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It is widely recognized that the HIV/AIDS epidemic may significantly disadvantage children's education in severely affected countries, but empirical quantitative data demonstrating effects and children at risk are scant. The main objective of this study was to investigate associations between chronic illness and death in the household and select educational outcomes in a school setting. This study provides information on the extent of household illness and death in schools in two provinces in South Africa and explores the relationship between these events and select educational measures. Based on the study findings, we present some of the challenges facing the education sector with regards to managing and monitoring the impacts of illness and death, including HIV and AIDS on education at school level. [ABSTRACT FROM AUTHOR]

A study was undertaken in a Cape Town public sector STD clinic to evaluate the content and quality of care provided since it has been recognized that appropriate improvements in the management of conventional sexually transmitted diseases (STDs), including provision of correct therapy, health education, condom promotion and partner notification, could result in a reduced incidence of HIV infection. Our objectives were to assess patients' needs for health education and to assess the quality of STD management in terms of health education, condom promotion, partner notification, the validity of the clinical diagnoses and the adequacy of the treatments prescribed. The study subjects were sampled systematically, according to their gender. Patients included in the study were given a standardized interview and their clinical records reviewed. Specimens were collected for laboratory investigations. For each STD detected, the treatment was defined as adequate if drugs currently known to be active against that infection were prescribed. One hundred and seventy men and 161 women were included in the study (median age: females 22 years, males 26 years). While almost all patients believed their STD may have been caused by unprotected sexual intercourse, many also believed it may have been caused by other factors, such as bewitchment with traditional medicine. Only 21% of male and 37% of female patients received any education about STD transmission during the clinic visit, and only 25% of male and 36% of female patients received education about condom use. As a result of the low sensitivity of the clinicians' diagnoses, 16% of men and 61% of women left the clinic with at least one infection inadequately treated. The majority of patients were not receiving education for the prevention of STDs including HIV. Many were not receiving adequate treatment for their infections. The introduction of a syndromic management protocol in this setting would substantially reduce the proportion of inadequately-treated patients. However, syndromic protocols, and the means by which they are implemented, need to take into account problems with the clinical detection of genital ulcerative disease and candidiasis in women. [ABSTRACT FROM AUTHOR]

Objective: To determine whether previous health experiences affect the prevalence of occupational lung disease in a semirural Botswanan community where there is a long history of labour recruitment to South African mines.Method: A cross sectional prevalence study of 304 former miners examined according to a protocol including a questionnaire, chest radiograph, spirometry, and medical examination.Results: Overall mean age was 56.7 (range 28-93) years, mean duration of service 15.5 (range 2-42) years. 26.6% had a history of tuberculosis. 23.3% had experienced a disabling occupational injury. Overall prevalence of pnemoconiosis (> 1/0 profusion, by the International Labour Organisation classification) was 26.6%-31.0%, and 6.8% had progressive massive fibrosis (PMF). Many were entitled to compensation under South African law. Both radiograph readers detected time response relations between pneumoconiosis and PMF among the 234 underground gold miners. PMF could result from < 5 years of exposure, but was not found < 15 years after first exposure. Both pulmonary tuberculosis (PTB) and pneumoconiosis were found to be associated with airflow limitation.Conclusions: Former miners in Botswana have a high prevalence of previously unrecognised pneumoconiosis, indicative of high previous exposures to fibrogenic respirable dust. Their pneumoconiosis went unrecognised because they had no access to surveillance after employment. Inadequate radiographic surveillance or failure to act on results when employed or when leaving employment at the mines could have contributed to under recognition. Community based studies of former miners are essential to fully evaluate the effects of mining exposures. Our findings indicate a failure of established measures to prevent or identify pneumoconiosis while these miners were in employment and show that few of the social costs of occupational lung diseases are borne by mining companies through the compensation system. [ABSTRACT FROM AUTHOR]

Objectives: The main objective of this study was to investigate exposure-response relations between adverse musculoskeletal outcomes and ergonomic exposure variables.Methods: A cross sectional analytical study was conducted in 11 factories from seven sectors of manufacturing industry in South Africa. Exposure to workplace ergonomic stressors was assessed in factory floor jobs (n = 46) with a simple low technology observational model. Repetition, force, static posture, dynamic movement, and other job exposures were measured. Data of adverse musculoskeletal outcome and data on potential confounders and effect modifiers were obtained from subjects (n = 401) randomly sampled from each job category with a questionnaire given by interviewers.Results: High prevalences of regional musculoskeletal pain were found with substantial variability between industries. Sex was the only individual risk factor (after adjustment for potential confounders and effect modifiers) that was significantly associated with regional pain. Ergonomic exposures in the workplace were significantly associated with musculoskeletal pain of the neck and shoulders odds ratio (OR) 5.38 (95% confidence interval (95% CI) 1.16 to 25.0) for repetition, and OR 3.91 (95% CI 1.11 to 13.7) for seated compared with standing work; pain of the wrists and hands OR 10.2 (95% CI 1.39 to 75.6) for high summed score of dynamic postures of the wrist).Conclusions: This study indicates good predictive ability to reduce ergonomic stress with the exposure model, simple surveillance methods, and educational programmes in the workplace. Further study on sampling strategies and refinement of dimensions of ergonomic stressors are needed. [ABSTRACT FROM AUTHOR]

Objective: To describe the patterns of use of injectable progestogen contraceptives (IPCs) among coloured and black women in the Western Cape. These data are part of an ongoing study in the Western Cape, the main aim of which is to explore the relationship between IPCs and breast cancer., Design: A population-based case-control study of breast cancer risk in relation to the use of IPCs among coloured and black women., Setting: The Western Cape, including the Cape metropole and surrounding rural areas., Study Subjects: All coloured and black women with newly diagnosed breast cancer, resident in the study area and below age 55 years, who present at either of the two tertiary care hospitals in the Western Cape are recruited. Controls are a sample of hospitalised patients representative of the populations from which the patients are drawn. Cases are frequency-matched to controls according to cross-tabulation of age, ethnic group and residential area in a ratio of approximately 1:3., Measurements: Questionnaires are administered by trained nurse interviewers, information is elicited on a wide range of variables, including sociodemographic variables, medical history, family history of breast disease, lifetime history of all methods of contraception and use of non-contraceptive female steroids, reproductive variables, cigarette smoking, alcohol consumption and other potentially confounding variables., Results: Between January and December 1994, 122 incident cases and 389 controls were enrolled. Ever-use of IPCs among the controls was 72% (N = 280) and use for 5 years or more was 30% (N = 117). Use of IPCs in the distant past was common, with 61% (N = 232) of all controls having initiated use 10 or more years previously. Current use was also high (19%). Other contraceptive methods were used far less commonly., Conclusion: Coloured and black women in South Africa have been using and continue to use IPCs for more commonly and for longer periods than women anywhere else in the world. It is therefore especially important to evaluate the risk of breast cancer and other health effects of IPCs. The rates of use identified in this study ensure that there will be adequate statistical power to evaluate long-term use, use in the distant past and current use of IPCs.

Several recent studies have illustrated the need for a simple observational instrument for the estimation of exposure to postural stress in epidemiological studies of musculoskeletal disorders. Such an instrument is particularly necessary in developing countries. This paper describes the development of an observational instrument across a spectrum of industrial occupations in South Africa. The instrument was derived from adaptations to previously published observational methods and was specifically adapted to the measurement and application constraints identified during empirical development work in various industries. The final instrument fulfilled its aims of being applicable across a broad spectrum of jobs, including a broad spectrum of exposure variables and being reasonably cost- and time-effective. Some construct validity is indicated by the fact that two out of the three main exposure variables of interest showed significant associations with neck and shoulder pain in an epidemiological analysis. These variables were the score of summed estimates of the duration of time in sustained postures in a working day and the score of estimated overall repetitiveness based on cycle-time criteria. Further investigations are needed for pain at other anatomical sites. The measurement and scoring problems identified are discussed with reference to some aspects of these results.