Epidemiology of acute leukaemia in the Cape Province of South Africa.

Of 535 consecutive cases of acute leukaemia diagnosed in the Cape Province between 1978 and 1985, demographic data are incomplete in 75 black patients and they have had to be excluded from the spatial analysis. Of the remaining 460 cases, 223 (48.5%) occurred in white patients and 237 (51.5%) in those of mixed ancestry, classified as coloureds according to the Population Registration Act No. 30 of 1950. The average incidence was 2.12, 1.37 and 0.58/100,000 for whites, coloureds and blacks respectively. There was no temporal trend in the incidence of acute leukaemia between the three race groups. The median age for whites was 30 years and for the coloureds was 15 years, which is comparable to the 16 years for the black patients. The two-peak age distribution for leukaemia was seen in the white group, but was absent in the other two groups. This is accounted for by a different distribution in non-lymphoblastic as opposed to lymphoblastic subtypes. Furthermore, there was a disproportionately high frequency of acute progranulocytic leukaemia in the black patients, whereas the white and coloured groups were similar. There was a single, clearly defined macro-scale cluster restricted to white patients in Statistical Region 17 (SR-17). This exploratory study provides the first epidemiologic data for acute leukaemia in the Cape Province. It needs to be extended in order to verify these observations under more controlled circumstances and to seek evidence for some environmental factors that may account for the geographical cluster.

The community perinatal health care system of urban Cape Town, South Africa--I. Characteristics of mothers and birth outcomes.

Greater Cape Town has developed a geographical network of perinatal health care services for low-income mothers using community-based clinics with hospital referrals. This study analyzes 25,409 births recorded in 162 different urban residential areas during 1987. The data apply to two populations--black and mixed. Information on the mother, such as height, weight, education, parity, and prenatal visits is indicated by suburb, as well as birth outcomes such as gestational age, birthweight, and method of obstetrical delivery. Comparisons are drawn between black and mixed populations and among suburbs. High utilization rates and successful maternity and infant outcomes suggest that the outreach clinics of Cape Town could provide a model for urban agglomerations in other African countries.

The community perinatal health care system of urban Cape Town, South Africa--II. Geographical patterns.

Greater Cape Town has developed a geographical network of perinatal health care services for low-income mothers using community-based clinics with hospital referrals. This study analyzes 25,409 births recorded in 162 different urban residential areas during 1987. The data apply to two populations--black and mixed. Information on the mother, such as height, weight, education, parity, and prenatal visits is indicated by suburb, as well as birth outcomes such as gestational age, birthweight, and method of obstetrical delivery. Comparisons are drawn between black and mixed populations and among suburbs. High utilization rates and successful maternity and infant outcomes suggest that the outreach clinics of Cape Town could provide a model for urban agglomerations in other African countries.

Intra-urban variations of neonatal and post-neonatal mortality in a developing city.

Numerous surveys at the national and regional level have demonstrated that large inequalities in infant health status exist in Southern Africa. Few studies have assessed infant mortality at the intra-urban scale of geographic analysis. Comparisons between infant mortality rates from different areas are made even more meaningful if the data are divided into two primary categories based on period-of-death; these being the neonatal and post-neonatal components. This study presents the results of a survey undertaken in Metropolitan Cape Town (population 1.6 million) during 1982. The aim was to determine the spatial variation of neonatal and post-neonatal mortality at the suburb (or community) level within the city. Overall, a total of 36,789 live births and 928 infant deaths were recorded; 53.4% in the neonatal period and 46.6% in the post-neonatal period. The mean infant mortality rate was 25.2 per 1000 live births; the neonatal mortality rate and post-neonatal mortality rate being 13.5/1000 and 11.7/1000, respectively. A marked range in death rates was evident for both components. For the neonatal category it was 0.0-49.9/1000 and 0.0-40.0/1000 for the post-neonatal period. The generally low post-neonatal mortality rate among the 69 suburbs studied has made the neonatal component the dominant contributor to the infant mortality rate. However, in the lowest socio-economic areas the post-neonatal mortality rate was responsible for over 60% of infant deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Placental villous surface area of light-for-dates infants at term.

The placental villous surface area and ratios of villous surface area to body weight, length and head circumference were determined in 40 light-for-dates infants born at term. When infants were categorised by length, head circumference and ponderal index, the short infants and infants with small heads had a mean villous surface area similar to that of their peers of normal length and head circumference. However, wasted infants, with a low ponderal index, had both an absolutely and relatively reduced mean villous surface area when compared to non-wasted infants. It is concluded that not all light-for-dates infants, but only those that are wasted at birth, have quantitative placental inadequacy.

Spatial and temporal distribution of selected canine cancers in Michigan, USA, 1964-1994.

Although rates are commonly used to compare regional disease occurrence, rate-independent methods might also be useful in circumstances where geographic occurrence of a disease is known, but calculation of disease rates is not feasible. This is frequently the case for diseases in companion animals, where accurate enumeration of populations-at-risk is often arduous. This study had two objectives: to demonstrate a rate-independent method for investigating disease aggregation in companion animals; and, to assess the spatial and temporal clustering of canine cases of four cancers that are biologically similar in dogs and humans. Geographic information systems and point-pattern analysis were used to assess the spatial and temporal clustering of incident cases of four types of canine cancer in three counties in Michigan between 1964 and 1994, and to generate hypotheses concerning disease aggregation. Significant (P < or = 0.01) spatial clustering was found that varied by county and cancer type. No definitive temporal patterns could be deduced from a temporal analysis of the cases of canine cancer in this study. These results demonstrate distance-based methods for assessing clustering of disease, and suggest that processes determining the aggregation of canine cancer cases do not act in a spatially uniform manner.

The spatial distribution of infant mortality rates in South Africa, 1982.

Infant mortality rates (IMRs) systematically calculated for the statistical regions of South Africa are presented for those groups of the population for which birth and death data are routinely collected. The geographical variation in the IMR and its statistical significance is presented in a series of maps. A more detailed analysis is also provided for the larger metropolitan areas.

Black fertility patterns--Cape Town and Ciskei.

The reproductive and contraceptive experience of 491 Black women in urban and rural areas (Cape Town and Ciskei) is presented. The 'average woman' in the sample was 31 years old and first became pregnant by the age of 19,8 years; she had had 3,5 pregnancies, 2,9 living children and wished for 3,9 children. Family size was related to the level of education, degree of urbanization and age of the mother. A sizeable minority of the women experienced at least 1 miscarriage or the death of at least 1 child. Most of the women (65,5%) used some method of contraception between pregnancies, and 57% were using contraception when interviewed. All but 20,7% of those using contraception were receiving an injectable progestogen (Depo-Provera). In urban areas a significant minority used oral contraceptives or sterilization for contraception. Very few women used an intra-uterine contraceptive device. The results of our survey suggest that it is more difficult for the poor to maintain their desired family size. There is a need for family-planning services to be accessible to all, and especially to teenagers. The strongest motivation for a decrease in family size probably results from the settled family life and job opportunities which characterize urban life.

Characteristics of infant mortality in the RSA 1929-1983. Part I. Components of the white and coloured infant mortality rate.

Secular trends in white and coloured neonatal, post-neonatal and infant mortality rates are presented for the period 1929-1983. More detailed information is given for deaths in the first month of life. During this 54-year period the infant mortality rate for whites has declined from 64.2/1,000 to 13.5/1,000, whereas the rate for coloureds fell from 158.8 (1938) to 55.0/1,000. The greater part of the latter decline occurred after 1970. Since 1945 the neonatal mortality rate (NMR) for whites has exceeded the post-neonatal mortality rate (PNMR) but among coloureds the PNMR still exceeds the NMR.

Characteristics of infant mortality in the RSA 1929-1983. Part II. Causes of death among white and coloured infants.

The relative contribution of different causes of death in the first year of life is presented for the period 1929-1983. Infections and perinatal and respiratory causes most commonly result in infant death among coloureds, while perinatal and congenital causes are commonest among whites. Over the 54-year period studied the mortality rate due to infections has fallen dramatically among whites but much less so among coloureds. The two causes of death for which the ratios of coloured to white mortality are highest, viz. infections (28 times) and respiratory causes (9 times), are those which have the greatest post-neonatal mortality component.

A medical geography of perinatal mortality in Metropolitan Cape Town.

An infant's weight at birth as well as its socio-economic environment are recognized as constituting two of the major risk factors associated with perinatal mortality. Spatial analyses of birth weight, socio-economic status and perinatal mortality in Metropolitan Cape Town for the year 1982 are presented in an attempt to assess the relationship between these variables at the suburb (or community) level. Variations in perinatal mortality for each suburb were found to be highly correlated with variations in the distribution of low birth weights. Overall, it would appear that the geography of the interrelationship between low birth weight and perinatal mortality tends, in part, to mirror long-standing gradients in socio-economic status--particularly for those coloured communities which show high perinatal death rates. To what extent these variations are associated with available antenatal and infant health care services can only be postulated. Points for possible community intervention are suggested.

The spatial variation of mortality among children under 5 years of age in South Africa.

Childhood mortality rates between 1 and 4 years and under 5 years of age were systematically calculated according to the statistical regions of South Africa for the white and coloured populations. The geographical variation is wide and the statistical significance in these mortality rates is presented in map form. Mortality rates are particularly high in rural areas. For the coloured group, the correlation between the spatial distribution of infant mortality rates under 1 year of age and the 1-4 year mortality rate pattern was high.

The geographical variation in neonatal and post-neonatal mortality in South Africa, 1978-1982.

Early neonatal, neonatal and post-neonatal mortality rates were systematically calculated according to the statistical regions of South Africa for the white and coloured populations over a 5-year period. The geographical variation is wide and the statistical significance in these mortality rates for coloured infants in rural areas of the Cape and the Orange Free State are particularly high and call for urgent attention.

Births and perinatal deaths in Mitchell's Plain.

All births and perinatal deaths from Mitchell's Plain, Cape Town, during the first 8 months of 1985 were analysed. Out of a total of 4,228 liveborn infants 66.4% were delivered by the Peninsula Maternity and Neonatal Service (PMNS), while the remaining 33.6% were born to private patients. There was an overall preterm rate of 11.0%, while 13.8% of infants had a birth weight of less than 2,500 g. Only 16.1% of mothers booked early. The perinatal mortality rate was 22.2/1,000 and the stillbirth rate 12.6/1,000. The stillbirth rate for private patients was more than 6 times lower than that for their PMNS counterparts (2.8 v. 17.5/1,000).

Facilities for the mentally handicapped in the Western Cape. Some pressing needs.

The proper management of mental handicap requires a carefully planned system of interlocking services. To implement such a system, accurate assessment of needs is essential. In 1984 the Western Cape Forum for the Mentally Handicapped undertook a survey incorporating information received from all existing centres (N = 37) within four economic regions of the Western Cape. The most glaring deficiency in services was in the black community with only 5.4% of the estimated needs being met, whereas in the coloured and white communities the figures were 36% and 86% respectively. However, serious deficiencies and imbalances for all three ethnic groups were identified. Certain basic principles which underlie a well-planned system of provision for the mentally handicapped are outlined. A survey to establish needs on a national level is suggested.

The prevalence of locomotor disability and handicap in the Cape Peninsula. Part I. The coloured population of Bishop Lavis.

A door-to-door survey to identify the locomotor disabled was carried out on 33.35% of the so-called coloured population in a low socio-economic area of the Cape Peninsula (9112 people). The prevalence rate of locomotor disability was 11.2/1000. The main causes of disability were illness (44.1%) and trauma (41.2%); the former resulted mostly from cerebrovascular accidents (15.7%) and poliomyelitis (15.7%). Of the disabled persons 11.8% were 15 years of age or less, 57.8% between the ages of 16 and 59 years and 30.4% were more than 60 years. Of those in the working-age group 15% were employed. Few of the unemployed had hobbies or interests or had any contact with health or social services.

The prevalence of locomotor disability and handicap in the Cape Peninsula. Part II. The black population of Nyanga.

A door-to-door survey to identify the locomotor-disabled was carried out on 8.5% of the population of a black residential area of the Cape Peninsula (2072 people). The prevalence rate of locomotor disability was 18.3/1000; causes of disability related to illness (36.8%), trauma (31.6%) and congenital factors (23.7%). The main illnesses described were cerebrovascular accidents (26.1%) and poliomyelitis (21.7%). Persons aged 15 years or less constituted 18,4% of the disabled, while 42.1% were aged 16-59 years and 39.5% 60 years or more. Although many of the disabled individuals identified could move about independently, the proportion bedridden was high (15.8%). At the time of the survey 13.3% of adults were working and 51.1% of children over 6 years old attended school. Eighty per cent had no contact with health services.

The prevalence of locomotor disability and handicap in the Cape Peninsula. Part III. The white population of Fish Hoek.

A door-to-door survey to identify the locomotor-disabled was carried out on 24.2% of the population living in a white middle-class residential area of the Cape Peninsula (2391 people). This coastal resort is a popular place for retirement and has a large elderly population (23.3%). The prevalence rate of locomotor disability was 13/1000. Illness caused 74.2% of the disability, and in 34.5% of cases this was identified as arthritis. Most of the disabled were aged 60 years or more (77.4%), while 22.6% were 16-59 years old. Fifty per cent of those in the working-age group were employed; one-third competed in the open labour market and the rest were in sheltered employment. Few people were in contact with health, geriatric or social services.