The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa.

OBJECTIVE: To determine the prevalence of NIDDM and associated risk factors in urban Africans in Cape Town, South Africa. RESEARCH DESIGN AND METHODS: With a three-stage, proportional, stratified, random cluster method, we sampled 1000 Africans, > 30 yr of age, living in African residential areas in Cape Town. We assessed glucose tolerance with a 75-g oral glucose tolerance test, according to World Health Organization criteria, and obtained anthropometric and demographic data. RESULTS: The response rate was 79%. The prevalence of NIDDM was 8.0% (confidence interval 5.8-10.3%), age-adjusted to world population figures and that of impaired glucose tolerance, 7.0% (confidence interval 4.9-9.1%). Multivariate analysis indicated that increased age (odds ratio 4.18), upper-segment fat distribution (odds ratio 2.94), proportion of life spent in an urban area (odds ratio 2.32), and obesity (odds ratio 2.31) were significant independent risk factors for NIDDM. In contrast, sex, family history, alcohol intake, and physical activity were not independent risk factors. Only increased age (odds ratio 4.06) was a significant risk factor for impaired glucose tolerance. CONCLUSIONS: The prevalence of NIDDM in urban Africans in Cape Town, South Africa, is moderately high, and considerably higher than previous reports from Africa. The association of NIDDM with urbanization has important implications in view of the large-scale urbanization occurring in southern Africa.

Design and baseline characteristics of a hypertension intervention program in a South African village.

The Mamre Hypertension Project was initiated in response to studies indicating that hypertension and cardiovascular disease were prevalent in a rural community of Mamre, located in the Western Cape, South Africa. A survey was done to collect baseline information on the prevalence of hypertension and other cardiovascular disease risk factors. The age-adjusted prevalence of hypertension in people aged 15 years or more was 13.9% in men and 16.3% in women. Of the hypertensive subjects, 27% were not aware of their hypertension, a further 14.4% were not on treatment, and only 16.8% had their blood pressure (BP) controlled at under 140/90 mm Hg. There was a high prevalence of smoking, heavy alcohol use (in men), obesity (in women) and physical inactivity. The survey results will be used to assess the impact of the intervention programme using a before and after design, and are being used to direct interventions. The intervention programme comprises a BP station catering primarily for people with hypertension, and a health education and promotion programme directed at the general community. The BP station screens for hypertension, monitors BP and compliance with medication in hypertensives, and encourages risk factor modification. Health promotion activities include a smoking cessation group and a weight reduction and exercise group. These are run by community volunteers with support from outside consultants. The effects of the programme will be assessed after 4-5 years.

Studies on platelets: XXVIII: acute thrombocytopenic purpura due to lidocaine (Xylocaine)-mediated antibody. Report of a case.

A patient developed severe thrombocytopenia three days after the administration of lidocaine (Xylocaine) for dental extractions. Petechial bleeding and thrombocytopenia regressed promptly, probably aided by treatment with adrenocorticotropic hormone (ACTH) and prednisone. The patient is well one year after her experience and has received other drugs with impunity. The thrombocytopenia appeared related to the presence of a specific antibody, predominantly immunoglobulin M (IgM), heat labile, in the patient's plasma and serum. The antibody was lytic in action and needed complement. It probably coupled to the drug, forming an antigen-antibody complex able to fix itself to and cause the lysis of platelets. Thrombocytopenia was induced with the parenteral administration of a small dose of lidocaine to the patient. This case may represent the first recorded example of hematologic complication related to the use of lidocaine.

Meeting the continuing education needs of pediatric nurses: the Pediatric Nurse Exchange Program.

Today's dynamic health care environment offers multiple challenges as hospitals attempt to design and implement successful nursing career plans and support the development of professional nurses along such plans. The Pediatric Nurse Exchange Program is designed as a means for personal and professional development to support professional nurses as they are challenged to provide quality nursing care to children and their families. A pilot project is designed to provide experiences for professional nurses in three children's hospitals in Ohio. Exchange experiences, of two to five days in length, provide opportunities for nurses to share expertise, exchange patient care strategies, and develop skills as consultants, change agents, educators, and communicators. Nurse participants in the program are awarded continuing education contact hours for the experience.

Breast-feeding in a socio-economically disadvantaged area of Cape Town. Part I. Analysis of breast-feeding patterns among clinic attenders.

A survey of infant-feeding practices in a socio-economically disadvantaged community in the Cape Peninsula was undertaken. By the age of 6 weeks 47,3% of the infants were receiving bottle feeds, and this had increased to 76,3% by the age of 7-12 weeks. Analysis of factors which might have influenced this pattern indicated that subjective dissatisfaction with the quantity and quality of milk dominated the mothers' reasons for stopping breast-feeding. Since contact between the local authority and mothers often took place only after breast-feeding had been discontinued, it is suggested that concentrating on education and support during the perinatal period may have a positive influence on this disturbing trend.

Breast-feeding in a socio-economically disadvantaged area of Cape Town. Part II. The introduction of an educational and support programme.

A study of the infant-feeding practices of a socio-economically disadvantaged community in the Cape Peninsula suggested the need for improved support and education of mothers during the perinatal period. Such a programme was introduced and the study was repeated 2 years later. It was found that a significant increase in the rate of breast-feeding had occurred. It is suggested that the programme might have made an important contribution to this improvement.

A programme to promote breast feeding in a socio-economically disadvantaged area of Cape Town, Republic of South Africa.

PIP: 169 mothers with infants under 6 weeks who attended the Local Authority Child Health Clinic in a socioeconomically disadvantaged area of Cape Town, South Africa, were interviewed in a study of infant feeding practices. Data was obtained on ages of infant of mother, place of birth, i.e., home, hospital, or midwife obstetrics unit, number of previous pregnancies and live children, last birth interval, method used for feeding the infant, reasons for introducing bottle or discontinuing breast, and age of the infant when contact was first made with Local Authority. On the basis of the interview, infants were classified as either breastfed, i.e., exclusively except for water given in a bottle or bottle fed, i.e., receiving no breast milk at all, or mixed fed, i.e., part breast and part bottle. Of the 89 mothers who fulfilled the criteria for breastfeeding, 80 were interviewed 6 weeks later. At the 1st interview, 89 of the 169 babies (52.7%) were being breastfed, 28 (16.6%) were receiving bottle feeds only, and 52 (30.7%) a mixture of both. When 80 of the breastfeeding mother were interviewed for the 2nd time 6 weeks later, 40 were still giving breast milk alone and 5 were not breastfeeding at all. Further analysis showed that the major decrease in the practice of breastfeeding occurred in the first 2 weeks of life, after which there was a slow but steady decline. The reasons given for introducing bottle feeding both before and after 6 weeks were "insufficient quantity" or "poor quality" milk. Other significant problems reported included local breast complications and return to work. The maternal age, parity, and interval between pregnancies did not appear to influence the choice of feeding practice. Approximately 2 years after a program was introduced to give increased support and education to mothers from health personnel a survey similar to the 1st study was undertaken in the same area. Socioeconomic, age range, and other demographic characteristics were similar and the questionnaire constant. At the 1st interview, 94 (75.8%) of the 124 mothers were still breastfeeding, a significant increase from the 1st survey. This trend continued when the 94 mothers who were originally breastfeeding were interviewed for the 2nd time, 6 weeks later. 48, 38.7% of the original number interviewed, were still breastfeeding in comparison with the previous study. The study showed a significant increase in breastfeeding rate.^ieng

Coping with chronic illness. Part I. Locomotor disability.

A survey was undertaken to investigate the ability of 104 subjects with locomotor disability to cope in their homes. Factors which might affect coping, such as age, race, sex and type of disease, were assessed. Note was taken of support received from community-based organizations, ability to work and source of income. The majority of the subjects appeared to be isolated from health personnel after discharge from hospital and to be restricted to their homes. The deficits in the local health services which contributed to this situation are stressed.

Coping with chronic illness. Part III. The carer.

In the absence of well-organized community support for disabled people, the responsibility for their care usually falls on a close member of the family. The role of this person and the problems which they encounter were analysed. Emotional problems outweigh all others. The training which such ' carers ' receive for this task requires great attention, as does the role of community-based organizations in helping them with their duties.

Comparison of indirect immunofluorescence and membrane fluorescence assays for the differentiation of antibodies to human immunodeficiency virus types 1 and 2.

Serum samples from 20 human immunodeficiency virus type 1 (HIV-1)- and 30 HIV-2-infected and 7 dually infected individuals were reacted by using the indirect immunofluorescence assay (IFA) and membrane fluorescence assay in order to determine whether these methods were useful for typing HIV-1 and HIV-2 antibodies. Although 41 of 50 (82%) of the HIV-1- and HIV-2-positive specimens cross-reacted to some extent with the heterologous antigen in the IFA, the antigen with the higher titer correlated completely with the infecting type. The IFA could not distinguish single from dual infections, however. In contrast, only 4 of the 50 (8%) serum samples cross-reacted in the membrane fluorescence test. All seven of the specimens from patients with mixed infections reacted with both antigens. The membrane fluorescence test appears to be reliable for serodifferentiation of HIV-1 and HIV-2 infections and may be useful for laboratories with low-volume typing requirements.

Community health service planning in the education of medical students.

Few medical students gain practical experience in practical epidemiology during their undergraduate years or understand how this science is a prerequisite to decision-making in the health services. In an attempt to overcome this deficit a group of clinical students was asked to measure the incidence of cerebrovascular disease in the Cape Peninsula over a relatively short period in order that rehabilitation facilities could be planned for affected patients. The exercise proved extremely fruitful for both the staff and the students. For the latter it not only met the objectives outlined above but also forced them to enter the community and so gain a perspective of all health services provided. We suggest that this technique, which can be applied to many topics, is a useful way of introducing students to these important concepts.

Comparison of immunofluorescence, enzyme immunoassay, and Western blot (immunoblot) methods for detection of antibody to human T-cell leukemia virus type I.

A total of 3,349 serum samples were screened by the immunofluorescence (IF) method for antibody to human T-cell leukemia virus type I (HTLV-I). Only 9 of 2,409 specimens from selected individuals, blood bank donors, patients with encephalitis-meningitis, and human immunodeficiency virus antibody-positive homosexual or bisexual men were reactive by IF. In addition, 940 serum samples from intravenous drug abusers were tested by IF and also by an HTLV-I enzyme immunoassay (EIA) method. Of these, 222 (24%) were positive for both HTLV-I and HTLV-II antigens by IF, and 191 of these 222 were also reactive in the HTLV-I EIA. Of the 31 IF-positive, EIA-negative serum samples, 20 exhibited optical density readings greater than or equal to 70% of the positive cutoff in the EIA, and 29 samples reacted with 1 or more bands in the Western blot (immunoblot) test. An additional 10 specimens that were EIA negative reacted only with HTLV-I by IF. Differences in staining morphology and in reactions on HTLV-I and HTLV-II antigens before and after absorption of the serum specimens with HTLV-I and HTLV-II-infected cell pellets revealed six distinct serological patterns by IF. These results indicate that infections by HTLV-I or by another closely related retrovirus(es) occur in California. Further studies utilizing statistically valid sampling methods are needed to estimate true prevalence rates among various groups. IF and Western blot tests should supplement the EIA method to maximize sensitivity and specificity of test procedures.

Coping with chronic illness. Part II. Cerebrovascular accidents.

A survey was undertaken to investigate the fate after discharge of 41 patients admitted to Groote Schuur Hospital, Cape Town, after a cerebrovascular accident. The period of hospitalization, functional capacity after discharge and support received from community-based support agencies were analysed. Major deficiencies in the long-term management of such patients are stressed.

Urbanisation and women's health in Khayelitsha. Part I. Demographic and socio-economic profile.

Demographic and socio-economic data and information on migration patterns and urban/rural links was collected from 722 households in the formal housing area and the serviced and the unserviced site areas of Khayelitsha; 659 women and 61 men were interviewed. Thirty-eight per cent of the population were aged under 15 years and 77% under 35 years. There was a predominance of females in the 5-35-year age group. There was a mean of 4.9 persons per household, and 93.5% of sites contained 1 dwelling. Of the 659 female respondents, 7% had received no formal education, 39% had primary school education, and 54% had secondary school education. Unemployment among women was 45%. Domestic service accounted for 66.2% of formal employment. Of all women 86% were unskilled, 71.9% had been born in a 'homeland', and 69.7% had migrated to an urban area before 1985. Ties to the rural areas were strong, particularly in the 'shack' areas. 'New arrivals' to an urban area were young, mostly unemployed, and lived in the worst environmental conditions. In the unserviced 'shack' areas, 47.5% of women had migrated to an urban area in the last 5 years. There are important target areas for a study of the health effects of urbanisation and for possible interventions. This study tends to confirm the 'quadruple' oppression of women in Khayelitsha, on the basis of race, social class and gender and as new arrivals in an urban environment.

Urbanisation and women's health in Khayelitsha. Part II. Health status and use of health services.

A study was conducted among women in Khayelitsha to determine the relationship between urbanisation, health status and use of health services; 722 households were visited, and 659 female respondents provided information on acute and chronic illness for the 3,229 individuals who were members of their households. In addition, they provided information concerning their reproductive health, AIDS awareness, knowledge of cervical smears and use and knowledge of health services. Acute illness was reported for 4.3% of the study population, the commonest complaints being diarrhoea, abdominal pain and upper respiratory infections; 4.4% reported chronic illness, the commonest complaints being hypertension and tuberculosis; 16.2% of women reported gynaecological illness; 86% had of heard of AIDS (although their knowledge of transmission and prevention was poor); and 45% had heard of cervical smears. Patterns of illness and knowledge and use of health services vary in the different areas of residence of Khayelitsha. This appears to be related to urbanisation, age, and environmental and socio-economic factors.

Comparison of detection of antibody to the acquired immune deficiency syndrome virus by enzyme immunoassay, immunofluorescence, and Western blot methods.

There was 100% agreement between enzyme immunoassay (EIA) (Abbott Laboratories), Western blot, and indirect immunofluorescence (IF) when these three methods were used to measure antibody to the acquired immune deficiency syndrome (AIDS) virus in sera from 142 high-risk individuals, indicating that IF was a sensitive alternative method for detecting antibody to this agent. Thirty-two (64%) of 50 EIA-positive plasma specimens from a blood bank and 6 (21%) of 28 EIA-positive sera from alternative testing sites were negative by IF. In addition, two EIA-negative sera from the latter group were positive by IF. Western blotting agreed with IF on those 40 specimens which gave discrepant results by EIA and IF. The IF method was determined to be equal to Western blotting in sensitivity and specificity for detection of AIDS antibody, and it was found to be useful for confirming positive EIA results, especially in specimens from individuals in low-risk groups.