Browsing by Author "Watermeyer, G S"

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    Birth weight and infant mortality in a Western Cape metropolitan area
    (1984) Rip, Michael R; Watermeyer, G S
    The nature of the environment, as well as an infant's weight at birth, constitute the major risk factors associated with infant death. It is for this reason that the infant mortality rate is universally recognized as an important indicator of the health status of children, the efficacy of the health services, and the level of social and economic progress. An infant's birth weight is regarded as the most important single indicator of growth and development during uterine life, and as such is frequently used to indicate maternal nutritional status. The greatest risks of mortality and morbidity exist for those infants who are born with a low birth weight ((2500 grams). Any analysis of infant mortality, therefore, requires a sound understanding of the influences of birth weight on mortality. In this study, birth weight and infant mortality data have been used to characterize maternal and infant health status within a Regional Health Scheme. The cross-linkage of birth and infant death certificates has permitted the identification of those maternal and infant characteristics associated with the greatest risks of death, as well as the calculation of one of the most important infant mortality statistics, namely birth weight-specific death rates. The cross-linkage process has facilitated the identification of certain factors which are affecting the levels of infant mortality. The development of a statistic (ratio) for better describing the birth weight distribution is presented. Such a statistic is shown to be of value for the geographical analysis of maternal health status. Linear regression analysis applied to the birth weight ratio, and infant mortality rate is able to compare the 'health status' of mothers and infants in separate geographic units within the region. Birth weight is shown to be an important intervening variable between the circumstances of pregnancy and infant death. This study provides an alternative perspective to the understanding and assessment of infant mortality and its spatial variation, as well as aiding the identification of possible points for future intervention. The technique presented forms a useful epidemiological basis for the implementation of more appropriate strategies for reducing infantile mortality and enhancing the evaluation of interventive programmes. Moreover, the application of medical geographical methods is shown to provide practical advantages to health administrators in that maternal and neonatal health priorities may now be more reliably defined, as well as for the determination of future services in the various geographical areas.
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    A liquid consumption survey of individuals in greater Cape Town
    (1986) Bourne, Lesley Thelma; Watermeyer, G S; Klopper, J
    There is no published data for the per capita consumption of water of individuals in South Africa. A daily rounded volume of 2 litres per person is usually taken as a working estimate from world wide data. As part of ongoing epidemiological studies into potential health effects of changes in the water supply to greater Town, water consumption patterns were ascertained. As health effects are often spatially ascribed to the place of residence of a person, it was necessary to ascertain how much water was drunk at home as well as away from home. Water consumed was divided into three classes: (i) water consumed from the tap, (ii) commercial beverages and (iii) water bound in food. A review of methods of conducting dietary surveys indicated that a 24-hour recall would be the most appropriate method. Two surveys on total dietary intake utilizing a 24-hour recall were carried out (n = 2 000 persons for each survey), one in winter and the ether in summer. The design of the survey involved a cluster sample of households that were representative of the socio-economic and demographic structure of greater Cape Town. Three pretested types questionnaires were administered by trained interviewers: (i) a placement questionnaire to describe the household composition, (ii) a recall questionnaire for individual adults and children and (iii) a recall questionnaire for babies. Particular attention was paid to the accurate ascertainment of the volumes of food and drink consumed as well as their preparation to facilitate accurate analysis. The water content of each food item was calculated by a computer program that utilized computerized food composition tables. The water consumption data was analyzed by sex, age, population group, income and the season of the year. Detailed graphs and tables are provided. Results were also standardized to the population of greater Cape Town. It was found that the difference in consumption between the White and "Coloured" population groups was greater than the difference between those people of high and low-income groups. The mean total water intake for Whites was 2.19 litres per day, while for "Coloureds" it was 1.26 litres per day. There is no obvious bias to account for this difference. The figures for protein consumed by the two groups, which was used as a control, are consistent with values reported in the literature. Summer consumption was higher than that during winter. The ratio of tap water consumed at home to total liquid consumed was approximately 0.5.
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    The role of the professional nurse in providing continuity of care for geriatric patients at Groote Schuur Hospital
    (1982) Dick, Judy; Watermeyer, G S; Meiring, P de V; Jacka, Ethnee
    Due to the fragmented structure of the health organisation in South Africa, there is often difficulty in assuring good co-ordination between in-patient and domiciliary health facilities. This results in the discharge of patients from hospital with poor prospects for the continuity of health care in the community. At Groote Schuur Hospital, approximately 44% of the hospital beds in the white section of the Hospital are occupied by patients in the age group of sixty-five years and over. This group of patients must be regarded as particularly vulnerable with regard to the transition of the care in a hospital to their own home for some of the following reasons: - * The nature of the disease - The chronic and recurrent nature of the degenerative diseases of old age often results in varying degrees of disability. in the aged patient. Many geriatric patients suffer from several unrelated clinical conditions, and thus there is a need to coordinate the many health services required. * Social circumstances - The aged population frequently live alone or with a frail relative, often in poor economic circumstances. * Re-admission rate - The geriatric re-admission rate following discharge is high. As the first principle of geriatric care is to restore independence, and to help patients live away from the hospital environment, the provision of extended care facilities for vulnerable patients is of utmost importance. A structured interview was used to assess the need for extended care facilities of 172 white patients over the age of 60 years who were discharged from Groote Schuur Hospital during March to May of 1981. An attempt was made to evaluate how effectively these needs were being met in the community following discharge. It was found that 34% of the patients interviewed were not getting the nursing care and support in the community which they needed to facilitate rehabilitation. The most vulnerable patients as regards aftercare were: - * The aged * The chronically ill * Patients who live alone or without social support * Patients whose illness leads to temporary or permanent disability * Patients hospitalised for prolonged periods. It was found that the patients interviewed were given insufficient preparation, while still in hospital, for the problems they would be faced with on discharge. No systematic policy exists to ensure that health care staff give adequate information to the patient on discharge from hospital. The ward sister was found to play a vital role in making the preparations for a patient's transfer from hospital to home. A questionnaire was designed to assess the Groote Schuur ward sisters' attitudes towards the importance of discharge planning. An analysis of the ward sisters' response indicated that great variation existed in the attitudes towards the importance of this task. An investigation into the existing community services for geriatric patients was undertaken. An attempt was made to assess the limitations and gaps which exist in the provision of services for the aged. Finally, the role of the recently established Department of Community Liaison at Groote Schuur Hospital was investigated. It was evident that the Community Liaison nurse had proved to be an invaluable member of the health team of a large, specialist hospital such as Groote Schuur. The activities of the Community Liaison nurse led to improved continuity of care for patients needing extended care facilities in the community.
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    Toxicological consequences of pesticidal use in the Republic of South Africa
    (1986) Fourie, H O; Brown, Alec C; Watermeyer, G S
    Chemicals used in agricultural activities, could possibly be the most potent group of compounds used on a regular basis by employees representing a significant fraction of the unskilled, economically active, labour market of a country. Certainly, such a statement will hold true for South Africa and probably for most Third World and developing states. All chemical compounds contain the inherent property of being toxic and/or hazardous. However, pesticides are chemicals intentionally used to kill. They are therefore not avoidable and in contrast to other chemicals are used only because of their ability to kill. As in most other countries in the world, poisoning in the Republic of South Africa is to be expected due to the use of pesticides. In the handling of pesticides, statistics show South Africa to be vulnerable to an appreciable number of deaths and poisoning cases. There could be a number of reasons for this phenomenon, two of them probably being ignorance and negligence on the part of officers in charge of handling pesticides, and perhaps the most important, the exploitation of unskilled labour in applying and handling pesticides. It is believed that the South African agricultural industry represents both the First and Third World and should thus be ideally suited for investigating: (1) acute intoxication due to chemicals used in the agricultural industry. It was found that the annual consumption of pesticides in the Republic of South Africa results in a dose of approximately 250 mg/m² which compares very favourably with consumption rates of developed countries. An analysis of the products registered indicates a total of 1 211 products containing 359 different active ingredients. The three chemical groups responsible for 73% of the poisoning cases (organophosphates 55%, carbamates 14%, organochlorines 4%) are with the exception of pyrethroids, also the chemicals most frequently formulated. Products containing these three chemical groups constitute only 41% of all formulated products, but are responsible for 73% of all intoxications. It is concluded that the poisoning rate by pesticides is appreciably higher than officially notified, and that the fatality rate could be two orders of magnitude higher than developed countries. A compendium - the first of its kind in South Africa for use by hospitals and clinical practitioners and containing trade names, chemical classification, active ingredients, toxicology, symptomatology and proposed treatment procedures for each product, is presented as an appendix. (2) chronic exposure to residues of agricultural products in the diet of South Africans is investigated. Food intake data was calculated from 24-hour dietary recall studies. Residues of only 4 compounds were present in 33 composite, ready-to-eat foods, consisting of 5 538 foodstuffs sampled over a period of one-year country wide, and representing 142 different food items categorised into 11 food groups. The residues found were well within acceptable levels and compare very favourably with those found in the diets of developed countries. It has to be concluded that possible chronic exposure due to agricultural chemical contaminants, to the white population at least, does not exist, and emphasises a sound regulatory policy towards the use of these chemicals in South Africa. (3) a hypothesis of this study that it is not possible that neither the inherent toxicities of pesticidal compounds, nor a paucity of knowledge about the toxicological, chemical and physical properties of these compounds could be mainly responsible for the numerous intoxications recorded annually. An epidemiological 400 case study (descriptive design), investigated the contribution by occupational, environmental, cultural and socio-economic variables to poisoning. The numerous effects by these variables are described and amongst many others, it is concluded that the recommendations of the World Health Organization to classify pesticides by hazard, is confusing to illiterate and semi-educated users and should not be recommended to developing countries.