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Cablegate: South Africa Public Health April 1 Issue

This record is a partial extract of the original cable. The full text of the original cable is not available.




E.O. 12958: N/A


1. Summary. Every two weeks, USEmbassy Pretoria publishes a
public health newsletter highlighting South African health
issues based on press reports and studies of South African
researchers. Comments and analysis do not necessarily reflect
the opinion of the U.S. Government. Topics of this week's
newsletter cover: South African Violence Driven by Firearms
and Alcohol; South Africa Starts Trials Using Medicinal Plants;
South African TB Epidemic Grave; Cape Town's Success in TB
Program; and Italy and South Africa Collaborate on New Health
Projects. End Summary.

South African Violence Driven by Firearms and Alcohol
--------------------------------------------- --------

2. South Africans are more likely to be shot than suffer any
other kind of unnatural death as gun crime pushes the country's
violent death rate to up to eight times the global average,
according to a Medical Research Council (MRC) study. Firearms
and alcohol were key causes of unnatural deaths, and the MRC
survey showed 48 percent of more than 22,000 unnatural deaths
surveyed were caused by violence. Firearms made up 28 percent
of the total, and sharp-force injuries such as stabbings
accounted for 15 percent. Twelve percent of those suffering
unnatural deaths were pedestrians hit by vehicles. Analysts
estimate South Africa has between 1 million and 4 million
illegal firearms in circulation, prompting the government to
declare an amnesty aimed at getting them off the streets. The
report showed most violent deaths took place in impoverished
suburbs and townships. Men were more than four times more
likely to die a violent death than women. Violent deaths were
most likely to occur in the late evening or early morning, with
more than 40 percent taking place on Saturday or Sunday,
researchers said, suggesting this was when many victims were
drunk. Of those killed with a gun, 38 percent had alcohol in
their system, while 72 percent of stab victims had been
drinking. Source: Reuters, March 23.

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South Africa Starts Trials Using Medicinal Plants
--------------------------------------------- ----

3. South Africa is set to start testing as many as 10
different plants with the potential to offer treatment for
diseases including malaria, tuberculosis and diabetes. Just a
year after the launch of the Innovation Fund, a national
research and development platform for projects such as new drug
development from indigenous medical plants, results have been
so good that Phase 1 and 2 trials are expected to start this
year. Innovation Fund project manager Dr. Niresh Bhagwandin,
who is also executive manager of the South African Medical
Research Council in Cape Town, said they had no expectations at
the start of claiming major breakthroughs, but that the
promising leads had been extensive. A trust deed is being
registered with the South African Revenue Service ahead of
trials to assure "benefit sharing" for local communities
involved, allowing the community to have a 50 percent share in
the benefits with the consortium. The project involved about
135 scientists and students, and had R18 million ($3 million,
using 6 rands per dollar) funding for three years, from 2004 to
2006. The drugs will be tested by the University of Limpopo,
which has experience with Phase 1 and 2 clinical trials, and
the Medical Research Council's indigenous knowledge division.
Source: Cape Argus, March 24.

South African TB Epidemic Grave

4. While TB cases have more than doubled since 1996 when a
national TB program was implemented, the country's cure rate
remains around 54 percent. The increase is driven mainly by
the HIV epidemic and improved detection rates at clinic level.
Government bases its figures on registered TB cases and, by
2003, it put the TB incidence rate at 550 TB cases per 100 000
people. However, the Medical Research Council's (MRC) TB
Research Lead Program believes actual cases to be much higher.
It estimated the incidence rate last year to be closer to 1 084
cases per 100 000 people, with a total of 529 320 cases
countrywide. It estimates the national co-infection rate of TB
and HIV to be 66.4 percent. In comparison, Brazil has an
incidence rate of 62 cases per 100 000 people and only 4
percent of adult TB patients also have HIV Kenya's rates are
closer to South Africa's, with an incidence of 540 and TB/HIV
co-infection at around 51 percent. Although the national TB
program was adopted nine years ago, some provinces have yet to
appoint people to manage provincial and district TB programs or
dedicate funds to TB. The biggest failure of the TB program is
that patients do not complete their six-month course of drugs.
There is a shortage of Directly Observed Treatment (DOT)
volunteers, community workers who ensure that patients take
their daily tablets and complete the course. The DOTS
volunteers do not get paid, so they tended to move to the HIV
home-based care programs where they were paid a stipend.
Laboratory services in rural areas are also under-equipped.
Patients are often asked to return a week later for their TB
test results and many fail to do so.

5. The failure of patients to complete their drugs has led to
a sharp increase in multi-drug resistant TB (MDR-TB). Only
Kazakhstan has more cases of multi-drug resistant TB, according
to the World Health Organization, although MDR TB cases only
account for 1.7 percent of registered cases (2002 figures).
Infectious diseases expert Dr David Coetzee from the University
of Cape Town says that the MDR TB rate would have been much
higher had South Africa not been using a combination drug,
which uses all four TB drugs. Limpopo and Mpumalanga have been
identified as "hotspots" for MDR-TB, probably related to poor
programs in those provinces. While MDR TB makes up about 1.5
percent of TB cases nationally, over 3 percent of Mpumalanga's
cases and almost 2 percent of Limpopo's cases are MDR TB.
About 17 percent of repeat TB cases in Mpumalanga have MDR TB,
while around 6 percent of repeat TB cases nationally are multi-
drug resistant. Treatment of MDR TB takes at least 16 months,
costs up to 100 times more than ordinary TB and has been
associated with extraordinarily high mortality rates in HIV
infected patients.

6. An improvement in reporting and surveillance systems had
also contributed to the overall increase in TB rates, as many
more cases were being detected. All 183 health sub-districts
offer TB treatment and have electronic TB registers to monitor
the progress of TB patients. The World Health Organization
(WHO) noted in its global TB report last year that South Africa
had improved its case detection by 12 percent in 2002. The WHO
report also noted that despite the high correlation between TB
and HIV infection, there was no HIV surveillance for TB
patients and no plans to establish one. TB/HIV collaboration
existed in 13 health sub-districts out of 183 and no plans
established to involve the national TB program in anti-
retroviral delivery.

7. KwaZulu-Natal has the most TB cases in the country, and has
overtaken the Western Cape as the province with the highest
incidence rate. KwaZulu-Natal (KZN) also has the highest HIV
rate in the country, according to the annual health department
surveillance of pregnant women. Last year, the MRC estimated
that 173,944 KZN residents had active TB, the rate was 1,696
cases per 100,000 people and 83.4 percent of these were also
HIV infected. The Western Cape has the second highest TB
incidence rate at 1,333, according to the MRC, but the lowest
TB-HIV infection rate at around 50.4 percent.

8. TB is not common among HIV positive people in countries
where the TB incidence rate among the general population is
relatively low. This year's priorities are to further train
healthcare workers on TB care, ensure that patients take their
drugs for the entire six months and improve laboratory
services. A rapid TB test that could ensure patients get their
results the same day would help a great deal, while new drugs
with fewer side effects would also improve treatment outcomes.
Source: Health-E News, March 24.

Cape Town's Success in TB Program

9. The TB rate in Cape Town continues to be among the highest
in the world, yet the city has managed to achieve impressive
cure rates. Tuberculosis is one of the major contributors to
the burden of disease in Cape Town with a 74 percent increase
in the number of reported cases over the last seven years. In
2004, over 24,129 people were registered for TB treatment in
Cape Town alone, 12 percent of the national cases. Langa (a
township in Cape Town), with 850 patients, recorded a cure rate
of 74 percent, three percent higher than the city average.
Khayelitsha alone (with 8 clinics out of a total of 99 in the
City) treated almost 20 percent of the TB patients. In 1997,
21 percent of Cape Town TB patients didn't complete their
course of medication. This was brought down dramatically to 12
percent last year. In 2003, Southern and Tygerberg sub-
districts achieved cure rates of above 80 percent. Dr Ivan
Toms, director for Health in Cape Town, points out that the
city's success is based on good information systems and
rigorous monitoring to identify problem areas, strong
partnerships between the different role players, the commitment
by health personnel and community-based workers and the
strengthening of capacity at facility level through training
and support. The highest increase in caseloads has been in
Khayelitsha with 66 percent increase. Nyanga (another Cape
Town township) has seen a 30 percent increase. Cases of extra-
pulmonary (outside the lungs) TB cases have increased by 187
percent over the last four years. The highest reported cases
are in Khayelitsha and Nyanga. In 2004, all Cape Town health
sub-districts were offering voluntary counseling and HIV
testing to TB patients and 82 percent accepted the test. The
average co-infection rate for the region is around 50 percent.
However the range is very wide. Khayelitsha and Nyanga have 77
percent and 68 percent co-infection rates respectively, while
Tygerberg West has a low of 16 percent. Source: Health-E
News, March 24.

Italy and South Africa Collaborate on New Health Projects
--------------------------------------------- ------------

10. Four health and medical science projects with a total
value of R79 million ($13 million)were started by the Health
Department and the Italian government Health Minister Manto
Tshabalala-Msimang and Italian Ambassador Valerio Augusto

Astraldi signed an agreement to encourage co-operation between
the two countries in the field of healthcare and medical
science. The four projects constituted the second round of
initiatives resulting from a partnership between the two
governments. The first project was to support the national and
provincial health departments and capacity-building in health
management and health information systems. The second project
was to provide support to strategic planning in health at
national level with a funding of about R26 million ($4.3
million). The third project was aimed at providing support to
health planning capacity in KwaZulu-Natal with a funding of R17
million ($2.8 million). The fourth project would provide
support to mother and child care and the development of the
health information systems in KwaZulu-Natal with funding of R9-
million over a three-year period. Source: Sapa, March 23.


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