COMPETING AT THE "CUTTING EDGE": OPPORTUNITIES FOR AGRIBUSINESS PARTNERSHIPS AND CO-OPERATION IN THE SOUTHERN AFRICAN REGION

What are the opportunities for agricultural business, trade and co-operation in Southern Africa and, in particular, South Africa and Zimbabwe - two of the most significant economies in the SADC region? The competitiveness status of agribusiness - from a global viewpoint - in sixteen food and fibre supply chains in Zimbabwe and South Africa is determined in this study using the Revealed Comparative Advantage method of Balassa. Based on this status, there is potential in certain agro-food chains for supply chain integration and cooperation between agribusinesses in South Africa and Zimbabwe. Such partnerships will improve competitiveness and will allow agribusinesses to compete at the "cutting edge" in the global environment.Agribusiness,

ARE WE STILL INVESTING IN SOUTH AFRICAN AGRICULTURE: PERCEPTIONS, EVIDENCE AND ANALYSIS

In this paper the question of investment in the South African agro-food and fibre complex is explored. The analysis is based on empirical values and opinions/perceptions from ±400 agribusinesses operating in this complex. From the analysis it is clear that decisions to invest in the agro-food and fibre complex in South Africa must be viewed as on "knife-edge". A range of recommendations and policy options will be required to activate investment drivers and to address constraints in order to stimulate investment and to achieve growth.Agricultural and Food Policy,

DETERMINANTS OF COMPETITIVENESS IN THE SOUTH AFRICAN AGRO-FOOD AND FIBRE COMPLEX

The competitiveness of the South African agro-food and fibre complex depends on a number of factors: technological, socio-political and economic. This paper attempts to identify and analyse such factors by using a framework of analysis proposed by Michael Porter (1990). Appropriate measures to increase competitiveness are proposed. These include improved supply chain management, cost reduction, contractual pricing and the establishment of a clear "agribusiness development policy".Agribusiness, Industrial Organization,

HOW COMPETITIVE IS AGRIBUSINESS IN THE SOUTH AFRICAN FOOD COMMODITY CHAIN?

The competitiveness of sixteen selected food commodity chains in South Africa was calculated using the Revealed Comparative Advantage method of Balassa. The majority of commodity chains are marginally competitive. Except for the maize, pineapple, and apple chains, the competitiveness index generally decreases when moving from primary to processed products. This implies that benification or "value adding" opportunities in South Africa are restricted. To compete in a global economy strategies should be followed that improve the competitiveness of the whole food supply chain. It is i.e. not good enough for farmers to be able to compete globally at farm gate level, whilst the locally processed commodities that is sold to the consumer is not competitive in the world market.Agribusiness,

TECHNOLOGY, RESEARCH AND DEVELOPMENT AND THE IMPACT ON THE COMPETITIVENESS OF THE SOUTH AFRICAN AGRO-FOOD SUPPLY CHAINS

Industrial Organization, Research and Development/Tech Change/Emerging Technologies,

The role of treatment delays in surgical site infection after appendicectomy in a South African rural regional hospital

Background. Delays to surgery for acute appendicitis in low- and middle-income countries lead to significant morbidity.Objectives. To investigate the role of time to surgery in the development of complicated appendicitis and surgical site infection (SSI) in a rural referral hospital in South Africa (SA).Methods. A prospective cohort study was conducted of all patients presenting to a regional hospital in SA with acute appendicitis during 2017. Inpatient interview and data collection were followed by 30-day post-surgical follow-up to assess time periods to surgery and operative outcomes.Results. A total of 188 patients underwent surgery for acute appendicitis. The median (interquartile range (IQR)) age was 19 (3 - 73) years, and 62% were male. The median (IQR) time from symptoms to surgery was 60 (42 - 86) hours and from hospital admission to surgery 8 (4 - 16) hours. Forty-one percent were managed laparoscopically, 62% had complicated appendicitis, and 25% developed SSI. Time from symptoms to surgery >72 hours was associated with an increased risk of complicated appendicitis (odds ratio (OR) 4.32; 95% confidence interval (CI) 1.36 - 13.75; p=0.013). Patients with SSI had an increased median delay of 15 hours (p=0.05) compared with those without SSI. Multivariable analysis showed that the risk of SSI increased with complicated appendicitis (OR 8.96; 95% CI 2.73 - 29.41; p<0,001) and decreased with laparoscopic surgery (OR 0.21; 95% CI 0.07 - 0.59; p=0.003). Time to surgery had no effect on the risk of SSI in adjusted analyses.Conclusions. Delays to surgery beyond 72 hours significantly increased complicated appendicitis, an important risk factor for SSI. Access to facilities with surgical capability and the use of laparoscopic surgery are modifiable risk factors for SSI

The effect of the introduction of a standard monitoring protocol on the investigations performed on the metabolic control of type 2 diabetes at Addington Hospital Medical Outpatients Department, Durban, South Africa

Background: A comprehensive approach to the control of type 2 diabetes is required to reduce mortality and morbidity. To improve diabetes management, in 2005 a protocol for the monitoring and management of type 2 diabetes, aligned to the 2003 Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) guidelines, was introduced atAddington Hospital Medical Outpatients Department, Durban, South Africa.Method: Data were collected from 120 randomly selected patients with type 2 diabetes. The number of glycated haemoglobin (HbA1c) and lipid estimations, blood pressure (BP) measurements and body mass indices (BMIs) recorded in 2005 was compared with those recorded in 2008 and 2009. The mean levels of these parameters and the number of patients reaching goal in 2008 were compared with the figures for 2009.Results: In 2005, 18.8% of patients had HbA1c levels measured compared with 82.9% in 2009 (P < 0.01). The mean HbA1c was 6.9% (± 1.9) in 2008 and 6.4% (± 2.0) in 2009 (P = 0.1). BP and BMI was measured in over 93% of patients in 2005, 2008 and 2009. BP goals were attained by 21% of patients in 2008 and 30% in 2009 (P = 0.65). The mean BMI in 2008was 29.4 kg/m2 (24% achieved goal), and in 2009 it was 28.6kg/m2 (29% achieved goal; P = 0.267). Lipid estimations rose significantly from 26% in 2005 to 73% in 2009 (P < 0.01). There was no improvement in the number of patients reaching target lipid levels between 2008 and 2009.Conclusion: The monitoring protocol improved adherence to the SEMDSA 2003 guidelines from 2005 to 2009. Overall glycaemic control was within target, but attainment of most nonglycaemic goals was suboptimal and did not improve over the study period

Impact of Recent Evidence on Use of Hormone Therapy in the South African Private Sector (2001-2005)

Background: The release of the results of the oestrogen plus progesterone therapy (EPT) arm of the Women\'s Health Initiative (WHI) in July 2002 started a worldwide process of reconsideration of the rationale behind hormone therapy (HT). This process was accelerated after the release of the results from the oestrogen-only (ET) arm of the same study. The results of the WHI reinforced the indications of HT to alleviate vasomotor symptoms and to prevent bone loss associated with early menopause, but refuted the possibility of cardioprotective effects and raised uncertainty around the risk of breast cancer for long-term users. In response, new guidelines and position statements were developed to aid healthcare practitioners and patients in various countries, including South Africa. The dissemination and penetration of all this information has been assessed in a number of countries, but the extent of its effect on the South African market is as yet unknown. Accordingly, the aim of this study was to assess the use of HT in the South African private sector from 2001 to 2005. Methods: Monthly HT sales data for January 2001 to October 2005 were obtained from IMS Health (SA). Three successive periods were compared: (1) January 2001 to June 2002 (discontinuation of the WHI oestrogen plus progestogen arm), (2) July 2002 to February 2004 (termination of the WHI oestrogen only arm) and (3) March 2004 to October 2005. Results: Overall, sales of HT fell 6.9% between periods 1 and 2 and 14.6% between periods 2 and 3. The total sales of ET predominated; they were more than double those of EPT. For ET, the sale of conjugated equine oestrogen (CEE) preparations exceeded those of non-CEE ET preparations, while for EPT preparations the reverse was true. The decline in ET sales was mostly accounted for by the fall in sales of CEE, by 9.8% and 20.6% for the two periods respectively. There was an increase in sales of both low-dose CEE and non-CEE, although the magnitude of increase in the case of the latter was much greater. Throughout the entire study period, CEE 0.625 mg tablets were found to account for the greatest sales volumes. Private sector sales represented 74.4% of total national HT sales over this period. Conclusion: The release of the WHI findings resulted in a modest decrease in HT sales in South Africa, although it was less dramatic than sales reported elsewhere. The change in prescribing cannot be attributed to any single factor. Factors such as publicity, adherence to new guidelines, and pharmaceutical marketing may all have contributed. Guidelines need to be updated as the results of new research continue to be published. There is also a need to periodically review prescribing trends, and to assess compliance with evidence-based guidelines, in order to improve the quality of medicines use. The majority of prescriptions for HT in South Africa are written by general practitioners, rather than by specialists. It is thus imperative that guidelines be appropriately framed for this market, as well as interpreted and applied. Keywords: hormone therapy (HT), South Africa, Women's Health Initiative South African Family Practice Vol. 50 (6) 2008: pp. 42-42

Second-stage primary Caesarean deliveries: Are maternal complications increased?

Background: Second-stage Caesarean sections (CSs) are known to be associated with increased complications but most reports originate fromtertiary hospitals, which attend to high-risk patients. Complication rates may differ in district hospitals, which attend to low-risk patients.Methods: This was a retrospective study carried out at a district maternity unit in Durban. The hospital records of all CSs over an eight-month periodwere reviewed and obstetric and neonatal complications of second-stage CSs were compared with a group of first-stage CSs performed during thestudy period.Results: There were 4 654 deliveries, including 1 257 CSs, in the study period. The CS rate was 27.2%. Of 617 (8.5%) emergency CSs, 53 wereperformed in the second stage of labour.The maternal and neonatal complication rates were low and no statistical differences were found between the patients who had second-stage orthose who had first-stage CSs, except for increased blood loss, blood-stained urine, prolonged operative times and postoperative fever for secondstageCSs.Conclusions: Second-stage CSs performed in a district hospital are associated with increased maternal complication rates but not with neonatalcomplications

Tobacco and alcohol use among healthcare workers in three public hospitals in KwaZulu-Natal, South Africa

Background: Tobacco use is a risk factor for most of the leading causes of death in the world. Healthcare workers (HCWs) can play an important role in assisting patients to stop smoking, but this role is undermined if they themselves smoke. The study determined the prevalence of tobacco smoking and alcohol use among HCWs in public hospitals in KwaZulu-Natal, South Africa.Methods: In a cross-sectional study, 650 self-administered anonymous questionnaires (primary and secondary questionnaires) were administered to participants between December 2009 and June 2010. Six hundred and twenty primary questionnaires (on smoking) and 630 secondary questionnaires (on alcohol use) were returned, giving a response rate of 95% and 97% respectively. The Pearson chi-square test was used to test for statistical significance.Results: Eleven per cent of the participants were current smokers and 7.1% former smokers, while 27% of neversmokers were constantly exposed to second-hand smoke. Males were 13 times more likely to smoke than their female counterparts (P < 0.001). Never-smokers more frequently counselled their smoking patients to quit compared to former and current smokers (47.5%, 39.5% and 25.8% respectively). Alcohol use problems were reported by 22% of participants (P < 0.001). Current smokers were six times more likely to drink excessively than never-smokers (P < 0.001) and males were ten times more likely than females to drink excessively (P < 0.001).Conclusion: The smoking rate among HCWs is still high, although lower than the national average of 21.4%. A large number of participants reported exposure to second-hand smoke and alcohol use problems. Less than half of the HCWs counselled smoking patients to quit smoking.Keywords: health care worker, tobacco use, alcohol use, patient education for smoking cessatio