Cancer mortality among sub-Saharan African migrants in France

Not only are there few data on sub-Saharan migrant populations, but relatively little information is available on cancer patterns in Africa. This report presents cancer mortality patterns among the 290,000 sub-Saharan African migrants in France. Risks of mortality from different cancers in migrants born in West, Central, East, and Other parts of Africa have been compared with that observed in the local-born population, using mortality data from the period 1979–85 and population data from the 1982 French census. Relative risks were adjusted for important confounding factors such as social class and area of residence. Compared with natives, overall mortality from cancer is lower in sub-Saharan African migrants. Higher cancer mortality risks, however, are observed among males for several sites: liver in Central and West Africans; bladder in West Africans; and non-Hodgkin's lymphoma in Other African migrants. For females, risks were elevated for nasopharyngeal cancers in Other African and liver in West African migrants. The results are, for the most part, consistent with the few available data on cancer patterns in Africa, and with the patterns observed in African migrants to England and Wales (UK).This work was undertaken during the tenure of a Research Training Fellowship awarded to Dr Bouchardy by the International Agency for Research on Cancer, Lyon, France.     

Morbus sacer in Africa: some religious aspects of epilepsy in traditional cultures

Epilepsy when manifested as grand mal seizure provokes strong and ambivalent feelings in those witnessing it. Terms such as morbus sacer, denoting both a sacred and demoniac condition, or folk names indicating divine punishment, have expressed these feelings in European societies from antiquity to the Middle Ages and beyond. An atmosphere of fear, shame and mysticism surrounds epilepsy even in our days in many non-Western and also in Western cultures. In the course of work and studies in Tanzania, where I organized the Mahenge Clinic for Epilepsy in 1960, and in other parts of Africa, I found that epilepsy is conceived of as an "African' affliction, a manifestation of supernatural forces that makes it difficult to reach epilepsy sufferers with modern medical treatment. Epilepsy is traditionally looked on as caused by ancestral spirits or attributed to possession by evil spirits. It is also thought to be due to witchcraft, and "poisoning," and often taken to be contagious. Epilepsy may, under Christian missionary teaching, have come to be considered as due to demoniac possession or divine punishment for sins, in accordance with biblical examples. In many parts of Africa, syncretic amalgamation of indigenous traditions with Judeo-Christian doctrines influenced popular attitudes toward epilepsy. We demonstrated that persistent efforts at health education in the context of organized treatment of epilepsy can result in a change of popular notions about epilepsy and consequently lead to significant improvement in the quality of life of epilepsy sufferers.     

Evaluating problem-based learning in a multilingual student population

OBJECTIVES: The University of Natal Medical School in South Africa provides training for a student body composed of two groups: one with English as a first language and the other with an African language as a first language and English as the second. A new methodology was developed to evaluate an innovative course using modified problem-based learning techniques in this heterogeneous environment. DESIGN: The learning model proposed required achieving a balance of three components: content, enquiry/learning process and social interaction/group process. A multidimensional system, felt to be consistent with this educational philosophy, was developed using seven different quantitative and qualitative techniques. SETTING: The University of Natal Medical School. SUBJECTS: First-year multilingual medical students. RESULTS: The results revealed that social interaction was highly successful in reducing barriers between the student groups and between students and facilitators. However, the emphasis on group participation may have overshadowed the enquiry process, leading to superficial discussions of problems and feelings of repetitiveness. During the course students and facilitators expressed concern that the innovative assessments used did not assess the course content adequately. While the group presentations and projects were useful exercises for consolidation and group interaction, they did not enable facilitators to identify struggling students. CONCLUSIONS: The outcome of the evaluation stressed the need of achieving an appropriate balance both in the curriculum and assessments of the three components of the learning model, particularly in a setting where student backgrounds and language ability differ. Multidimensional methodology is needed for effective evaluation that promotes critical reflection.     

Prevalence of asthma and respiratory symptoms in south-central Durban, South Africa

The prevalence of asthma and respiratory symptoms in south-central Durban, one of the most heavily polluted areas of South Africa, has been determined using a cross-sectional survey of 213 households in the communities of Merewent (97% Indians) and Austerville (98% coloreds). The study population consisted of 367 children (less than 17 years old) and 693 adults. About 10% of the children and 12% of adults reported doctor diagnosed asthma. The self-reported prevalence rates for wheezing (37–40%) and attacks of shortness of breath with wheeze (16–28%) were much higher than that for doctor diagnosed asthma and common co-occurrence of the three symptoms is found. The prevalence rates for other respiratory symptoms include 33–35% for chronic cough, 31–32% for chronic phlegm, 44–50% for frequent blocked-runny nose, and 16–27% for sinusitis. Factors in the community that were associated with asthma, wheeze and shortness of breath with wheeze among the adult population included cigarette smoking, use of insecticides (coils and pump spray) and home ownership. An association between asthma among children and a number of household risk factors including dampness, carpet, pets or use of pesticides was not apparent in the community. Asthma prevalence was strongly correlated with missing of school by children (odds ratio (OR): 44; 95% confidence interval (CI): 13–141). The study serves to draw attention to a growing but neglected public health problem in urban areas of Africa.     

The sunflower syndrome. A new look at "self-induced" photosensitive epilepsy

The stereotyped, episodic abnormal behaviour manifested by a child and her mother on exposure to a particular sort of sunlight is described in detail. The child is the first fully documented patient with this so-called "self-induced" form of photosensitive epilepsy in whom for several years no electroencephalographic sensitivity to flickering light could be demonstrated. The probability that the cingulate circuit may be the anatomical substrate involved in the pathogenesis of these patients' unusual response to sunlight is discussed. Both patients also exhibited remarkably persistent habit rhythmias--the one common to both being that of circling.     

Patient satisfaction with health care providers in South Africa: the influences of race and socioeconomic status.

OBJECTIVE: The first democratic government elected in South Africa in 1994 inherited huge inequalities in health status and health provision across all sections of the population. This study set out to assess, 4 years later, the influence of race and socioeconomic status (SES) on perceived quality of care from health care providers. DESIGN: A 1998 countrywide survey of 3820 households assessed many aspects of health care delivery, including levels of satisfaction with health care providers among different segments of South African society. RESULTS: Fifty-one percent (n = 1953) of the respondents had attended a primary care facility in the year preceding the interview and were retained in the analysis. Both race and SES were significant predictors of levels of satisfaction with the services of the health care provider, after adjusting for gender, age, and type of facility visited. White and high SES respondents were about 1.5 times more likely to report excellent service compared with Black and low SES respondents, respectively. CONCLUSION: In South Africa, race and SES are not synonymous and can no longer be considered reliable proxy indicators of one another. Each has distinct and significant but different degrees of association with client satisfaction. Any assessment of equity-driven health policy in South Africa should consider the impacts of both race and SES on client satisfaction as one of the indicators of success.     

Household and environmental factors influencing anthropometric outcomes in preschool children in a rural Ethiopian community

This article tests the hypothesis that anthropometrical outcomes in preschool children are a function of complex interaction between food, nutrition, health, and other physical environmental conditions within which children live and grow. A system of simultaneous equations is used to test the above hypothesis using data from an Ethiopian highland community. The results show that a child's nutritional and health status are jointly determined by dietary intake, well-being of the mother as the primary caregiver, and the state of the physical environment for agricultural production and healthy living. Among other factors, children were found to be in better health with an increase in the number of cows in their households' livestock herds. The revealed interrelatedness and complexities of cause and effect clearly dictate the need for a multi- or transdisciplinary approach to research and development addressing health, nutrition, sanitation, agricultural production practices, among other factors for alleviating the nutritional and health problems of children and rural households.