Angela Mathee

High prevalence of hookah smoking among secondary school students in a disadvantaged community in Johannesburg

The daily dose of budesonide used in our cases varied from 200 µg to 1 200 µg. Adherence to medication was assessed by verbal report and medication demonstration by the caregiver. In case 2 the child was given medication by a trained nurse in a children’s home and medication was boarded for us to review. Dosing of inhaled budesonide in children with obstructive lung disease is based on clinical response to treatment. Recommended dosing ranges from a low dose of 100 - 200 µg/d to higher doses of >400 µg/d. With the exception of case 1 these children were on moderate doses of budesonide only and in case 3 initially a low dose of fluticasone (50 µg/d). The fact that the children may have been overdosed cannot be entirely excluded. However, it appears that adrenal axis suppression can occur at standard recommended doses of budesonide and fluticasone when used concomitantly with ritonavir. This relationship requires further

Lead exposure is associated with a delay in the onset of puberty in South African adolescent females: Findings from the Birth to Twenty cohort

INTRODUCTION One of the suggested, yet under-researched, causes of pubertal delay is lead exposure. In South Africa blood lead levels are generally higher than in resource-rich countries. Thus the effects of lead exposure on pubertal development may be significant. OBJECTIVE The objective of this study is to determine the association between lead exposure and pubertal development in adolescent females in the Birth to Twenty cohort (Bt20). METHODS Bt20 is a Johannesburg based birth cohort study that commenced in 1990 and includes 1682 girls. At 13 years of age venous blood samples were collected from 725 adolescent female participants for lead content analyses; of these, 712 had menarche data. Pubertal measurement was based on age of menarche and self-reported Tanner staging for pubic hair (n=684) and breast development (n=682). RESULTS The mean blood lead level for the sample was 4.9 microg/dl. Fifty percent had blood lead levels <5.0 microg/dl, 49% were > or = 5.0 microg/dl and 1% was >10.0 microg/dl. The average age of menarche was 12.7 years. At 13 years, 4% and 7% had reached Tanner stage 5 for pubic hair and breast development, respectively. Analyses showed that higher blood lead levels were associated with significant delays in the onset of puberty (p<0.001). CONCLUSION The study found that higher blood lead levels were associated with a delay in the onset of puberty, after adjustment for confounders. Lead exposure in resource-poor countries is generally higher compared to resource-rich countries and thus the effects of high blood levels have personal and public health significance.

A Behavioral Intervention to Reduce Child Exposure to Indoor Air Pollution: Identifying Possible Target Behaviors

Indoor air pollution has been causally linked to acute lower respiratory infections in children younger than 5. The aim of this study was to identify target behaviors for a behavioral intervention to reduce child exposure to indoor air pollution by attempting to answer two research questions: Which behaviors are protective of child respiratory health in the study context? and Which behaviors do mothers recommend to reduce their children’s exposure to indoor air pollution? Observations and interviews were conducted with 67 mother-child combinations. The authors recommend that four behavioral clusters should be considered for the main intervention. These are to improve stove maintenance practices, to increase the duration that two ventilation sources are opened while a fire is burning, to reduce the time that children spend close to burning fires, and to reduce the duration of solid fuel burning.

Lead exposure in young school children in South African subsistence fishing communities.

BACKGROUND Lead is an established toxic substance, with wide-ranging health effects, including neurodevelopmental decrements and behavioural problems, even at low levels in blood. Anecdotal reports of lead melting to make fishing sinkers in South African subsistence fishing communities prompted the conduct of an epidemiological study in two South African fishing villages to investigate the extent of lead melting and the associated risks in children. OBJECTIVES The objectives of the study were to determine the extent of lead melting, and the blood lead distributions and associated risk factors in children. METHODS Cross-sectional, analytical studies were undertaken among 160 young school children in the fishing villages of Struis Bay and Elands Bay located along the south-eastern and western South African coastline, respectively. Blood samples were collected for lead content analysis, and anthropometric and hemoglobin measurements were taken. Questionnaires were administered to obtain information about socio-economic status and risk factors for lead exposure. RESULTS Blood lead levels ranged from 2.2 to 22.4 µg/dl, with the mean blood lead level equalling 7.4. Around 74% of the children had blood lead levels ≥5 µg/dl and 16% had blood lead levels ≥10 µg/dl. Socio-economic factors, and lead melting practices were strongly associated with elevated blood lead levels. CONCLUSIONS Blood lead levels in these remote subsistence fishing communities were unexpectedly elevated, given the absence of local lead industries or other obvious sources of lead exposure. Lead exposure and poisoning is an important, yet neglected, public health concern in South African subsistence fishing communities, and potentially on the entire African continent.

Prenatal and adolescent blood lead levels in South Africa: Child, maternal and household risk factors in the Birth to Twenty cohort

INTRODUCTION The risk factors for lead exposure in developing countries have not been fully described. This study looks at child, maternal and household factors associated with increased risk of lead exposure at birth and at 13 years of age in the Birth to Twenty cohort. METHODS Mothers were recruited from antenatal clinics in the Johannesburg-Soweto metropolitan area in 1990 (n=3273). Lead levels were analysed in cord blood collected at birth (n=618) and at 13 years (n=1546). Data on selected child, maternal and household factors were collected using a structured questionnaire in the third trimester and at 13 years of age. Statistical analyses were conducted to determine the associated risk factors. RESULTS The mean blood lead level at birth was 5.85 microg/dl, and at 13 years of age it was 5.66 microg/dl. The majority of children had blood lead levels above 5 microg/dl (52% at birth and 56% at 13 years). At birth, being a teenage mother and having low educational status were strong predictors for elevated cord blood lead levels. Being a male child, having an elevated cord blood level, and lack of household ownership of a phone were significant risk factors for high blood lead levels at 13 years. CONCLUSION Significant associations found in the study point to the low socio-economic status of lead-affected mothers and children. These poor circumstances frequently persist into later childhood, resulting in continued high lead levels. Thus broader measures of poverty alleviation and provision of better education may help decrease the risk of exposure.

Towards the prevention of lead exposure in South Africa: Contemporary and emerging challenges

The prevention of lead exposure continues to constitute a major public health challenge in developed countries. In well-resourced countries major lead exposure reduction interventions have resulted in significant improvements in childhood blood lead distributions. In developing countries on the other hand, while lead exposure and poisoning remain serious public health concerns, a range of prevailing factors and circumstances, such as poverty, a large informal sector, competing public health challenges, low levels of awareness of lead hazards and weak capacity to enforce legislation, contribute to an increase in the scale and intensity of the challenge, and limit the prospects of comparable success in the foreseeable future. This paper collates available information to illustrate that despite some progress, a wide range of sources of lead exist in South Africa, and that certain settings and groups continue to be at high risk of lead exposure. Lead exposure in relation to paint, mining, lead melting in subsistence fishing communities, the consumption of Ayurvedic medicines and food production is described, and discussed with regard to the key factors hindering efforts to prevent lead poisoning and exposure in South Africa and many other developing countries.

Elevated mercury exposure in communities living alongside the Inanda Dam, South Africa

Mercury is a persistent heavy metal that has been associated with damage to the central nervous system, including hearing and speech impairment, visual constriction and loss of muscle control. In aquatic environments mercury may be methylated to its most toxic form, methyl-mercury. In 1990 concerns were raised over mercury contamination in the vicinity of a mercury processing plant in KwaZulu-Natal, South Africa. Mercury waste was reported to have been discharged into the Mngceweni River, situated in close proximity to the plant. The Mngceweni River joins the uMgeni River, which in turn flows into the Inanda Dam, along the banks of which several villages are located. This study evaluated the mercury levels in river and dam sediments, fish from the Inanda Dam and hair samples collected from residents of three villages along the banks of the Inanda Dam. The study results showed that 50% of the fish samples and 17% of hair samples collected from villagers had mercury concentrations that exceeded guideline levels of the World Health Organization. Mercury concentrations in 62% of the river sediment samples collected in close proximity to the former mercury processing plant exceeded the level at which remedial action is required according to legislation in the Netherlands. These preliminary findings give reasons for concern and should be used as a baseline for further investigations.

Informal sub-division of residential and commercial buildings in São Paulo and Johannesburg: living conditions and policy implications

Abstract The spontaneous conversion of formal residential and commercial buildings into high-density, informal housing is a major policy issue in the inner cities of developing countries. Yet there remains little research material to date analysing the residence dynamics, environmental health and related policy implications of this form of settlement. This paper presents and compares findings from two preliminary studies of informal sub-divided housing in the cities of Sao Paulo, Brazil, and Johannesburg, South Africa. It points to some of the policy implications of the work, in the light of broader debate on the management of informal settlements, and calls for further research examining this housing form within developing countries.

Environment and health in South Africa: Gains, losses, and opportunities

South Africans face a range of preventable environmental hazards to their health, many of which are rooted in the countrys colonial and apartheid past, and ongoing poverty and inequality. Since the advent of democracy in the country, government has made considerable progress in improving living conditions and in developing the legal framework to prevent and manage environmental contamination. Considerable, under-exploited potential also exists in South Africa to prevent disease, including infectious and chronic diseases, and to promote health through a more holistic and public health approach. This article summarizes the main environmental health concerns and reflects on mechanisms and opportunities to improve public environmental health.

Retrospective Investigation of a Lead Poisoning Outbreak from the Consumption of an Ayurvedic Medicine: Durban, South Africa.

Ayurvedic medicines have been gaining in popularity around the world in recent decades, but have also been associated with lead contamination and poisoning. In 2012 in Durban, South Africa, a lead poisoning outbreak among adolescents was associated with the consumption of an Ayurvedic medicine for the treatment of skin conditions. In 2014 eight individuals (out of 12 affected) were traced and interviewed. Questionnaires were administered; blood samples were taken for lead content analysis; and medical records were reviewed. Samples of the implicated medicines were analyzed to determine lead levels. Blood lead levels during the acute phase ranged from 34 to 116 µg/dL; and during the current study (two years later) from 13 to 34 µg/dL. The implicated lead capsules had a lead content of 125,235 µg/g. Participants suffered a wide range of non-specific ill health symptoms; and there was a significant delay in the diagnosis of lead poisoning. This study highlights the potential for lead poisoning outbreaks from the consumption of Ayurvedic medicines in African settings. There were weaknesses with regard to the diagnosis of and response to the outbreak, for which measures need to be put in place to ensure greater awareness of the role of Ayurvedic medicine in lead poisoning, and prompt diagnosis and treatment of future cases.