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Viewing cable 06PRETORIA2249, SOUTH AFRICA PUBLIC HEALTH June 2 2006 ISSUE

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Reference ID Created Released Classification Origin
06PRETORIA2249 2006-06-01 14:44 2011-08-24 01:00 UNCLASSIFIED Embassy Pretoria
VZCZCXRO4797
RR RUEHDU RUEHJO RUEHMR
DE RUEHSA #2249/01 1521444
ZNR UUUUU ZZH
R 011444Z JUN 06
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 3767
INFO RUCNSAD/SOUTHERN AFRICAN DEVELOPMENT COMMUNITY
RUCPDC/DEPT OF COMMERCE WASHDC
RUEATRS/DEPT OF TREASURY WASHDC
RUEAUSA/DEPT OF HHS WASHDC
RUEHPH/CDC ATLANTA GA 1159
UNCLAS SECTION 01 OF 04 PRETORIA 002249 
 
SIPDIS 
 
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 KHILL 
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, NIH/HFRANCIS 
CDC FOR SBLOUNT AND DBIRX 
 
E.O.  12958: N/A 
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH June 2 2006 ISSUE 
 
Summary 
------- 
 
1.  Summary.  Every two weeks, Embassy 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 Child Mortality High, Shortage 
of South African Nurses, Student Aid Funds Lose R8 Million 
Annually, KZN Survey Shows High Risk Behaviors, MRC Survey 
Shows Overweight Children in Primary School, Modeling Center 
Opens at Stellenbosch, High Cost of HIV/AIDS to Business 
Sector, UNGASS Will Hear Two Sides of SA AIDS Story, SA Health 
Costs to Increase, and Pediatric HIV/AIDS.  End Summary. 
 
South African Child Mortality High 
---------------------------------- 
 
2.  South Africa is one of only seven countries on the 
continent where child deaths are rising, reversing a steady 
drop that began in the mid-1990s.  Angola, Burundi and Somalia, 
have been more successful in curbing child deaths than South 
Africa, while Botswana, Zimbabwe, Zambia, Kenya, Rwanda and 
Swaziland also have rising child mortality rates.  High rates 
of poverty and HIV/AIDS take a toll on South African youth. 
Every hour, 10 children under five years of age die.  Almost 
one in 10 children will not survive to see their fifth 
birthday.  For most South African children dying before the age 
of five, HIV/AIDS, diarrhea, respiratory tract infection and 
malnutrition are the primary causes of death.  According to the 
Medical Research Council, 40% of children who die before they 
are five die as a result of HIV/AIDS.  Another 30% die as a 
result of diseases of poverty.  For the poorest, basics such as 
clean water and fuel can be hard to obtain.  In South Africa, a 
little over half of all children live in rural areas, where the 
challenge of survival is often related to the most basic of 
needs.  The Children's Institute has conducted research near 
Butterworth, the fourth poorest district in the Eastern Cape 
with an average monthly expenditure of R800 ($125, using 6.4 
rands per dollar) per household.  Most of the roads are unpaved 
and impassable during summer rains.  The Department of Health's 
mobile clinics cannot get through when it rains, leaving about 
3,000 people with no access to health care services. The 
schools complain that bread trucks for the feeding scheme 
cannot get through either.  The area has no water, electricity, 
sanitation services.  While a few residents have dug their own 
pit latrines and bought zinc or ready-made top structures, the 
majority use the bucket system, open field or the ruins of old 
buildings for their sanitary facilities.  According to a survey 
of child care providers in October 2005, more than one third of 
all the children had been sick in the previous three months 
with one or more of the following diseases: asthma, flu, 
diarrhea or vomiting.  One in 10 had suffered from diarrhea or 
vomiting, and one in 10 was an asthma sufferer due to 
respiratory problems associated with smoke inhalation from 
cooking fires.  Younger children were most likely to suffer 
from these health problems, and almost half of all children 
under six years had ill health.  Source:  IRIN Plus News, May 
25 and The Pretoria News, May 29. 
 
Shortage of South African Nurses 
-------------------------------- 
 
3.  The number of South African nurses increase 10% a year 
while the population increases by 14%, resulting in a gradual 
shortage of fully-qualified nurses.  South African Nursing 
Council (SANC) statistics from a population survey dated 
December 31, 2005 showed there was one auxiliary nurse for 
every 577 people in Gauteng Province, the most populated and 
wealthiest province in South Africa.  The South African nursing 
profession lacks nurses trained for intensive care units, 
operating rooms, midwifery and mental health.  Although the 
SANC register reflected that there were 99,534 professional 
nurses or midwives, 37,085 enrolled nurses or midwives and 
54,650 enrolled nursing auxiliaries, the SANC could not confirm 
that these nurses were working in the South African health care 
system.  The majority of professional nurses in South Africa 
were over the age of 40 years which means they will be retiring 
in the next 10 years.  Some of the reasons for the shortages 
include poor working conditions, a high rate of violence and 
 
PRETORIA 00002249  002.2 OF 004 
 
 
abuse in the workplace, lack of training opportunities and the 
burden of HIV/AIDS as nurses are now terminal caregivers. 
Source:  IOL, May 12. 
 
Student Aid Funds Lose R8 Million Annually 
------------------------------------------ 
 
4.  The National Students' Financial Aid Scheme (NSFAS) writes 
off R8 million ($1.25 million) per year in outstanding loans 
because of student deaths, half of which are estimated to be 
AIDS-related.  Other causes of death in the student population 
are traffic casualties and heart attacks, but most are from 
opportunistic infections, such as tuberculosis and pneumonia 
which are closely related to HIV/AIDS.  There is no 
comprehensive study on the student HIV/AIDS prevalence rates; 
however, some universities have conducted their own surveys. 
In 2000, the University of Durban-Westville, now part of the 
larger University of KwaZulu-Natal, found that HIV/AIDS 
infections rate were 26% among women and 12% among males at the 
university.  The university is one of the few South African 
universities that offer free antiretrovirals to infected 
students.  Source:  City Press, May 21. 
 
KZN Survey Shows High Risk Behaviors 
------------------------------------ 
 
5.  A survey of 1,600 students in the Kwa-Zulu Natal province 
shows increasingly risky behavior in students aged 16-18.  The 
University of KwaZulu-Natal's Sports Science Department 
sponsored the survey investigating the habits of high school 
students in the province.  Approximately half (50.3%) of the 
students drank, with students aged 17 consuming the most 
alcohol.  Only 30% of students engaged in safe sex.  Roughly 
17% of students smoked while 12.2% carried weapons to school 
(10% carried knives and nearly 2.5% carried guns).  Only 60% 
are actively involved in sports, with 77.4% of students 
watching television 3 or more times per week.  Source:  Sunday 
Times, May 21. 
 
MRC Survey Shows Overweight Children in Primary School 
--------------------------------------------- --------- 
 
6.  A new study of South African primary school children, 
published in the South African Medical Journal, shows that 25% 
of girls and 17% of boys are either overweight or obese.  The 
research found that 17.9% of girls and 14% of boys were 
overweight and 4.9% of girls and 3.2% of boys were obese.  The 
study points to a future sedentary South African population 
having an increased risk of chronic diseases such as diabetes 
and hypertension.  The study used body mass index, BMI or 
weight divided by height squared, to calculate obesity, with a 
BMI above 25 overweight and above 30 obese.  Recent research by 
the Medical Research Council found the 22% of children between 
the ages of one and nine were either overweight or obese. 
Source:  Business Day, May 23. 
 
Modeling Center Opens at Stellenbosch 
------------------------------------- 
 
7.  The South Africa Center of Excellence in Epidemiological 
Modeling and Analysis (SACEMA) opened at Stellenbosch 
University after two years of planning.  SACEMA is a multi- 
disciplinary project combining mathematics, medical research, 
statistics, and biology in order to find out how diseases are 
spread in Africa.  The Center will focus on HIV/AIDS, 
tuberculosis and malaria and will provide interested 
governments advice on formulating health policies.  The 
Center's director is Professor John Hargrove, a biologist who 
specialized in research on the tsetse fly.  Source:  Cape 
Argus, May 22. 
 
High Cost of HIV/AIDS to Business Sector 
---------------------------------------- 
 
8.  Several studies have detailed the direct impact of HIV/AIDS 
on the business sector.  In a survey on absenteeism in Gauteng 
Province's tourist industry, Empowerment Concepts (EC) found 
that the number of employees taking days off has risen sharply 
and the increase is directly correlated with the rise in HIV 
prevalence levels.  Sick leave levels are expected to reach 
5.3% of working days by 2012, according to EC research.  For 
 
PRETORIA 00002249  003 OF 004 
 
 
each direct working day lost to illness, another three are lost 
to indirect costs.  Almost 50% of absenteeism is due to 
respiratory tract infections, 14.5% to gastro-intestinal 
infections, and 10.4% to ear-nose-throat illness.  About one- 
third of the workforce that took sick leave was aged 26-30.  By 
2012, HIV-related direct and indirect costs to business will 
reach 26% of payroll costs compared with 8.4% in 2003 and 1.9% 
in 1998.  Another research firm, CAM Solutions, estimated that 
increased absenteeism by infected employees cost R12 billion 
($2 billion) in 2005.  Daimler Chrysler reported that its 
direct financial cost of sick leave was 4% of payroll, while 
AngloGold Ashanti expects that HIV/AIDS-related absenteeism 
will cost 17% of payroll by 2009.  These cost projections do 
not include the potential provision of ARV treatment, which has 
been expensive for those employees having no medical insurance. 
Brad Mears, Chief Executive Officer of the SA Business 
Coalition on HIV/AIDS cites two differing business approaches 
to the pandemic.  A `rational' approach is to pay attention 
only to the performance of the business without considering the 
long-term impact, in the belief that HIV has no effect on 
operations.  He believes most small companies use this 
approach.  A `reasonable' approach looks at the long term 
impact of the disease and that dismissing infected workers 
would merely add to the unemployed, and undermining security of 
the business environment.  Source:  Financial Mail, May 26. 
 
UNGASS Will Hear Two Sides of SA AIDS Story 
------------------------------------------- 
 
9.  At the United Nation General Assembly Special Session 
(UNGASS) on AIDS, delegates will hear two opposing views of 
South African HIV/AIDS policies.  Health Minister Tshabalala- 
Msimang will present the government's Strategic Plan for 2000 
to 2005 and the Comprehensive Plan for Management, Care and 
Treatment of HIV/AIDS.  According to these reports, by the end 
of March 2006, over 130,000 patients had started antiretroviral 
(ARV) treatment in government facilities.  She will also state 
that the Health Department has exceeded its target of 
establishing at least one service facility for AIDS-related 
care and treatment in all of the 53 health districts before the 
end of March 2005.  The Treatment Action Campaign (TAC), not an 
official part of the South African delegation this year, will 
report that the government's reports are too optimistic. 
According to TAC, the government's report does not acknowledge 
the extent of HIV/AIDS on South Africa, and ignores the fact 
that there are 1,500 new infections daily or that 800,000 need 
ARV treatment.  TAC also criticizes the absence of treatment 
targets set by the South African government, decrying a lack of 
government leadership towards combating HIV/AIDS.  Source: 
City Press, May 28. 
 
SA Health Costs to Increase 
--------------------------- 
 
10.  According to the Health Economics & HIV/AIDS Research 
Division (HEARD) of the University of KwaZulu-Natal, South 
African health care costs will increase sharply as the 
country's high HIV/AIDS prevalence rate begins to impact health 
care facilities.  HIV/AIDS patients will account for 60% and 
70% of expenditures in medical wards.  Health Systems Trust 
researchers estimate that only 12 to 13% of patients in need of 
antiretroviral treatment receive it.  As the number of AIDS 
patients increase, there will be a greater demand for skilled 
health workers, medication and hospital facilities, all of 
which will place a growing financial burden on providing health 
care facilities on the Department of Health.  Source:  The Star 
and The Citizen, May 29. 
 
Pediatric HIV/AIDS 
------------------ 
 
11.  According to the Medical Research Council, about 37,000 
children are born HIV-positive in South Africa every year and a 
further 26,000 are infected through breast feeding in 2004.  A 
study done by Tammy Meyers, director of the Children's Clinic 
at Hani-Baragwanath Hospital, found that at least half of all 
pediatric admissions were due to HIV-related illnesses. 
Pediatric antiretroviral treatment can cost much more than 
prices of adult ARV drugs, with many health care workers using 
the adult medicine and estimating the dosage needed.  Source: 
The Sunday Independent, May 28. 
 
PRETORIA 00002249  004 OF 004 
 
 
 
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