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Government public health policy: three cautionary tales from Malaysia, South Africa and the United States

Blum J, Carstens P, Talib N

Med Law, 2007 Dec;26(4):615-42.
PMID: 18284107

Three authors describe problematic scenarios of health policy in their respective countries. These examples illustrate the role of government influences in determining resource allocation, legislation, health provision and health outcomes in very different situations. These outcomes are affected not only by attitudes to public health, but also by the legal systems in the countries which are the subjects of this study. The authors draw conclusions about the use and abuse of public health regulation.

Matched MeSH terms: South Africa
Fulltext Emotional intelligence and perceived stress in dental undergraduates: a multinational survey

Pau A, Rowland ML, Naidoo S, AbdulKadir R, Makrynika E, Moraru R, et al.

J Dent Educ, 2007 Feb;71(2):197-204.
PMID: 17314380

This multinational survey investigated the relationship between emotional intelligence (EI) and perceived stress (PS) in seven countries. First-year dental undergraduates attending a dental school in England, Greece, Romania, South Africa, Australia, and the United States and three schools in Malaysia were invited to complete a set of questionnaires on age, gender, academic background, satisfaction with career choice, EI, and PS. Of 860 questionnaires distributed, 596 were fully completed--a response rate of 69.3 percent. Mean EI score was 123.8 (95 percent CI 122.7-124.9), and mean PS score was 19.1 (95 percent CI 18.6-19.7). Significant differences in EI and PS scores were detected between different countries. Females (p<0.05), younger students (p<0.001), those without a previous higher education qualification (p<0.001), and those not satisfied with their decision to study dentistry (p<0.001) were more likely to report PS when compared to their counterparts. A significant inverse relationship (coefficient=-0.29, p=0.001) between EI and PS was detected. Independent significant predictors of PS identified were gender (beta=0.22, t=5.71, p=0.001), previous higher education qualification (beta=-0.14, t=-2.42, p=0.010), satisfaction with decision to study dentistry (beta=-0.20, t=-5.11, p=0.001), and EI (beta=-0.24, t=-6.09, p=0.001), with the latter being relatively the most important predictor. In conclusion, the inverse relationship between EI and PS has been confirmed in this heterogeneous sample representing diverse sociocultural and academic contexts of dental undergraduates.

Matched MeSH terms: South Africa
Single, rapid coastal settlement of Asia revealed by analysis of complete mitochondrial genomes

Macaulay V, Hill C, Achilli A, Rengo C, Clarke D, Meehan W, et al.

Science, 2005 May 13;308(5724):1034-6.
PMID: 15890885

A recent dispersal of modern humans out of Africa is now widely accepted, but the routes taken across Eurasia are still disputed. We show that mitochondrial DNA variation in isolated "relict" populations in southeast Asia supports the view that there was only a single dispersal from Africa, most likely via a southern coastal route, through India and onward into southeast Asia and Australasia. There was an early offshoot, leading ultimately to the settlement of the Near East and Europe, but the main dispersal from India to Australia approximately 65,000 years ago was rapid, most likely taking only a few thousand years.

Matched MeSH terms: Africa
Low prevalence of latex sensitivity in South African spina bifida children in Cape Town

Johar A, Lim DL, Arif SA, Hawarden D, Toit GD, Weinberg EG, et al.

Pediatr Allergy Immunol, 2005 Mar;16(2):165-70.
PMID: 15787875

Spina bifida children have a high prevalence of latex allergy in studies reported from Europe and the USA. This study investigated the prevalence of latex allergy in a cohort of 24 spina bifida children at the Red Cross Children's Hospital from Cape Town, South Africa. The children were investigated using a detailed questionnaire, skin prick tests (ALK-Abello), ImmunoCap RASTs, Western blotting and ELISA, using the purified latex proteins Hev b1 and Hev b3 and whole latex preparation. A low overall prevalence of latex sensitization of 16.7% was found in the children. Children who were sensitive reacted to water insoluble to Hev b1 and Hev b3 proteins. The low prevalence of latex sensitization in the South African children may not be entirely explained by stringent latex avoidance. The children were from a low socioeconomic social status and 'hygiene' and other factors should be considered.

Matched MeSH terms: South Africa
Inter-country consultation

Reid E

AIDS Health Promot Exch, 1993.
PMID: 12287485
Matched MeSH terms: Africa
Rights of patients: comparative perspectives from five countries

Blum JD, Talib N, Carstens P, Nasser M, Tomkin D, McAuley A

Med Law, 2003;22(3):451-71.
PMID: 14626880

Recognition and articulation of patient rights are core issues in the medical jurisprudence of most nations. While the nature of rights in medical care may vary from country to country, reflecting the idiosyncrasies of domestic law and health delivery, there are commonalities in this area of law that cut across borders. This paper presents five case studies in the patient rights area from Malaysia, Ireland, South Africa, Indonesia and the United States, respectively. The case discussions range from ongoing and fundamental concerns over broad patient rights issues, such as access to health care and informed consent, to rights concerns of those suffering from HIV/AIDS, to a novel consideration over ethical and legal issues concerning ownership of infant organs. It is the hope of the authors that individually, and collectively, the cases will provide helpful insights into this core area of medical law.

Matched MeSH terms: South Africa
A holistic (Horney) approach to the psychoses: the schizophrenias. I. Sociocultural, developmental and psychogenetic factors

Rubins JL

Am J Psychoanal, 1969;29(2):131-46.
PMID: 4900056
Matched MeSH terms: Africa
Recent advances in experimental leprosy

Rees RJ

Bibl Tuberc, 1970;26:189-232.
PMID: 4244234
Matched MeSH terms: Africa
Adolescent providers' knowledge of human papillomavirus vaccination age guidelines in five countries

Topazian HM, Dizon AM, Di Bona VL, Levitz L, Ramos S, Morgan K, et al.

Hum Vaccin Immunother, 2019;15(7-8):1672-1677.
PMID: 30625017 DOI: 10.1080/21645515.2018.1558688

Purpose: To examine provider knowledge of HPV vaccination age guidelines in five countries. Methods: A total of 151 providers of adolescent vaccinations in Argentina, Malaysia, South Africa, South Korea, and Spain were interviewed between October 2013 and April 2014. Univariate analyses compared providers' understanding of recommended age groups for HPV vaccination to that of each country's national guidelines. Results: In three of five countries surveyed, most providers (97% South Africa, 95% Argentina, 87% Malaysia) included all nationally recommended ages in their target age group. However, a relatively large proportion of vaccinators in some countries (83% Malaysia, 55% Argentina) believed that HPV vaccination was recommended for women above age 26, far exceeding national guidelines, and beyond the maximum recommended age in the United States. National median minimum and maximum age recommendations cited by the respondents for HPV vaccination were 11 and 29 years in Argentina (national guideline: 11-14), 13 and 48 years in Malaysia (guideline 13-14), 8 and 14 years in South Africa (guideline 9-14), 10 and 20 years in South Korea (guideline 11-14), and 11 and 12 years in Spain (guideline 11-14). In all countries, a higher percentage of vaccinators included all nationally recommended ages for vaccination, as compared to providers who did not administer HPV vaccination. Conclusions: Overall, a substantial proportion of providers incorrectly reported their country's age guidelines for HPV vaccination, particularly the upper age limit. As provider recommendation is among the strongest predictors of successful vaccination uptake among adolescents, improved education and clarification of national guidelines for providers administering HPV vaccination is essential to optimize prevention of infection and associated disease.

Matched MeSH terms: South Africa
The oil of Adenanthera pavonina L. seeds and its emulsions

Zarnowski R, Jaromin A, Certik M, Czabany T, Fontaine J, Jakubik T, et al.

Z Naturforsch C J Biosci, 2008 11 13;59(5-6):321-6.
PMID: 18998394

The oil of Adenanthera pavonina L. seeds was analysed by chromatographic and instrumental means. The oil was found to be rich in neutral lipids (86.2%), and low in polar lipids (13.8%). The neutral lipids consisted mainly of triacylglycerols (64.2%). Unsaturated fatty acids were found as high as 71%, while the percentage of saturated fatty acids was only 29%. GC and GC/MS analyses revealed linoleic, oleic and lignocerotic acid to be predominant among all fatty acids in the A. pavonina oil, whereas stigmasterol was the major steroid identified within this study. Subsequently, the oil was used for preparation of submicron oil-in-water (o/w) lipid emulsions. Lipid emulsions were formulated by using soybean lecithin (SL) to investigate their particle size, Zeta potential and stability at the different oil and SL ratios. The results obtained indicate possible applications of the tested oil in pharmaceutical and medical fields as drug and cosmetic active ingredient carriers.

Matched MeSH terms: Africa
Fulltext Expediting the sampling, decalcification, and forensic DNA analysis of large elephant ivory seizures to aid investigations and prosecutions

Ewart KM, Lightson AL, Sitam FT, Rovie-Ryan JJ, Mather N, McEwing R

Forensic Sci Int Genet, 2020 01;44:102187.
PMID: 31670244 DOI: 10.1016/j.fsigen.2019.102187

The illegal ivory trade continues to drive elephant poaching. Large ivory seizures in Africa and Asia are still commonplace. Wildlife forensics is recognised as a key enforcement tool to combat this trade. However, the time and resources required to effectively test large ivory seizures is often prohibitive. This limits or delays testing, which may impede investigations and/or prosecutions. Typically, DNA analysis of an ivory seizure involves pairing and sorting the tusks, sampling the tusks, powdering the sample, decalcification, then DNA extraction. Here, we optimize the most time-consuming components of this process: sampling and decalcification. Firstly, using simulations, we demonstrate that tusks do not need to be paired to ensure an adequate number of unique elephants are sampled in a large seizure. Secondly, we determined that directly powdering the ivory using a Dremel drill with a high-speed cutter bit, instead of cutting the ivory with a circular saw and subsequently powdering the sample in liquid nitrogen with a freezer mill, produces comparable results. Finally, we optimized a rapid 2 -h decalcification protocol that produces comparable results to a standard 3-day protocol. We tested/optimised the protocols on 33 raw and worked ivory samples, and demonstrated their utility on a case study, successfully identifying 94% of samples taken from 123 tusks. Using these new rapid protocols, the entire sampling and DNA extraction process takes less than one day and requires less-expensive equipment. We expect that the implementation of these rapid protocols will promote more consistent and timely testing of ivory seizures suitable for enforcement action.

Matched MeSH terms: Africa
Necator americanus (Nematoda: Ancylostomatidae) from Africa and Malaysia have different ITS-2 rDNA sequences

Romstad A, Gasser RB, Nansen P, Polderman AM, Chilton NB

Int J Parasitol, 1998 Apr;28(4):611-5.
PMID: 9602384

The nucleotide sequences of the second internal transcribed spacer of rDNA were determined for adult worms of Necator americanus originating from Togo (Africa) and Sarawak (Malaysia). The length of the sequences of specimens from Togo (325 bp) were shorter than those from Sarawak (327 bp). There were six fixed genetic differences in the aligned sequences of N. americanus from Sarawak and Togo, excluding one or two polymorphic sites within the sequence of N. americanus from each geographical region. These findings suggest that there is either population variation in the sequence of N. americanus, or that N. americanus from the two countries may represent genetically distinct but morphologically similar (i.e. cryptic) species, however, comparison of the sequence differences among other hookworm species supports the latter conclusion.

Matched MeSH terms: Africa
Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya

Ashur ST, Shah SA, Bosseri S, Fah TS, Shamsuddin K

Libyan J Med, 2016 Jan;11(1):31086.
PMID: 28349838 DOI: 10.3402/ljm.v11.31086

Background Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. Methods A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8(©)), while glycaemic control status was based on the HbA1c level. Results Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77-0.94). Conclusion The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.

Matched MeSH terms: Africa
Fulltext Development of a web-based application to improve data collection of antimicrobial utilization in the public health care system in South Africa

Kruger D, Dlamini NN, Meyer JC, Godman B, Kurdi A, Lennon M, et al.

Hosp Pract (1995), 2021 Aug;49(3):184-193.
PMID: 33566710 DOI: 10.1080/21548331.2021.1889213

OBJECTIVE: Determining antimicrobial utilization patterns in hospitals can be a challenge given personnel and resource constraints with paper-based systems. A web-based application (APP) was developed in South Africa to address this, building on a recent point prevalence survey (PPS) using a paper-based system. Consequently, there was a need to test and evaluate the ease of use of a newly developed app and potential time saving versus paper-based methods for PPS. The findings can be used to further refine the APP.
METHODS: The developed app was tested in a large academic public hospital in a PPS in South Africa. During data collection, the app was evaluated for functionality on 35 variables and subsequently refined. After data collection, the app was evaluated in terms of its time-saving potential and ease of use.
RESULTS: 181 patient's files were surveyed across 13 wards in the hospital, with the antimicrobial usage findings similar to the previous paper-based study in the same hospital. The median age for males was 45.5 years and 42 years for females. Overall 80 out of 181 (44%) patients received antibiotics. Whilst 38% (12 out of 31) of patients in the adult surgical ward received antimicrobials, the prevalence was the highest (78%) in the pediatric medical wards. All the data collectors were confident in using the app after training and found the tool is not complex at all to use. In addition, the time taken to plan for the study and to collect data was considerably reduced. Reduced time spent in data collection and analysis is important for timely instigation of quality improvement programs in resource limited settings.
CONCLUSIONS: All data collectors would recommend the app for future PPSs. Several concerns with data entry were identified, which have now been addressed. The app development has been successful and is now being deployed across South Africa as part of a national PPS as well as wider.

Matched MeSH terms: South Africa
Genetic disorders in Southern Africa

Beighton P

S. Afr. Med. J., 1976 Jul 10;50(29):1125-8.
PMID: 959924

Certain uncommon genetic disorders occur relatively frequently in the various population groups of Southern Africa. Prominent among these are porphyria, colonic polyposis and sclerosteosis in the Afrikaner community, Huntington's chorea in the British, Gaucher's and Tay-Sachs diseases in the Jewish population, glucose-6-phosphate dehydrogenase deficiency (G-6-PD deficiency) and thalassaemia in the Greek community, various skeletal dysplasias in the Black group, lipoid proteinosis and cleidocranial dysostosis in the Cape Coloured population, diabetes mellitus in the Indian community and retinitis pigmentosa in the Tristan da Cunha islanders. In addition, 'private' syndromes have been encountered in virtually every group. Awareness of the ethnic distribution of unusual genetic conditions is of considerable practical importance during the differential diagnosis of obscure disease.

Matched MeSH terms: South Africa
Serological evidence of infection with Tana and Yaba pox viruses among several species of monkey

Downie AW

J Hyg (Lond), 1974 Apr;72(2):245-50.
PMID: 4362411

Sera from cynomolgus monkeys from Malaysia, from Indian rhesus monkeys, from various species of monkeys from Africa and from South America have been examined for neutralizing antibody to Tanapox and Yaba viruses. No antibody was found to either virus in the sera of rhesus monkeys or South American monkeys. A certain proportion of sera from cynomolgus monkeys and various species of African monkey showed antibody to one or other of the viruses, but few of the positive sera showed antibody to both. The results would seem to suggest that infection with the two viruses is endemic in African and Malaysian monkeys but does not occur or is very rare in Indian rhesus and New World monkeys.

Matched MeSH terms: Africa
Fulltext Antiproliferative effect on breast cancer (MCF7) of Moringa oleifera seed extracts

Adebayo IA, Arsad H, Samian MR

Afr J Tradit Complement Altern Med, 2017;14(2):282-287.
PMID: 28573245 DOI: 10.21010/ajtcam.v14i2.30

BACKGROUND: Moringa oleifera belongs to plant family, Moringaceae and popularly called "wonderful tree", for it is used traditionally to cure many diseases including cancer in Africa and Asia, however, there is limited knowledge on cytotoxic activity of Moringa oleifera seeds on MCF7 breast cancer cell. The present study evaluated antiproliferative effect on MCF7 of the seed.
MATERIALS AND METHODS: Seeds of Moringa oleifera were grinded to powder and its phytochemicals were extracted using water and 80% ethanol solvents, part of the ethanolic extract were sequentially partitioned to fractions with four solvents (hexane, dichloromethane, chloroform, and n-butanol). Antiproliferative effects on MCF7 of the samples were determined. Finally, potent samples that significantly inhibited MCF7 growth were tested on MCF 10A.
RESULTS: Crude water extract, hexane and dichloromethane fractions of the seeds inhibited the proliferation of MCF7 with the following IC50 values 280 μg/ml, 130 μg/ml and 26 μg/ml respectively, however, of the 3 samples, only hexane fraction had minimal cytotoxic effect on MCF 10A (IC50 > 400μg/ml).
CONCLUSION: Moringa oleifera seed has antiproliferative effect on MCF7.

Matched MeSH terms: Africa; Medicine, African Traditional
Fulltext Emergence of Undetectable Malaria Parasites: A Threat under the Radar amid the COVID-19 Pandemic?

Beshir KB, Grignard L, Hajissa K, Mohammed A, Nurhussein AM, Ishengoma DS, et al.

Am J Trop Med Hyg, 2020 08;103(2):558-560.
PMID: 32553046 DOI: 10.4269/ajtmh.20-0467

Rapid diagnostic tests (RDTs) play a critical role in malaria diagnosis and control. The emergence of Plasmodium falciparum parasites that can evade detection by RDTs threatens control and elimination efforts. These parasites lack or have altered genes encoding histidine-rich proteins (HRPs) 2 and 3, the antigens recognized by HRP2-based RDTs. Surveillance of such parasites is dependent on identifying false-negative RDT results among suspected malaria cases, a task made more challenging during the current pandemic because of the overlap of symptoms between malaria and COVID-19, particularly in areas of low malaria transmission. Here, we share our perspective on the emergence of P. falciparum parasites lacking HRP2 and HRP3, and the surveillance needed to identify them amid the COVID-19 pandemic.

Matched MeSH terms: Africa
Fulltext African midwifery students' self-assessed confidence in antenatal care: a multi-country study

Hildingsson I, Lindgren H, Karlström A, Christensson K, Bäck L, Mudokwenyu-Rawdon C, et al.

Glob Health Action, 2019;12(1):1689721.
PMID: 31747850 DOI: 10.1080/16549716.2019.1689721

Background: Evidence-based antenatal care is one cornerstone in Safe Motherhood and educated and confident midwives remain to be optimal caregivers in Africa. Confidence in antenatal midwifery skills is important and could differ depending on the provision of education among the training institutions across Africa.Objective: The aim of the study was to describe and compare midwifery students' confidence in basic antenatal skills, in relation to age, sex, program type and level of program.Methods: A survey in seven sub-Saharan African countries was conducted. Enrolled midwifery students from selected midwifery institutions in each country presented selfreported data on confidence to provide antenatal care. Data were collected using a selfadministered questionnaire. The questionnaire consisted of 22 antenatal skills based on the competency framework from the International Confederation of Midwives. The skills were grouped into three domains; Identify fetal and maternal risk factors and educate parents; Manage and document emergent complications and Physical assessment and nutrition.Results: In total, 1407 midwifery students from seven Sub-Saharan countries responded. Almost one third (25-32%) of the students reported high levels of confidence in all three domains. Direct entry programs were associated with higher levels of confidence in all three domains, compared to post-nursing and double degree programs. Students enrolled at education with diploma level presented with high levels of confidence in two out of three domains.Conclusions: A significant proportion of student midwives rated themselves low on confidence to provide ANC. Midwifery students enrolled in direct entry programs reported higher levels of confidence in all domains. It is important that local governments develop education standards, based on recommendations from the International Confederation of midwives. Further research is needed for the evaluation of actual competence.

Matched MeSH terms: Africa South of the Sahara
Old World screwworm fly, Chrysomya bezziana, occurs as two geographical races

Hall MJ, Edge W, Testa JM, Adams ZJ, Ready PD

Med Vet Entomol, 2001 Dec;15(4):393-402.
PMID: 11776458

A morphological and molecular analysis was undertaken with the objective of identifying markers for geographical populations of Old World screwworm flies, Chrysomya bezziana Villeneuve (Diptera: Calliphoridae). The morphological analysis involved 192 adult flies from 14 countries, and the molecular analysis involved 45 larvae or adults from 14 populations in 11 countries. Principal components and cluster analysis of 10 morphological characters indicated that flies from Papua New Guinea (PNG) were a distinct group and most similar to flies from nearby Asian islands (Java, Sabah). There was poor resolution of other geographical regions, but some support for clustering of flies from Africa or India. Cladistic analysis of mitochondrial DNA sequences gave strong support for recognizing two races of Old World screwworm, one from sub-Saharan Africa and the other from the Gulf region and Asia. This latter race could be further divided into two lineages, i.e. one from mainland Asia (from Iraq to the Malay Peninsula) and the other from two islands of PNG.

Matched MeSH terms: Africa

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