Carl Lombard | South African Medical Research Council (original) (raw)

Papers by Carl Lombard

International Journal of Std & Aids - INT J STD AIDS, 2002

This review compares the effects of various sexually transmitted disease (STD) partner-noti® cati... more This review compares the effects of various sexually transmitted disease (STD) partner-noti® cation strategies. Using review methods endorsed by the Cochrane Collaboration, it updates previous reviews, and addresses some of their methodological limitations. It includes 11 randomized controlled trials (RCTs) comparing two or more strategies, including 8014 participants. Only two trials were conducted in developing countries, and only two trials were conducted among HIV-positive patients. The review found moderately strong evidence that: (1) provider referral alone, or the choice between patient and provider referral, when compared with patient referral among patients with HIV or any STD, increases the rate of partners presenting for medical evaluation; (2) contract referral, when compared with patient referral among patients with gonorrhoea, results in more partners presenting for medical evaluation; (3) verbal, nurse-given health education together with patient-centred counselling by lay workers, when compared with standard care among patients with any STD, results in small increases in the rate of partners treated. The review concludes that there is a need for evaluations of interventions combining provider training and patient education, for evaluations conducted in developing countries, and for the measurement of potential harmful effects.

Journal of studies on alcohol and drugs, 2009

Objective: Levels of alcohol use are high in South Africa and not much is known about women's use... more Objective: Levels of alcohol use are high in South Africa and not much is known about women's use of alcohol when murdered. The aim of this article is to describe the patterns of blood alcohol concentration (BAC) at the time of death for female homicide victims and to explore the factors associated with having an elevated BAC. Method: A subsample of a national, representative, retrospective mortuary-based study of female homicides ages 14 years and older was analyzed. Data were gathered from medical legal laboratory records, autopsy reports and police interviews from 153 cases at sampled mortuaries in the Western Cape Province of South Africa in 1999. Results: Sixty-two percent of women who were murdered had a high BAC at the time of their death, with an overall median BAC of .11% (110 mg/100 ml). A quantile

Child Abuse & Neglect, 2004

Objective: The aim of this article is twofold: first, to examine the prevalence of being the vict... more Objective: The aim of this article is twofold: first, to examine the prevalence of being the victim of actual and attempted rape among a large representative sample of Cape Town high school students; and second, to identify the correlates of sexual assault for both boys and girls, including alcohol, tobacco and other drug use, behavioral problems, and suicidality.Method: Data for this study were derived from the 1997 South African Community Epidemiology Network on Drug Use (SACENDU) school survey. A stratified sampling procedure was used to select students in Grades 8 and 11 at non-private high schools in Cape Town. A total of 2,946 students completed a survey consisting of socio-demographic questions and items about substance abuse, sexual activity, and other adolescent health risk behaviors. A subsample of 939 was randomly selected to complete items about sexual violence.Results: The results revealed that 8.4% of respondents were victims of attempted rape, while 5.8% were victims of actual rape. Ordinal logistic regression showed that girls were 3.9 times more likely than boys to have been victims of sexual abuse. Family structure was also significantly related to rape as persons who lived with a single parent (OR = 1.74, CI = 1.00–3.04) and those who resided with one biological parent and one step parent (OR = 2.59, CI = 1.34–5.01) were more likely to have been have been victims of sexual abuse than those living with both biological parents. Alcohol use (OR = 2.0, CI = 1.10–3.62), anti-social behavior (stolen property, caused physical damage to property, bullied others, or been in physical fights) (OR = 1.44, CI = 1.12–1.86), suicidal dialogue (OR = 2.48, CI = 1.19–5.19), and suicidal attempts (OR = 3.2, CI = 1.65–6.30) were also significant predictors of sexual abuse victimization. Racially classified social groups (RCSG), age, drug use, and cigarette smoking were not significant predictors of sexual abuse victimization, while socioeconomic status was found to be marginally significant.Conclusion: This study reinforces the importance of multiple factors including alcohol use, anti-social behavior, suicidal thoughts and actions, and family structure with respect to sexual assault of adolescents in South Africa. Establishing and strengthening intervention programs, school based child protective protocols, professional education of teachers and school personnel, community prevention programs, and initiatives could help prevent adolescent sexual violence and reduce the sequelae associated with this problem.French-language abstract not available at time of publication.Objetivo: Este artı́culo tiene dos objetivos. El primero es el examinar la prevalencia de haber sido vı́ctima de violación real o intento de violación en una amplia muestra representativa de estudiantes de bachiller de Ciudad del Cabo. El segundo es identificar los correlatos de la agresión sexual para varones y mujeres, tales como el consumo de alcohol, tabaco y otras drogas, los problemas de comportamiento y la tendencia al suicidio.Método: Los datos de este estudio se derivan de la una encuesta escolar realizada por el Grupo de Trabajo Comunitario Sudafricano Epidemiológico sobre el abuso de drogas (1997). Se utilizó un procedimiento de muestreo estratificado para seleccionar estudiantes entre el nivel octavo y undécimo en institutos no privados de Ciudad del Cabo. Un total de 2,946 estudiantes completaron una encuesta que consistı́a en preguntas sociodemográficas e ı́tems sobre el consumo de drogas, la actividad sexual y otras conductas con riesgo para la salud en adolescentes. Una submuestra de 939 participantes fue seleccionada al azar para completar los ı́tems sobre violencia sexual.Resultados: Los resultados revelaron que el 8.4% de los que respondieron fueron vı́ctimas de un intento de violación, mientras que un 5.8% fueron vı́ctimas de una violación consumada. Los análisis de regresión logı́stica ordinal mostraron que las mujeres tuvieron 3.9 veces más posibilidades que los varones de haber sido vı́ctimas de abuso sexual. La estructura familiar estaba relacionada con las posibilidades de sufrir violación de manera que las personas que vivı́an con un único padre (OR = 1.74, CI = 1–3.04) y aquellos que residı́an con un padre biológico y un padre no biológico (OR = 2.59, CI = 1.34–5.01) tenı́an más posibilidades de ser vı́ctimas de abuso sexual que quienes vivı́an con los dos padres biológicos. El abuso del alcohol (OR = 2.0, CI = 1.10–3.62), la conducta anti-social (robos contra la propiedad, daños fı́sicos causados a la propiedad, agresión a otros o participación en peleas fı́sicas) (OR = 3.2, CI = 1.65–3.60) fueron también predictores significativos de ser vı́ctimas de agresión sexual. La clasificación por razas, la edad, el uso de drogas y el consumo de tabaco no fueron predoctores significativos de la victimización por abuso sexual, mientras se observó que el nivel socioeconómico era marginalmente significativo.Conclusión: Este estudio refuerza la importancia de múltiples factores como el abuso de alcohol, la conducta anti-social, las acciones y pensamientos suicidas y la estructura familiar con respecto a las agresiones sexuales que sufren los adolescentes en Sudáfrica. El establecimiento y fortalecimiento de programas de intervención, de protocolos de protección infantil de ámbito escolar, de educación profesional de profesores/as y personal escolar, de programas de prevención comunitarios y de otras iniciativas puede ayudar a prevenir la violencia sexual contra adolescentes y reducir las secuelas asociadas con este problema.

Journal of Adolescent Health, 2003

The work reported in this paper was supported by grants from the World Health Organisation Progra... more The work reported in this paper was supported by grants from the World Health Organisation Programme on Substance Abuse, the United Nations Development Programme, the South African Medical Research Council, and the Medical Faculty Research Committee of the University of Cape Town.To document the prevalence rates for use of cigarettes, alcohol, and cannabis among high school students in Cape Town, and to investigate whether use of these substances is associated with a set of hypothesized psychosocial correlates.A multistage sampling procedure produced a sample of 2930 students in grades 8 and 11 at 39 high schools in Cape Town, who completed a self-administered questionnaire. The questionnaire contained items about whether the students had used various substances and that addressed the potential correlates of interest. We calculated prevalence rates with 95% confidence intervals and constructed a set of generalized estimating equations of use in the past month of cigarettes, alcohol, or cannabis on the hypothesized correlates.The prevalence rates for previous month (recent) use of cigarettes, alcohol, and cannabis were 27%, 31%, and 7%, respectively. Rates were low for black females. Recent use of each of the substances was significantly associated with the number of days absent and the number of years lived in a city. Repeating a grade was significantly associated with previous month use of cigarettes and alcohol by colored (derived from Asian, European, and African ancestry) students and alcohol use by black grade 8 students (race classifications “colored” and “black” are as defined by the repealed population Registration Act of 1950). Not being raised by both parents was significantly associated with cigarette smoking by black and colored students, alcohol use by colored students, and cannabis use by female students. It was inversely associated with cigarette use by black students.It is necessary to identify the factors that protect black female adolescents from substance use. It is important to address demographic factors such as race classification and gender analytically if one is to avoid obscuring differences among groups.

AIDS Care, 2014

A case-control study was conducted to describe the frequency with which structural-and individual... more A case-control study was conducted to describe the frequency with which structural-and individual-level barriers to adherence are experienced by people receiving antiretroviral (ARV) treatment and to determine predictors of nonadherence. Three hundred adherent and 300 non-adherent patients from 6 clinics in Cape Town completed the LifeWindows Information-Motivation-Behavioral Skills ART Adherence Questionnaire, the Substance Abuse and Mental Illness Symptoms Screener and the Structural Barriers to Clinic Attendance (SBCA) and Medication-taking (SBMT) scales. Overall, information-related barriers were reported most frequently followed by motivation and behaviour skill defects. Structural barriers were reported least frequently. Logistic regression analyses revealed that gender, behaviour skill deficit scores, SBCA scores and SBMT scores predicted non-adherence. Despite the experience of structural barriers being reported least frequently, structural barriers to medication-taking had the greatest impact on adherence (OR: 2.32, 95% CI: 1.73 to 3.12), followed by structural barriers to clinic attendance (OR: 2.06, 95% CI: 1.58 to 2.69) and behaviour skill deficits (OR: 1.34, 95% CI: 1.05 to 1.71). Our data indicate the need for policy directed at the creation of a health-enabling environment that would enhance the likelihood of adherence among antiretroviral therapy users. Specifically, patient empowerment strategies aimed at increasing treatment literacy and management skills should be strengthened. Attempts to reduce structural barriers to antiretroviral treatment adherence should be expanded to include increased access to mental health care services and nutrition support.

Nutrition, 2014

This cross-sectional study examined the nutritional factors associated with the high levels of st... more This cross-sectional study examined the nutritional factors associated with the high levels of stunting in 2- to 5-y-old children in an impoverished South African setting where liver is frequently eaten and vitamin A deficiency known to be absent. Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s dietary intake was assessed by a single 24-h recall. Heights and weights were measured and information was obtained on breast-feeding history, the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s habitual milk intake, as well as substance use by the mother during pregnancy (n = 150). The overall prevalence of stunting was 36.9% (CI 29.2, 44.6) and increased with age, being 49% in the 4- to 5-y-old age category. Birth weight correlated significantly with height-for-age z-scores (HAZ; r = 0.250, P = 0.003), and was lower in children whose mothers smoked and used alcohol during pregnancy than in children whose mothers abstained (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Median intake of energy, carbohydrate and protein was adequate. Median intake for all micronutrients was at least 90% of the estimated average requirement, except for calcium, vitamin D and vitamin E, which was 21%, 15%, and 32%, respectively. Intake of fat, calcium, phosphorous, vitamin D, riboflavin, and vitamin B12 (nutrients that typically occur in milk) was significantly lower in stunted than in non-stunted children (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). When excluding children with low birth weight, intake of calcium, vitamin D, and riboflavin were still significantly lower (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). HAZ was higher in children who habitually drank milk compared to those who did not (P = 0.003). Inadequate calcium and vitamin D intake, presumably because of low intake of milk after weaning, may have contributed to stunting in this population.

Clinical Chemistry and Laboratory Medicine, 2002

Our laboratory, engaged in a prospective study of adult pulmonary tuberculosis, processed on aver... more Our laboratory, engaged in a prospective study of adult pulmonary tuberculosis, processed on average 1186 sputum samples per year for the detection of Mycobacterium tuberculosis (M. tuberculosis). Approximately 55% of all sputum samples were culture-positive. The study protocol required that all patients had their M. tuberculosis isolates DNA fingerprinted at diagnosis, and at subsequent time points if the patients either failed treatment or presented again with tuberculosis. Over a 22-month period, there were 14 apparent treatment failures from 109 patients who had completed 6 months of therapy. Only two of these were true treatment failures, while the other 12 had DNA fingerprints that were different from those obtained at diagnosis. It was concluded that these 12 cultures represented episodes of laboratory cross-contamination. Retrospective DNA fingerprinting of patient isolates was done so that each patient had at least two independent isolates fingerprinted. This survey revealed that 7.3% of DNA fingerprints were discordant. False-positive cultures with discordant DNA fingerprints generally arose late in chemotherapy and the isolates were usually co-processed with other strongly smear-positive sputum samples. Simple modifications of laboratory procedures were made, and over a following 10.5-month period the false-positive rate was reduced to 2.1%. These modifications did not increase the workload or the cost of processing samples and can thus be used successfully by any laboratory, and particularly by those in resource-poor settings.

Background: ␤-Carotene-rich orange-fleshed sweet potato (OFSP) is an excellent source of provitam... more Background: ␤-Carotene-rich orange-fleshed sweet potato (OFSP) is an excellent source of provitamin A. In many developing countries, sweet potato is a secondary staple food and may play a role in controlling vitamin A deficiency. Objective: The objective was to determine the efficacy of daily consumption of boiled and mashed OFSP in improving the vitamin A status of primary school children. Design: Children aged 5-10 y were randomly assigned to 2 groups. The treatment group (n ҃ 90) consumed 125 g boiled and mashed OFSP (1031 retinol activity equivalents/d as ␤-carotene), and the control group (n ҃ 90) consumed an equal amount of white-fleshed sweet potato devoid of ␤-carotene for 53 school days. All children were dewormed to exclude helminthic infection. The modifiedrelative-dose-response test for vitamin A status was conducted before and after intervention. Results: The estimated intervention effect for the ratio of 3,4didehydroretinol to retinol (DR:R) was Ҁ0.008 (95% CI: Ҁ0.015, Ҁ0.001; P ҃ 0.0203), which indicated a greater improvement in vitamin A liver stores in the treatment group than in the control group. The proportions of children with normal vitamin A status (DR:R 0.060) in the treatment group tended to increase from 78% to 87% (P ҃ 0.096) and did not change significantly (from 86% to 82%) in the control group (P ҃ 0.267). These proportions were not used to test the intervention effect or within-group changes because the study was powered to test the intervention effect on DR:R. Conclusions: Consumption of OFSP improves vitamin A status and can play a significant role in developing countries as a viable longterm food-based strategy for controlling vitamin A deficiency in children.

Child Abuse & Neglect, 2007

To examine the prevalence of bullying behavior in adolescents from Cape Town and Durban, South Af... more To examine the prevalence of bullying behavior in adolescents from Cape Town and Durban, South Africa, and the association of these behaviors with levels of violence and risk behavior.Five thousand and seventy-four adolescent schoolchildren in grade 8 (mean age 14.2 years) and grade 11 (mean age 17.4 years) at 72 Government schools in Cape Town and Durban, South Africa completed self-report questionnaires on participation in bullying, violent, anti-social and risk behaviors.Over a third (36.3%) of students were involved in bullying behavior, 8.2% as bullies, 19.3% as victims and 8.7% as bully-victims (those that are both bullied and bully others). Male students were most at risk of both perpetration and victimization, with younger boys more vulnerable to victimization. Violent and anti-social behaviors were increased in bullies, victims and bully-victims compared to controls not involved in any bullying behavior (p < .01 in all cases). Risk taking behavior was elevated for bullies and bully-victims, but for victims was largely comparable to controls. Victims were less likely to smoke than controls (odds ratio .83, p < .05). Bully-victims showed largely comparable violent, anti-social and risk taking behavior profiles to bullies. Bully-victims showed comparable suicidal ideation and smoking profiles to victims.Results were in keeping with Western findings. Involvement in bullying is a common problem for young South Africans. Bullying behavior can act as an indicator of violent, anti-social and risk-taking behaviors.French- and Spanish-language abstracts not available at time of publication.

Journal of Adolescence, 2004

This study aimed to disentangle the influence of depression and self-esteem on suicidal behaviour... more This study aimed to disentangle the influence of depression and self-esteem on suicidal behaviour in adolescence. Grades 8 and 11 students in Cape Town, South Africa (n=939) completed questionnaires assessing suicidal ideation and behaviour, depression, and self-esteem with respect to family, peers, school, sports/athletics, body image and global self-worth. Data were analysed using a series of multinomial logistic regression models adjusted for gender, grade, race and the sampling strategy. Results indicated that depression and low self-esteem in the family context were independently associated with suicide ideation and attempts. Moreover, low family self-esteem significantly differentiated suicide attempters from ideators. Screening for depression and low self-esteem in the family context is discussed as a possible strategy for helping to identify adolescents at risk for suicide attempts.

Journal of Cardiovascular Risk, 1997

Men and women have experienced differing patterns of urbanization. Men spent more time in the cit... more Men and women have experienced differing patterns of urbanization. Men spent more time in the city as migrant labourers, which could be attributed to the influx control legislation during the apartheid years. To investigate urban exposure among black people of the Cape Peninsula, South Africa, in relation to unhealthy lifestyles and the risk factors for chronic diseases of lifestyle. Blood pressure, height, weight and serum cholesterol were measured in a random sample of 986 persons, aged 15-64 years. Sociodemographic details, urban exposure, dietary intake patterns and personal habits were elicited by questionnaire. An urbanization index (percentage of life spent in a city), the dietary Keys score and body mass index were calculated. Linear regression modelling for cholesterol and hypertension, and multiple correspondence analysis for risk factors and demographic characteristics were performed. The degree of urbanization had no effect on total serum cholesterol concentrations, which were very low compared with other groups in South Africa. Hypertension was independently related to age, obesity and the degree of urbanization. Smoking patterns were influenced by the degree of urbanization in women only. Correspondence analysis identified groups with clusters of risk factors: formal housing-westernized diet-highly urbanized; male-normal weight-increased exercise-alcohol-smoking; female-obesity-non-smoking; and hypertension-ageing. Those who spent larger proportions of their lives in an urban setting tended to have unhealthier lifestyles and higher risk for chronic diseases lifestyle compared with their less urbanized counterparts. Groups to whom intervention should be targeted were also identified.

The International Journal of Tuberculosis and Lung Disease

Tuberculosis (TB) is a common cause of mortality and morbidity in children infected with the huma... more Tuberculosis (TB) is a common cause of mortality and morbidity in children infected with the human immunodeficiency virus (HIV). Data on isoniazid preventive therapy (IPT) efficacy in HIV-infected children receiving antiretroviral therapy (ART) are inconclusive. To assess the efficacy, tolerability and safety of isoniazid (INH) in HIV-infected children on ART. A pilot randomised controlled study of INH was undertaken in HIV-infected children on ART. The primary outcome measure was TB disease or death. A total of 167 children were randomised to receive INH (n = 85) or placebo (n = 82), and followed for a median of 34 months (interquartile range [IQR] 24-52). The median age was 35 months (IQR 15-65). There was one death in a child on INH and none in the placebo group. Eleven (6.6%) cases of TB occurred, 4 (5%) in the INH and 7 (9%) in the placebo group. Among the TB cases, 5 were culture confirmed-2 in the INH group and 3 in the placebo group, all susceptible to INH. Severe adverse events occurred rarely (n = 6; 2%). IPT is safe and well tolerated in HIV-infected children on concomitant ART. This study supports the need for a larger study to assess efficacy in HIV-infected children living in TB-endemic areas.

Preventive Medicine, 2003

Background. This paper examines the effect of proand antisocial opinions about communities on cig... more Background. This paper examines the effect of proand antisocial opinions about communities on cigarette use by Black, Colored, and White 8th-and 11thgrade students in Cape Town, South Africa.

Reviews, 1996

Partner notification, a principal means of controlling sexually transmitted diseases, has traditi... more Partner notification, a principal means of controlling sexually transmitted diseases, has traditionally been performed by public health professionals. They interview infected persons and contact the sex partners of these persons to notify them and convince them of the need to seek evaluation and treatment (known as "provider referral"). This notification method is labor intensive; the typical alternative to provider referral is to leave notification to the infected person (known as "patient referral"). However, innovations in partner notification, often created by public health professionals responsible for the practice, have yielded adjuncts and complements to both provider and patient referral. The present review article covers 4 areas of innovation:

Tropical Medicine & International Health, 2013

objective To estimate the cost-effectiveness of nurse-led versus doctor-led antiretroviral treatm... more objective To estimate the cost-effectiveness of nurse-led versus doctor-led antiretroviral treatment (ART) for HIV-infected people.

Objective To determine the iodine concentration in household salt, the coverage of adequately iod... more Objective To determine the iodine concentration in household salt, the coverage of adequately iodized salt, the use of non-iodized agricultural and producers' salt, and the usefulness of salt as a carrier of iodine, and to relate these observations to socioeconomic status in South Africa. Method The iodometric titration method was used to analyse 2043 household salt samples collected using a national, multistage, stratified, cluster survey. Findings The national mean and median iodine concentrations of household salt were 27 mg/kg (95% confidence interval (CI): 25-29 mg/kg) and 30 mg/kg (range = 0-155 mg/kg), respectively. There was considerable variation within and between geographical areas. Coverage of adequately iodized household salt, i.e. iodized at >15 mg/kg, was 62.4% of households (95% CI: 58.8-66.0%) two years after the introduction of compulsory iodization at a level of 40-60 mg/kg. A total of 7.3% of households used non-iodized agricultural salt and salt obtained directly from producers. People at the lower end of the socioeconomic spectrum were more likely to suffer the consequences of using under-iodized salt because more of them used agricultural or coarse salt than did people in the higher socioeconomic categories. The iodine concentration in salt was lower in rural areas than in urban and periurban areas. Conclusions The consequences of using under-iodized or non-iodized salt were most likely to be experienced in the country's three northern provinces, among people in the low socioeconomic categories, and in rural households. Since 95.4% of households in South Africa use salt regularly and 2.9% use it occasionally, the national iodization programme has the potential to meet the iodine requirements of the population. However, this can only be achieved if the primary reasons for the inadequate iodization of salt are eliminated and if special attention is given to vulnerable groups.

PLoS ONE, 2014

Objectives: To ascertain the prevalence and determinants of overweight/obesity in the 25-74-year-... more Objectives: To ascertain the prevalence and determinants of overweight/obesity in the 25-74-year-old urban black population of Cape Town and examine the changes between 1990 and 2008/09.