The findings support the need for private-public collaboration as well as the importance of spine fellowships for all specialists intending to practice spine surgery.
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Made, Felix, Vusi Ntlebi, Tahira Kootbodien, Kerry Wilson, Nonhlanhla Tlotleng, Angela Mathee, Mpume Ndaba, Spo Kgalamono, and Nisha Naicker. "Illness, Self-Rated Health and Access to Medical Care among Waste Pickers in Landfill Sites in Johannesburg, South Africa." International Journal of Environmental Research and Public Health 17, no. 7 (March 27, 2020): 2252. http://dx.doi.org/10.3390/ijerph17072252.
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Waste pickers are exposed to various environmental health hazards, and self-rated health (SRH) could influence their medical care access. This study investigated the association between illness, clinic visits and SRH, and assessed if SRH can increase clinic visits. A cross-sectional study was conducted. SRH was defined as “very good”, “good”, “fair”, and “poor”. The illnesses were mental health, infectious, and chronic diseases. Medical care access included clinic visits in the previous 12 months. An ordinal logistic regression model was fitted to assess the association. There were 361 participants, 265 (73.41%) were males. Median age was 31 years, (interquartile range (IQR): 27–39). SRH: poor (29.89%), fair (15.92%), good (43.30%) very good (10.89%). Ever smoked (adjusted odds ratio (AOR): 1.72; 95% confidence interval (CI): 1.11–2.66), mental health (AOR: 1.87; 95% CI: 1.22–2.84), chronic (AOR: 2.34; 95% CI:1.47–3.68) and infectious (AOR: 2.07; 95% CI: 1.77–3.63) diseases were significantly associated with increased odds of reporting poor health. Clinic visit was not associated with SRH. From 99 (31%) individuals who rated their health as poor and ill, 40% visited a clinic (p = 0.0606). Acute and chronic illnesses were associated with poor SRH but this did not increase clinic visits. Provision of mobile clinic services at the landfill sites could increase access to medical care.
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Davis, Stephanie, Carlos Toledo, Lara Lewis, Brendan Maughan-Brown, Kassahun Ayalew, and Ayesha B. M. Kharsany. "Does voluntary medical male circumcision protect against sexually transmitted infections among men and women in real-world scale-up settings? Findings of a household survey in KwaZulu-Natal, South Africa." BMJ Global Health 4, no. 3 (May 2019): e001389. http://dx.doi.org/10.1136/bmjgh-2019-001389.
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IntroductionMale circumcision (MC) confers partial protection to men against HIV and, in research settings, some sexually transmitted infections (STIs). It is also associated with protection from some STIs among female partners. However, real-world data on changes in STI transmission associated with large-scale public African medical male circumcision (MMC) conducted for HIV prevention are lacking and would improve estimates of the health impact of MMC.MethodsThe HIV Incidence Provincial Surveillance System is a community-based surveillance platform for HIV prevalence, incidence and intervention coverage trends in KwaZulu-Natal province, South Africa. HIPPS collected cross-sectional self-reported data on circumcision status (from men), partner circumcision status for past three partners (from women) and demographic characteristics and behavioural risk factors; and tested participants for HIV, herpes simplex virus type 2 (HSV-2), syphilis, hepatitis B, Neisseriagonorrhoeae, Chlamydiatrachomatis, Trichomonasvaginalis and Mycoplasmagenitalium. Bivariable and multivariable analyses were performed on associations between own (men) or partner’s (women) circumcision status and each STI. Multivariable analyses adjusted for age, demographic characteristics and behavioural risk factors, and incorporated false discovery rate (FDR) correction.ResultsAmong men, MMC had a protective association with HSV-2 (OR 0.66, 95% CI 0.50 to 0.86), hepatitis B (OR 0.53, 95% CI 0.30 to 0.95), HIV (OR 0.50, 95% CI 0.38 to 0.65) and M.genitalium (OR 0.53, 95% CI 0.32 to 0.88). Among women, partner circumcision had a protective association with HSV-2 (OR 0.71, 95% CI 0.53 to 0.95) and HIV (OR 0.66, 95% CI 0.49 to 0.90). Associations with HIV and HSV-2 remained significant for men and all women after FDR correction.ConclusionThese real-world data, supporting protective associations between MMC conducted for HIV prevention and STIs in men and women, can help clarify the full impact of MMC and support a role in broader sexual health programming.
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Lewin, S., J. de Gruchy, and M. Armstrong. "BMA's gold medal award to the president of the South African Medical Association." BMJ 318, no. 7180 (February 6, 1999): 396. http://dx.doi.org/10.1136/bmj.318.7180.396.
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Perumal-Pillay, Velisha A., Shiraz R. Alli, and Fatima Suleman. "The Perceptions of Patient Copayment on the Reported Adherence to Prescription Medication." Global Journal of Health Science 10, no. 11 (October 13, 2018): 105. http://dx.doi.org/10.5539/gjhs.v10n11p105.
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BACKGROUND: In South Africa, a large proportion of the population is dependent entirely on the publicly funded system for healthcare, while private funding covers only a small percentage of those who can afford to pay for health insurance or out-of-pocket payments. Non-compliance to medical treatment is a well-known problem and may lead to an increase in healthcare costs.
OBJECTIVES: To investigate how the perception of prescription copayments influences medication use and the effect of this on safe and correct medicine usage
METHODS: The study was conducted with a sample of patients from the Umbilo suburb of eThekwini, South Africa. Participants were members of a medical scheme and completed a questionnaire after informed consent. The questionnaire design included an eight-item scale to ascertain the degree of concern regarding prescription costs. Quantitative data were analysed using descriptive statistics; associations between household characteristics and outcomes were explored using odds ratios and chi square analysis.
RESULTS: Overall 82% of the participants reported that prescription cost was a major factor that influenced medication collection. The association between demographic data and concern scale was assessed and revealed that participants had an increased concern with meeting prescription costs (OR 1.73, 95% CI 0.66-4.52). Most (93%) of the participants with a salary less than ZAR10 000 indicated a concern with prescription costs (chi square=21.7, df=2, p<0.05).
CONCLUSION: The study indicated that prescription cost posed as a barrier to medication adherence as the copayment affected patients’ decisions to continue optimal treatment.
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Li, Jonathan Z., Natalia Stella, Manish C. Choudhary, Aneela Javed, Katherine Rodriguez, Heather Ribaudo, Mahomed-Yunus Moosa, et al. "Impact of pre-existing drug resistance on risk of virological failure in South Africa." Journal of Antimicrobial Chemotherapy 76, no. 6 (March 10, 2021): 1558–63. http://dx.doi.org/10.1093/jac/dkab062.
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Abstract Objectives There is conflicting evidence on the impact of pre-existing HIV drug resistance mutations (DRMs) in patients infected with non-B subtype virus. Methods We performed a case–cohort substudy of the AIDS Drug Resistance Surveillance Study, which enrolled South African patients initiating first-line efavirenz/emtricitabine/tenofovir. Pre-ART DRMs were detected by Illumina sequencing of HIV pol and DRMs present at <20% of the viral population were labelled as minority variants (MVs). Weighted Cox proportional hazards models estimated the association between pre-ART DRMs and risk of virological failure (VF), defined as confirmed HIV-1 RNA ≥1000 copies/mL after ≥5 months of ART. Results The evaluable population included 178 participants from a randomly selected subcohort (16 with VF, 162 without VF) and 83 additional participants with VF. In the subcohort, 16% of participants harboured ≥1 majority DRM. The presence of any majority DRM was associated with a 3-fold greater risk of VF (P = 0.002), which increased to 9.2-fold (P < 0.001) in those with <2 active drugs. Thirteen percent of participants harboured MV DRMs in the absence of majority DRMs. Presence of MVs alone had no significant impact on the risk of VF. Inclusion of pre-ART MVs with majority DRMs improved the sensitivity but reduced the specificity of predicting VF. Conclusions In a South African cohort, the presence of majority DRMs increased the risk of VF, especially for participants receiving <2 active drugs. The detection of drug-resistant MVs alone did not predict an increased risk of VF, but their inclusion with majority DRMs affected the sensitivity/specificity of predicting VF.
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Dunkle, K. L., M. E. Beksinska, V. H. Rees, R. C. Ballard, Ye Htun, and M. L. Wilson. "Risk factors for HIV infection among sex workers in Johannesburg, South Africa." International Journal of STD & AIDS 16, no. 3 (March 1, 2005): 256–61. http://dx.doi.org/10.1258/0956462053420220.
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Our objective was to determine the prevalence and risk factors for HIV infection among female sex workers in Johannesburg, South Africa. A cross-sectional survey of female sex workers was conducted using interviewer-administered questionnaires. Prevalent sexually transmitted infections including HIV were evaluated through standard laboratory testing. HIV infection was identified in 137 (46.4%) of 295 subjects tested. Increasing frequency of condom use was significantly negatively associated with HIV infection (odds ratio [OR] for moderate use = 0.21; 95% confidence interval [CI]: [0.09, 0.50]; OR for high use = 0.14; 95% CI: [0.06, 0.34]). Sex workers aged ≥29 years reported significantly different patterns of behaviour than younger workers. Among women aged ≥29, a negative association with HIV infection (OR = 0.16; 95% CI: [0.07, 0.38]) was found, but only among those not infected with Neisseria gonorrhoeae. Older women in the Johannesburg sex industry may have adaptive behavioural strategies besides condom usage which reduce their risk of acquiring HIV. However, older sex workers with gonorrhoea constitute a high-risk subgroup.
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Johansson, Isabelle, Philip Joseph, Kumar Balasubramanian, John J. V. McMurray, Lars H. Lund, Justin A. Ezekowitz, Deepak Kamath, et al. "Health-Related Quality of Life and Mortality in Heart Failure: The Global Congestive Heart Failure Study of 23 000 Patients From 40 Countries." Circulation 143, no. 22 (June 2021): 2129–42. http://dx.doi.org/10.1161/circulationaha.120.050850.
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Background: Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. Methods: We used the Kansas City Cardiomyopathy Questionnaire–12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. Results: The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17–1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03–1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21–1.42]; interaction P <0.0001). Lower HRQL predicted death in patients with New York Heart Association class I or II and III or IV symptoms (HR, 1.17 [95% CI, 1.14–1.19] and HR, 1.14 [95% CI, 1.12–1.17]; interaction P =0.13) and was a stronger predictor for the composite outcome in New York Heart Association class I or II versus class III or IV (HR 1.15 [95% CI, 1.13–1.17] versus 1.09 [95% CI, [1.07–1.11]; interaction P <0.0001). HR for death was greater in ejection fraction ≥40 versus <40% (HR, 1.23 [95% CI, 1.20–1.26] and HR, 1.15 [95% CI, 1.13–1.17]; interaction P <0.0001). Conclusion: HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF, and among patients with preserved and reduced ejection fraction. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03078166.
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Norte, Ana Cláudia, Pierre H. Boyer, Santiago Castillo-Ramirez, Michal Chvostáč, Mohand O. Brahami, Robert E. Rollins, Tom Woudenberg, et al. "The Population Structure of Borrelia lusitaniae Is Reflected by a Population Division of Its Ixodes Vector." Microorganisms 9, no. 5 (April 27, 2021): 933. http://dx.doi.org/10.3390/microorganisms9050933.
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Populations of vector-borne pathogens are shaped by the distribution and movement of vector and reservoir hosts. To study what impact host and vector association have on tick-borne pathogens, we investigated the population structure of Borrelia lusitaniae using multilocus sequence typing (MLST). Novel sequences were acquired from questing ticks collected in multiple North African and European locations and were supplemented by publicly available sequences at the Borrelia Pubmlst database (accessed on 11 February 2020). Population structure of B. lusitaniae was inferred using clustering and network analyses. Maximum likelihood phylogenies for two molecular tick markers (the mitochondrial 16S rRNA locus and a nuclear locus, Tick-receptor of outer surface protein A, trospA) were used to confirm the morphological species identification of collected ticks. Our results confirmed that B. lusitaniae does indeed form two distinguishable populations: one containing mostly European samples and the other mostly Portuguese and North African samples. Of interest, Portuguese samples clustered largely based on being from north (European) or south (North African) of the river Targus. As two different Ixodes species (i.e., I. ricinus and I. inopinatus) may vector Borrelia in these regions, reference samples were included for I. inopinatus but did not form monophyletic clades in either tree, suggesting some misidentification. Even so, the trospA phylogeny showed a monophyletic clade containing tick samples from Northern Africa and Portugal south of the river Tagus suggesting a population division in Ixodes on this locus. The pattern mirrored the clustering of B. lusitaniae samples, suggesting a potential co-evolution between tick and Borrelia populations that deserve further investigation.
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Tretter, Justin T., and Jeffrey P. Jacobs. "Global leadership in paediatric and congenital cardiac care: “global health advocacy, lift as you rise – an interview with Liesl J. Zühlke, MBChB, MPH, PhD”." Cardiology in the Young 31, no. 10 (October 2021): 1549–56. http://dx.doi.org/10.1017/s104795112100411x.
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AbstractProfessor Liesl Zühlke is the focus of our fifth in a series of interviews in Cardiology in the Young entitled, “Global Leadership in Paediatric and Congenital Cardiac Care”. Professor Zühlke (nee Hendricks) was born in Cape Town, South Africa. She would attend medical school in her hometown at University of Cape Town, graduating in 1991. Professor Zühlke then went on to complete a Diploma in Child Health at College of Medicine in Cape Town followed by completion of her Paediatric and Paediatric Cardiology training in 1999 and 2007, respectively. She would subsequently complete her Masters of Public Health (Clinical Research Methods) at the University of Cape Town, completing her dissertation in 2011 on computer-assisted auscultation as a screening tool for cardiovascular disease, under the supervision of Professors Landon Myer and Bongani Mayosi.Professor Zühlke began her clinical position as a paediatric cardiologist in the Department of Paediatrics and Child Health at the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa in 2007. In this role, she has been instrumental in developing a transitional clinic at the paediatric hospital, is a team member of the combined cardio-obstetric and grown-up congenital heart disease clinics, each of which are rare in South Africa, with very few similar clinics in Africa. Professor Zühlke would continue her research training, completing her Doctorate at the University of Cape Town in 2015, with her dissertation on the outcomes of asymptomatic and symptomatic rheumatic heart disease under the supervision of Professor Bongani Mayosi and Associate Professor Mark Engel. In 2015, in affiliation with the University of Cape Town and the Department of Paediatrics and the Institute of Child Health, she established The Children’s Heart Disease Research Unit, with the goals to conduct, promote and support paediatric cardiac research on the African continent, facilitate Implementation Science and provide postgraduate supervision and training in paediatric cardiac research. In 2018, she would subsequently complete her Master of Science at the London School of Economics in Health Economics, Outcomes and Management of cardiovascular sciences. Professor Zühlke currently serves as the acting Deputy-Dean of Research at the Faculty of Health Sciences, University of Cape Town.Professor Zühlke has achieved the highest leadership positions within cardiology in South Africa, including President of the Paediatric Cardiac Society of South Africa and President of the South African Heart Association. She is internationally regarded as a leader in research related to rheumatic heart disease. Professor Zühlke’s work includes patient, family and health advocacy on a global scale, being involved in the development of policies that have been adopted by major global organisations such as the World Health Organization. In addition to her clinical and research efforts, she is highly regarded by students, colleagues and graduates as an effective teacher, mentor and advisor. This article presents our interview with Professor Zühlke, an interview that covers her experience as a thought leader in the field of Paediatric Cardiology, specifically in her work related to rheumatic heart disease, Global Health and paediatric and congenital cardiac care in resource-limited settings.
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Beksinska, Mags, Bethel Lulie, Ivana Beesham, and Jenni Smit. "Pubic hair grooming practices in KwaZulu-Natal, South Africa: prevalence, side effects and association with sexually transmitted infections." International Journal of STD & AIDS 31, no. 11 (August 4, 2020): 1034–39. http://dx.doi.org/10.1177/0956462420941709.
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Pubic hair grooming is common in many countries, but little is known about this practice in Africa. Grooming has been positively associated with self-reported sexually transmitted infections (STIs). This study aimed to investigate the prevalence and safety of pubic hair grooming in two South African settings. In KwaZulu-Natal province, 1218 women participating in the Evidence for Contraceptive Options and HIV Outcomes Trial completed an interviewer-administered questionnaire on pubic hair grooming practices, and were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and herpes simplex virus type 2 (HSV-2). Pubic hair removal was reported by 705 (58.2%) of women. Common areas for grooming were the pubis (n = 616, 99.4%), vagina/perineum (n = 529, 85.3%) and inner thigh (n = 255, 41.1%). Half (n= 361, 51.4%) removed some or all of their pubic hair at least monthly and 59 (8.4%) once a week or more often. Common side effects reported included itching (n = 439, 77.1%) and pimples and blisters (n = 249, 43.9%). A quarter (n = 173, 24.5%) of groomers had a positive result for either or both of CT and NG compared to a fifth (n = 98, 19.4%) of non-groomers (p-value < 0.033). There was no difference between the groups for HSV-2. After adjusting for age and having more than one sex partner, groomers were significantly more likely to have CT or NG than non-groomers (OR: 1.31; 95% CI: 1.19–1.45). Similarly, those who experienced hair removal-related complications had 1.26 times the odds of testing positive for CT or NG (95% CI: 1.03–1.54). The practice of pubic hair removal is common and reporting of side effects is high in this population. These injuries could put women at a higher risk of STIs.
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Sotunde, Olusola Funmilayo, Herculina Salome Kruger, Hattie H. Wright, Lize Havemann-Nel, Carina M. C. Mels, Chrisna Ravyse, and Marlien Pieters. "Association of 25-hydroxyvitamin D and parathyroid hormone with the metabolic syndrome in black South African women." Applied Physiology, Nutrition, and Metabolism 42, no. 4 (April 2017): 413–19. http://dx.doi.org/10.1139/apnm-2016-0257.
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The relationship between 25 hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH) and metabolic traits appear to differ among ethnicities and may be influenced by obesity. The aim of the study was to examine the association of serum 25(OH)D or PTH with metabolic syndrome (MetS) while controlling for adiposity in black women. Using a cross-sectional study design, 209 urban black women aged ≥ 43 years from the North West Province, South Africa, were included. Multiple regression models were used to explore the relationship between 25(OH)D or PTH and body composition. To explore the association between 25(OH)D or PTH and MetS, a separate variable was created including at least 3 of the MetS criteria, but excluding elevated waist circumference as a diagnostic criterion in a logistic regression model. The majority of the women (69.9%) were overweight or obese and 65.5% of the women had excessive adiposity using the age-specific cut-off points for body fat percentage. All body composition variables were positively associated with PTH, whereas body mass index and waist circumference, but not body fat percentage, had negative associations with 25(OH)D also after adjusting for confounders. Before and after adjusting for age, body fat, habitual physical activity, tobacco use, season of data collection, and estimated glomerular filtration rate, neither 25(OH)D nor PTH showed significant associations with MetS. Although PTH was positively associated and 25(OH)D was negatively associated with adiposity in black women, there was no association between either 25(OH)D or PTH and MetS in this study population, nor did adiposity influence these relationships.
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Wouters, Olivier J., Jonathan Cylus, Wei Yang, Sarah Thomson, and Martin McKee. "Medical savings accounts: assessing their impact on efficiency, equity and financial protection in health care." Health Economics, Policy and Law 11, no. 3 (February 17, 2016): 321–35. http://dx.doi.org/10.1017/s1744133116000025.
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AbstractMedical savings accounts (MSAs) allow enrolees to withdraw money from earmarked funds to pay for health care. The accounts are usually accompanied by out-of-pocket payments and a high-deductible insurance plan. This article reviews the association of MSAs with efficiency, equity, and financial protection. We draw on evidence from four countries where MSAs play a significant role in the financing of health care: China, Singapore, South Africa, and the United States of America. The available evidence suggests that MSA schemes have generally been inefficient and inequitable and have not provided adequate financial protection. The impact of these schemes on long-term health-care costs is unclear. Policymakers and others proposing the expansion of MSAs should make explicit what they seek to achieve given the shortcomings of the accounts.
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Kietrys, David, Hellen Myezwa, Mary Lou Galantino, James Scott Parrott, Tracy Davis, Todd Levin, Kelly O’Brien, and Jill Hanass-Hancock. "Functional Limitations and Disability in Persons Living with HIV in South Africa and United States: Similarities and Differences." Journal of the International Association of Providers of AIDS Care (JIAPAC) 18 (January 1, 2019): 232595821985055. http://dx.doi.org/10.1177/2325958219850558.
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Persons living with HIV (PLHIV) may experience disability. We compared disability among PLHIV in the United States and South Africa and investigated associations with health and demographic characteristics. Secondary analysis of cross-sectional data using medical records and questionnaires including the World Health Organization Disability Assessment Schedule (WHO-DAS) 2.0 12-item version (range: 0-36, with higher scores indicative of more severe disability). Between-country differences for the presence of disability were assessed with logistic regression and differences in severity using multiple regression. Eighty-six percent of US participants reported disability, compared to 51.3% in South Africa. The mean WHO-DAS score was higher in the United States (12.09 ± 6.96) compared to South Africa (8.3 ± 6.27). Participants with muscle pain, depression, or more years since HIV diagnosis were more likely to report disability. Being female or depressed was associated with more severity. Being adherent to anti-retroviral therapy (ART) and employed were associated with less severity. Because muscle pain and depression were predictive factors for disability, treatment of those problems may help mitigate disability in PLHIV.
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Datay, Mohammed Ishaaq, Andrew Boulle, David Mant, and Patricia Yudkin. "Associations With Virologic Treatment Failure in Adults on Antiretroviral Therapy in South Africa." JAIDS Journal of Acquired Immune Deficiency Syndromes 54, no. 5 (August 2010): 489–95. http://dx.doi.org/10.1097/qai.0b013e3181d91788.
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Maroga, N., T. Mokoena, N. Ledibane, A. Musekiwa, M. Bida, M. Kgomo, and R. Lebelo. "Profile of human papillomavirus genotypes in breast and oesophageal cancer patients in Pretoria, South Africa." South African Medical Journal 113, no. 7 (July 5, 2023): 49–54. http://dx.doi.org/10.7196/samj.2023.v113i7.560.
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Background. The association between human papillomavirus (HPV) and cervical cancer is well established, and cervical cancer can be prevented through HPV vaccination. Little has been reported on the association between HPV and breast carcinoma (BC) or oesophageal squamous cell carcinoma (OSCC) in Africa. It is possible that use of appropriate HPV vaccines against genotypes responsible for these cancers may also prevent their development. Objectives. To investigate HPV genotype prevalence in BC and OSCC patients in Pretoria, South Africa (SA).Methods. A retrospective cross‐sectional study of BC and OSCC patients managed at Steve Biko Academic Hospital from 2015 to 2019 was undertaken. Patient medical records were analysed, and DNA was extracted from their archived pathology material and amplified by polymerase chain reaction before hybridisation for HPV genotypes.Results. There were 101 patients with BC and 50 with OSCC. The prevalence of HPV infection in BC patients was 77.2%, with 35.6% high‐ risk (HR) genotypes, and that in OSCC patients 90.0%, with 56.0% HR genotypes. The most prevalent HPV genotypes (>20% each) were HPV 16, 70 and 51 for BC and HPV 51, 70, 16 and 82 for OSCC, with 31.7% and 60.0% of patients, respectively, having co‐infection with ≥2 genotypes.Conclusion. The high prevalence of infection with multiple HPV genotypes in BC and OSCC patients, with HPV 16, 51, 70, 35 and 82 the most common genotypes in these cancers, warrants expansion of the current SA bivalent HPV 16/18 vaccine for girls to include boys, and inclusion of HPV 51, 70, 35 and 82, in order to prevent BC and OSCC as well as cervical cancer.