Decisions and advice about infant feeding: findings from sociological work in KwaZulu-Natal,South Africa

This paper provides preliminary empirical evidence regarding the perceived role and actual experiences of HIV/AIDS intervention-focused civil society organisations (CSOs) in Botswana's national response. Key informants see the national response as government-centred and the role of CSOs within interventions as negligible. Despite secondary evidence that indicates a fairly robust and diverse civil society community, interviews with CSO personnel revealed that the roles and experiences of grassroots organisations are currently hampered by spatial, institutional and socio-cultural dynamics of intervention operationalisation. This raises questions about the extent to which this scenario may create or exacerbate obstacles regarding the efficiency and effectiveness of the national HIV/AIDS response in Botswana.     

Assessing health seeking behaviour among tuberculosis patients in rural South Africa.

SETTING: South Africa's rural Northern Province. OBJECTIVES: To examine patterns of health seeking behaviour among hospitalised tuberculosis patients. DESIGN: Information on personal characteristics, health seeking behaviour and delays to presentation and hospitalisation was collected from hospitalised TB patients. Analysis of rates was used to investigate factors associated with delay. RESULTS: Among 298 patients, median total delay to hospitalisation was 10 weeks, with patient delay contributing a greater proportion than service provider delay. Patients more often presented initially to public hospitals (41%) or clinics (31 %) than to spiritual/traditional healers (15%) or private GPs (13%). Total delay was shorter amongst those presenting to hospitals than those presenting to clinics (rate ratio 1.33, 95%CI 1.13-1.85), with a significantly smaller proportion of the total delay attributable to the health service provider (18% vs. 42%). Those exhibiting a conventional risk profile for TB (migrants, alcohol drinkers, history of TB) were diagnosed most quickly by health services, while women remained undiagnosed for longer. CONCLUSION: Considerable delay exists between symptom onset and treatment initiation among pulmonary tuberculosis patients. While a substantial delay was attributable to late patient presentation, an important, preventable period of infectiousness was caused by the failure of recognised clinical services to diagnose tuberculosis among symptomatic individuals.     

Travelling to Africa: health risks reviewed

Africa's varied ecology presents a wide range of travel health threats: infections; accidents; envenomations; an uncertain drug supply; problematic access to competent medical care outside South Africa. Important vaccine preventable diseases include yellow fever, meningococcal disease, typhoid, polio, rabies, and hepatitis A and B; routine vaccinations should be up to date. Much, but not all, of sub-Saharan Africa is malarious with chloroquine resistant falciparum dominating; chemoprophylaxis and personal protection measures will often be indicated. Other threats are less obvious, e.g. helminth and protozoal infections. The immunocompromised and other high-risk groups may require special attention. Risk mitigation strategies may include education, vaccination, chemoprophylaxis, personal protection measures, provision of treatment and equipment packs, behaviour modification, and evacuation insurance.     

成都地区男男性行为者的性病就医意向调查

目的促进男男性行为者的正确就医行为。方法以匿名问卷的方式开展性病就医意向调查。结果70名接受调查者平均年龄26．6岁，以青壮年为主，且文化程度较高。患了性病后60例(85．7％)表示愿意去正规医院和皮肤性病专科医院就诊，42例(60．0％)对医院所处的地理位置不介意，44例(62．9％)希望男医生接诊，希望得到全面认真的检查和治疗，69例(98．6％)赞成提供转介卡进行性病转介服务的设想。结论本次调查对今后在男男性行为人群中开展针对性的性病医疗服务，促进正确的就医行为提供了依据。     

Africa activism: money for AIDS not for war; South Africa antiretrovirals

Africa Action seeks organizational endorsements for prioritizing an epidemic that has already killed 25 million people. Separately, South Africa's Treatment Action Campaign seeks international support for government cooperation in making antiretroviral treatment available there.     

South Africa: alcohol today

In 1995 Addiction published an editorial on prospects for substance abuse control in South Africa. This paper reflects on where the country is 10 years later.     

Temperature-suitability maps for schistosomiasis in South Africa

The results of parasitological surveys have shown that both urinary and intestinal schistosomiasis occur widely among the human residents of South Africa. The national data on both diseases have now been incorporated into a geographical information system, to develop new maps based on defined temperature constraints. The disease data, obtained from a 'hard-copy' atlas of schistosomiasis, were used as a template to select temperature regimes that were (1) suitable and (2) unsuitable for the transmission of schistosomes to humans in South Africa. The regimes were derived from the published results of investigations in which the biology of larval schistosomes (i.e. schistosome transmission) was related to temperature in South Africa. Those regimes that were based on the estimated temperature minima for transmission corresponded more closely to the disease-distribution data than those based on the corresponding maxima. An estimate of the number of children living in the climate-suitable areas was made but, within the context of the spatial methodology used and the limitations of the available disease data, it was not possible to predict the prevalences of schistosomiasis.     

Obesity in South Africa

South Africa has not been spared in the rampant global increase in obesity. Throughout Africa, as elsewhere, ethnicity has a major impact on the incidence and pathogenesis of comorbid diseases, particularly diabetes. Combined figures for obesity and overweight (body mass index [BMI] > 25 kg m(-2)) obtained across all ethnic groups in the adult population in 1998, were 57% for women and 29% for men. From the 1960s until the late 1980s, the notion of 'healthy' or 'benign' obesity was propagated in South Africa. Not surprisingly, this led to ignorance around the problem of obesity, and treatment of some of the comorbid diseases was neglected. Fortunately, as an increasing number of seminal studies draw us closer to reality, the misperception of benign obesity is being corrected. This is allowing us to address the real issues underlying the current epidemic, and to recognize and manage the comorbid diseases, in particular type 2 diabetes. A new framework for research is also emerging as we begin to define the factors underlying the impact of ethnicity on obesity.     

Gram-negative bacteria from patients seeking medical advice in Stockholm after the tsunami catastrophe

Microbiological cultures from 229 patients seeking medical advice in Stockholm after the tsunami catastrophe of December 2004 were analysed at the Clinical Microbiology Laboratory, Karolinska University Hospital, Stockholm, Sweden. Gram-negative bacilli were the most common findings from wound cultures. Common human pathogens such as Escherichia coli, Proteus species, Klebsiella spp., and Pseudomonas aeruginosa were isolated. More rare species of Gram-negative bacilli, e.g. Myroides odoratus, Sphingomonas paucimobilis and Bergeyella zoohelcum were also isolated. Resistance towards ordinary antibiotics was more extensive compared to our Swedish reference material for Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Acinetobacter spp., but not for Pseudomonas aeruginosa, probably reflecting that the resistant isolates were nosocomially acquired in Asia.     

Interventional cardiology in South Africa

South Africa is a country in political and cultural flux. Because of the iniquitous system of apartheid, inequalities have been perpetuated at all levels including health care. Due to the high prevalence of ischemic heart disease and rheumatic heart disease, coronary angiography, PTCA, intracoronary stenting, and balloon valvuloplasty have become established cardiological procedures in South Africa. However, a new political dispensation promises changes to health care, which will impact on interventional cardiology. With a proposed emphasis on primary health care, resources for tertiary health care will probably be curtailed. Thus consideration will have to be given to reducing expenditure by careful review of indications for expensive interventional procedures and developing new ideas to contain costs. This will be the challenge facing cardiologists in a "New South Africa".     

Gendered home-based care in South Africa: more trouble for the troubled

This study investigates the experiences of informal caregivers of people living with HIV in two semi-rural communities in South Africa. Ethnographic methods were used to collect and analyse data on the gendered nature and consequences of home-based care from 21 primary caregivers and 20 volunteer caregivers as well as 10 key informants. It was generally women who were poor, unemployed and unmarried who combined the care-giving role with their traditional role as homemaker and that of being the household head and breadwinner. The caregivers experienced physical strains and emotional problems, and were at elevated risk of being infected with HIV and TB. Men were largely absent in HIV/AIDS-affected homes and usually did not assist because of rigid gendered divisions of labour. Home-based care, by creating a disproportionate burden on women, is exacerbating existing gender inequities. It is argued that a thorough understanding of how home-based care undermines the physical health and psychological wellbeing of already vulnerable women is crucial for informing policies on home-based care. Thus, there is a need to incorporate gender perspectives when planning and implementing home-based care programmes.