Provincial mortality in South Africa, 2000 - priority-setting for now and a benchmark for the future

Background. Cause-of-death statistics are an essential component of health information. Despite improvements, underregistration and misclassification of causes make it difficult to interpret the official death statistics. Objective. To estimate consistent cause-specific death rates for the year 2000 and to identify the leading causes of death and premature mortality in the provinces. Methods. Total number of deaths and population size were estimated using the Actuarial Society of South Africa ASSA2000 AIDS and demographic model. Cause-of-death profiles based on Statistics South Africa's 15% sample, adjusted for misclassification of deaths due to ill-defined causes and AIDS deaths due to indicator conditions, were applied to the total deaths by age and sex. Age-standardised rates and years of life lost were calculated using age weighting and discounting. Results. Life expectancy in KwaZulu-Natal and Mpumalanga is about 10 years lower than that in the Western Cape, the province with the lowest mortality rate. HIV/AIDS is the leading cause of premature mortality for all provinces. Mortality due to pre-transitional causes, such as diarrhoea, is more pronounced in the poorer and more rural provinces. In contrast, non-communicable disease mortality is similar across all provinces, although the cause profiles differ. Injury mortality rates are particularly high in provinces with large metropolitan areas and in Mpumalanga. Conclusion. The quadruple burden experienced in all provinces requires a broad range of interventions, including improved access to health care; ensuring that basic needs such as those related to water and sanitation are met; disease and injury prevention; and promotion of a healthy lifestyle. High death rates as a result of HIV/AIDS highlight the urgent need to accelerate the implementation of the treatment and prevention plan. In addition, there is an urgent need to improve the cause-of-death data system to provide reliable cause-of-death statistics at health district level.

Erythristic leopards Panthera pardus in South Africa

Background. Leopards Panthera pardus show genetically determined colour variation. Erythristic (strawberry) morphs, where individuals are paler and black pigment in the coat is replaced by a red-brown colour, are exceptionally rare in the wild. Historically, few records exist, with only five putative records from India known. Objectives. To record the presence of erythristic leopards in our study site (Thabo Thalo Wilderness Reserve, Mpumalanga), and to collate records from across South Africa. Method. A network of camera traps was used to record individual leopards at Thabo Thalo. We also surveyed local experts, searched the popular South African press and used social media to request observations. Results. Two out of 27 individual leopards (7.1%) recorded in our study site over three years were of this colour morph. We obtained records of five other erythristic leopards in the Waterberg and Mpumalanga region, with no reports outside of this population. Conclusions. Erythristic leopards are widely dispersed across north-west South Africa, predominantly in the Lydenburg region. The presence of this rare colour morph may reflect the consequences of population fragmentation.

Setores exportador e importador da Africa do Sul

As dificuldades observadas nas negociações multilaterais têm estimulado muitos países a promover acordos regionais e bilaterais de comércio, os quais vêm assumindo crescente importância na economia mundial: metade do comércio internacional é realizado, hoje, no âmbito de acordos preferenciais. Os três grandes blocos regionais - na Europa, na América e na Ásia - estão se consolidando, com pequena participação do Brasil que se limitou ao Mercosul, de modestas dimensões para o potencial de exportações do país. O governo brasileiro vem procurando fortalecer as relações comerciais do Brasil com parceiros do terceiro mundo, e este trabalho se inscreve nesse tema. A importância relativa da África do Sul no conjunto dos países em desenvolvimento foi a motivação deste estudo, destinado a descrever e analisar as características básicas dos setores exportador e importador daquele país, comparando-as com as do Brasil. Tal comparação visa identificar prováveis complementaridades e desafios que possam subsidiar a estratégia de aproximação comercial em curso. Algumas das conclusões e recomendações são: i) o Brasil tem mais a ceder em termos de redução de alíquotas de imposto de importação, e a África do Sul em abrangência dos itens envolvidos na negociação; ii) apesar de se identificar certa possibilidade de complementaridade entre os dois países, recomenda-se que o acordo abranja o maior número possível de produtos; iii) os esforços privados dos empresários brasileiros devem se concentrar na província de Gauteng, e em KwaZulu-Natal, que respondem pela maior parte da produção exportada assim como das empresas exportadoras - já os exportadores brasileiros de bens de consumo devem dar especial atenção às províncias de Gauteng, Western Cape e Mpumalanga; iv) para não dispersar esforços, mais eficaz se os empresários brasileiros fizerem seus contactos comerciais através de entidades que congreguem as empresas sul-africanas; v) São Paulo deve concentrar o maior número de empresários interessados no acordo, embora os empresários de outros estados possam ser mais receptivos porque individualmente se voltam mais para o mercado externo do que os paulistas, como os do Espírito Santo, Pará, Mato Grosso e os da região sul, Paraná, Santa Catarina e Rio Grande do Sul.

Transvaal & Orange Free State Regions, South Africa, ca. 1899 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Bacon's large-print map of the Transvaal and Orange Free State. It was published by G.W. Bacon & Co. ca. 1899. Scale [ca. 1:1,900,000]. Covers also Swaziland, Lesotho, and portions of Botswana, Zimbabwe, and Mozambique.The image inside the map neatline is georeferenced to the surface of the earth and fit to the Africa Sinusoidal projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, territorial and administrative boundaries, roads, railroads, shoreline features, and more. Relief shown by shading and spot heights. Includes also insets: "Map showing the routes from England and India to South Africa", "Environs of Cape Town", "Lorenço Marquez [and vicinity]", 'South Africa" and "Durban and Port Natal".This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Precolonial agricultural terracing in Bokoni, South Africa : Typology and an exploratory excavation

Earlier work on the terraced settlements of the Bokoni area (16th to 19th century, Mpumalanga province, South Africa) focussed on the homesteads, their contents, layout and chronology. This paper suggests a terminology and typology of agrarian structures in Bokoni in order to improve comparative approaches in Africa and beyond. The typology and an excavation of the terracing have made possible preliminary conclusions relevant for the further analysis of the terracing and stone-walling in Bokoni. The terracing developed incrementally, whereby cultivation, stone-clearing and terracing were intermixed processes. This is supported both by the organic content in a section of a terrace and by a phytolith analysis. The phytolith analysis furthermore indicated that maize was cultivated on the terraces, but this should be seen as a pilot study only, and presence of maize in Bokoni must be tested with other archaeobotanical methods.

The Barriers to the Integration of the Uterine Balloon Tamponade into South Africa and Ghana's Health Systems for the Management of Postpartum Hemorrhage

Background

Postpartum hemorrhage is the most significant contributor to maternal mortality globally, claiming 140,000 lives annually. Postpartum hemorrhage is a leading cause of maternal death in South Africa, with the literature indicating that 80 percent of the postpartum hemorrhage deaths in South Africa are avoidable. Ghana, as of 2010, witnesses 2700 maternal deaths annually, primarily because of poor quality of care in health facilities and services being difficult to access. As per WHO recommendations, uterotonics are integral to treating postpartum hemorrhage as soon as it is diagnosed. In case of persistent bleeding or limited availability of uterotonics, the uterine balloon tamponade (UBT) can be used as a second line of defense. If both these measures are unable to counter the bleeding, providers must perform surgical interventions. Literature on the UBT, as one tool in the protocol to address postpartum hemorrhage, has shown it to have success rates ranging from 60 to 100 percent. Despite the potential to lower the number of postpartum hemorrhage deaths in South Africa and Ghana, the UBT has not been incorporated widely in South Africa and Ghana. The aim of this study is to describe the barriers involved with integrating the UBT into South Africa and Ghana’s health systems to address postpartum hemorrhage.

Methods

The study took place in multiple sites in South Africa (Cape Town, Johannesburg, Durban and Mpumalanga) and in Accra, Ghana. South Africa and Ghana were selected because postpartum hemorrhage contributes greatly to their maternal mortality numbers and there is potential in both countries to lower those rates through greater use of the UBT. A total of 25 participants were interviewed through purposive sampling, snowball sampling and participant referrals, and included various categories of stakeholders integral to the integration process of a medical device. Individual in-depth interviews were used for data collection, with interview questions being tailored to each stakeholder category. The focus of the interviews was on the protocol used to counter postpartum hemorrhage, the frequency with which the UBT is used as part of the protocol, and the process of integrating it into the South Africa and Ghana’s health systems. The data collected were coded using NVivo and analyzed using content analysis.

Results

The barriers to integration of the uterine balloon tamponade to address postpartum hemorrhage in South Africa and Ghana were evident on the political, economic and health delivery levels. The results indicated that the barriers to integration in South Africa included the low recognition of postpartum hemorrhage as a problem, the lack of clarity surrounding the role of the Medicines Control Council as a regulatory body for medical devices, and low awareness of the UBT as an intervention to control postpartum hemorrhage. The barriers in Ghana were the cash constraints experienced by the Ghana Health Services to fund medical devices, a heavy reliance on donors for funding, and the lack of consistent knowledge on processes involving clinical trials for new medical devices in Ghana.

Conclusion

Existing literature on methods to counter postpartum hemorrhage to reduce maternal mortality has focused on and emphasized the efficacy of the UBT. Despite overwhelming evidence supporting the use of the UBT, many health systems across the world, particularly low-income countries, do not have access to the device owing to numerous barriers in integrating the device into obstetric care. This study illustrates the need to focus on incorporating the UBT into health systems for greater availability to health workers and its use as standard of care. Ultimately, this study can be used as a stepping-stone for more research on this subject, providing evidence to influence policymakers to integrate the UBT into their protocols for postpartum hemorrhage response.