Review of the distribution of Kaposi's sarcoma-associated herpesvirus (KSHV) in Africa in relation to the incidence of Kaposi's sarcoma.

In the years before human immunodeficiency virus (HIV) infection, the incidence of Kaposi's sarcoma varied markedly across the African continent, and it was a disease primarily affecting men. In contrast, the evidence reviewed here shows that the causal virus-Kaposi's sarcoma associated herpesvirus (KSHV)-is prevalent in many African countries, including places where Kaposi's sarcoma was almost unknown before HIV, and that it is as common in women as in men. Therefore, the geographical distribution of Kaposi's sarcoma in Africa before the spread of HIV and its predominance as a disease affecting men are not a simple reflection of the distribution of KSHV.

Influence of HIV-1 coinfection on effective management of abnormal vaginal discharge.

Background: Reports on microbiologic cure rates following syndromic management (SM) of women with nonulcerative sexually transmitted infections (STIs) are limited.

Goal: The goal of the study was to determine the effectiveness of the drugs used in SM of nonulcerative STIs and bacterial vaginosis in women and to compare the response among those with and without HIV-1 coinfection.

Study Design: This was a cohort study of women with nonulcerative STIs who were treated according to local SM protocols.

Where is the condom? Contraceptive practice in a rural district of South Africa.

Interviews were conducted with 848 African women aged 15-49 years in a rural area of South Africa to determine the extent to which condoms are used, reasons for contraceptive method choice and unmet contraceptive need. Injectable contraceptives were being used by 22.1% of respondents, who considered them to be convenient, safe, effective, and/or a method that could be used secretly.

The application of GIS technology to equitably distribute fieldworker workload in a large, rural South African health survey.

A method is presented that has numerous applications to health systems provision in developing countries where limited physical access to primary health care is a major factor contributing to the poor health of populations. An accessibility model within a geographical information system (GIS) is used to predict average inter-homestead walking times and subdivide the study area into units of equal completion time. The method could be used to ergonomically design home-based care and tuberculosis directly observed treatment programmes and inform the siting of health facilities.

Emergency contraception in South Africa: knowledge, attitudes, and use among public sector primary healthcare clients.

To determine knowledge of, attitudes toward, and use of emergency contraception (EC), interviews were held with 1068 clients of 89 public sector primary healthcare facilities in two urban and two rural areas of South Africa. Only 22.8% of the clients had heard of EC.

Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus.

We assessed the association between the causative agents of vaginal discharge and pelvic inflammatory disease (PID) among women attending a rural sexually transmitted disease clinic in South Africa; the role played by coinfection with human immunodeficiency virus type 1 (HIV-1) was studied. Vaginal and cervical specimens were obtained to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and bacterial vaginosis. HIV-1 infection was established by use of serum antibody tests.

Interrelationships among human immunodeficiency virus type 1 infection, bacterial vaginosis, trichomoniasis, and the presence of yeasts.

Vaginal discharge of mixed etiology occurs frequently, with abnormal vaginal flora being the most common condition. The interrelationships among the disturbance of the vaginal ecology, the presence of yeasts, and infection with Trichomonas vaginalis and human immunodeficiency virus type 1 (HIV-1) were investigated among women presenting to a sexually transmitted diseases service. Analysis was done for 598 women.

Evolution in the trends of antimicrobial resistance in Neisseria gonorrhoeae isolated in Durban over a 5 year period: impact of the introduction of syndromic management.

Antimicrobial susceptibility testing was performed on isolates of Neisseria gonorrhoeae obtained from patients attending the City Health STD clinic in Durban, KwaZuluNatal, using the following drugs: penicillin, tetracycline, ciprofloxacin, ofloxacin, ceftriaxone, spectinomycin, erythromycin and azithromycin. These isolates were collected over a 6 year period from 1995 to 2000. Four hundred and fifteen strains were tested: 61 in 1995, 198 in 1997, 98 in 1998/99 and 58 in 1999/2000.

New approaches to spatially analyse primary health care usage patterns in rural South Africa.

Objective: To develop indices to quantitatively assess and understand the spatial usage patterns of health facilities in the Hlabisa district of South Africa.

Methodology: We mapped and interviewed more than 23 000 homesteads (approximately 200 000 people) in Hlabisa district, South Africa and spatially analysed their modal primary health usage patterns using a geographical information system. We generated contour maps of health service use and quantified the relationship between clinic catchments and distance-defined catchments using inclusion and exclusion error.

Counting the costs: comparing depot medroxyprogesterone acetate and norethisterone oenanthate utilisation patterns in South Africa.

Background: In South Africa, where health care resources are limited, it is important to ensure that drugs provision and use is rational. The Essential Drug List includes depot medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NET-EN) as injectable progestagen-only contraceptives (IPCs), and both products are extensively used.

Objectives And Methods: Utilisation patterns of the injectable contraceptive products DMPA and NET-EN are compared in the context of current knowledge of the safety and efficacy of these agents.

Sexually transmitted infections, adverse pregnancy outcome and neonatal infection.

Prevention and treatment of sexually transmitted infections (STIs) in the sexually active population are the main steps to prevent perinatal infection. However, the spread of STIs continues at an astronomical pace despite various attempts at controlling the epidemic. An important reason for this lack of STI control is that a large percentage of infected people go untreated because they have asymptomatic or unrecognized infections.

HIV heterogeneity and proximity of homestead to roads in rural South Africa: an exploration using a geographical information system.

objective To describe heterogeneity of HIV prevalence among pregnant women in Hlabisa health district, South Africa and to correlate this with proximity of homestead to roads. methods HIV prevalence measured through anonymous surveillance among pregnant women and stratified by local village clinic. Polygons were created around each clinic, assuming women attend the clinic nearest their home.

Spatial implications of the tuberculosis DOTS strategy in rural South Africa: a novel application of geographical information system and global positioning system technologies.

We used GIS/GPS technology to document and quantify improved access to tuberculosis treatment through a community-based programme in Hlabisa, South Africa. We plotted tuberculosis supervision points used by the district health system in 1991 (programme's first year) and 1996 (programme fully established), and quantified access by using GIS to measure the mean distance from each homestead in the district to hospital, clinics, community health workers (CHW) and volunteer supervisors. While the tuberculosis caseload tripled, the number of community supervision points used increased from 37 in 1991 to 147 in 1996.

Randomized trial testing the effect of vitamin A supplementation on pregnancy outcomes and early mother-to-child HIV-1 transmission in Durban, South Africa. South African Vitamin A Study Group.

Objective: Poor vitamin A status has been associated with a higher risk for mother-to-child transmission of HIV-1 and there is contradictory evidence on the impact of vitamin A on perinatal outcome. We therefore assessed the effect of vitamin A supplementation to mothers on birth outcome and mother-to-child transmission of HIV-1.

Design And Methods: In Durban, South Africa 728 pregnant HIV infected women received either vitamin A (368) or placebo (360) in a randomized, double-blind trial.