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AbstractObjective.To evaluate the effectiveness of iron and folate supplementation in antenatal clinics.Design. A cross-sectional analytical study.Setting.Villages in the central region of Limpopo province, which are serviced by Mankweng Hospital.Subjects.Third-trimester pregnant women (N= 262) attending antenatal clinics at eight local clinics inthe villages.Results.The prevalence of anaemia (haemoglobin < 10.5 g/dl) in this study population was 16.4%. The mean number of clinic visits during pregnancy was 4.1 (standard deviation (SD) 2.18). There were no differences in clinic attendance for the anaemic and non-anaemic participants. Maternal weight was found to be lower (p= 0.051) in the anaemic than the non-anaemic group. Iron, vitamin B12 and folate deficiencies are still common in this area, with 50.9%, 16.4% and 10.3% of the pregnant women respectively having biochemical evidence of these deficiencies. In the anaemic group iron deficiency was the most prevalent deficiency, with 62.8% of the women having iron deficiency (serum ferritin < 12 5g/ml). In the non-anaemic group there was a significant negative correlation between both serum and red cell folate and the time of first visit to the clinic, indicating that folate supplementation given by the clinics is effective in prevention of folate deficiency.Conclusion.Although both iron and folate supplements are issued at antenatal clinics in the central area of Limpopo province, iron deficiency and iron deficiency anaemia are still prevalent in pregnant women. However there has been a marked improvement in the prevalence of folate deficiency.

Primary hypoadrenalism, assessed by 250 μg ACTH stimulation, is uncommon in patients with active pulmonary tuberculosis (PTB). Since 1 μg ACTH produces an equivalent +30 min cortisol response to 250 μg in control subjects, the 250 μg dose is supraphysiological and may lack sensitivity for the diagnosis of hypoadrenalism. Furthermore, the impact of coexistent HIV infection on the prevalence of primary hypoadrenalism in PTB is uncertain. We thus determined the cortisol response to an intravenous bolus of 1 μg ACTH in 21 controls, 18 HIV‐positive (BMI 19.5±0.9 kg/m2, albumin 24±1.4 g/l, CD4 count 192±47/mm3) and 22 HIV‐negative (BMI 19.3±0.8 kg/m2, albumin 29±1 g/l, CD4 count 652±76/mm3) patients with active PTB. The mean basal cortisol was greater in patients than in controls (559 vs. 373 nmol/l, p=0.0009). The mean cortisol after 1 μg ACTH stimulation did not, however, differ significantly when comparing either patients and controls or patients who were HIV‐positive and ‐negative (p>0.05). Using the minimum +30 min cortisol derived from the 21 controls as a marker of normal adrenal function (414 nmol/l), a single patient was classified as hypoadrenal. In conclusion, primary hypoadrenalism, as assessed by the 1 μg ACTH test, is uncommon in a cohort of ill, hospitalized patients with active PTB, irrespective of HIV status.

Study objectiveTo examine the relation between birth weight and blood pressure at 5 years in a cohort of South African children.DesignProspective cohort study.Participants849 five year old children.SettingSoweto, a sprawling urban area close to Johannesburg, South Africa, which was a designated residential area for people classified as "black" under apartheid legislation.Main resultsSystolic blood pressure at 5 years was inversely related to birthweight (r=-0.05, p=0.0007), independent of current weight, height, gestational age, maternal age or socioeconomic status at 5 years. There was no relation between birth weight and diastolic blood pressure. After adjusting for current weight and height, there was a mean decline in systolic blood pressure of 3.4 mm Hg (95% confidence intervals 1.4, 5.3 mm Hg) for every 1000 g increase in birth weight.ConclusionsThese data from a disadvantaged urbanised community in Southern Africa extend the reported observations of an inverse relation between birth weight and systolic blood pressure. The study adds to the evidence that influences in fetal life and early childhood influence systolic blood pressure. Further research is required to assess whether efforts to reduce the incidence of low birthweight babies will attenuate the prevalence of hypertension in future generations.

This study was undertaken to investigate the prevalence of diabetes complications and level of glycaemic and blood pressure control in Black African patients at the primary care level in the public sector Cape Town, South Africa. A stratified random sample of 300 patients attending the three largest ambulatory diabetes clinics in community health centres in Black African residential areas of Cape Town (100 patients from each) during the last 6 months of 1992 was selected. Each patient had a clinical examination, interview, and 1 year retrospective record review. Eighty‐one per cent of the sampled patients were reviewed, 90 % were non‐insulin‐dependent (NIDDM) and 10 % were treated with insulin. The mean duration of diabetes was 8 (range 0–28) years. Acceptable glycaemic control was present in 49.4 % (95 % Confidence Intervals 45.6–53.5) of patients while 38.5 % (CI 24.8–52.2) of hypertensive patients had acceptable blood pressure control. The prevalence of any grade of retinopathy was 55.4 % (CI 48.90–62.9), proliferative and preproliferative retinopathy 15.6 % (CI 8.5–22.8), cataracts 7.9 % (CI 4.4–11.4), peripheral neuropathy 27.6 % (CI 15.2–39.4), absent foot pulses 8.2 % (CI 5.2–12.6), amputations 1.4 % (CI 0.4–2.4), persistent proteinuria 5.3 % (CI 2.5–8.1) and an elevated albumin‐creatinine ratio 36.7 % (CI 29.0–44.4). The complications were not documented in the clinic records of the preceding year with the exception of 1 patient with absent foot pulses and the 12 patients with proteinuria. The high prevalence of suboptimal glycaemic and blood pressure control as well as complications of diabetes, largely unrecorded in the preceding years’ clinic notes, demonstrates the deficiency of and need for preventative diabetes care at the primary care level. The design, institution, and evaluation of effective intervention programmes are a priority to improve the quality of care provided and the health of diabetic patients. © 1997 John Wiley & Sons, Ltd.

Primary hypoadrenalism, assessed by 250 μg ACTH stimulation, is uncommon in patients with active pulmonary tuberculosis (PTB). Since 1 μg ACTH produces an equivalent +30 min cortisol response to 250 μg in control subjects, the 250 μg dose is supraphysiological and may lack sensitivity for the diagnosis of hypoadrenalism. Furthermore, the impact of coexistent HIV infection on the prevalence of primary hypoadrenalism in PTB is uncertain. We thus determined the cortisol response to an intravenous bolus of 1 μg ACTH in 21 controls, 18 HIV‐positive (BMI 19.5±0.9 kg/m2, albumin 24±1.4 g/l, CD4 count 192±47/mm3) and 22 HIV‐negative (BMI 19.3±0.8 kg/m2, albumin 29±1 g/l, CD4 count 652±76/mm3) patients with active PTB. The mean basal cortisol was greater in patients than in controls (559 vs. 373 nmol/l, p=0.0009). The mean cortisol after 1 μg ACTH stimulation did not, however, differ significantly when comparing either patients and controls or patients who were HIV‐positive and ‐negative (p>0.05). Using the minimum +30 min cortisol derived from the 21 controls as a marker of normal adrenal function (414 nmol/l), a single patient was classified as hypoadrenal. In conclusion, primary hypoadrenalism, as assessed by the 1 μg ACTH test, is uncommon in a cohort of ill, hospitalized patients with active PTB, irrespective of HIV status.