Effect of stress on birth weight in two Johannesburg populations.

The effect of stress on birth weight was assessed in mothers delivering at Johannesburg (predominantly white) and Baragwanath (exclusively black) Hospitals. The Social Readjustment Rating Scale of Holmes and Rahe was used to assign maternal stress scores established during an interview conducted within 36 hours of delivery. Only mothers without medical problems who had delivered liveborn infants were included. Maternal age, obstetric history, smoking history and stresses present during the 12 months preceding delivery were recorded. Of 535 Johannesburg and 662 Baragwanath mothers studied, 48% and 55% respectively reported significant stresses. Analysis of the two groups revealed that for the Johannesburg mothers, smoking, cumulative stress score and previous preterm birth were important determinants of birth weight. Of the stress factors studied, marital separation and death of a spouse were significantly associated with a lower birth weight. For Baragwanath mothers the major determinants of low birth weight were maternal age, loss of income through being dismissed from work, or having to leave school as a consequence of the pregnancy.

Televised paediatric consultations: a student evaluation of a multipurpose learning strategy.

Since 1984, each student in the sixth-year paediatric rotation in the Department of Paediatrics and Child Health at the University of the Witwatersrand has been videotaped while undertaking a comprehensive paediatric primary care consultation. Video replay of the consultation by each individual student was evaluated by the student together with medical and social work tutors. This incorporated psychosocial aspects, communication skills, doctor-mother-child interactions, as well as essential medical content, clinical examination techniques, and management strategies. The student was expected to provide comprehensive health care, viz. dealing with the presenting health problems, identifying any possible hidden agenda, giving due attention to nutrition, immunization, development, optimal use of available records, health surveillance and appropriate education. This teaching programme was introduced in 1984. In 1988, 68 consecutive final-year medical students completed an anonymous Likert-type evaluation form scoring their perceived learning. They affirmed that the use of television in medical education provides a unique multipurpose learning strategy and in particular enhances awareness of self and of patient/family needs. The time, cost and effort invested in this programme are considered justified.

Compliance with chemotherapy in childhood leukaemia in Africa.

Compliance with chemotherapy in childhood leukaemia is usually good because of parental fear of the disease. However, poor compliance and refusal of treatment have been reported from both the USA and the UK. Little is known about African concepts of leukaemia, attitudes to treatment or compliance. A study was undertaken to investigate factors which might affect compliance in 15 black and 30 white families of leukaemic children in Johannesburg. The socio-economic and educational status of the black families was lower than that of the white. Only 53% of black children attended hospital on the appointed day compared with 90% of white children. Less than 50% of black parents understood the nature of their child's illness. Both black and white families had unused medication at home. White parents more frequently reported toxic effects related to chemotherapy and more white children than black children exhibited lymphopenia during maintenance therapy. Assessment of drug compliance should be included as an independent variable when evaluating factors affecting response to chemotherapy in communities of diverse ethnic, socio-economic and cultural backgrounds.

Comparisons in the therapeutic management of Black paediatric outpatients by primary health care nurses and doctors.

Studies were conducted in 1977 and again in 1980 comparing the knowledge and information escorts of paediatric outpatients had about the child's illness and treatment after completing primary care consultations of various kinds. Primary health care nurses achieved the best communication as judged by answers to a questionnaire administered to the escorts by a social worker. Understanding was greater when patients were seen initially by doctors in the Department of Paediatrics outpatient clinic rather than by doctors in the Soweto polyclinics. Some of the associated factors are discussed.

The effect of dietary calcium supplementation on serum calcium, phosphorus, and alkaline phosphatase concentrations in a rural black population.

In a rural community, where low calcium intakes and a high prevalence of hypocalcemia elevated alkaline phosphatase values and hypocalciuria had previously been documented, two groups of 30 black school children were supplemented with calcium (500 mg/day) or a placebo for a period of 3 months. No change in serum calcium or alkaline phosphatase values occurred in the placebo group, while a significant rise in mean serum calcium and fall in mean alkaline phosphatase concentrations was found in the calcium-supplemented group over the 3-month trial. No difference in growth velocities in the two groups of children was noted over the period. These results suggest that the prevalence of biochemical abnormalities in the rural population is related to a low dietary calcium intake which can be corrected by a supplement of oral calcium only.

A demographic and socio-economic profile of a rural black South African community.

Demographic data regarding households in a Black rural community in the Eastern Transvaal were collected. Detailed socio-economic and health data were collected from a 10% random sample of households (response rate 92,5%). These data will be used for planning and evaluating a community health project. An extremely high infant mortality rate (198,1/1 000 live births), very low household incomes (median monetary household income R20 - R50 per month), low rates of immunization (39,4% of children under 12 years old had not been immunized), and gaps between the knowledge and practice of and the expressed desire for family planning were striking features.

Calcium deficiency in rural black children in South Africa--a comparison between rural and urban communities.

The prevalence of biochemical abnormalities usually associated with rickets was investigated in three black school-going populations, one from a rural community, one from a small urban community, and one from a large urban area. A high prevalence of biochemical abnormalities was found in the rural community, where 13.2% of children were hypocalcemic and 41.5% had elevated alkaline phosphatase concentrations. No hypocalcemia was detected in the children from the large urban area. Urinary calcium excretion was lowest in the community with the highest prevalence of hypocalcimia and elevated alkaline phosphatase concentrations. Dietary calcium intake in those children with biochemical abnormalities was estimated at 125 mg/day, compared with 337 mg/day in those children with normal biochemistry. It is suggested that the pathogenesis of the biochemical abnormalities in the rural community is due to a low dietary intake of calcium.

Factors influencing drug compliance in ambulatory Black urban patients.

The present study was designed to ascertain the causes of patient non-compliance among 150 urban Black patients. Three groups of patients were studied: those with acute illnesses, a chronic asymptomatic group and a chronic symptomatic group. The incidence of causes of non-compliance was found to be similar to that described in other population groups. A variety of faults in the health care delivery system has been pin-pointed and is discussed.

A socio-economic, health and cultural survey in Soweto.

The socio-economic, health and nutritional status of 186 families in Diepkloof, Soweto, was studied. The results, detailed in the text, reveal considerable socio-economic ills, of which the most important is the observation that 30% of the families existed below the poverty datum line, even when there was more than one wage-earner. More emphasis on health education and the promotion by health personnel of a better understanding of the backgrounds of clinic and hospital patients are urgent priorities for health services.

Isoniazid inactivation in Black patients with tuberculosis.

A 27% incidence of slow INH inactivator (acetylator) status was observed in a group of 100 Black tuberculotic patients. It is suggested that the incidence of INH toxicity may be high in this group of patients and that clinical cognisance of this problem is desirable.