Current strategies are inadequate to curb the rise of tobacco use in Africa

Recently, there have been significant advances in the battle against tobacco use in Africa, with achievements including ratification of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and the passing of tobacco control legislation in several countries. Many African countries have achieved measured success, while Uganda, South Africa and Mauritius have accomplished significantly more in their efforts to curb tobacco use. Nevertheless, few African countries meet the standards of the individual WHO FCTC articles with regard to comprehensive implementation. Africa has lower rates of tobacco taxation, weaker smoke-free policies and fewer restrictions on tobacco advertising compared with other world regions. These shortcomings have enabled the tobacco industry to expand its markets on the continent by capitalising on economic growth, changing social norms and population demographics. Consequently, tobacco use is increasing in Africa, with smoking prevalence having risen 57% between 1990 and 2009 compared with western Europe, where it decreased substantially during the same period. Rapid smoking uptake in Africa has led to tobacco-related conditions emerging as increasingly important public health problems. African nations are unlikely to meet the 2025 goal of a 30% relative reduction in tobacco use, as advocated by the World Health Assembly in 2013 and identified as the ‘most urgent and immediate priority’ intervention to reduce non-communicable diseases (NCDs). While there has been some progress, the current commitment of most African countries to the WHO FCTC has not translated into effective delivery of tobacco control policies and programmes. Strong tobacco control policies, which are among the most effective population-based strategies for NCD prevention, are needed. These include introducing higher tobacco excise taxes, stronger smoke-free policies, graphic warnings on cigarette packages, bans on tobacco advertising, promotion and sponsorship, and anti-smoking mass media campaigns. Furthermore, tobacco industry interference needs to be actively addressed by monitoring its activities and exposing misconducts, thereby changing attitudes to the industry. Technical support, capacity building and adequate financing are needed in Africa to enable countries to competently manage legal challenges to tobacco control and deal with the subversive tactics of the industry. Civil society and the media – major players in holding governments accountable for responsible stewardship – need to educate and pressurise African politicians and governments to implement and enforce effective tobacco control policies. Otherwise, if unchecked, the widespread uptake of tobacco use will be a threat not only to health but also to sustainable human development in Africa.S Afr Med J 2018;108(7):551-55

TBC of the thoracic wall with fistulisation through the breast

A 53-year-old North African woman presented with a longstanding history of ulcerations of the right breast. Physical examination showed (Fig. 1 subfigure) an ulcer of 1.5 cm in the outer inferior quadrant, another smaller areolar ulcer and a discharging sinus tract in the inframammary sulcus. Apart from female genital mutilation, her past medical history was negative. Laboratory work up was essentially normal, culture of the ulcers were taken. Mammography showed infra-areolar skin retraction, associated with irregular, high density distortion of the breast tissue. Ultrasound (Fig. 1) revealed communicating sinus tracts coming from an intercostal mass with central necrosis. Mobile internal echoes were suggestive for abscess formation and a truecut biopsy was taken. An important granulomatous inflammatory pattern and fibrosis were found. Axillary lymphadenopathy was present

A weighty matter: Identification and management of overweight and obesity in adolescents

Overweight and obesity are common in South African boys (18.8%) and girls (26.3%). Considering the potential serious consequences of these conditions, clinicians need to identify overweight and obese adolescents to enable early diagnosis and treatment. The key contributor in adolescents is increased intake of unhealthy foods and lower levels of physical activity. The consequences of overweight and obesity in adolescence are multisystemic and include  cardiometabolic (type 2 diabetes mellitus, high blood pressure, dyslipidaemia), respiratory (obstructive sleep apnoea), gastrointestinal (non-alcoholic fatty liver disease), musculoskeletal, psychological (depression) and social (stigmatisation) effects. Body mass index (BMI) is calculated to determine overweight and obesity in adolescents. Numerous expert committees, despite using different methods, classify overweight and obesity in children by age- and gender-specific cut points for BMI. After a diagnosis of overweight and obesity, secondary causes must be excluded, and a history of dietary intake, physical activity and sedentary behaviour obtained. This will identify modifiable behaviours that promote energy imbalance. All obese adolescents should undergo cardiometabolic assessments comprising fasting glucose, lipid and blood pressure measurements every 2 years. Interventions should focus on creating healthier home environments that provide easy access to healthy foods, encourage physical activity and discourage sedentary behaviour. Medication for weight loss or bariatric surgery may be considered for severely obese adolescents who do not respond to other strategies

Factors associated with contraceptive use in a rural area in Western Cape Province

Background. Safe and effective contraceptive use can substantially improve women’s reproductive health. Although the contraceptive prevalence rate (CPR) in South Africa is comparable to rates globally, inequalities in CPR affect poor and rural women. This study aimed to determine the CPR and factors associated with contraceptive use in a rural district of Western Cape Province. Method. Cross-sectional survey data based on 412 face-to-face interviews with female participants between 18 and 44 years of age were collected in 2006 for a primary fetal alcohol syndrome prevention study in a rural district in Western Cape Province. The study used effective contraception (ECC) as the outcome variable. ECC included use of oral contraceptives, condoms, injectables or sterilisation. Independent variables included socio-demographic factors, substance use, psychosocial factors, community factors, childbearing characteristics and partner characteristics. Results. Women were more likely to use ECC if they reported high self-esteem (compared with low or moderate self-esteem (prevalence risk ratio (PRR)=1.23; 95% confidence interval (CI) 0.99 - 1.53); if they strongly or moderately agreed that their culture entitled men to make decisions regarding child-bearing compared with those who disagreed (PRR=1.28; 95% CI 0.96 - 1.71); and if they had one child or more compared with no children (PRR=1.62; 95% CI 1.24 - 2.11). Conclusion. The CPR for sexually active women in this study was low at 39.3%. To promote contraceptive use in similar rural populations, family planning programmes should focus on increasing men’s approval of contraception, improving partner communication around family planning and bolstering women’s confidence in their reproductive decision-making, and particularly their self-esteem. There should be greater focus on nulliparous women

Factors associated with contraceptive use in a rural area in Western Cape Province

BACKGROUND: Safe and effective contraceptive use can substantially improve women's reproductive health. Although the contraceptive prevalence rate (CPR) in South Africa is comparable to rates globally, inequalities in CPR affect poor and rural women. This study aimed to determine the CPR and factors associated with contraceptive use in a rural district of Western Cape Province. METHOD: Cross-sectional survey data based on 412 face-to-face interviews with female participants between 18 and 44 years of age were collected in 2006 for a primary fetal alcohol syndrome prevention study in a rural district in Western Cape Province. The study used effective contraception (ECC) as the outcome variable. ECC included use of oral contraceptives, condoms, injectables or sterilisation. Independent variables included socio-demographic factors, substance use, psychosocial factors, community factors, childbearing characteristics and partner characteristics. RESULTS: Women were more likely to use ECC if they reported high self-esteem (compared with low or moderate self-esteem (prevalence risk ratio (PRR)=1.23; 95% confidence interval (CI) 0.99 - 1.53); if they strongly or moderately agreed that their culture entitled men to make decisions regarding child-bearing compared with those who disagreed (PRR=1.28; 95% CI 0.96 - 1.71); and if they had one child or more compared with no children (PRR=1.62; 95% CI 1.24 - 2.11). CONCLUSION: The CPR for sexually active women in this study was low at 39.3%. To promote contraceptive use in similar rural populations, family planning programmes should focus on increasing men's approval of contraception, improving partner communication around family planning and bolstering women's confidence in their reproductive decision-making, and particularly their self-esteem. There should be greater focus on nulliparous women

Some investigations on the activity of phenol oxidase in the isopod Cirolana fluviatilis

Phenol oxidase activity in the isopod Cirolana fluviatilis averaged 0.0015 w.units/mg protein/min in the larger isopod.samples (10-17 mg) and 0.00034 O.D. units/mg protein/min in the smaller samples (6-9 mg). The enzyme showed equal affinity for epinephrine and dopamine and >5O% affinity for DOPA

Hearing outcomes in children with meningitis at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A silent crisis

Background. Bacterial meningitis is one of the most common causes of hearing loss. Hearing loss develops within the first few days following the onset of meningitis, highlighting the importance of early audiology referrals. Post-meningitis hearing loss may lead to cochlear ossification, making traditional cochlear implantation impossible.Objectives. To determine the duration of time from meningitis diagnosis to audiology referral. A second objective was to determine the prevalence and severity of meningitis-related sensorineural hearing loss (SNHL) at Red Cross War Memorial Children’s Hospital (RCWMCH), a paediatric tertiary hospital in Cape Town, South Africa (SA).Methods. A retrospective folder review of all children diagnosed with meningitis and referred for audiological evaluation was conducted over an 18-month period between 1 January 2015 and 30 June 2016. Descriptive statistical methods were used for data analysis.Results. The total number of inpatients diagnosed with unspecified meningitis at RCWMCH between January 2015 and June 2016 was 345. The total number diagnosed with bacterial meningitis was 68. Only 16 children with meningitis (23.5%) were referred to the Department of Audiology at RCWMCH over the 18-month period. Twelve children had confirmed bacterial meningitis. All the children had up-to-date immunisations. The mean (standard deviation) time from diagnosis to audiology referral was 17 weeks (16.9; range 1 - 60). The overall prevalence of hearing loss was 42.8%. Four children (28.5%) were diagnosed with severe to profound SNHL.Conclusions. Less than a quarter of all children diagnosed with bacterial meningitis at RCWMCH over the 18-month study period were referred to audiology. Frequent delays in referrals for audiological assessment following meningitis were noted. This may indicate a lack of awareness on the part of doctors. Healthcare practitioners need to be made aware of the need for prompt audiological testing for children with meningitis. In SA, local guidelines for early diagnosis and monitoring of hearing in children who have had meningitis should be developed in order to improve hearing outcomes

Knowledge generation via publications on hypertension prevalence in population-based studies conducted in sub-Saharan Africa over 30 years: 1990 - 2019

Hypertension prevalence in sub-Saharan Africa (SSA) is high, is rising and has emerged as the most prevalent cardiovascular disease risk factor. Research is required to provide evidence-based findings to prioritise hypertension prevention and control. This systematic review aims to describe the distribution of and trends in scientific outputs on hypertension prevalence in population-based studies in SSA over the last three decades. Relevant English-language articles documenting hypertension prevalence in population-based studies in SSA, published between 1 January 1990 and 25 April 2019, were identified through a comprehensive electronic search of MEDLINE. Of the 3 795 citations retrieved, 414 fulfilled the inclusion criteria. Scientific outputs increased incrementally per 10-year period: 1990 - 1999: n=32; 2000 - 2009: n=65; and 2010 - 2019: n=317. The greatest number of scientific outputs over the 30-year period originated from South Africa (n=81) and Nigeria (n=74). Increasing scientific outputs on hypertension prevalence in SSA have not translated into optimal hypertension management, which remains inadequate

Current strategies are inadequate to curb the rise of tobacco use in Africa

Recently, there have been significant advances in the battle against tobacco use in Africa, with achievements including ratification of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and the passing of tobacco control legislation in several countries. Many African countries have achieved measured success, while Uganda, South Africa and Mauritius have accomplished significantly more in their efforts to curb tobacco use. Nevertheless, few African countries meet the standards of the individual WHO FCTC articles with regard to comprehensive implementation. Africa has lower rates of tobacco taxation, weaker smoke-free policies and fewer restrictions on tobacco advertising compared with other world regions. These shortcomings have enabled the tobacco industry to expand its markets on the continent by capitalising on economic growth, changing social norms and population demographics. Consequently, tobacco use is increasing in Africa, with smoking prevalence having risen 57% between 1990 and 2009 compared with western Europe, where it decreased substantially during the same period. Rapid smoking uptake in Africa has led to tobacco-related conditions emerging as increasingly important public health problems. African nations are unlikely to meet the 2025 goal of a 30% relative reduction in tobacco use, as advocated by the World Health Assembly in 2013 and identified as the ‘most urgent and immediate priority’ intervention to reduce non-communicable diseases (NCDs). While there has been some progress, the current commitment of most African countries to the WHO FCTC has not translated into effective delivery of tobacco control policies and programmes. Strong tobacco control policies, which are among the most effective population-based strategies for NCD prevention, are needed. These include introducing higher tobacco excise taxes, stronger smoke-free policies, graphic warnings on cigarette packages, bans on tobacco advertising, promotion and sponsorship, and anti-smoking mass media campaigns. Furthermore, tobacco industry interference needs to be actively addressed by monitoring its activities and exposing misconducts, thereby changing attitudes to the industry. Technical support, capacity building and adequate financing are needed in Africa to enable countries to competently manage legal challenges to tobacco control and deal with the subversive tactics of the industry. Civil society and the media – major players in holding governments accountable for responsible stewardship – need to educate and pressurise African politicians and governments to implement and enforce effective tobacco control policies. Otherwise, if unchecked, the widespread uptake of tobacco use will be a threat not only to health but also to sustainable human development in Africa.

A stable isotopic study of the diet of Potamonautes sidneyi (Brachyura: Potamonautidae) in two coastal lakes of the iSimangaliso Wetland Park, South Africa

Potamonautes sidneyi Rathbun 1904, is a dominant freshwater crab in KwaZulu-Natal, South Africa. Recent flood events in the iSimangaliso Wetland Park have allowed a substantial range expansion of this species, including previously hypersaline and desiccated areas. A stable isotope study was conducted to examine the feeding habits of the populations from Lake Sibaya and Mpophomeni Stream, two contrasting sites in the iSimangaliso Wetland Park. Juveniles from Mpophomeni Stream were more depleted in δ13C and more enriched in δ15N compared to adults, indicating a more carnivorous diet and higher trophic position. A general shift in diet was observed at both sites, with consumption of aquatic invertebrates and sedimentary organic matter more prevalent in the wet summer months, while greater proportions of detritus and microphytobenthos were consumed in autumn/winter. No significant difference was observed between adults from the two sites despite the abiotic variations. The species appears to play a complex role in the trophic web, by acting as an intermediate consumer facilitating the flow of nutrients across levels and by breaking down decomposing organic matter, allowing for rapid recycling of nutrients within its ecosystem.Keywords: diet, trophic role, stable isotopes, freshwater, brachyurans, opportunistic feeder