Etiology of developmental disabilities in Soweto, South Africa.

A retrospective review was undertaken of the records of 725 children who attended the neurodevelopmental clinic at the Baragwanath Hospital in Soweto, South Africa. Most children presented at an early age (less than 2-6 years). The etiological factors were prenatal, 4 per cent; perinatal, 41 per cent; postnatal, 21 per cent. Seventy-one per cent of the perinatal factors were a result of birth related problems in full-term infants; only 22 per cent of this group were represented by premature and low birthweight infants, contrasting sharply with data from industrialized centers. Almost a third of the postnatal causes were a result of acute intracranial infections. Another 13 per cent were a result of the metabolic consequences of acute gastroenteritis. Thus a high proportion of problems were preventable through provision of adequate nutrition, mass immunization campaigns, and adequate primary health care services including antenatal and obstetric management.     

Shigella bacteraemia over a decade in Soweto, South Africa

Shigella infection rarely penetrates beyond the intestinal mucosa to cause bacteraemia. AIDS patients may be at increased risk. We investigated Shigella bacteraemia rates over a decade in a South African population with a high HIV prevalence and analysed presentation and outcome. A retrospective cohort analysis was performed for hospitalized patients for 2003-2006. The rates were compared to those for 1996-1998. Adult medical rates decreased from 0.195/1000 in 1996-1998 to 0.087/1000 admissions in 2003-2006, and paediatric rates were 0.807/1000 and 0.809/1000 admissions, respectively. Twenty patients were children (median age 7 months) and 14 were adults (median age 41 years). The main clinical presentations were acute (相似文献   

Women's perceptions and experiences of HIV prevention trials in Soweto, South Africa

Persistently high rates of HIV infection in sub-Saharan Africa have driven the exploration for additional methods of prevention, such as microbicides. Multi-site, field-based clinical trials of microbicides are conducted in diverse social and cultural contexts. Local social and cultural perceptions of HIV/AIDS and sexual risk can have profound implications in shaping community responses to the clinical trials, thereby affecting enrollment and retention. Moreover, clinical trials may have a significant impact on trial participants with regard to their views of AIDS, health and relationships. Following these issues, this paper explores the subjective experiences of women enrolled in a microbicide feasibility study. Qualitative data were collected in two phases. The first phase took place prior to the inception of the feasibility study. Men and women from Soweto participated in focus group discussions about their perceptions and experiences of the AIDS epidemic and sexual risk. The second phase started once enrollment into the feasibility study had begun. Twenty-one women who were enrolled in the microbicide feasibility study were interviewed and participated in focus groups, and were asked about their experiences of participating in the microbicide feasibility study. Special attention was placed on how they felt their participation had affected their everyday lives. Interviews and discussions were conducted in local languages, recorded, translated and transcribed. Data were analysed thematically. The central finding of this study is the sense of empowerment that feasibility study participants felt in spite of their being embedded in a culture that has come to fear, deny or ignore AIDS. We discuss the critical role of repeated, voluntary counselling and testing, knowledge of HIV status, and heightened awareness of sexual and reproductive health in reshaping study participants' approaches to sexual relationships and AIDS, as well as the benefits that participation entailed.     

Hidden consequences of state violence: spinal cord injuries in Soweto, South Africa

Many spinal cord injured people in Soweto are victims of direct, repressive state violence, such as police shootings. All of them are victims of the indirect structural violence that is institutionalized against both blacks and disabled people in South Africa. SCI people in Soweto are therefore subject to two sources of disadvantage and exclusion. This paper describes a survey of 88 SCI Sowetans. Their lives are marked by poverty and social isolation. Their experiences bring into sharp focus some of the concrete and hidden results of apartheid as a violent and disabling system.     

Neurodevelopmental delay in children infected with human immunodeficiency virus in Soweto,South Africa

HIV in children is a serious and growing problem in sub-Saharan Africa. At present very little is known about the neurological complications of human immunodeficiency virus (HIV)-infected children in South Africa. The aim of this study was to determine the extent and prevalence of neurodevelopmental delay in a group of HIV-positive children in Soweto, South Africa, as well as to determine what factors were predictive of neurodevelopmental delay. One hundred and twenty-two consecutive HIV-positive children under 2.5 years of age were assessed using the Bayley Scales of Infant Development II. Ethical approval and informed consent were obtained prior to testing. The children assessed in this study were extremely delayed in both motor and cognitive development. Seventy-two per cent of the children had severe motor delay and 52% had severe cognitive delay. The mean age of the children was 18.5 months (±8.1). The mean CD4 count was 14.4% (±8.8) and only 16% of the children were receiving highly active antiretroviral therapy (HAART). Weight, height and head circumference Z‐scores were also very low in this group of children, with both stunting and wasting being extremely common. Neurodevelopmental delay was very common in this group of children. Motor development was affected more severely than cognitive development. Weight-for-age, age and whether the child was on HAART were the most important factors in predicting cognitive and motor development. Poverty and poor socioeconomic status of families of HIV-infected children may well be additional developmental risk factors.     

Measles control in Sub-Saharan Africa: South Africa as a case study

Background

Due to intensified measles immunization efforts, measles mortality has decreased substantially worldwide, particularly in Sub-Saharan Africa (SSA). The World Health Organization (WHO) estimated a 92% decrease in measles-related deaths in the WHO AFRO region for the period 2000–2008. Recently, the AFRO region established a measles pre-elimination goal and experts have suggested engaging in a measles eradication campaign at the global level. However, recent large-scale outbreaks in many Sub-Saharan African countries present a challenge to measles control efforts. This paper examines measles immunization and the impact of measles supplemental immunization activities (SIAs) on routine immunization coverage in South Africa (SA).

Methods

We reported on immunization coverage trends in SA for the period 2001–2010 at the province and district levels. The data included routine immunization for 1st and 2nd doses of measles vaccine (MCV1, MCV2), SIAs, 1st dose of Bacille Calmette-Guérin vaccine, 1st and 3rd doses of oral polio vaccine (OPV1, OPV3), 3rd dose of Diphtheria–Tetanus–Pertussis–Haemophilus-influenzae-B vaccine (DTP-Hib3), and the number of under-one-year-olds having completed a primary course of immunization (Imm1). A regression model looked at the SIA impact on routine coverage.

Results

Over the past decade, MCV1 and MCV2 coverage have increased nationally from 68% and 57% in 2001 to 95% and 83% in 2010, respectively. SIA coverage has remained at high levels, around 90%, over the same period. Substantial heterogeneity in MCV1 and MCV2 coverage is present across SA districts, with differences in coverage of 56% (MCV1) and 51% (MCV2) in 2010. In any given year, occurrence of SIAs was associated with a decrease in routine immunization coverage of MCV1, MCV2, OPV1, OPV3, DTP-Hib3, and Imm1, at the district level.

Conclusions

The heterogeneity in measles vaccination coverage across SA districts challenges the goal of measles elimination in SA and SSA. The reduction in routine immunization coverage associated with the occurrence of SIAs raises the legitimate concern that SIAs may negatively impact health systems’ functioning.     

Social aspects of living with rheumatoid arthritis: a qualitative descriptive study in Soweto,South Africa – a low resource context

Background  

Rheumatoid Arthritis (RA) is a chronic illness with important functional, social and employment consequences. We therefore undertook a cross-sectional study, using the International Classification of Functioning, Disability and Health framework, to investigate the personal and social consequences of RA in women, living under largely impoverished conditions.     

Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa

Gender-based violence is a key health risk for women globally and in South Africa. The authors analyzed data from 1,395 interviews with women attending antenatal clinics in Soweto, South Africa, between November 2001 and April 2002 to estimate the prevalence of physical/sexual partner violence (55.5%), adult sexual assault by nonpartners (7.9%), child sexual assault (8.0%), and forced first intercourse (7.3%). Age at first experience of each type of violence was modeled by the Kaplan-Meier method, and Cox hazard models with time-varying covariates were used to explore whether child sexual assault and forced first intercourse were associated with risk of violent revictimization in adulthood. Child sexual assault was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.43, 95% confidence interval: 1.93, 3.06) and with adult sexual assault by a nonpartner (risk ratio = 2.33, 95% confidence interval: 1.40, 3.89). Forced first intercourse was associated with increased risk of physical and/or sexual partner violence (risk ratio = 2.64, 95% confidence interval: 2.07, 3.38) and nonsignificantly with adult sexual assault by a nonpartner (risk ratio = 2.14, 95% confidence interval: 0.92, 4.98). This study confirms the need for increased attention by the public health community to primary and secondary prevention of gender-based violence, with a specific need to reduce risk among South African adolescents.     

Associations between abdominal adiposity,body size and objectively measured physical activity in infants from Soweto,South Africa

Maternal and Child Health Journal - Considering the importance of the early life period, in conjunction with the increasing prevalence of adiposity and insufficient physical activity already...     

Potential risk factors for asbestos exposure amongst six-month-old infants living in the township of Soweto,South Africa

During recent years there has been increased attention paid to public exposure to asbestos in the non-occupational environment. As part of a longitudinal cohort study of urban child health and development (the Birth to Ten Project) undertaken in Soweto-Johannesburg, environment and health conditions were assessed, including the potential for exposure to asbestos in low-income housing settlements. Respondents from Soweto reported that 52% of a sample of 1488 six-month-old infants, were living in asbestos-roofed houses. Analyses in relation to the asbestos-roofed houses, showed that more than 63% were older than 20 years, and that ceilings were absent in 62% of such houses. Leaking roofs, water damage and flaking interior paint in 17%, 13% and 14% of asbestos-roofed houses, respectively, indicated considerable infrastructural decay. In 6% of houses, household members themselves had undertaken work involving cutting or sawing the asbestos roofs, during the six-month period prior to the interview. Only 10% of respondents thought that asbestos could adversely affect their health, or that of their children. The study indicated a need for vigilance in relation to the potential for current and future community exposure to asbestos in low-cost, ageing housing settlements in South Africa.     

Tuberculosis and social stratification in South Africa

Tuberculosis (TB) continues to be a barometer of poverty, determined by racial classification, in both town and countryside in the Republic of South Africa. Despite the fact that whites with the disease stand a greater chance of being diagnosed than their black counterparts, because they have very much better access to health care, the risks of TB for people classified by the state as black and colored are 27 and 16 times, respectively, the risk for whites. Black gold miners, the nutritional elite of the workforce, have also experienced an increase in TB rates. Tuberculosis accounts for 50 percent of all black compensation cases and some 2.5 percent of white cases. The risks of TB have increased over recent years among colored and blacks. Rates of tuberculous meningitis have also increased over the past decade, and show the dramatically worse health care available to people classified as black and colored. Although about 60,000 new TB cases are reported in the country each year, there have been cutbacks in the resources available for TB control and treatment.     

Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection

Sex workers have long been considered a high-risk group for HIV infection, but to date little quantitative research has explored the association between HIV risk and exchange of sex for material gain by women in the general population. The objective of this study was to estimate the prevalence of such transactional sex among women attending antenatal clinics in Soweto, South Africa, to identify demographic and social variables associated with reporting transactional sex, and to determine the association between transactional sex and HIV serostatus. We conducted a cross-sectional study of women seeking antenatal care in four Soweto health centres who accepted routine antenatal HIV testing. Private face-to-face interviews covered socio-demographics, sexual history and experience of gender-based violence. 21.1% of participants reported having ever had sex with a non-primary male partner in exchange for material goods or money. Women who reported past experience of violence by male intimate partners, problematic substance use, urban residence, ever earning money, or living in substandard housing were more likely to report transactional sex, while women who reported delayed first coitus, were married, or had a post-secondary education were less likely to report transactional sex. Transactional sex was associated with HIV seropositivity after controlling for lifetime number of male sex partners and length of time a woman had been sexually active (OR = 1.54, 95% CI: 1.07, 2.21). Women who reported non-primary partners without transactional sex did not have increased odds of being HIV seropositive (OR = 1.04, 95% CI: 0.75, 1.43). We conclude that transactional sex may place women at increased risk for HIV, and is associated with gender-based violence, substance use and socio-economic disadvantage. Research, policy and programmatic initiatives should consider the role of transactional sex in women's HIV risk, with attention to the intersecting roles of violence, poverty, and substance use in shaping women's sexual behaviour.     

Low-fat intake with falling fiber intake commensurate with rarity of noninfective bowel diseases in blacks in Soweto, Johannesburg, South Africa

Among urban blacks in Johannesburg, South Africa, a measure of westernization of diet has occurred. Yet, the frequencies of most noninfective bowel diseases not only are low but also appear to have scarcely increased. To assess more adequately the current dietary pattern, a survey was undertaken. Results indicated a habitually low-fat intake, which supplied a mean of 24% of energy but also greatly decreased fiber intake (now about 14 g daily). Possibly, a meaningful rise in the incidence of bowel diseases requires, among other things, simultaneous rise in fat intake; alternatively, there are factors yet unknown in the dietary context of urban blacks (perhaps operating in their bowels) that are inhibiting rises in the diseases mentioned.     

Mineral contamination from cemetery soils: case study of Zandfontein Cemetery, South Africa

The burial of coffins may pose an environmental and health hazard since the metals that are used in coffin-making may corrode or degrade into harmful toxins. These may leach into the surrounding soils and groundwater. Very little research has been conducted world-wide on the mineral contamination potential of cemeteries, and virtually none in South Africa. The aim of the study is to determine whether burial practices affect the mineral content of soils in cemeteries. This was done by comparing the mineral concentrations of soils within the Zandfontein Cemetery in Tshwane (Gauteng, South Africa) to those off-site as well as those in zones with high burial loads with those zones with fewer burials. Twenty three soil samples were collected from various sites on- and off-site and analyzed for 31 minerals using ICP-AES. It was found that mineral concentrations of soils within the Zandfontein Cemetery were considerably higher than those off-site. Soil samples in multiple burials blocks also have elevated metal concentrations. These excess metals are probably of anthropogenic origin associated with burial practices and could pose an environmental and human health hazard. Strict monitoring of water quality in boreholes in the vicinity of the cemetery is recommended.     

Towards authentic supervision of social workers in South Africa

ABSTRACT

Supervision of social workers has been practiced in South Africa for more than half a century. A process of authentication was reinvigorated at South African tertiary institutions in 2015 to decolonize university curricula. This process included dismantling of Western-dominated theories—also in social work supervision practice. The authentication of supervision is expounded in this article as steps in a process model devised with the aim to compose determinants and a definition of social work supervision in South Africa, in order to engender future nationally relevant inquiries into the ongoing development of an authentic body of supervision knowledge and practices.     

Developing a plan for primary health care facilities in Soweto, South Africa. Part II: Applying locational criteria

This article is the second of a two-part series describing the development of a ten-year plan for primary health care facility development in Soweto. The first article concentrated on the political problems and general methodological approach of the project. This second article describes how the technical problem of planning in the context of scanty information was overcome. The reasoning behind the various assumptions and criteria which were used to assist the planning of the location of facilities is explained, as well as the process by which they were applied. The merits and limitations of this planning approach are discussed, and it is suggested that the approach may be useful to other facility planners, particularly in the developing world.     

High rates of HIV in surgical patients in Soweto, South Africa: impact on resource utilisation and recommendations for HIV testing

Interactions between HIV and surgical diseases are relatively poorly described in high HIV prevalence settings. We report HIV prevalence and its associations in a prospective study of adults admitted to surgical units in Soweto, South Africa. Voluntary counselling and testing (VCT) for HIV was offered to surgical inpatients. Research nurses interviewed participants at enrolment and doctors reviewed records after discharge. In HIV-infected participants, CD4 counts and viral loads were ascertained. Of 1000 participants, 537 consented to VCT, of whom 176 (32.8%, 95% CI 28.8-36.9%) tested HIV positive. A history of tuberculosis (adjusted odds ratio (AOR) 3.0, 95% CI 1.5-6.2) or sexually transmitted infection (AOR 2.7, 95% CI 1.8-4.2) was associated with HIV infection. Diagnoses of cutaneous abscesses (OR 3.4, 95% CI 1.4-8.1) and anorectal sepsis (OR 3.1, 95% CI 1.1-9.0) were associated with HIV and indicated advanced disease. There were no differences in rates of operative procedures, wound sepsis, investigations or length of stay by HIV status. Hospital-acquired pneumonia was more common in HIV-infected participants (P=0.028). In conclusion, in this high HIV prevalence setting, resource utilisation is similar between HIV-infected and uninfected patients in surgical wards where high rates of HIV in young adults support routine HIV testing. WHO clinical staging of HIV should include anal sepsis as an indicator of advanced HIV disease.     

Developing a plan for primary health care facilities in Soweto, South Africa. Part I: Guiding principles and methods

The new political era in South Africa offers unique opportunities for the development of more equitable health care policies. However, resource constraints are likely to remain in the foreseeable future, and efficiency therefore remains an important concern. This article describes the guiding principles and methods used to develop a coherent and objective plan for comprehensive primary health care facilities in Soweto. The article begins with an overview of the context within which the research was undertaken. Problems associated with planning in transition are highlighted, and a participatory research approach is recommended as a solution to these problems. The article goes on to describe how the research methods were developed and applied in line with the principles of participatory research. The methods were essentially rapid appraisal techniques which included group discussions, detailed checklists, observation, record reviews and the adaptation of international and local guidelines for service planning. It is suggested that these methods could be applied to other urban areas in South Africa and elsewhere, and that they are particularly appropriate in periods of transition when careful facilitation of dialogue between stakeholders is required in tandem with the generation of rapid results for policy-makers.     

High prevalence of depression symptomology among adolescents in Soweto,South Africa associated with being female and cofactors relating to HIV transmission

Adolescents in HIV endemic settings are a priority demographic with respect to HIV prevention. Some studies have shown that behaviours associated with HIV transmission, may be mediated by mental health factors such as depression. We undertook this study to explore the prevalence and associations of depression symptomology among adolescents living in the HIV endemic community of Soweto, South Africa through the Botsha Bophelo Adolescent Health Study (BBAHS). We estimated the prevalence of depression using the Centre for Epidemiological Studies of Depression Scale, using a score of ≥24 to indicate ‘probable depression’. Among the 789 adolescents (14–19 years) with depression scores, 262 (33%) met the criteria for probable depression (99 [38%] men and 163 [62%] women; p = 0.061). In multivariable logistic regression, factors independently associated with depression included being female (AOR = 2.44, 95% CI: 1.45–4.00), marijuana use (AOR = 2.67, 95% CI: 1.21–5.93), physical violence (AOR = 1.63, 95% CI: 1.01–2.62), pregnancy (AOR = 2.00, 95% CI: 1.03–3.88) and incarceration (AOR = 2.09, 95% CI: 0.99–4.42). These data indicate that a concerning proportion of adolescents in Soweto may be suffering from depression and those screened as potentially depressed, were more likely to be female and have cofactors relating to increased risk for HIV. As part of a comprehensive HIV prevention strategy, we recommend that depression screening for adolescents be integrated into public and school health programs that triage those suffering into treatment programs.