Towards developing a national health information standards framework for South Africa.

An outline is given of the development of a health information standards framework for South Africa. The main emphasis has been in the development of data standards including coding schemes. Choices for diagnostic, procedure, and reason for encounter codes are given as well as options for personal identifiers, telemedicine, and pharmaceutical codes and messaging standards.

Short-term relationships between winter temperatures and cardiac disease mortality in Cape Town.

The short-term relationship between winter temperatures and cardiac disease mortality in Cape Town was investigated for the period 1978-1985. The mortality data were stratified according to age (0-4 years, 5-59 years, 60 years and older), while the temperature data comprised daily maximum and minimum temperatures at Cape Town International Airport. The analyses identified a strong lagged relationship between extreme (high and low) temperatures and daily mortality, and it was established that large daily temperature variations were associated with above-average mortality rates.

Sources of South African mortality data, 1910-1992.

A complete bibliography is given of official statistical publications that are the primary source of mortality data (number of deaths, ages and causes) for the South African population for the period 1910-1992. Details of the edition of the International Classification of Diseases used in the reports are noted, as well as the causes of death listed in the reports. Details of unpublished computer tapes used to produce these reports from 1968 onwards are also presented.

Nutritional status of 3-6 year-old African children in the Cape Peninsula.

A survey was conducted in the Cape Town metropolitan area in 1990 to determine the dietary intake and anthropometric status of 3-6 year-old African children (N = 163). Dietary data obtained from 24-hour recalls revealed that mean energy intake (5200 kJ) was low and that mean intakes of most nutrients fell considerably below the recommended dietary allowances (RDAs). The average diet included an adequate number of portions from the meat and cereal groups, but was inadequate with respect to the milk and fruit/vegetable groups when compared with the recommendations of the Department of Health Services and Welfare. The macronutrient energy distribution was within prudent dietary guidelines, with 28.1% of energy (E) being obtained from total fat, 63.7% from carbohydrate and 13.2% from protein. Anthropometric profiles expressed in terms of the National Centre for Health Statistics' (NCHS) standards, revealed evidence of growth retardation and wasting in this population, coexisting with emergent obesity. The development of a nutrition and health policy to address the problems of both deficit and excess represents a pressing challenge.

PIP: During the first quarter of 1990, Xhosa-speaking nurses interviewed mothers and took anthropometric measurements of 163 children 3-6 years old living in squatter and formal housing areas of Cape Town, South Africa, to determine the nutritional status of the children. 39% of the children received less than 67% of the recommended daily allowance (RDA) of calories (i.e., deficiency) and 3% received more than 120% of the RDA. Most children were deficient in calcium (80%), iron (77%), vitamin A (64%), riboflavin (52%), niacin (53%), vitamin B6 (58%), and vitamin C (76%). Most children received more than 120% of the RDA for folic acid (68%) and for vitamin B12 (63%). Milk consumption was low (median intake, 0.5 portion vs. 2-3 portions as recommended by the department of national health and population development guidelines). The diet was also deficient in vegetables and fruit intake (1.32 vs. =or 4 portions) and fat intake (2.5 vs. =or 4 portions). Children did receive adequate portions of meat and foods from the cereal group, however. Macronutrient energy distribution fell within prudent dietary guidelines: 28.1% of energy from total fat, 63.7% from carbohydrates, and 13.2% from protein. 44.8% of children had only 2 meals with more than 600 kJ. 15 children (9.2%) had only 1 meal. 27.6% were stunted. 7.7% were underweight. 7.9% were wasted. 20.1% were obese. The undernourished children and the obese children consumed a diet low in micronutrients. These anthropometric findings indicate a population in transition--acutely and chronically undernourished children coexisting with obesity. The overall findings suggest a need to develop a nutrition and health policy to address nutrient deficit and excess.

Asthma deaths among coloured and white South Africans: 1962 to 1988.

To determine whether death rates from asthma have been rising in South Africa, asthma mortality rates among coloured and white South Africans were calculated from official figures for the years 1962-1988. Sharp increases in the 1960s were noted in both groups. Since the early 1970s whites rates have generally shown a downward trend. In contrast, coloured rates have remained high, with a marked excess of male deaths. In the age stratum 5-34 years, there has been considerable fluctuation, with the long-term trend being slightly downward. Some increase in death rates occurred among the young in the early 1980s, but coloureds in this age group have shown falling rates in the most recent years. Coloured death rates in the younger age stratum have, however, continued to exceed whites rates, although by a decreasing margin, and have been high by international comparison. These group disparities are unlikely to be due to differences in certification or in coding. Variation in prevalence or severity of asthma may explain some of the disparity. However, these group differences, taken with well-known inequalities in medical care, suggest that preventable determinants of asthma deaths related to access to and quality of medical care may be important and accordingly a target for preventive strategies.

The morbidity spectrum seen by general practitioners in South Africa.

Information was obtained from a survey of a representive sample of 8% of the medical practitioners in South Africa in 1985. Each practitioner recorded all reasons for contact, diagnoses, whether a contact was new or a repeat, and demographic details of the patients over a 1-week period. Tables are presented only for general practitioners for contact rates of 70 causes of morbidity (ICD abridged list) as well as a chronicity index for each condition (the ratio of repeat to new contacts for that condition). Acute respiratory infections and diseases of the genito-urinary system were the most common reasons for contact, while diabetes mellitus was the condition with the highest chronicity.

A methodology for resource allocation in health care for South Africa. Part IV. Application of South African Health Resource Allocation formula.

The primary concern of this concluding article in a series is the application of the South African Health Resource Allocation (SAHRA) formula proposed in the previous article (SAMJ 1990; 77: 456-459). Target allocations based on this formula are compared with current budgets to estimate the extent of geographical maldistribution of health care resources. Under the present health service structure, the direction of redistribution of these resources should be from the provinces to 'homelands'. A number of refinements to the crude formula, such as the introduction of a more rational regionalisation policy and accounting for the teaching commitments of academic hospitals, are considered and their effects illustrated. Despite data deficiencies and the wide range of possible technical modifications to SAHRA, the concept of basing resource allocation decisions on an internationally applied formula is worthy of public debate.

Risk factors for coronary heart disease in the black population of the Cape Peninsula. The BRISK study.

A cross-sectional study of risk factors for ischaemic heart disease (IHD) in a random sample of 986 black people aged 15-64 years living in the Cape Peninsula revealed a population at lower risk for IHD than other South Africans. Blood pressures of 140/95 mmHg or above were found in 14.4% of males and 13.7% of females. Fifty-two per cent of males and 8.4% of females smoked, while 16.5% of males and 25.8% of females had a total cholesterol (TC) level imparting risk for developing IHD. In this population the TC level is not a good surrogate measure for low-density lipoprotein cholesterol because of the high level of high-density lipoprotein cholesterol (HDLC) found in this population. A protective HDLC/TC ratio of 20% was found in 96% of males and 96.1% of females. When considering the three major reversible IHD risk factors at a high level of risk, 30.8% of males and 12.5% of females had at least one such a risk factor. The population was frequently exposed to the media, with 80% listening to the radio every day and 55% watching television at least once a week. This suggests that a healthy lifestyle could be promoted successfully by means of these media. In addition, schools should promote a healthy lifestyle and the prevention of chronic degenerative diseases should be incorporated into the evolving primary health care services in South Africa.

A methodology for resource allocation in health care for South Africa. Part III. A South African health resource allocation formula.

A formula to calculate the proportion of the public sector budget that should be allocated to various geographical regions of South Africa is described. The formula is broadly classified into curative and preventive components. Using data that are routinely available, indices of need are calculated for each of these components. It is concluded that resource allocation on a macro level should closely approximate regional population distribution if cross-border flow of patients and additional teaching-hospital expenditure are ignored.

A methodology for resource allocation in health care for South Africa. Part II. The British experience and its relevance to South Africa.

This second article in the series on resource allocation in health care, argues for a formula-based method of resource allocation in South Africa. The model employed in England since 1976 and its application in a number of developed and developing countries is reviewed. The international experience is related to South African conditions and the principal elements necessary for a formula to achieve greater spatial equity in South African health-resource distribution are discussed.

The relationship between the hardness of treated water and cardiovascular disease mortality in South African urban areas.

A number of studies carried out in other countries have shown the existence of negative correlations between cardiovascular disease mortality and the hardness of water supplies. A study here showed negative correlation (P less than 0.10) between cardiovascular disease mortality for the South African urban white population and total water hardness (equivalent calcium carbonate mg/l). Negative correlations were also found to exist with the hardness-associated factors potassium (P less than 0.05), sulphate (P less than 0.05) and chloride (P less than 0.05) and manganese (P less than 0.10). The results are described in terms of existing studies and a number of local problems have been identified and discussed.

A methodology for resource allocation in health care for South Africa. Part I. Rationale and prerequisites.

A strategy for the equitable allocation of health care resources is needed in South Africa. The existing health administrative structures are obstacles to achieving this goal. An attempt is made to describe a framework in which the prerequisites for the equitable allocation of resources are a major restructuring of health services into a number of regional health authorities in a unified health service, and to establish a formula which is adapted from the RAWP (Resource Allocation Working Party) model used in the UK.

Research on the health implications of the use of recycled water in South Africa.

South Africa has an inadequate and unreliable supply of water. It is expected that water resources will be a limiting factor to development by the year 2020. Reclamation and reuse of sewage effluent is one possible method of supplementing existing supplies. Windhoek has had direct supplementation of its water supply for over a decade. Guidelines for using recycled sewage as a source of potable water are given and South African studies on chemical, microbiological and virological aspects of reclaimed water are reviewed. Epidemiological studies, retrospective in Windhoek and prospective for Cape Town, are discussed.

The geographical variation in neonatal and post-neonatal mortality in South Africa, 1978-1982.

Early neonatal, neonatal and post-neonatal mortality rates were systematically calculated according to the statistical regions of South Africa for the white and coloured populations over a 5-year period. The geographical variation is wide and the statistical significance in these mortality rates for coloured infants in rural areas of the Cape and the Orange Free State are particularly high and call for urgent attention.

Birth defects surveillance. A pilot system in the Cape Peninsula.

A pilot birth defects surveillance system was established in 1982 as part of an epidemiological baseline study pertaining to potential changes in water quality in the Cape Peninsula. The methodology used for reporting birth defects for two information systems, one hospital-based and the other population-based, utilizing statutory notifications of births, is described. Preliminary birth defect rates by cause are presented for a hospital-based system and are consistent with rates reported internationally. The system based on statutory notifications showed gross under-reporting.