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Book Review 1Book Title: Drugs in Old Age: New Perspectives. British Medical Bulletin. Vol. 46Book Authors: M.J. Denham & C.F. George (Eds.)Pp. 299. Edinburgh: Churchill Livingstone. 1990.Book Review 2Book Title: Bile and Bile-duct Abnormalities. Pathophysiology, Diagnosis and ManagementBook Authors: G.N.J. Tytgat & K. Huibregrse (Eds.)Stuttgart: Georg Theme Verlag. 1989.Book Review 3Book Title: Radiology of Syndromes, Metabolic Disorders, and Skeletal Dysplasias. 3rd ed Book Authors: Hooshang Taybi & Ralph S. Lachman (Eds.)Chicago: Year Book Publishers. 1990Book Review 4Book Title: Manual of Epidemiology for District Health ManagementBook Authors: J.P. Vaughan & R.J. Morrow (Eds.)Pp. viii + 198. Illustrated. Geneva: WHO. 1989.Book Review 5Book Title: Intra-uterine Growth Retardation. Nestle Nutrition Workshop Series. Vol. 18Book Author: Jacques Senterre (Ed.)Pp. xvi + 300. Illustrated. New York: Raven Press. 1989

Meta-analysis is the structured and systematic qualitative and quantitative integration of the results of several independent studies (Le. the epidemiology of results). As in any epidemiological study, a meta-analysis needs to start with clearly stated aims and objectives. Attention needs to be paid to selection bias in selecting the study population (all publications on the topic). An initial qualitative assessment (conducted blinded to results) categorises projects on the basis of their methods, as unacceptable (dropped from later analysis) and acceptable or good. Further analysis could be conducted by stratifying or weighting independent studies according to preset quality criteria. The quantitative assessment involves deriving a pooled measure of outcome (usually the relative or attributable risk). Tests for heterogeneity are required before pooling. By pooling the results from many settings using different methods, the ability to generalise them in terms of their public health relevance is increased.S Afr Med J 1990; 78: 94·97.

ABC series from the BMJABC of Monitoring Drug Therapy. By ]. K. Aronson, M. Hardman and D. J. M. Reynolds. Pp. ix + 38. Illustrated. £9. BM]. 1993. (ABC books are available through the Book Division, MASA Publications, tel. (021) 531-3081.) ISBN 0-7279-0791-3.ABC of AIDS. 3rd ed. Ed. by Michael Wadler. Pp. 86. Illustrated. £15. BM]. 1993. ISB T 0-7279-0761-1.ABC of Dermatology. 2nd ed. By P. K. Buxton. Pp. 98. Illustrated. £15. BM]. 1993. ISBN 0-7279-0777-8.ABC of Healthy Travel 4th ed. By Eric Walker, Glyn Williams and Fiona Raeside. Pp. 49. Illustrated. £12. BM]. 1993. ISBN 0-7279-0762-X.ABC of Otolaryngology. 3rd ed. By Harold Ludman. Pp. 58. Illustrated. £11. BM]. 1993. ISH- T 0-7279-0765-4.ABC of Colorectal Diseases. Ed. by D. ]. Jones and M. H. Irving. Pp. 103. Illustrated. £15. BM]. 1993. ISBN 07279- 9755-7.Tissue bankingMusculoskeletal Tissue Banking. By William W. Tornford (with contributions by James H. Forsell, Allen P. MacKenzie and D. Michael Stron). Pp. xiii + 240. Illustrated.$94,50. Raven Press. 1993. ISBN 0-88167-995-X.Tobacco smokingLegislative Action to COIIlbat the World Tobacco Epidemic. 2nd ed. R. Roemer. pp. xiii + 297. SFr.59. in developing counrries: SFr.41,30. WHO. 1993. ISBN 92-4156157-2.There's Sunlight in My Leaf. Biography of Nicotiana tabacum. By Johan Fourie. Pp. 69. Marius du Plooy Communications. 1992. ISBN 0-620-17064-6.NutritionFood, Facts and Figures. The Complete South African Guide. Pp. 135. Illustrated. RI9,99. Oxford University Press (In collaboration with the Medical Research Council). 1992. ISBN 0-19-570736-2.OrthopeadicsOrthopaedic Diagnosis and ManagelDent: A Guide to the Care of Orthopaedic Patients. By Boyd S. Goldie. Pp. xviii + 247. £17,95. Blackwell Scientific Publications.1992. ISBN 0-632-03043-7.Biliary stonesBailliere's Clinical Gastroenterology. International Practice and Research. Diagnosis and Management of Biliary Stones. Ed. by M. Sackmann. Pp. x + 200. lllustrated. £27,50. Harcourt Brace Jovanovich. 1992. ISBN 0-7020-1 625-X.Molecular and cell biologyBasic Molecular and Cell Biology. 2nd ed. Pp. vii + 209. illustrated. BM}. 1993. ISBN 0-7279-0772-7.Nutritional anaemiasNutritional Anaemias. Nestle Nutritional Workshop Series. Vol. 30. Ed by Samuel }. Fomon and Stanley Zlotkin. Pp. xii + 220. $75. New York: Raven Press. 1992.

A mass measles immunisation campaign, with a target coverage rate of 85 - 90%, was launched in Khayelitsha, a rapidly growing urban township in the Cape Town area. Cross-sectional surveys of the measles immunisation status of resident 6 - 23-month-old infants were conducted immediately before, immediately after, and approximately 2 months after the campaign in order to determine the effectiveness of a mass campaign in boosting coverage in an area with a high influx rate. Immunisation coverage rates were 55% in the first survey, 76% in the second, and 72% in the third. In the first survey, coverage rates for children born in Cape Town were 1,4 times higher than those born elsewhere. This trend continued throughout the survey. Duration of stay in Cape Town also influenced coverage, with rates for the recently arrived children being considerably lower than those for the more established Cape Town residents. The influx rate between the second and third survey (over the Christmas period) was 9,1% per month. Failure to reach the targeted rate is attributed to the influx rate, campaign design and implementation, and factors related to child and career mobility. Alternative immunisation strategies, with social awareness playing a key role, are being urgently investigated.S Afr Med J 1989; 76: 157-159

A local component of the national measles vaccination campaign was evaluated in an area undergoing rapid urbanisation near Cape Town. Four serial cross-sectional cluster samples were used. Proven vaccination coverage before the campaign was 55,8% (95% confidence interval (Cl) 46 - 66%), immediately afterwards it was 71,1% (95% Cl 65 - 77%), and 6 months later 73,6% (95% Cl 67 - 80%). The increase was not sustained among Transkei-born children. Significant determinants of vaccination coverage were: place of birth (X2 = 9,7; 2 df; P = 0,008); ≤6 months stay in Cape Town (odds ratio (OR) 2,22; 95% Cl 1,2 - 4,0%); and home birth (OR 3,21; 95% Cl 1,2 - 8,4%). The value of campaigns in controlling measles, as well as the role of a comprehensive health care service are discussed.

The impact of environmental risk factors associated with housing was examined in relation to diarrhoeal disease and acute respiratory symptoms in South African coloured children. A multistage cluster sample representative of all coloured people living in the major urban and peri-urban areas of South Africa was used for the study. Interviews were conducted with respondents from 1 227 households. Overall, 8,5% children under 5 years were reported to have had diarrhoea, while 29% had experienced coughing and breathing problems in a 2-week recall period. Individual risk factors identified using the odds ratios (ORs) for diarrhoea included not having an inside tap or a flush toilet in the homes (both yielded an OR of 3,3), not owning a refuse receptacle (OR = 2,5), not being connected to an electricity supply (OR = 2,5), low household income (OR = 1,8), more than 2 people per room (OR = 2,0) and less than Standard 5 maternal education (OR = 1,6). Absence of an inside toilet, not having a refuse receptacle and overcrowding all remained as independent risk factors after logistic regression analyses. Multiple logistic regression analyses revealed that not having a refuse receptacle and the absence of electricity for heating purposes were independently associated with respiratory symptoms. The overall preventive potentials for respiratory symptoms were significantly less than those for diarrhoea. Improving physical access to essential environmental health services in urban areas and improvements in the educational status of women are urgently needed if childhood infections are to be prevented.

Measles is still a major cause of childhood mortality and morbidity in South Africa. The World Health Organisation (WHO) has recently recommended that greater a"ention be paid to opportunities for immunisation in the curative sector. This study quantified the extent of missed opportunities for measles immunisation in children a"ending primary, secondary and tertiary level curative hospitals in the western Cape. Exit interviews of 1 068 carers of children aged between 6 and 59 months inclusive showed that 2,4 - 40,7% of carers had been requested to produce a Road-to-Health card, and that 4,8 - 43,1% of carers had a card available. The proportion of children with documented evidence of measles immunisation available ranged from 4,8% to 40,0% between facilities. The study demonstrated that a considerable number of potential opportunities to immunise children against measles are currently being missed in children a"ending hospitals and day hospitals in the western Cape. The study documents the effect of a fragmented approach to health care, and'indicates a need for rapid integration of preventive and curative components of health care into a metropolitan-based primary health care service.

A total of 3535 trauma cases were enumerated in Johannesburg- Soweto between 1989 and 1990 in the course of 271 hospital ward rounds and 43 casualty watches. The overall trauma incidence was 2886 new cases per annum per 100000 population, rising to 19872 for coloured males aged 20 - 24 years and to 8761 for black males aged 20 - 24 years. Overall the malelfemale ratio was 2,9 rising to 6 or more in adolescence (15 - 19) for blacks andcoloureds. There were some 156 new resident cases of trauma daily; half these were victims of interpersonal violence, and coloureds constituted 22% of this group, although forming only 8% of the denominator population. Witluegards to cause, most trauma among blacks and coloureds arose from interpersonal violence and significantly less from transport accidents. Among blacks injured in transport accidents (the majority of which involved motor vehicles) most were pedestrians, whereas most whites injured in such accidents were occupants of vehicles. For all groups trauma was most likely to be incurred 'in the street' although for white and coloured women the home was most dangerous. The implications of these and related findings for treatment and prevention and briefly reviewed.

In this, the first of two articles examining the epidemiology of non-fatal trauma in Johannesburg-Soweto, we define case inclusion criteria, and discuss the methodology and materials used in this low-cost, hospital-based survey. The survey was conducted between 8 June 1989 and 24 August 1990. Sampling of both inpatient trauma cases and those seen in casualty departments took place in 6 state and 5 private hospitals located within or nearby the Johannesburg magisterial district. Demographic details about each patient, as well as information concerning spatial and temporal details of the incident, involvement of alcohol or drugs, diagnosis, severity of injury, and placement after casualty treatment, were collected by interviewing each patient. Data concerning the age, sex and racial composition of the background population were assembled from a number of sources. After discussing the internal limitations of this methodology, it is concluded that its findings may be of limited use for improving secondary interventions, but are of definite value for trauma prevention programmes.

In the year ending 30 June 1989, 26,8% of 5345 deaths in the Port Elizabeth area were classified as ill-defined. A study was undertaken in an attempt to identify the reasons for the high proportion of such deaths. Copies of all death notifications and death register forms of black people in the area served by the Port Elizabeth City Health Department were collected for a 6-week period. Of the 316 deaths, 154 (48,7%) were certified by medical practitioners at a hospital, 158 (50%) by the police and 4 (1,3%) by private medical practitioners. Of the police-certified deaths 116 (73,4%) were recorded as due to 'natural causes', with the remainder being submitted to autopsy. Of the hospital deaths, 26% were not adequately described in the section for the cause of death on the death certificate. Review of national mortality data for 1985 showed that only 29,9% of ill-defined deaths (in all population groups) were certified by a medical practitioner. The prime source of deaths classifed as ill-defined, both in Port Elizabeth and nationally, were those not certified by a medical practitioner. Strategies aimed' at minimising the number of deaths certified by the police need to be developed.

Medical audit Audit in Action. Ed. by Richard Smith. Pp. xiv + 245. Illustrated. £10,95. London: British Medical Journal. 1992. Available from Libriger Book Distributors, Bloemfontein.Rheumatology Bailliere's Clinical Rheumatology: Giant Cell Arteritis and Polymyalgia RheuIDatica. Guest eds B. L. Hazleman and B.-A. Bengtsson. Pp. xi + 507. illustrated. £27,50. London: Bailliere Tindall. 1991.AIDS, drugs and sexual risk AIDS, Drugs and Sexual Risk. By N. McKeganey and M. Bamard. Johannesburg: Random Century. 1992.Radiation When is a Dose Not a Dose? By Victor P. Bond. Pp. 39. Illustrated. Bethesda: National Council on Radiation Protection and Measurements. 1992.Autoimmune disease Clinical and Molecular Aspects of Autoimmune Diseases. Vol. 8. Ed. by J. M. Cruse and R. E. Lewis. Pp. x + 258. Illustrated. SFr. 248. Basel: Karger. 1992.Biochemical toxicology Principles of Biochemical Toxicology. 2nd ed. By J. A. Timbrel!. Illustrated. Pp. 415. RI53,73. London: Taylor & Frands. 1991.Advances in pineal research Advances in Pineal Research. Vol. 6. Ed. by Andrew Foldes and R. J. Reiter. pp. viii + 286. illustrated. £32,50. London: John Libbey. 1991.Health care for the future The Future of Health Care. Pp. 83. Illustrated. London: British Medical Journal. 1992.STDs and AIDS School Health Education to Prevent AIDS and Sexually Transmitted Disease. Pp. 79. SFr. 18. Geneva: World Health Organisation. 1992.

Objective: To provide data on the South African adult population's smoking status, their knowledge of the health effects of tobacco and their attitudes towards tobacco control in South Africa Methodology: A national representative sample of 2 238 adult (> 18 years) South Africans was surveyed by means of an interviewer-administered questionnaire. Results: Thirty-four per cent of adult South Africans smoke (52% male, 17% female). There were notable differences in gender smoking rates for Indians (61% of men and only 7% of women smoke) and blacks (53% of men and 10% of women smoke) but not for coloureds (58% of men and 59% of women smoke). Provinces with the highest smoking rates are the Northern Cape (55%), Western Cape (48%) and North-West (46%). Forty-eight per cent of respondents reported that at least one household member smoked. The majority of the respondents (87%) acknowledged the harmful effects of direct smoking. Fifty-eight per cent were aware that cancer is associated with smoking but only 36% associated heart disease with smoking. Sixty per cent of the respondents have tried to quit at least once for reasons such as the protection of their own health, the expense of tobacco products and because of a medical doctor's advice. Contusion existed with regard to the effects of the cigarette constituents described on cigarette packages. Forty-two per cent of adults incorrectly indicated that nicotine causes cancer while 28% correctly indicated that it causes addiction, and 44% correctly indicated that condensate causes cancer. There is substantial support for a total ban of tobacco advertising on radio (61 %), for local authorities to regulate smoking in public places (78%), for government assistance to fanners for tobacco crop replacement (53%) and for an increase in tobacco excise tax if the money is used for health purposes (50%). Conclusion: The extremely high proportion of both male and female coloured smokers is a cause for concern and requires prompt action. Knowledge of the specific effects of tobacco in respect of active and passive smoking needs to be improved and this could be a first step towards facilitating behaviour change. The public support that exists for stronger measures against tobacco use, promotion, pricing and growing provides many opportunities for health promotion action.S Afr Med J 1996; 86: 1389-1393

Aim. To estimate the exposure to active and passive smoking of pregnant women in South Africa and to determine their knowledge and behaviour with regard to smoking during pregnancy.Methods. A questionnaire was completed by pregnant women attending antenatal services in four South African cities. Questions were asked about smoking status, beliefs on the health effects of tobacco smoke during pregnancy exposure to passive smoking and behavioural changes with regard to smoking during pregnancy. Women from different ethnic groups and social classes participated.Results. The study population was 394 pregnant women. Of these 42% were black, 29% coloured and 10% Indian women, who used public antenatal services, and 19% were pregnant women (ethnicity unspecified) who attended private obstetric practices. Of the coloured women, 47% smoked; for the black and Indian women and those who attended a private practice, the smoking rates were 4%, 3% and 28%, respectively. Approximately 90% of the pregnant women knew it was unhealthy to smoke during pregnancy. Most women who smoked stopped or reduced tobacco use during their pregnancy. Of the pregnant women, 70% lived with at least one smoker in the house.Conclusions. Few black and Indian pregnant women in South Africa smoke, while coloured pregnant women smoke heavily. QUitting programmes should be targeted at them when they attend antenatal services. Pregnant women and their families should be alerted to the impact of environmental tobacco smoke, since so many are passive smokers during pregnancy.

Immunisation practices were examined at 6 hospitals in the western Cape during the latter half of 1992 to determine whether these practices had improved subsequent to the February 1991 resolution of the Health Matters Committee (HMC) on immunisation in hospitals, and since a similar study was undertaken in 1990. Exit interviews were conducted with the escorts of all children aged 3 - 59 months who attended the study hospitals on the days designated for the study.In the second study, 88 of the 311 children studied (28,3%) were in need of immunisation on arrival, but only 12 of the 88 (13,6%) were immunised during the hospital visit. There was no evidence of an increase in requests to see children's Road-to-Health cards (37,1% compared with 35,2% previously). The incidence of missed opportunities for measles immunisation in children aged 6 - 59 months remained unacceptably high (51,4% compared with 63,7% previously, when a strict definition was used; and 15,7% compared with 18,1% previously, when a lenient definition was used).Health authorities at all levels need to take urgent action to address the problem of missed opportunities for immunisation at hospitals.

The Global Youth Tobacco Survey (GYTS) project was developed by the World Health Organization and the US Centers for Disease Control and Prevention to track tobacco use among youth in countries across the world, using a common methodology and core questionnaire. The GYTS is school based and employs a two-stage sample design to produce representative data on smoking among students aged 13-15 years. The first stage consists of a probabilistic selection of schools, and the second consists of a random selection of classes from the participating schools. All students in the selected classes are eligible for the survey. In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries. This report describes data from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland, the Russian Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela, and Zimbabwe. The findings show that tobacco use in the surveyed age group ranged from a high of 33% to a low of 10%. While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme. In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare. The majority of young people reported being taught in school about the dangers of smoking. Environmental tobacco smoke exposure was very high in all countries. These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes.

Data on births, on deaths by cause and on morbidity are essential in planning appropriate health interventions, but the scarcity of these data in South Africa is striking. Some of the limitations of national mortality and morbidity data collection systems are reviewed. In order to improve the usefulness of vital statistical information, it is proposed that active disease monitoring be introduced in a number of surveillance sites where the population has been properly enumerated. A network of these sites would routinely gather information on births and deaths by cause and on a list of conditions that are: (i) easy to identify clinically; (ii) would bring most people to the attention of health personnel; and (iii) would indicate failure of health service provision, environmental control or resource allocation. The measurement of the geographical variation of a number of conditions, coupled with geographical information on health care indicators and risk and health promotive factors in each site, would facilitate the planning of interventions in a rational manner.

Inspiration drawn from South African public health initiatives in the 1940s played an important role in the development of the network of community and migrant health centers in the United States. The first such center at Pholela in Natal emphasized the need for a comprehensive (preventive and curative) service that based its practices on empirical data derived from epidemiological and anthropological research. In addition, community consultation preceded the introduction of new service or research initiatives. The Institute of Family and Community Health in Durban pioneered community-based multidisciplinary training and developed Pholela and other sites as centers for service, teaching, and research. Several important lessons for South African health professionals emerge from the Pholela experience. First, public health models of the past need to be reintroduced locally; second, the training of public health professionals needs to be upgraded and reoriented; third, appropriate research programs need to respond to community needs and address service demands; fourth, community involvement strategies need to be implemented early on; and fifth, funding sources for innovation in health service provision should be sought.