Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420090010&lang=en vol. 99 num. 10 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>SAAVI HIV vaccine trials</b>: <b>one small step for humankind</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000001&lng=en&nrm=iso&tlng=en http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Protecting the public and guiding the profession?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Running (and walking) the talk: 2009 Life Healthcare Medical 10</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000004&lng=en&nrm=iso&tlng=en <![CDATA[<b>OSD furore</b>: <b>Sama bloodied but unbowed</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000005&lng=en&nrm=iso&tlng=en <![CDATA[<b>Incompetent, unaccountable managers paralysing health care</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000006&lng=en&nrm=iso&tlng=en <![CDATA[<b>Experts review motsoaledi's first 3 months</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000007&lng=en&nrm=iso&tlng=en <![CDATA[<b>Assisting victims of sexual offences</b>: <b>Ensuring a professional service by the SAPS - how it affects medical practitioners</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Malignant otitis externa with ecthyma gangrenosum and pneumonia in an infant</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000009&lng=en&nrm=iso&tlng=en <![CDATA[<b>A striking 'Natal' experience</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Severe acute respiratory infection with influenza A (H1N1) during pregnancy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000011&lng=en&nrm=iso&tlng=en <![CDATA[<b>HIV transmission from mother to child</b>: <b>HAART compared with dual therapy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000012&lng=en&nrm=iso&tlng=en <![CDATA[<b>Effectiveness of community participation in tuberculosis control</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000013&lng=en&nrm=iso&tlng=en <![CDATA[<b>CFTR structural rearrangements are not a major mutational mechanism in black and coloured southern African patients with cystic fibrosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000014&lng=en&nrm=iso&tlng=en <![CDATA[<b>Prerequisites for National Health Insurance in South Africa</b>: <b>results of a national household survey</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000015&lng=en&nrm=iso&tlng=en BACKGROUND: National Health Insurance (NHI) is currently high on the health policy agenda. The intention of this financing system is to promote efficiency and the equitable distribution of financial and human resources, improving health outcomes for the majority. However, there are some key prerequisites that need to be in place before an NHI can achieve these goals. OBJECTIVES: To explore public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of an NHI, and whether South Africans are ready for a change in the health system. METHODS: A cross-sectional nationally representative survey of 4 800 households was undertaken, using a structured questionnaire. Data were analysed in STATA IC10. RESULTS AND CONCLUSIONS: There is dissatisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers' behaviour. South Africans do not appear to be well acquainted or generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services. <![CDATA[<b>Outcomes of the South African National Antiretroviral Treatment Programme for children</b>: <b>the IeDEA Southern Africa collaboration</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000016&lng=en&nrm=iso&tlng=en OBJECTIVES: To assess paediatric antiretroviral treatment (ART) outcomes and their associations from a collaborative cohort representing 20% of the South African national treatment programme. DESIGN AND SETTING: Multi-cohort study of 7 public sector paediatric ART programmes in Gauteng, Western Cape and KwaZulu-Natal provinces. SUBJECTS: ART-naïve children (<16 years) who commenced treatment with >3 antiretroviral drugs before March 2008. OUTCOME MEASURES: Time to death or loss to follow-up were assessed using the Kaplan-Meier method. Associations between baseline characteristics and mortality were assessed with Cox proportional hazards models stratified by site. Immune status, virological suppression and growth were described in relation to duration of ART. RESULTS: The median (interquartile range) age of 6 078 children with 9 368 child-years of follow-up was 43 (15 - 83) months, with 29% being <18 months. Most were severely ill at ART initiation. More than 75% of children were appropriately monitored at 6-monthly intervals with viral load suppression (<400 copies/ml) being 80% or above throughout 36 months of treatment. Mortality and retention in care at 3 years were 7.7% (95% confidence interval 7.0 - 8.6%) and 81.4% (80.1 - 82.6%), respectively. Together with young age, all markers of disease severity (low weight-for-age z-score, high viral load, severe immune suppression, stage 3/4 disease and anaemia) were independently associated with mortality. CONCLUSIONS: Dramatic clinical benefit for children accessing the national ART programme is demonstrated. Higher mortality in infants and those with advanced disease highlights the need for early diagnosis of HIV infection and commencement of ART. <![CDATA[<b>Childhood tuberculosis infection and disease</b>: <b>a spatial and temporal transmission analysis in a South African township</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000017&lng=en&nrm=iso&tlng=en BACKGROUND: Tuberculosis (TB) remains a leading cause of mortality and morbidity in South Africa. While adult TB results from both recent and past infection, childhood TB results from recent infection and reflects ongoing transmission despite current TB control strategies. SETTING: A South African community with high rates of TB and HIV disease. OUTCOMES: A Geographic Information System was used to spatially and temporally define the relationships between TB exposure, infection and disease in children <15 years of age with exposure to adult HIV-positive and HIV-negative TB disease on residential plots between 1997 and 2007. RESULTS: During the study period the annual adult TB notification rate increased from 629 to 2 106/100 000 and the rate in children aged <15 years ranged between 664/100 000 and 1 044/100 000. The mean number of exposures to adult TB for TB-uninfected children, latently TB-infected children and TB cases were 5.1%, 5.4% and 33% per annum and the mean number of adult smear-positive cases per exposed child was 1.0, 1.6 and 1.9, respectively. Acquisition of TB infection was not associated with HIV status of the adult TB case to which the child was exposed, and 36% of child TB cases were diagnosed before the temporally closest adult case on their plot. CONCLUSIONS: Childhood infection and disease were quantitatively linked to infectious adult TB prevalence in an immediate social network. Childhood infection should be monitored in high-burden settings as a marker of ongoing TB transmission. Improved knowledge of township childhood and adult social networks could also facilitate targeted active case finding, which may provide an adjunct to currently failing TB control strategies. <![CDATA[<b>Trends in adult tobacco use from two South African demographic and health surveys conducted in 1998 and 2003</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000018&lng=en&nrm=iso&tlng=en INTRODUCTION: Since peaking in the early 1990s in South Africa, tobacco use has declined significantly. The reduction has been attributed to the government's comprehensive tobacco control policies that were introduced at the time. OBJECTIVE: To assess the pattern of tobacco use in the South African Demographic and Health Surveys of 1998 and 2003. METHODS: Multi-stage sampling was used to select approximately 11 000 households in cross-sectional national surveys. Face-to-face interviews, conducted with 13 826 adults (41% men) aged >15 years in 1998, and 8 115 (42% men) in 2003, included questions on tobacco use according to the WHO STEP-wise surveillance programme. Logistic regression analysis was used to assess the independent effects of selected characteristics on smoking prevalence. RESULTS: Daily or occasional smoking prevalence among women remained unchanged at 10 - 11%; it decreased among men from 42% (1998) to 35% (2003). The decline for men was significant among the poorest and those aged 25 - 44 years. Strong age patterns were observed, peaking at 35 - 44 years, which was reduced among men in 2003. Higher income and education were associated with low prevalence of smoking, while living in urban areas was associated with higher rates. Black men and women smoked significantly less than other population groups. CONCLUSION: Despite decreased smoking rates in some subgroups, a lapse exists in the efforts to reduce tobacco use, as smoking rates have remained unchanged among women, and also among young adults aged 15 - 24 years. <![CDATA[<b>Trends in adult tobacco use from two South African demographic and health surveys conducted in 1998 and 2003</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000018&lng=en&nrm=iso&tlng=en INTRODUCTION: Since peaking in the early 1990s in South Africa, tobacco use has declined significantly. The reduction has been attributed to the government's comprehensive tobacco control policies that were introduced at the time. OBJECTIVE: To assess the pattern of tobacco use in the South African Demographic and Health Surveys of 1998 and 2003. METHODS: Multi-stage sampling was used to select approximately 11 000 households in cross-sectional national surveys. Face-to-face interviews, conducted with 13 826 adults (41% men) aged >15 years in 1998, and 8 115 (42% men) in 2003, included questions on tobacco use according to the WHO STEP-wise surveillance programme. Logistic regression analysis was used to assess the independent effects of selected characteristics on smoking prevalence. RESULTS: Daily or occasional smoking prevalence among women remained unchanged at 10 - 11%; it decreased among men from 42% (1998) to 35% (2003). The decline for men was significant among the poorest and those aged 25 - 44 years. Strong age patterns were observed, peaking at 35 - 44 years, which was reduced among men in 2003. Higher income and education were associated with low prevalence of smoking, while living in urban areas was associated with higher rates. Black men and women smoked significantly less than other population groups. CONCLUSION: Despite decreased smoking rates in some subgroups, a lapse exists in the efforts to reduce tobacco use, as smoking rates have remained unchanged among women, and also among young adults aged 15 - 24 years. <![CDATA[<b>Influenza-and respiratory syncytial virus-associated adult mortality in Soweto</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000019&lng=en&nrm=iso&tlng=en BACKGROUND: Influenza and respiratory syncytial virus (RSV) infections cause seasonal excess mortality and hospitalisation in adults (particularly the elderly) in high-income countries. Little information exists on the impact of these infections on adults in Africa. OBJECTIVES: To estimate influenza- and RSV-related adult mortality, stratified by age and hospitalisation in Soweto. STUDY DESIGN: A retrospective hospital-based study in Soweto from 1997 to 1999 to estimate influenza- and RSV-related excess all-cause deaths and hospitalisation using a ratedifference method. The study was based on influenza seasons of varying severity, provided by surveillance data. RESULTS: Influenza seasons were significantly associated with excess mortality in adults across all 3 years, except for 18 - 64-year-olds in 1998. Excess mortality was highest in those >65 years of age: 82.8/100 000 population in the mild 1997 season and 220.9/100 000 in the severe 1998 season. Influenza significantly increased adult medical hospitalisation in the severe 1998 season alone. RSV did not significantly affect mortality or hospitalisation. CONCLUSION: Influenza-related mortality was substantial and disproportionately affected the elderly. Influenza vaccination for the elderly warrants consideration. The RSV-related burden was not significantly increased but merits observation over a longer period. <![CDATA[<b>Guideline for the treatment of Parkinson's disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001000020&lng=en&nrm=iso&tlng=en BACKGROUND: Influenza and respiratory syncytial virus (RSV) infections cause seasonal excess mortality and hospitalisation in adults (particularly the elderly) in high-income countries. Little information exists on the impact of these infections on adults in Africa. OBJECTIVES: To estimate influenza- and RSV-related adult mortality, stratified by age and hospitalisation in Soweto. STUDY DESIGN: A retrospective hospital-based study in Soweto from 1997 to 1999 to estimate influenza- and RSV-related excess all-cause deaths and hospitalisation using a ratedifference method. The study was based on influenza seasons of varying severity, provided by surveillance data. RESULTS: Influenza seasons were significantly associated with excess mortality in adults across all 3 years, except for 18 - 64-year-olds in 1998. Excess mortality was highest in those >65 years of age: 82.8/100 000 population in the mild 1997 season and 220.9/100 000 in the severe 1998 season. Influenza significantly increased adult medical hospitalisation in the severe 1998 season alone. RSV did not significantly affect mortality or hospitalisation. CONCLUSION: Influenza-related mortality was substantial and disproportionately affected the elderly. Influenza vaccination for the elderly warrants consideration. The RSV-related burden was not significantly increased but merits observation over a longer period.