Under-reporting in hepatitis B notifications

Notification and laboratory data for the period January 1985 December 1988 were compared in order to estimate: (i) the minimum level of under-reporting of hepatitis B; and (ii) the consistency of the level of under-reporting, both regiorially and nationally. Ratios between hepatitis B notifications and positive hepatitis B laboratory tests (reporting ratios) were calculated to quantify the discrepancy between these parameters. There were at least 7 positive hepatitis B laboratory results for each notified case of hepatitis B during each year studied. The differences between the national reporting ratios for each of the study years were small, indicating that nationally the level of reporting of hepatitis B is fairly consistent. The Cape region had the highest and most constant level of hepatitis B reporting compared with other regions. We conclude that the national incidence of hepatitis B is at least 7 times higher than that calculated from notification data. Further, the inter-year analysis of hepatitis B notification data to identify trends nationally and within the Cape region is valid. However, caution is called for when comparing the incidence rates between regions due to inter-region and region-specific inter-year inconsistencies in reporting levels

Traditional healers and AIDS prevention

A qualitative case study of the views and experiences of an isangomia was undertaken to explore potential preventive health roles that traditional healers could play with regard to the AIDS epidemic. The isangoma's knowledge of the transmission mechanisms, risk groups and prevention strategies for AIDS was accurate. Her questionable beliefs included a Nazi conspiracy as the source of AIDS, a string ritual to prevent promiscuity and a conviction that she could treat AIDS. Notwithstanding the latter beliefs, her generally factual knowledge of AIDS indicated that she could be an important source of AIDS information in the community; she was, in fact, already providing some AIDS counselling. Considering their large clientele, established preventive health ethic, extensive distribution in rural areas and potential ability to influence the contextual factors that affect risk-reducing behaviours (e.g. condom. use), it is recommended that traditional healers be incorporated into AIDS prevention programmes where they can play a role in community-based AIDS education and condom promotion

Editorial: Why viral hepatitis?

No Abstrac

Viral hepatitis B - an overview

Worldwide the hepatitis B virus (HBV) is responsible for a large proportion of all forms of liver disease and is probably the most frequent cause of chronic viral disease in man. The economic and human cost of HBV is further exacerbated by its association with hepatocellular carcinoma (HCC), one of the ten most common malignant human tumours

The prevention of hepatitis

The identification and characterisation of the hepatitis viruses A, B, C, D and E has allowed greater insight into their diagnosis, prevalence and modes of transmission. The clinical, pathological and serological features of each of these viruses have been dealt with elsewhere in this issue of the SAMJ, as have general and specific measures required for the prevention and future elimination of the diseases they cause. A recent consensus statement defined the problem posed by the hepatitis viruses in South Africa and highlighted the measures necessary to manage this effectively. This article will concentrate on measures designed to convey passive or active immunity to hepatitis A and B. However, the importance of general measures for the upliftment of underprivileged communities must constantly be borne in mind since these play a vital role in reducing infection, morbidity and mortality due to the hepatitis viruses

Loss of maternal measles antibody in black South African infants in the first year of life implications for age of vaccination

In order to investigate the feasibility of measles vaccination before the age of 9 months the duration of passive immunity against measles was estimated by conducting a longitudinal study of measles antibody levels in 20 black neonates delivered at term. Measles serum antibody (lgG) was measured by enzyme-linked immunosorbent assay in the mother at childbirth and on consecutive samples taken from the infants from birth until 9 months of age. Protective measles antibody level was defined as > 200 mlU. Unprotective levels were found in 88% (95% confidence interval (Cl) 81 - 99%) of 6-month-old infants, while at 9 months all were susceptible. The mean antibody level was 192 mlU (Cl 104 - 348%) at 4 months; 34 mlU (Cl 15 - 73%) at 6 months and 13 mlU (Cl 6-24%) at 9 months of age. Our data support the recent World Health Organisation recommendation to immunise children in developing countries at 6 months with the 'high titre' Edmonston-Zagreb measles vaccine, since most infants in our study had lost passive immunity against measles by this age

Migration and AIDS

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Maternal and child health indicators in a rural South African health district

Objective. To measure important maternal and child health indicators in a rural health district as part of the process of developing a comprehensive district health information system.Design. A modified Expanded Programme on Immunisation cluster sample survey.Setting. Hlabisa health djstrict. Kwazulu-Natal.Participants. 480 mothers (or carers) of children aged 12 - 35 months surveyed in 32 clusters. Interventions. A questionnaire was administered and Road-to-Health cards were examined.Main outcome measures. Proportion of women receiving antenatal care and delivering in a health facility; knowledge and understanding of vaccination and recall of vaccination history. Proportion of children with a Road-to-Health card, overall coverage of each vaccine, coverage at 12 months of age and proportion receiving an immunogenic dose.Results. Most mothers (91 %) had attended antenatal care, 77% had received tetanus toxoid and 83% delivered in a health facility. Only 14 children (3%) had never received a Road-to-Health card and 73% had one available at the time of the survey. Overail immunisation coverage was high (80 - 98%), as was the proportion receiving an immunogenic dose of each vaccine (78 98%). However, only 76% had received all the vaccines due to a 12-month-old child, and only 88% of these had received all doses by 12 months of age.Conclusions. While the key maternal health indicators measured here are reassuring, there is still room for improvement in the child health indicators. The proportion of women receiving antenatal care and delivering in a health facility is very high, but the proportion of children receiving all vaccines can be improved upon, as can the timing of immunisation. The results of this survey are being used to strengthen further the primary health care services in the district