US embassy cable - 05PRETORIA1306

UNCLAS SECTION 01 OF 03 PRETORIA 001306 
 
SIPDIS 
 
DEPT FOR AF/S; AF/EPS; AF/EPS/SDRIANO 
DEPT FOR S/OFFICE OF GLOBAL AIDS COORDINATOR 
STATE PLEASE PASS TO USAID FOR GLOBAL BUREAU APETERSON 
USAID ALSO FOR GH/OHA/CCARRINO AND RROGERS, AFR/SD/DOTT 
ALSO FOR AA/EGAT SIMMONS, AA/DCHA WINTER 
HHS FOR THE OFFICE OF THE SECRETARY,WSTEIGER AND NIH,HFRANCIS 
CDC FOR SBLOUNT AND EMCCRAY 
 
E.O. 12958:  N/A 
TAGS: ECON, KHIV, SOCI, TBIO, EAID, SF 
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH APRIL 1 ISSUE 
 
Summary 
------- 
 
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. 
 
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 
 
SIPDIS 
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. 
 
FRAZER