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Johnson L.F.,University of Cape Town | Dorrington R.E.,University of Cape Town | Bradshaw D.,Burden of Disease Research Unit | Coetzee D.J.,University of Cape Town
Tropical Medicine and International Health | Year: 2012

Objectives To assess the extent to which sexually transmitted infections (STIs) have contributed to the spread of HIV in South Africa and to estimate the extent to which improvements in STI treatment have reduced HIV incidence. Methods A mathematical model was used to simulate interactions between HIV and six other STIs (genital herpes, syphilis, chancroid, gonorrhoea, chlamydial infection and trichomoniasis) as well as bacterial vaginosis and vaginal candidiasis. The effects of STIs on HIV transmission probabilities were assumed to be consistent with meta-analytic reviews of observational studies, and the model was fitted to South African HIV prevalence data. Results The proportion of new HIV infections in adults that were attributable to curable STIs reduced from 39% (uncertainty range: 24-50%) in 1990 to 14% (8-18%) in 2010, while the proportion of new infections attributable to genital herpes increased. Syndromic management programmes are estimated to have reduced adult HIV incidence by 6.6% (3.3-10.3%) between 1994 and 2004, by which time syndromic management coverage was 52%. Had syndromic management been introduced in 1986, with immediate achievement of 100% coverage and a doubling of the rate of health seeking, HIV incidence would have reduced by 64% (36-82%) over the next decade, but had the same intervention been delayed until 2004, HIV incidence would have reduced by only 5.5% (2.8-9.0%). Conclusions Sexually transmitted infections have contributed significantly to the spread of HIV in South Africa, but STI control efforts have had limited impact on HIV incidence because of their late introduction and suboptimal coverage. © 2011 Blackwell Publishing Ltd. Source


Mayosi B.M.,University of Cape Town | Lawn J.E.,Saving Newborn Lives | Van Niekerk A.,Safety and Peace Promotion Research Unit | Van Niekerk A.,University of South Africa | And 5 more authors.
The Lancet | Year: 2012

Since the 2009 Lancet Health in South Africa Series, important changes have occurred in the country, resulting in an increase in life expectancy to 60 years. Historical injustices together with the disastrous health policies of the previous administration are being transformed. The change in leadership of the Ministry of Health has been key, but new momentum is inhibited by stasis within the health management bureaucracy. Specifi c policy and programme changes are evident for all four of the so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental health; injury and violence; and maternal, neonatal, and child health. South Africa now has the world's largest programme of antiretroviral therapy, and some advances have been made in implementation of new tuberculosis diagnostics and treatment scale-up and integration. HIV prevention has received increased attention. Child mortality has benefi ted from progress in addressing HIV. However, more attention to postnatal feeding support is needed. Many risk factors for non-communicable diseases have increased substantially during the past two decades, but an ambitious government policy to address lifestyle risks such as consumption of salt and alcohol provide real potential for change. Although mortality due to injuries seems to be decreasing, high levels of interpersonal violence and accidents persist. An integrated strategic framework for prevention of injury and violence is in progress but its successful implementation will need high-level commitment, support for evidence-led prevention interventions, investment in surveillance systems and research, and improved human-resources and management capacities. A radical system of national health insurance and re-engineering of primary health care will be phased in for 14 years to enable universal, equitable, and affordable health-care coverage. Finally, national consensus has been reached about seven priorities for health research with a commitment to increase the health research budget to 2·0% of national health spending. However, large racial diff erentials exist in social determinants of health, especially housing and sanitation for the poor and inequity between the sexes, although progress has been made in access to basic education, electricity, piped water, and social protection. Integration of the private and public sectors and of services for HIV, tuberculosis, and non-communicable diseases needs to improve, as do surveillance and information systems. Additionally, successful interventions need to be delivered widely. Transformation of the health system into a national institution that is based on equity and merit and is built on an eff ective human-resources system could still place South Africa on track to achieve Millennium Development Goals 4, 5, and 6 and would enhance the lives of its citizens. Source


Bradshaw D.,Burden of Disease Research Unit | Dorrington R.E.,University of Cape Town
South African Journal of Obstetrics and Gynaecology | Year: 2012

Background. The paucity of quality data on maternal deaths and possible mis-specification of models have resulted in a range of estimates of the maternal mortality ratio (MMR) for South Africa. Objectives. This paper contrasts the estimates from multi-country models for estimating the MMR with the South African data from vital registration. Method. A literature review was undertaken to identify estimates of the MMR for South Africa and methodologies used. In addition, cause of death data from Statistics SA were analysed for trends. Results. In contrast to prediction models used by international agencies, the Health Data Advisory and Co-ordinating Committee (HDACC) recommended the use of the vital registration data adjusted for under-registration and misclassification of causes to monitor maternal mortality. HDACC also recommended that, as is done by the Maternal Mortality Estimation Interagency Group (MMEIG), the number of maternal deaths identified be scaled up by 50% to account for the general under-reporting of maternal deaths. Based on this approach, the baseline MMR in 2008 was estimated to be 310 per 100 000 live births. From vital statistics, the indications are that by 2009, South Africa had not yet managed to reverse the upward trend in MMR. The increase is largely a result of an increase in the number of maternal deaths from indirect causes, as might be expected in the context of the HIV pandemic. However, the number of indirect maternal deaths increased markedly only since 2003, a few years later than the rapid increase in AIDS mortality. Conclusions. There are opportunities to improve monitoring maternal mortality, including strengthening the information systems (vital registration, the confidential enquiry and the routine health information system) and exploring opportunities for linking data from different sources. Better data on the role of HIV in maternal mortality are needed. Source


Peer N.,Chronic Diseases of Lifestyle Research Unit | Bradshaw D.,Burden of Disease Research Unit | Laubscher R.,Biostatistics Unit | Steyn N.,Human science Research Council | Steyn K.,University of Cape Town
Global Health Action | Year: 2013

Background: Non-communicable chronic diseases (NCDs) have increased in South Africa over the past 15 years. While these usually manifest during mid-to-late adulthood, the development of modifiable risk factors that contribute to NCDs are usually adopted early in life. Objective: To describe the urban-rural and gender patterns of NCD risk factors in black adolescents and young adults (15-to 24-year-olds) from two South African Demographic and Health Surveys conducted 5 years apart. Design: An observational study based on interviews and measurements from two cross-sectional national household surveys. Changes in tobacco and alcohol use, dietary intake, physical inactivity, and overweight/obesity among 15-to 24-year-olds as well as urban-rural and gender differences were analysed using logistic regression. The 'Surveyset' option in Stata statistical software was used to allow for the sampling weight in the analysis. Results: Data from 3,186 and 2,066 black 15-to 24-year-old participants in 1998 and 2003, respectively, were analysed. In males, the prevalence of smoking (1998: 21.6%, 2003: 19.1%) and problem drinking (1998: 17.2%, 2003: 15.2%) were high and increased with age, but in females were much lower (smoking - 1998: 1.0%, 2003: 2.1%; problem drinking - 1998: 4.2%, 2003: 5.8%). The predominant risk factors in females were overweight/obesity (1998: 29.9%, 2003: 31.1%) and physical inactivity (2003: 46%). Urban youth, compared to their rural counterparts, were more likely to smoke (odds ratio (OR): 1.39, 95% confidence interval (CI): 1.09-1.75), have high salt intake (OR: 1.75, 95% CI: 1.12-2.78), be overweight/obese (OR: 1.39, 95% CI: 1.14-1.69), or be physically inactive (OR: 1.45, 95% CI: 1.12-1.89). However, they had lower odds of inadequate micronutrient intake (OR: 0.46, 95% CI 0.34-0.62), and there was no overall significant urban- rural difference in the odds for problem drinking but among females the odds were higher in urban compared to rural females. Conclusion: Considering that the prevalence of modifiable NCD risk factors was high in this population, and that these may persist into adulthood, innovative measures are required to prevent the uptake of unhealthy behaviours, and regular surveillance is needed. © 2013 Nasheeta Peer et al. Source


Johnson L.F.,University of Cape Town | Dorrington R.E.,University of Cape Town | Bradshaw D.,Burden of Disease Research Unit | Coetzee D.J.,University of Cape Town
Sexual and Reproductive Healthcare | Year: 2011

Objectives: Few studies have assessed the effect of syndromic management interventions on the prevalence of sexually transmitted infections (STIs) at a population level. This study aims to determine the effect of syndromic management protocols that have been introduced in South Africa since 1994. Study design: A mathematical model of sexual behaviour patterns in South Africa was used to model the incidence of HIV, genital herpes, syphilis, chancroid, gonorrhoea, chlamydial infection, trichomoniasis, bacterial vaginosis and vaginal candidiasis. Assumptions about health seeking behaviour and treatment effectiveness were based on South African survey data. The model was fitted to available STI prevalence data. Main outcome measures: Reductions in STI prevalence due to syndromic management. Results: Between 1995 and 2005, there were significant reductions in the prevalence of syphilis, chancroid, gonorrhoea, trichomoniasis and chlamydial infection. In women aged between 15 and 49, syndromic management resulted in a 33% (95% CI: 23-43%) decline in syphilis prevalence, a 6% (95% CI: 3-11%) reduction in gonorrhoea prevalence, a 5% (95% CI: 1-13%) reduction in the prevalence of bacterial vaginosis and a substantial decline in chancroid. However, syndromic management did not significantly reduce the prevalence of other STIs. For all STIs, much of the modelled reduction in STI prevalence between 1995 and 2005 can be attributed to either increased condom usage or AIDS mortality. Conclusions: Syndromic management of STIs can be expected to decrease the prevalence of curable STIs that tend to become symptomatic, but has little effect on the prevalence of STIs that are mostly asymptomatic. © 2010 Elsevier B.V. Source

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