Human Interest

Initial estimates from the South African National Burden of Disease Study,2000

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Medical Research Council

The National Burden of Disease Study is the first ever national BoD study carried out in SA and is an initial attempt to derive coherent and consistent estimates of the BoD experienced in SA in the year 2000. Estimates are derived from different data sources for the levels and underlying causes of mortality and morbidity.The top 20 diseases are ranked and those contributing the greatest burden are prioritised for seeking cost-effective interventions.

Publication Webpage http://www.mrc.ac.za/policybriefs/policybriefs.htm

Are our teens still not getting the HIV message?

Pharmacies are doing a brisk trade in the morning-after pill, especially among teens. It seems that even though there is a high risk of contracting HIV/AIDS, young people are still having unprotected sex and are concerned simply with preventing unwanted pregnancies. A spot survey conducted by The Star of a number of pharmacies around Johannesburg, revealed that chemists are doing a roaring trade in the three available types of morning-after pill. E-GEN-C, NorLevo and Ovral 28 must be orally ingested by a woman within 72 hours of her having had unprotected sex. The pills can be obtained over the counter without prescription and it seems young women are taking advantage of this. Graham Naughtin, a pharmacist at the Cliffview Medicare Pharmacy at Cresta, says that about 70 boxes of the morning-after pill are sold every weekend. While they are 90% effective in preventing pregnancy, they do not protect the user against any sexually transmitted infections (STIs) or AIDS.A locum doctor at the Selgo Pharmacy in Braamfontein, Blessing Motgatlha, says she has noticed a 50% increase in the use of the morning-after pill in the past two years. Lipalesa Malebanye, a pharmacist at Bruma Pharmacy, says where condom usage has dropped, there is a notable increase in the use of the morning-after pill, especially by teenagers. A teenager, who does not want to be named, says she has taken the morning-after pill four times this year alone. She adds that contracting an STI was not something she was concerned about at the time. While these drugs might prevent unwanted pregnancies, they do have side effects. Professor Basil van Iddekinge, a gynaecologist at Wits Medical School, says the morning-after pill is not meant for continuous or repetitive use and he stressed that it is not a long-term contraceptive. A women should rather use a non-emergency, long-term type of contraceptive. Van Iddekinge says one of the main problems of the morning-after pill is that it may alter the user's menstrual cycle. He explains the emergency pill is meant to be just that, used in an emergency. An emergency would be when the condom broke during intercourse, or perhaps when a woman has sex even though she did not intend to do so. Another emergency would be in the case of rape. Meanwhile, loveLife CEO, David Harrison, says the awareness organisation has not picked up this trend. If this is the case, it is really worrying that young people are being more irresponsible in their sexual activities, he says. Harrison warns that youngsters should employ dual protection to prevent pregnancy and STIs. The chief director of maternal, child and women's health unit in the department of health, Dr Eddie Mhlangu, holds Harrison's point of view. It's worrying, on the one hand, that people are not using condoms despite the threat of AIDS, while on the other, it is encouraging that it is cutting down on the number of unwanted pregnancies, he says. (Source: The Star, 14 April, 2003).

South Africa recognises violence as a health issue

Health Minister Dr Manto Tshabalala-Msimang said 9 December that South Africa had long recognised violence as a health issue and that the health department was currently running a number of programmes to combat the scourge. Msimang was speaking in Port Shepstone at the World Health Organisation's local launch of the World Report on Violence and Health - a report that came about as a result of a motion tabled by South Africa in 1996 at the world health assembly. The minister told Dr Etienne Krug, the WHO's Geneva-based research coordinator that the health department was considering plans to put health warnings on alcohol.She said that while there were a number of clearly identifiable risk factors for violence, two stood out above all others - poverty and alcohol. The latest Statistics SA report on the causes of death in South Africa, non-natural causes remain the highest single cause of death. and a significant portion of the health budget was being spent on emergency services . In some areas, up to half a hospital's budget went to emergency outpatient service. Violence-related injuries are the main cause of admission for emergency services. The WHO report has made recommendations that governments and others involved in combating violence should try out new ways of preventing violence, evaluate them and roll out the methods that work well. According to Msimang, the health department was currently doing just that. It was, she said, involved in a project along with the Education Department for reducing violence in schools. Also the department of health, as part of the government's Victim Empowerment Programme, had trained over 500 nurses to adopt a more caring attitude towards survivors of violence. Specially trained health workers can also collect forensic evidence to assist the police and the courts in effectively prosecuting offenders. Were designing training and curriculum models and will ensure that such services become much more accessible to all, she said. In assuring WHO representatives that government was taking their report and recommendations to heart, Msimang said a central team, consisting of representatives from all major sectors responsible for violence prevention, was being set up. to organise an intersectoral plan to combat violence.( SAPA, 9 December 2002).

Top ten ways to an early grave

London - Bad habits like drinking, smoking and overeating, once the preserve of the rich, are taking a hold in developing nations, the World Health Organisation (WHO) has said.In a report on one of its largest research projects yet, it said the top 10 killers, in order of deadliness, were: 1. Malnourishment 2. Unsafe sex 3. High blood pressure 4. Smoking 5. Alcohol 6. Bad water and poor sanitation 7. Iron deficiency 8. Smoke inhalation from indoor fires 9. High cholesterol 10.Obesity Chris Morris, author of the WHO's World Health Report 2002, said this report is a signpost for public health policy. The report said the top 10 killers accounted for more than one-third of the 56-million deaths around the world annually. The report also slated the large amount of salt added to industrially produced food like bread. Salt reduction was the most cost-effective way of tackling high blood pressure, it said, and legislation was the most reliable way of bringing this about. This report shows the world is living dangerously - because it has little choice - or because it is making the wrong choices. Not all is doom and gloom though, as the WHO officials have said that many of the risk factors can be reversed quickly. (Source- Reuters, Sapa-AFP, Cape Times, 30 October 2002)

Mining diseases unacceptably high

The burden of disease resulting from working in mines is unacceptably high in South Africa, Health Minister Dr Manto Tshabalala-Msimang said on Tuesday. Speaking in the National Assembly during debate on the Occupational Diseases in Mines and Works Amendment Bill, she said about 25 000 compensation applications were made each year for occupational lung diseases resulting from working in mines. In the past, occupational health has often been neglected, and yet the fact remains that globally over one million workers die from work-related diseases and injuries, and there are over 160-million cases of work-related diseases annually. The amendments in the bill might appear to be minor, but had far-reaching implications, as they will unblock some of the problems experienced thus far, she said. Among other things, the bill extended the length of time during which an ex-miner could apply to be medically examined from six to 24 months. Tshabalala-Msimang said one of the most important provisions in the bill was one that limited commission for agents who assisted mineworkers in accessing compensation. A fee of not more than half a percent of the benefit paid to the sick worker could be charged, and the bill made it an offence to charge more. The measure received the support of all sides of the House, and will now go to the National Council of Provinces for concurrence.(Source:SAPA, 22 October 2002)

Break the silence on Aids - minister

National Minister of Health Manto Tshabalala-Msimang urged society to break its silence over HIV/AIDS. This silence, she said, made it difficult for people to reveal their status. Thousands of people from one of the most AIDS-ravaged areas in the world lit candles for those they had lost to the disease and for family and friends living with it at a candlelight memorial earlier this week (Sunday). Openly weeping, many said for the first time they were speaking about how HIV/AIDS was affecting their lives. Tshabalala-Msimang said the candlelight memorial was a reminder not to focus on illnesses and the statistics but on the people who are affected - the woman who has lost her partner, the orphan who has lost a parent, the grandmother who is caring for her daughter's children. The theme for this year's candlelight memorial was Share your vision for a brighter tomorrow. The minister said this message was needed to encourage individuals to share their personal vision with others - to create the future we dream about. Referring to the fact that something could be done to prevent unborn babies from getting the infection, she said it was more important for women to find out their status before they even fell pregnant so that they and their partners could make proper decisions about their lives. She said if the call to volunteerism was heeded it would not be difficult for us to look after those who are ill and who need care. Orphans will be taken care of in our communities. In this way we can overcome the challenges of this epidemic. Her personal vision for HIV and Aids was a South Africa where every citizen plays their special and unique role in preventing further spread of HIV. I have a vision of a South Africa united as never before, united and committed to a common action and a deep resolve to stop this pandemic. (Source: IOL, May 20 2002)

Nevirapine trials controversy

There have recently been a number of media reports that Boeringer-Ingelheim's application to the Food and Drug Authority of the USA for the registration of Nevirapine was withdrawn due to irregularities and deficiencies related to the HIVNet 012 trail in Uganda. (This was the first field study that demonstrated the efficacy of NVP to reduce mother to child transmission). The irregularities and deficiencies relate to documentation procedures and DO NOT relate to any of the substantive findings on both the efficacy and safety of NVP. Included in the full text are press statements made by WHO/UNAIDS, CDC, Boeringer Ingelheim, National Institute of Health (USA) and the Elizabeth Glaser Foundation. They all essentially state that NVP still works and is still safe.

Medicinal plant faces scientific test

A medicinal plant used in Africa for centuries to boost immunity - and currently being taken by people with HIV - is to be tested by scientists in a clinical trial next year. This follows a growing body of scientific research, medical reports and anecdotal evidence that the plant, Sutherlandia, helps those with HIV and other diseases that compromise the immune system, to gain weight and fight infection. The Medical Research Council (MRC) is setting up a phase I/II trial on Sutherlandia (referred to locally as unwele), and its ethics committee has already approved the terms of the trial. The trial will involve 40 people and look at safety as well as some aspects of efficacy. According to the MRC, the pilot trial will start once we have approval from the Medicines Control Council. Renowned traditional healer Credo Mutwa is also part of Phyto Nova, a unique enterprise that brings together South African scientists and traditional healers committed to using indigenous remedies to treat diseases such as HIV/AIDS. A local pharmaceutical manufacturing company has linked up with Phyto Nova to manufacture Sutherlandia tablets countrywide, and Phyto Nova has taken a principled decision not to patent any part of the plant. The Sutherlandia tablets will hit the shelves of the retail chain Discom within the next two weeks, retailing at R16,99 for two weeks' supply. Sutherlandia is one of a basket of natural remedies being distributed by Discom to boost immune-compromised people who cannot afford expensive drugs. Other remedies available are tablets of the African potato (retailing as Labatheka), Spirulina and Aloe Vera. Extensive research by botanist Professor Ben-Erik van Wyk from Rand Afrikaans University and medical scientist Dr Carl Albrecht of Stellenbosch University has found that compounds in the plant have anti-viral, anti-bacterial and anti-fungal activities. It also contains a natural anti-depressant. Gericke says the plant is safe to use and no severe side effects have been reported. In the interest of public health, formal scientific safety studies are currently underway at MRC facilities funded by the National Research Foundation. Should the MRC trial confirm anecdotal reports that Sutherlandia improves appetite, mediates weight gain and boosts the immune system, this is likely to greatly increase the demand for Sutherlandia tablets as well as providing an affordable local weapon in the fight against HIV/AIDS. (Source: Health-e News Service, 30 November 2001.)

Mandela urges business to get involved in HIV/AIDS

Former President Nelson Mandela urged business leaders in South Africa on Saturday to follow the examples of others who had become involved in sponsoring various AIDS projects. Speaking at a belated birthday bash at the Chris Hani Baragwanath Hospital near Soweto, he said that all sectors of society should form a solid and united front to tackle the epidemic which was the toughest challenge facing the country. Mandela praised a large banking institution that has pledged to give R1 million for AIDS orphans and families. He said religious leaders should lead the battle against the silent killer by showing communities how they baptised, cuddled and counselled people infected with HIV. He said that people should not treat those who were infected as though they were living in the shadow of a death sentence. Mandela condemned the actions of the ignorant who had killed people like Dudu Dhlamini, a KwaZulu-Natal AIDS worker, when she revealed her HIV positive status. He said that stigmatising people who had the disease served no purpose. He said that celebrities like Princess Diana had been seen visiting the sick and dying, she had held their hands and talked to them. If a British princess can be seen treating HIV infected people like ordinary humans, then who are we to treat them any differently. Those who have HIV/AIDS deserve to be treated with dignity, said Mandela. (Source: SAPA, 21 July 2001)