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Community-based seroprevalence survey for human T-cell lymphotropic virus type I (HTLV-I) was undertaken in the Ngwelezane district of Natal/KwaZulu. A total of 1 018 individuals was interviewed for risk factors and had blood drawn for serological examination. To exclude antibody cross-reactivity between anti-HTLV-I and anti-HTLV-II all Western blot HTLV-I-positive examples were further subjected to a Select HTLV test. For comparison, anonymous HIV testing was done. The areas of residence of patients with myelopathy associated with HTLV-I were also ascertained.The seroprevalence of HTLV-I was 2,6% (95% confidence interval (Cl) 1,62 - 3,58). An age-related rise in HTLV-I seropositivity from 1,3% in the 15 - 24-year age group to 6,1% in the over 55-year old group was noted. There was no significant association between HTLV-I antibody positivity and marital status, occupation, history of blood transfusion, scarification, age at first sexual experience and number of sexual partners.Anti-HIV-I antibody testing revealed a positivity of 3,5% (95% Cl 2,4 - 4,68) and the relative risk for co-infection with both HTLV-I and HIV-I in the 15 - 24-year group was 1,16 (95% Cl.1,08 - 1,24). The study also identified the first HTLV-II-seropositive case in the Natal/KwaZulu region.Up to December 1991, 90 cases of HTLV-I associated myelopathy/tropical spastic paraparesis were seen at the Neurology Unit, Wentworth Hospital. The patients came from all parts of Natal, from Pongola in the north to Transkei in the south. The Natal/KwaZulu region is, therefore, an endemic HTLV-I area.

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Objectives. The demographic, socio-economic and environmental status of the peri-urban informal settlement of Besters and its inhabitants' health, welfare and disability profiles were investigated for the development of a community-based health intervention programme.Study design. A cross-sectional study using a structured household questionnaire assessed community health status in July 1991 in order to identify specific health and development needs through focus group discussions and community consultations. A health and development programme was established during 1992. Community participation in this programme was then assessed by measurement of the components of the health and development programme, categorised as inputs (resources), processes (activities), outputs (effects) and outcomes.Setting. Besters, an informal pari-urban settlement north of Durban, KwaZulu-Natal.Subjects. Residents of Besters.Results. The demographic, environmental and morbidity profiles of Besters were consistent with both South African and international studies of informal communities. Patterns of health service utilisation reflected inappropriate use of the tertiary hospital in the city centre, grossly fragmented patterns of utilisation - both for preventive and curative care and for antenatal and maternity services - and, finally, a discordance between community health needs and ability to pay for services. The interaction between input, process and output measures of community participation are discussed.Conclusion. Integration of health service provision with other infrastructural development, based on community perceptions, enhances health development and community participation. Important lessons emerged about the strengths and limitations of community participation and its relevance for other communities.

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Objective. To describe severe and complicated malaria, including the common complications. causes of death and predictors of poor outcome.Design. Retrospective case series.Setting. King Edward VIII Hospital, Durban, Natal, a referral centre.Patients. One hundred and forty-three consecutive patients (88 males, 55 females; median age 25 years, range 2 - 86 years) admitted with a microscopic diagnosis of Plasmodium falciparum malaria from 1984 to 1991 .Main outcome measures. A univariate analysis comparing survival and death for categorical and continuous data for various complications was perlormed using the t-test or x2-test (or Fisher's exact test in the case of small cell sizes). Variables that showed significance on univariat,e analysis (P < 0.1) were used in a multivariate analysis to determine which contributed independently to survival or death.Results. The case tatality rate was 11.1% (15/135) and the commonest complications were hyperparasitaemia (30%), renal tailure (17%), acidaemia (14%), jaundice (10.4%) and cerebral malaria (6%). The commonest complications in patients who died were renal failure (10 patients), cerebral malaria (7), hyperparasitaemia (6) and severe anaemia (5). Multivariate analysis using a logisticregression model showed a high parasite load and cerebral malaria (relative risks of 11.9 and 51.8 respectively) and high urea levels to be the significant predictors of poor outcome (95% confidence intervals 1.53 - 91 .9, 2.74 - 100.0 and 1.01 - 1.09, respectively).Conclusions. Patients with high parasite densities, cerebral involvement and renal dysfunction need urgent attention with parenteral chemotherapy, intravenous fluidreplacement and early referral to a tertiary hospital with facilities for intensive monitoring and supportive treatment.

This retrospective study of 569 cases of meconium aspiration from 11 institutions in South Africa reveals a high incidence varying from 4 to 11/1 000 and a mortality rate of 12%. Mortality was significantly related to the degree of asphyxia at birth. Twenty-five per cent of the babies (136/569) required intensive care and 36% died. Of the mothers 18 - 25% were unbooked and most of the babies were inborn (87%). Babies born to primiparous mothers and to mothers over 35 years of age were at greater risk of death. In order to reduce mortality and the numbers admitted to the intensive care unit simple measures for the reduction in the incidence of this disease need to be emphasised in all teaching and training programmes.

Coronary heart disease (CHD) is the leading cause of death among the white and Indian populations of Durban. This was a community-based study of the white population of Durban, which is predominantly English-speaking. There were 396 subjects (194 men, 202 women) aged 15 - 69 years. A history of CHD was present in 9,3% of the subjects. The important risk factors were hypercholesterolaemia, hypertension and smoking. The minor risk factors were obesity, hypertriglyceridaemia, hypeuricaemia, a sedentary occupation and a history of CHD in the immediate family. Electrocardiograph abnormalities denoting CHD were present in 17% of subjects. A study of the major risk factors showed that 35,1% (age and sex adjusted) had at least one major risk factor at the higher level (level A) and 33,8% (age and sex adjusted) at the lower risk levels (level B). When the combination of risk factors was taken into account, 15,2% and 28% had two major risk factors, one each at levels A and B respectively. On average the percentage of men and women with one risk factor or more increased with age. A protective high-density lipoprotein/total cholesterol ratio≥20% was present in 53,5% of the respondents. Because of the severe nature of CHD, an intensive programme for the primary prevention of CHD risk factors should be instituted.

Objective. To compare the efficacy of mebendazole 500 mg and aIbendazole 400 mg single-close treatments of Trichuris trichiura infection in children in the Durban area of KwaZuluatal, South Africa.Design. A single-blind randomised trial in children with a documented moderate infection of T. mchiura. Ova were counted in stool specimens before and 10 days after treatment by the formal-ether concentration method.Setting. Two shelters for abandoned and orphaned children in Durban.Participants. inety-six children aged between 2 and 12 years.Outcome measures. The number of children who showed reduced T. trichiura ova counts after the treatments, and reductions in ova counts, both expressed as percentages. Statistical analysis using the Wilcoxon 2-sample test and thechi-square test.Results. Eighty-two children completed the trial; 42 received mebendazole and 40 albendazole. Of the mebendazole group 85% showed a reduction in T. trichiura ova count, compared with 75% of children who received albendazole. Mebendazole treatment was associated with a median percentage reduction in ova count of 72.2%, which significantly exceeded the 44.1% reduction after albendazole (P =0.024).Conclusion. The mebendazole 500 mg single-close therapy was more efficacious than the albendazole 400 mg singledose therapy in treating T. trichiura infection in these children.

Issuance of national policy guidance is a critical step to ensure quality HIV-TB (human immunodeficiency virustuberculosis) coordination and programme implementation. From the database of the Joint United Nations Programme on HIV/AIDS (UNAIDS), we reviewed 62 national HIV and TB guidelines from 23 high-burden countries for recommendations on HIV testing for TB patients, criteria for initiating antiretroviral therapy (ART) and the Three I’s for HIV/TB (isoniazid preventive treatment [IPT], intensified TB case finding and TB infection control). We used UNAIDS country-level programme data to determine the status of implementation of existing guidance. Of the 23 countries representing 89% of the global HIV-TB burden, Brazil recommends ART irrespective of CD4 count for all people living with HIV, and four (17%) countries recommend ART at the World Health Organization (WHO) 2013 guidelines level of CD4 count 6500 cells/mm3 for asymptomatic persons. Nineteen (83%) countries are consistent with WHO 2013 guidelines and recommend ART for HIV-positive TB patients irrespective of CD4 count. IPT is recommended by 16 (70%) countries, representing 67% of the HIV-TB burden; 12 recommend symptom-based screening alone for IPT initiation. Guidelines from 15 (65%) countries with 79% of the world’s HIV-TB burden include recommendations on HIV testing and counselling for TB patients. Although uptake of ART, HIV testing for TB patients, TB screening for people living with HIV and IPT have increased significantly, progress is still limited in many countries. There is considerable variance in the timing and content of national policies compared with WHO guidelines. Missed opportunities to implement new scientific evidence and delayed adaptation of existing WHO guidance remains a key challenge for many countries.

Objectives In 2001 the United Nations (UN) Declaration of Commitment was signed by 189 countries with a goal to reduce HIV prevalence among young people by 25% by 2010. Progress towards this target is assessed. In addition, changes in reported sexual behaviour among young people aged 15–24 years are investigated. Methods Thirty countries most affected by HIV were invited to participate in the study. Trends in HIV prevalence among young antenatal clinic (ANC) attendees were analysed using data from sites that were consistently included in surveillance between 2000 and 2008. Regression analysis was used to determine if the UN target had been reached. Trends in prevalence data from repeat national population-based surveys were also analysed. Trends in sexual behaviour were analysed using data from repeat standardised national population-based surveys between 1990 and 2008. Results Seven countries showed a statistically significant decline of 25% or more in HIV prevalence among young ANC attendees by 2008, in rural or urban areas or in both: Botswana, Côte d'Ivoire, Ethiopia, Kenya, Malawi, Namibia and Zimbabwe. Three further countries showed a significant decline in HIV prevalence among young women (Zambia) or men (South Africa, Tanzania) in national surveys. Seven other countries are on track, whereas four are unlikely to reach the goal by 2010. Nine countries did not have adequate data to assess prevalence trends. Indications suggestive of changes towards less risky sexual behaviour were observed in the majority of countries. In eight countries with significant declines in HIV prevalence, significant changes were also observed in sexual behaviour in either men or women for at least two of the three sexual behaviour indicators. Conclusions Declines in HIV prevalence among young people were documented in the majority of countries with adequate data and in most cases were accompanied by changes in sexual behaviour. Further data, research and more rigorous analysis at country level are needed to understand the associations between programmatic efforts, reported behavioural changes and changes in prevalence and incidence of HIV.