Black Population Groups Research Articles

Effectiveness and Treatment Outcome of ESWL as Intervention Method at Shaafi Hospital, Mogadishu-Somalia


 
 
 Renal stone is a most common clinical disorder affecting up to 5% of the general population in the USA. The prevalence of renal stone disease has been rising in both sexes, being estimated that about 5% of American women and 12% of men will develop a kidney stone at some time in their life, however, in certain areas of the world, as in the Middle East, the lifetime risk appears to be even higher, There has been heightened awareness of renal stone disease in children as well, Recurrence rates of 50% after 10 years and 75% after 20 years have been reported Epidemiological data on urolithiasis in sub-Saharan Africa are rare because research resources throughout most of the continent are poor. South Africa is an exception in this concern. Stone disease has been reported in several countries. Epidemiological factors in these regions are not unusual. However, in a few countries the disease is extremely rare. The absence of stones can be attributed to epidemiological factors in all regions except South Africa, where stone shortage arises because of racial differences between the white and black population groups. Routine urinary biochemical risk factors cannot account for this phenomenon. However, the protective capacity of urinary proteins may play a role in this regard The aim of this study were to investigate factors associated kidney stone and effectiveness and treatment outcome of ESWL as intervention method in shaafi hospital Mogadishu Somalia The specific objectives of this study were . To determine factors associated kidney stone at shaafi hospital. To asses availability and treatment outcome with renal calculi among adult patient in shaafi hospital in hodan district. Methodology used a descriptive cross-sectional design and the study area is shaafi hospital Mogadishu Somalia A total 40 respondents was purposively selected from 40 respondents The data were collected during 1-14 days may 2018 using structured questionnaire, . The data was compiled and analyzed by using SPSS version 20. The Result reveal that the majority of the respondents (65.0%) were male and the majority of the respondents (32.5%) were between 18-25 years and mostly respondent (70.0%) of the respondent said yes when asked the question saying do you eat food such as peanut red meat poultry eggs and seafood sugar sweetened foods that have the risk of kidney stone. (42.9%) of the respondent said red meat when asked the question saying if yes what food or diet. (50.0%) of the respondent said 1-2 litter of water when asked the question saying what is the level of your fluid or water intake. (55.0%) of the respondent said lower calceal when asked question saying The location of your kidney stone (65.0%) of the respondent were said 1-10mm when asking question saying what is the characteristic of the stone after the ESWL, intervention with size. The study recommends. To Changes in dietary habits, and changes in lifestyle and increase water intake To The composition of previous stone dietary advice will vary additional medication may be necessary for patient with high risk profile. To educate health workers to consult the patient with kidney stone to visit in the machine to increase awareness of the patient of important of machine during kidney stone.
 
 

Documented composition of cadaveric skeletal remains in the University of Cape Town Human Skeletal Collection, South Africa

The University of Cape Town Human Skeletal Collection is one of the oldest documented skeletal collections in South Africa. The skeletal remains housed in this collection have been used for a variety of studies, but no complete description of the composition of the collection currently exists in the published literature. The aim of this study is to provide a detailed description of the composition of the cadaveric collection to encourage use thereof by national and international researchers.As of 2016, the collection contained the skeletal remains of 343 cadaveric individuals, 163 of which have mostly complete crania and postcrania. The male to female ratio of the collection is approximately 3:2. White individuals constitute 70% of the collection, with smaller contributions by individuals of the Black and Coloured population groups. Most of the individuals in the collection were 60–90 years old at death, though the mean age of the Black and Coloured groups was much lower, likely due to differences in origin of the cadavers received by the Faculty of Health Sciences. The most common reported cause of death in the collection was circulatory disease, followed by neoplasms and respiratory disease.Despite differences in the composition of this collection and the provincial and national demographic profiles, the collection remains an invaluable resource for training and research in a wide variety of scientific fields.

Black living standards in South Africa before democracy: New evidence from height

Very little income or wage data were systematically recorded about the living standards of South Africa’s black majority during much of the 20th century. We used four data sets to provide an alternative measure of living standards – namely stature – to document, for the first time, living standards of black South Africans over the course of the 20th century. We found evidence to suggest that living standards in the first three decades of the century were particularly poor, perhaps because of the increasingly repressive labour policies in urban areas and famine and land expropriation that weighed especially heavily on the Basotho. The decade following South Africa’s departure from the gold standard, a higher international gold price and the demand for manufactured goods from South Africa as a consequence of World War II seem to have benefitted both black and white South Africans. The data also allowed us to disaggregate by ethnicity within the black population group, revealing levels of inequality within race groups that have been neglected in the literature. Finally, we compared black and white living standards, and revealed the large and widening levels of inequality that characterised 20th-century South Africa.
 Significance: 
 
 We provide the first long-run estimates of black living standards in South Africa and evidence of inter-group differences in the effects of 20th-century events and policies.

Differences in Sleep Duration among Four Different Population Groups of Older Adults in South Africa.

The study aims to investigate sleep duration in four different population groups in a national probability sample of older South Africans who participated in the Study of Global Ageing and Adult Health (SAGE) Wave 1. A national population-based cross-sectional study with a sample of 3284 aged 50 years or older in South Africa was conducted in 2008. The questionnaire included socio-demographic characteristics, health variables, and self-reported sleep duration. Results indicate that White Africans compared to other population groups had the lowest mean sleep duration (7.88 h among men and 7.46 h among women). The prevalence of short sleep was the highest among both men and women among the White African (18.8% in men and 16.9% in women) and Indian or Asian African population groups (14.5% in men and 17.1% in women), and lowest among both men and women in the Black African (7.0% in men and 6.5% in women) and multi-ancestry population groups (15.6% in men and 12.7% in women). The prevalence of long sleep was among both men and women the highest in the Black African population group (56.2% in men and 58.5% in women), and the lowest in the White African population group (36.4% in men and 24.3% in women). In a Poisson regression model, adjusted for sociodemographics and chronic disease status, coming from the male and female White African population group was associated with short sleep. In addition, coming from the Indian or Asian African population group was associated with short sleep. No population group differences were found regarding long sleep prevalence. White Africans reported more short sleep duration than the other population groups, while there were no racial or ethnic differences in long sleep. White Africans are more likely to have sleep durations that are associated with negative health outcomes. An explanation of the high short sleep prevalence among White Africans may be related to their racial or ethnic minority status in South Africa.

Influence of social media marketing communications on young consumers’ attitudes

PurposeThis paper aims to examine the influence of interactive social media marketing communications on teenagers’ cognitive, affective and behavioral attitude components in South Africa. The study also considers the impact of a number of additional factors such as usage (access, length of usage, log-on frequency, log-on duration and profile update incidence) and demographic (gender, age and population group) variables on young consumers’ attitudes toward social media marketing communications.Design/methodology/approachA survey was used via three self-administered questionnaires, which were distributed to over 13,000 learners in the age range of 13-18 years (Generation Z cohort) at colleges and high schools in South Africa. A generalized linear model was used for statistical data analysis.FindingsThe study ascertained that social media marketing communications had a positive on each attitude component among adolescents, but on a declining scale, which correlates to the purchase funnel. The results also revealed that teenagers who used social media for long time periods; updated their profiles frequently and were from the Colored and Black population groups, displayed the most favorable attitudinal responses to social media marketing communications.Research limitations/implicationsSocial media was collectively analyzed and did not consider the number of different social media types, which could be examined individually. This investigation only considered the Generation Z cohort, but other cohorts to attitudes toward social media marketing communications could also be assessed.Practical implicationsCompanies and their brands should consider using and/or adapting their strategies based on the declining impact of social media marketing communications on the hierarchical attitude stages among young consumers and the divergent influence on usage and demographic variables when targeting the lucrative and technologically advanced, but capricious, Generation Z consumers.Originality/valueThis research established that social media marketing communications had a favorable influence on cognitive, affective and behavioral attitude components among young consumers, but on a declining scale, which is in congruence with the purchase funnel model. This investigation also makes an important contribution to attitudinal research in developing countries, where there is a lack of research in social media marketing communications.

The influence of HIV infection on the age dependence of squamous cell carcinoma of the skin in South Africa.

Cancer incidence typically increases with age, but it is not known whether ethnic characteristics influence the age dependence of squamous cell carcinoma of the skin (SCC). (i) To determine the age dependence of SCC in the black African, coloured and white population groups of South Africa (SA); and (ii) to show whether any differences in the rate of change of age dependence could be influenced by diversity in behaviour and lifestyle, especially with regard to the prevalence of HIV infection, rather than by a fundamental variation in cancer biology between the populations. Linear regression analysis was applied to the logarithm of the age-specific incidence rates for SCC v. the logarithm of age between 35 and 74 years. The slopes of the regression (age exponent) were compared for each subset of gender, population group and year of diagnosis (between 2000 and 2010). The most notable feature was the low value of the age exponent in both male and female black African compared with the white and coloured populations. This finding could be explained in part by the difference in the prevalence of HIV infection in the black African population group compared with the white and coloured population groups. The prevalence of HIV infection in black Africans in SA tends to decrease the apparent age component in SCC compared with the white and coloured population groups. Other factors relating to lifestyle and behaviour that differ between the population groups are also likely to influence the age component in SCC.

Geographic patterns of end-stage renal disease and kidney transplants in the Midwestern United States

This research analyzes geographic patterns of ESRD incidence and kidney transplantation at county level in an area that covers 11 states in the Midwestern US from 2004 to 2011. We investigate whether variations in ESRD incidence exist among white, black, and Native American population groups, and the degree to which disparities existed with respect to access to kidney transplantation, and with respect to rural and urban counties. Spatial clusters of ESRD incidence rates are detected using global Moran's I and local Getis-Ord Gi∗ statistic. Spatial accessibility to transplant centers is evaluated using the enhanced two-step floating catchment area method where dissimilarities due to varying travel times and ESRD incidence rates result in differences in spatial access among the groups. Results show that while similar age-adjusted ESRD incidence rates hold for white and black population groups in urban counties, the kidney transplant rate is 73% lower among black patients than for whites in the study area. A lack of transplant centers in locations that correspond to strongly clustered age-adjusted ESRD incidence rates in southern Missouri and central South Dakota, contribute to lower spatial access indices in these counties. The results of the analyses capture varying patterns of ESRD incidence rates and kidney transplants in this Midwestern region and highlight spatial disparities for certain population groups.

Hematologic malignancies in South Africa 2000-2006: analysis of data reported to the National Cancer Registry.

Little is known about the incidence patterns of hematologic malignancies in Sub‐Saharan Africa, including South Africa. We estimated incidence rates of pathology‐confirmed adult cases of leukemia, myeloma and related diseases (myeloma), Hodgkin lymphoma (HL), and non‐Hodgkin lymphoma (NHL) reported to the National Cancer Registry of South Africa (NCR) between 2000 and2006, by age, gender, and population group (Black, White, Coloured, Asian/Indian). Gender‐specific age‐standardized rates were calculated overall and by population group and incidence rate ratios (IRRs) were estimated using Poisson regression models. Between 2000 and 2006, there were 14662 cases of leukemia, myeloma, HL, and NHL reported to the registry. Incidence rates of reported hematologic malignancies were generally 20–50% higher among males than females. Our analyses suggested marked differences in the rates of reported hematologic malignancies by population group which were most pronounced when comparing the White versus Black population groups (IRRs ranging from 1.6 for myeloma to 3.8 for HL for males and females combined). Challenges related to diagnosis and reporting of cancers may play a role in the patterns observed by population group while the set‐up of the NCR (pathology‐based) could lead to some degree of under‐ascertainment in all groups. This is the first country‐wide report of the incidence of hematologic malignancies in South Africa. Despite challenges, it is important to analyze and report available national cancer incidence data to raise awareness of the cancer burden and to characterize patterns by demographic characteristics so as ultimately to improve the provision of cancer‐related health care.

BRCA1, BRCA2 and PALB2 mutations and CHEK2 c.1100delC in different South African ethnic groups diagnosed with premenopausal and/or triple negative breast cancer.

BackgroundCurrent knowledge of the aetiology of hereditary breast cancer in the four main South African population groups (black, coloured, Indian and white) is limited. Risk assessments in the black, coloured and Indian population groups are challenging because of restricted information regarding the underlying genetic contributions to inherited breast cancer in these populations. We focused this study on premenopausal patients (diagnosed with breast cancer before the age of 50; n = 78) and triple negative breast cancer (TNBC) patients (n = 30) from the four South African ethnic groups. The aim of this study was to determine the frequency and spectrum of germline mutations in BRCA1, BRCA2 and PALB2 and to evaluate the presence of the CHEK2 c.1100delC allele in these patients.MethodsIn total, 108 South African breast cancer patients underwent mutation screening using a Next-Generation Sequencing (NGS) approach in combination with Multiplex Ligation-dependent Probe Amplification (MLPA) to detect large rearrangements in BRCA1 and BRCA2.ResultsIn 13 (12 %) patients a deleterious mutation in BRCA1/2 was detected, three of which were novel mutations in black patients. None of the study participants was found to have an unequivocal pathogenic mutation in PALB2. Two (white) patients tested positive for the CHEK2 c.1100delC mutation, however, one of these also carried a deleterious BRCA2 mutation. Additionally, six variants of unknown clinical significance were identified (4 in BRCA2, 2 in PALB2), all in black patients. Within the group of TNBC patients, a higher mutation frequency was obtained (23.3 %; 7/30) than in the group of patients diagnosed before the age of 50 (7.7 %; 6/78).ConclusionThis study highlights the importance of evaluating germline mutations in major breast cancer genes in all of the South African population groups. This NGS study shows that mutation analysis is warranted in South African patients with triple negative and/or in premenopausal breast cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1913-6) contains supplementary material, which is available to authorized users.

Transformation of a cadaver population: Analysis of a South African cadaver program, 1921-2013.

Anatomy has served as a cornerstone in the training of various allied and clinical disciplines and has traditionally been based on dissection of the human body. Thus, to pursue this method of teaching and learning, access to cadavers is of continuing importance. Over a significant period of time unclaimed cadavers have performed an essential role in the teaching of anatomy in South Africa and in Africa. As recent cadaver numbers were declining at the School of Anatomical Sciences, University of the Witwatersrand, Johannesburg and difficulty in procurement was being experienced, the purpose of this study was to critically evaluate the composition of our cadaver population over time so as to provide possible strategies to arrest the decline. A retrospective, quantitative analysis of cadaver records from the School of Anatomical Sciences between 1921 and 2013 was undertaken. Analysis included a comparison of Poisson counts and Fischer's exact test. A significant decrease in the number of cadavers received during the period 2000-2013 and a slow bequest program over the same period of time has led to concerns about the sustainability of teaching anatomy through dissection. Decreases in the numbers of males and cadavers of the black population group occurred between 1990 and 2013, and of bequests from 2000 to 2013. An influence on the cadaver population from a changing political climate and change in socioeconomic status of part of the population was perceived. Changes in sex and population group of the cadavers may have a long-term effect on teaching and research.

Prevalence and acceptability of male circumcision in South Africa.

The objectives of the current national study were to determine the rates of self-reported circumcision among South African men and, more importantly, evaluate the acceptability of male circumcision in South Africa by uncircumcised adult men and all adult women. The study based on a population-based survey included a nationally representative subgroup of 6654 men aged 15 years and older who where included in the analysis on male circumcision prevalence, and a subgroup of 6796 women aged 15 to 49 years who were included in the analysis on male circumcision acceptance. An overall prevalence of self-reported male circumcision of 42.8% was found. Among the Black African population group the prevalence of male circumcision was 48.2%, 32.1% were traditionally and 13.4% were medically circumcised. Among males not circumcised 45.7% of 15-24 years olds indicated that they would consider being circumcised compared to 28.3% among 25-49 years olds. In multivariate analysis among non-circumcised men Black African and Coloured population groups and having heard of the HIV protective effect of male circumcision were significant predictors for male circumcision acceptability, and among women with a non-circumcised sexual partner, Black African and Coloured population groups and higher education were predictors for male circumcision acceptability. The study found high rates and high acceptability of male circumcision. Findings associated with the acceptability of male circumcision can be used to increase awareness of the benefits of male circumcision for HIV prevention.

Comparison of a quantitative Real-Time PCR assay and droplet digital PCR for copy number analysis of the CCL4L genes

The controversy surrounding the findings that copy number variation, of the CCL3 encoding genes, influences HIV-1 infection and disease progression has been in part attributed to the variable results obtained from methods used for copy number evaluation. Like CCL3, the genes encoding the CC chemokine CCL4, also a natural ligand of the CCR5 receptor, are found to occur in population-specific multiple copy number and have been shown to play a protective role against HIV-1. This study evaluated the standard method of quantitative Real-Time PCR (qPCR) and droplet digital PCR (ddPCR) for CCL4L gene copy number determination. The CCL4 encoding genes are CCL4, occurring in two copies per diploid genome (pdg), and the non-allelic CCL4L genes, comprised of CCL4L1 and CCL4L2, which are both found in multiple copies pdg. Copy number of CCL4L, CCL4L1 and CCL4L2 was determined in a cohort of HIV-1-uninfected individuals from the South African Black (n=23) and Caucasian (n=32) population groups using qPCR and ddPCR. A stronger correlation between the number of CCL4L copies and the sum of CCL4L1 and CCL4L2 copies generated by ddPCR (r=0.99, p<0.0001) compared to qPCR (r=0.87, p<0.0001) was observed. Real-Time qPCR exhibited greater inaccuracy at higher copy numbers which is particularly relevant to our cohort of Black individuals who have a higher range of CCL4L copies (3–6) compared to Caucasians (0–4) and a higher population median (4 and 2, respectively). Medians and ranges of CCL4L1 (Black: 2, 0–4, Caucasian: 0, 0–2) and CCL4L2 (Black: 2, 1–5, Caucasian: 2, 0–3) were also higher in the Black population. Droplet digital PCR was shown to be a far superior method to qPCR for assessment of CCL4 gene copy number variation, the accuracy of which is essential for studies of the contribution of variable gene copy number to phenotypic outcomes of host infection and disease course.

Oral squamous cell carcinoma in a South African sample: Race/ethnicity, age, gender, and degree of histopathological differentiation.

The purpose of this retrospective study was to investigate differences between black and white persons with oral squamous cell carcinoma (OSCC) with regard to age, gender, oral site affected, and histopathological degree of differentiation; and to compare these clinicopathological parameters between persons younger and older than 40 years in a South African population sample from the greater Johannesburg area. The histopathological reports of 510 cases of OSCC during the period 1995-2002 were retrospectively evaluated, and the data regarding age, gender, ethnicity/race, oral site affected, and degree of histopathological differentiation were recorded and statistically analyzed for differences between black and white persons, and between persons younger and older than 40 years of age. Statistically significantly, black persons were diagnosed with OSCC at a younger mean age (57 years) than white persons (61 years) (P=0.0086). The difference between male: female (M:F) ratio in black (3.74:1) and white persons (1.96:1) was statistically significant (P=0.0041). White persons had a significantly higher proportion of SCC of the lower lip than black persons (P<0.0001). OSCC was diagnosed at a younger age in black than in white persons; the proportion of black males in the black population group was greater than that of white males in the white population group; and the proportion of SCC of the lips was higher in younger than in older persons.

Cutting the apron strings: the South African experience of decolonisation

Decolonisation is a recurring constitutional and political theme in the process of change and reform in South Africa’s history during the 20th century. The constitutional emancipation of the erstwhile Union of South Africa and the subsequent internal decolonisation of designated black ethnic population and cultural groups, are two kindred processes which have interesting similarities, but also important differences. The former involved British Imperialism, the latter involved Afrikaner Nationalism and African Nationalism. The former was a natural, legitimate and spontaneous process, the latter was an artificial process that was induced by Afrikaner Nationalism, that was spurned internationally and domestically by the the international community of nations and indigenous people of South Africa respectively.The article examines the legitimacy of the process of the decolonisation of the Union of South Africa resulting in its independence, followed by the adoption of a republican form of government. In contrast, a comparison is made with the controversial and questionable evolution of the Bantustans, which emerged out of the erstwhile native reserves, a stratagem designed in effect to thwart the liberation struggle for a truly democratic form of government for all the people of South Africa. This pseudo decolonisation was an analogous process to that of genuine decolonisation. The former involved political fragmentation, whatever it was designated, that in effect, denied to the indigenous people, freedom and liberation for decades. As an odyssey it was a very protracted and painful process. Ultimately, in a belated and circuitous manner, after the inordinate suffering and oppression of South Africa’s indigenous people, a genuine democracy in a unified and consolidated state for all the people of South Africa was to transpire. This was liberation and not decolonisation, and was the final stage in the historic and traumatic process for South Africa.It is also argued that only with the inception of the Interim Constitution, following the first historic democratic election of 27 April 1994, did South Africa and its people adopt an authentic democratic and republican constitution.Keywords: Union of South Africa, Status, dominions, decolonisation, liberation movements, Afrikaner nationalism, African nationalism.

MicroRNA Polymorphisms and Environmental Smoke Exposure as Risk Factors for Oesophageal Squamous Cell Carcinoma

MicroRNAs (miRNAs) and related polymorphisms have been implicated in the susceptibility to oesophageal squamous cell carcinoma (OSCC). In our study, three miRNA-related SNPs: rs6505162 A>C (pre-miRNA of miR-423), rs213210 A>G (3’UTR of miR-219-1) and rs7372209 C>T (5’UTR of miR-26a-1) were investigated in the Black and Mixed Ancestry population groups in South Africa. The potential cumulative effects of these SNPs, as well as gene-environment interactions were also analysed. In Blacks, rs6505162 A>C was associated with OSCC under dominant, additive and recessive models with odds ratios (ORs) 1.353, 1.404, and 2.858, respectively. This locus showed very strong interactions with smoke inhalation from burning wood or charcoal used for heating and cooking in very poorly ventilated areas (OR(GE)=7.855, P(GE)=9.17*10-10 in the Black group). Furthermore, the miR-423-3p level was 1.39 fold up-regulated in tumour tissues compared to the adjacent normal tissue (paired t-test P value 0.0087). SNP-SNP interaction between rs2132210 and rs7372209 was found in both Black and Mixed Ancestry subjects. The AArs213210-CTrs7372209 genotype had a protective effect on OSCC risk (in the Black, OR=0.229, P=0.012; and the Mixed Ancestry groups, OR=0.230, P=0.00014). This study is the first to link SNPs in miR-423 together with environmental smoke exposure to risk for developing OSCC.

Fruit and vegetable intake and associated factors in older adults in South Africa

Background and objective: Numerous studies support the protective effect of high fruit and vegetable (FV) consumption on chronic disease risk, mainly against cancer and cardiovascular diseases. Compared with younger adults, older people experience additional health, social, and environmental conditions that affect dietary intake. To identify those additional dimensions and examine them in association with FV intake, data on 3,840 participants in the Study of Global Ageing and Adults Health (SAGE) in South Africa were analyzed.Methods: We conducted a national population-based cross-sectional study in 2008 with a sample of 3,840 participants, aged 50 years or older, in South Africa. The questionnaire included questions on socio-demographic characteristics, health variables, anthropometry, and blood pressure measurements. Multivariable regression analysis was performed to assess the associations between socio-demographic factors, health variables, and inadequate FV consumption.Results: Overall prevalence rates of insufficient FV intake were 68.5%, 64.8% among men and 71.4% among women, with a mean intake of 4.0 servings of FV among older adults (50 years and older). In multivariable analysis, coming from the Black African or Colored population group, lower educational level and daily tobacco use were associated with inadequate FV intake.Conclusions: The amount of fruit and vegetables (FVs) consumed by older South African participants was considerably lower than current recommendations (daily intake of at least five servings; 400 g). Public education and campaigns on adequate consumption of FVs should be promoted targeting lower educated and Black African and Colored population groups.

Medical inpatient mortality at Groote Schuur Hospital, Cape Town, South Africa, 2002-2009

Despite the challenges facing healthcare in South Africa, empirical insights into the performance of healthcare services over time are scarce. We analysed first admissions of adult medical inpatients to Groote Schuur Hospital, Cape Town, from January 2002 to July 2009. Data included age, sex, medical specialty, and date of admission and discharge. We used population group and hospital billing codes as proxy measures for socio-economic status (SES). We calculated the duration of stay in days from the date of admission to discharge, and inpatient mortality rates per 1 000 patient days. Poisson regression was used to estimate mortality rate ratios (MRR) in unadjusted analysis and after adjusting for potential confounders. There were 42 582 first admissions. Patient demographics shifted towards a lower SES. Median age decreased from 52 years in 2002 to 49 years in 2009, while patients aged 20 - 39 years increased in proportion from 26% to 31%. The unadjusted proportion of admissions which resulted in in-hospital deaths increased from 12% in 2002 to 17% in 2009. Corresponding mortality rates per 1 000 patient days were 17.0 (95% confidence interval (CI) 15.9 - 18.3) and 23.4 (95% CI 21.6 - 25.4), respectively (unadjusted MRR 1.37; 95% CI 1.23 - 1.53). Annual increases in mortality rates were highest during the first 2 days following admission (increasing from 30.1 to 50.3 deaths per 1 000), and were associated with increasing age, non-paying patient status, black population group and male sex, and were greatest in the emergency ward (adjusted MRR 1.73, comparing 2009 with 2002; 95% CI 1.49 - 2.01). Increasing medical inpatient mortality rates at a large South African academic hospital were most marked during the first 2 days after admission and appeared greatest among emergency medical inpatients.

Age structural transition in South Africa

This chapter deals with the current age structure and the age structural transition (AST) underway in South Africa. We have used the national Census data for 1996 and 2001 and the Community survey data for 2007. In 2007, 31 percent of the population was enumerated below 15 years of age, 64 percent between 15- 64 and 5.4 percent 65+ implying the early stages of aging process. The median age in 2007 is 24.3 years, increased from 23 years in 1996. The proportion of young dependents is declining whereas that of the economically active and aged populations are increasing. Generally, the Black population appears younger and the Whites older. The other two ethnic groups are placed in the middle. This is, perhaps, a reflection of the differential fertility across the ethnic groups. The proportion of labour force population in 2007 is the highest for Asians & Indians followed by Whites; and the lowest for Blacks. So far as the proportion of the aged is concerned, Whites lead relatively high (12.4 %) as compared to coloured and Black population groups. During 1996-2007, the age structural transition for the total population is only marginal in South Africa. The median age of the total population grew from 23 years to 24.3 years, an increase of 5.6 percent. The female median age grew from 24.5 to 25.2 years, slightly better than that of males. The old age population has increased by 12.5 percent during the same period along with the global trend of female advantage. Again, the labour force population has increased by 5.5 percent. AST is highest for the white population, followed closely by Asians & Indians. This calls for continued higher investments in primary and secondary education, health care service delivery including reproductive health and social security. Again, for a country like South Africa where unemployment is quite high, the enormity of labour force (64%) has to be viewed seriously. Rapid employment generation, especially for the weaker groups, is the key. Further, one fifth (20.4 %) of the population is in the 15-24 years age group which is the target group for tertiary education. The slow process of AST among Black population warrants for preferential resource allocations especially in the areas of reproductive health and employment.

Bioactive androgens and glucuronidated androgen metabolites are associated with subcutaneous and ectopic skeletal muscle adiposity among older black men

Aging is associated with declining serum levels of androgenic hormones and with increased skeletal muscle fat infiltration, an emerging risk factor for type 2 diabetes mellitus (T2DM). Androgens regulate fat mass and glucose homeostasis, but the effect of androgenic hormones on skeletal muscle fat infiltration is largely unknown. Thus, the aim of the current study was to examine the association of serum androgens and their precursors and metabolites with skeletal muscle fat infiltration and T2DM in a black male population group at high risk of T2DM. Serum androgens, estrogens, and androgen precursors and metabolites were measured using mass spectrometry; and calf skeletal muscle fat distribution (subcutaneous and intermuscular fat; skeletal muscle density) was measured using quantitative computed tomography in 472 Afro-Caribbean men 65 years and older. Bioactive androgens, testosterone, free testosterone, and dihydrotestosterone were associated with less skeletal muscle fat infiltration (r = −0.14 to −0.18, P < .05) and increased skeletal muscle density (r = 0.10 to 0.14, P < .05), independent of total adiposity. In addition, glucuronidated androgen metabolites were associated with less subcutaneous fat (r = −0.11 to −0.15, P < .05). Multivariate logistic regression analysis identified an increased level of 3α-diol-3 glucuronide (odds ratio = 1.38, P < .01) and a decreased level of dihydrotestosterone (odds ratio = 0.66, P < .01) to be significantly associated with T2DM. Our findings suggest that, in elderly black men, independent of total adiposity, bioactive androgens and glucuronidated androgen metabolites may play previously unrecognized role in skeletal muscle fat distribution. Longitudinal studies are needed to further evaluate the relationship between androgens and androgen metabolites with changes in skeletal muscle fat distribution with aging and the incidence of T2DM.

Sexual Behaviour, HIV Status, and HIV Risk among Older South Africans

The aim of this study was to conduct a secondary analysis on sexual behaviour, HIV status and HIV risk and co-morbidity among older South Africans using the South African 2005 HIV prevalence and behaviour survey. A multistage probability nationally representative sample involving 3795 male and female respondents, aged 50 years or older was selected. About 41.1% had been sexually active in the past 12 months and 35.9% in the past month. Men (63.1%) were significantly more sexually active than women (29.8%). Having more than one sexual partner in the past 12 months was significantly more prevalent among men (4.9%) than among women (0.2%) 50 years and above. The overall HIV prevalence was 5.8% and it was significantly higher among the rural and less educated Black African population group than among the urban, educated and non-Black African population group. Among men the HIV prevalence seemed to decline with age, while HIV prevalence was similar across age groups among women. In multiple regression analysis, older age, being female, rural residence, lower educational level, receiving social grants or pension, and low HIV risk perception were associated with HIV risk behaviour. The study contributes to the understanding of the epidemiology of HIV infection in older individuals which is critical for intervention efforts.