Spatial Access to Emergency Services in Low- and Middle-Income Countries: A GIS-Based Analysis

Injury is a leading cause of the global disease burden, accounting for 10 percent of all deaths worldwide. Despite 90 percent of these deaths occurring in low and middle-income countries (LMICs), the majority of trauma research and infrastructure development has taken place in high-income settings. Furthermore, although accessible services are of central importance to a mature trauma system, there remains a paucity of literature describing the spatial accessibility of emergency services in LMICs. Using data from the Service Provision Assessment component of the Demographic and Health Surveys of Namibia and Haiti we defined the capabilities of healthcare facilities in each country in terms of their preparedness to provide emergency services. A Geographic Information System-based network analysis method was used to define 5- 10- and 50-kilometer catchment areas for all facilities capable of providing 24-hour care, higher-level resuscitative services or tertiary care. The proportion of a country’s population with access to each level of service was obtained by amalgamating the catchment areas with a population layer. A significant proportion of the population of both countries had poor spatial access to lower level services with 25% of the population of Haiti and 51% of the population of Namibia living further than 50 kilometers from a facility capable of providing 24-hour care. Spatial access to tertiary care was considerably lower with 51% of Haitians and 72% of Namibians having no access to these higher-level services within 50 kilometers. These results demonstrate a significant disparity in potential spatial access to emergency services in two LMICs compared to analogous estimates from high-income settings, and suggest that strengthening the capabilities of existing facilities may improve the equity of emergency services in these countries. Routine collection of georeferenced patient and facility data in LMICs will be important to understanding how spatial access to services influences outcomes.     

Sex hormone level and body shape of the !Kung San. A contribution to explaining pedomorphic stature of San populations

In order to test the hypothesis that oestrogens as well as androgens modify the body shape resp. the paedomorphous habitus of !Kung San circulating levels of sex hormones (testosterone, 5 alpha-dihydrotestosterone, and oestradiol in the serum as well as free testosterone in the saliva) of 114 healthy !Kung San men from the Northern Kalahari of Namibia were quantitatively determined by means of the radioimmunoassay method. The probands were described by 50 body measurements and morphological characters like gynaecomastia. The results show that sex hormone concentrations and body shape are significantly correlated in !Kung San men as it has been previously demonstrated for non-African samples. This does not only refer to the expression of sexual dimorphism but also to the special aspect of paedomorphism. The hypothesis of Marrett, Davies and Tobias, however, that the paedomorphous type of the San is due to "over-oestrogenization" could not be confirmed. Rather, the comparatively low testosterone level of the !Kung San men seems to be of significance.     

Does disappearance mean extirpation? The case of right whales off Namibia

Right whales off Namibia were severely depleted by early 19th century whaling, and rarely featured in modern whaling catches in the 1920s. Aerial surveys of the Namibian coastline from 1978 and onwards revealed increasing numbers of right whales, but few cow‐calf pairs. Aerial surveys off South Africa since 2009 showed a major decline in the availability of animals without calves. Twenty individual matches were made between 94 whales photographed off Namibia/Northern Cape in 2003–2012 and 1,677 photographed off South Africa in 1979–2012. Eight were adult females that calved in South African waters, but only one was also seen with a calf off Namibia. Twelve out of 13 individuals off Namibia with distinctive dorsal pigmentation were first seen as calves off South Africa. These results strongly indicate connectivity between the two regions, while the presence off Namibia of three adult females from the South African population in the season in which they are believed to conceive suggests that there is unlikely to be any genetic differentiation between the two areas. We conclude that the reappearance of right whales off Namibia represents range expansion from South Africa rather than the survival of a few remnants of an originally separate stock.     

Hypertension in sub-Saharan Africa: cross-sectional surveys in four rural and urban communities

Background

Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural Nigeria and Kenya, and urban Namibia and Tanzania.

Methods and Findings

We performed four cross-sectional household surveys in Kwara State, Nigeria; Nandi district, Kenya; Dar es Salaam, Tanzania and Greater Windhoek, Namibia, between 2009–2011. Representative population-based samples were drawn in Nigeria and Namibia. The Kenya and Tanzania study populations consisted of specific target groups. Within a final sample size of 5,500 households, 9,857 non-pregnant adults were eligible for analysis on hypertension. Of those, 7,568 respondents ≥18 years were included. The primary outcome measure was the prevalence of hypertension in each of the populations under study.The age-standardized prevalence of hypertension was 19.3% (95%CI:17.3–21.3) in rural Nigeria, 21.4% (19.8–23.0) in rural Kenya, 23.7% (21.3–26.2) in urban Tanzania, and 38.0% (35.9–40.1) in urban Namibia. In individuals with hypertension, the proportion of grade 2 (≥160/100 mmHg) or grade 3 hypertension (≥180/110 mmHg) ranged from 29.2% (Namibia) to 43.3% (Nigeria). Control of hypertension ranged from 2.6% in Kenya to 17.8% in Namibia. Obesity prevalence (BMI ≥30) ranged from 6.1% (Nigeria) to 17.4% (Tanzania) and together with age and gender, BMI independently predicted blood pressure level in all study populations. Diabetes prevalence ranged from 2.1% (Namibia) to 3.7% (Tanzania).

Conclusion

Hypertension was the most frequently observed risk factor for CVD in both urban and rural communities in SSA and will contribute to the growing burden of CVD in SSA. Low levels of control of hypertension are alarming. Strengthening of health care systems in SSA to contain the emerging epidemic of CVD is urgently needed.     

Endemism in Namibia: patterns, processes and predictions

Sandwiched between the Namib and Kalahari Deserts of southwestern Africa are the karooid and escarpment biotopes of Namibia which are rich in endemics of many taxa. Most plant, invertebrate, amphibian, reptile, mammal and bird species endemic to Namibia are found in a zone running through, and to the west of, Namibia's escarpment region. There is also an important region of endemism for succulent plants, reptiles and invertebrates in the Succulent Karoo biome. Congruence between endemism hotspots, particularly on rocky substrates, is remarkably high for most taxa, implying broadly similar speciation processes. Possible speciation mechanisms in different parts of the country include the spatial isolation of rupicolous taxa such as insects and reptiles by the formation of large coastal dune fields; the expansion and contraction of wooded savannas during pluvial and interpluvial periods; and global temperature shifts which created highland refugia for frost-susceptible plants and poikilotherms. Areas of endemism and species richness overlap poorly for Namibia's mainly arid-dwelling endemic vertebrates, as richness is highest in the mesic wetlands and woodlands of northeast Namibia. The overlap for succulent plants, insects and arachnids, however, is relatively high. Centres of endemism for plants and vertebrates fall mainly outside protected areas, as few parks were established with biodiversity indices in mind. Our analysis of endemism congruence provides a strong platform for the promulgation of new protected areas to safeguard Namibia's unique biota. Furthermore, analysis of speciation patterns and processes is a useful predictive tool for the identification of other biotically important sites.     

The effects of utilization by people and livestock on Hyphaene petersiana (Arecaceae) basketry resources in the palm savanna of North-Central Namibia

Basketry production is an important informal sector activity in the palm savanna of north-central Namibia, particularly for women. This study assesses the comparative impact of utilization by basket makers and browsing livestock in areas of different human and livestock population pressures on the source of weaving fibre, leaves from juvenile individuals of the vegetable ivory palm,Hyphaene petersiana. Mature individuals of this species are an important source of edible fruit. Destructive uses of mature individuals such as tapping for palm wine and the cutting of stems for construction purposes are also practised, even though they are forbidden by customary law. Unlike other centres of basket production in southern Africa, the level of leaf utilization for basketry is low and there is potential for greater use of this resource. Despite the unpalatability of this species, a cause for concern, however, is the intensity of browsing by domestic livestock on young palms, which may affect the future structure and viability of the palm population in north-central Namibia. This predicted degradation of a multiple-use species such asH. petersiana represents the gradual erosion of an important buffer against rural poverty, loss of income and reduction in food security.     

OBSERVATIONS ON THE SLATY EGRET EGRETTA VINACEIGULA IN NORTHERN NAMIBIA

Hines, C.J.H. 1992. Observations on the Slaty Egret Egretta vinaceigula in northern Namibia. Ostrich 63: 118–122.

The Slaty Egret is an endemic African resident with a limited distribution in Botswana, Zambia and Namibia. Distribution records for Namibia are reviewed and information on movements and habitat preferences is given. Diet and feeding habits are described. Two colonies of Slaty Egrets containing eggs and chicks were found on temporary wetlands in eastern Bushmanland. Nests and eggs are described and egg measurements and weights given. The plumage of immature birds is described as well as the variation in adult plumages. The conservation status of the species is reviewed, and the possible importance of temporary wetlands to the Slaty Egret is discussed.     

Bridging the gap: western rock skinks (Trachylepis sulcata) have a short history in South Africa

Phylogeographic patterns in wide-ranging species in southern Africa remain largely unexplored, especially in areas north of South Africa. Here, we investigate population structuring, demographic history, and the colonization pattern of the western rock skink (Trachylepis sulcata), a rock-dwelling species with a range extending from southwestern South Africa into Angola. Using 1056 bp from the mitochondrial marker ND2 and > 2.5 kb from three nuclear genes (EXPH5, KIF24, RAG-1), we constructed allele networks, generated extended Bayesian skyline plots and performed population clustering analyses. Analyses of historical demographic patterns show an overall southward range expansion from Northern Namibia into Southern Namibia and South Africa, although we find contrasting genetic breaks across these geographic regions using nuclear and mitochondrial data. We suggest that mtDNA has introgressed across a nuclear break corresponding to the Knersvlakte region of South Africa, a previously proposed biogeographic barrier for rupicolous species. This pattern of mitochondrial variation contrasts sharply to that of other South African taxa previously investigated, which all show significant mtDNA differentiation across the Knersvlakte region. Additionally, while other taxa show divergences dating to the Pliocene, T. sulcata appears to be a recent arrival in southern Africa, having crossed this barrier and colonized South Africa in the mid-Pleistocene. The complex phylogeographic history of T. sulcata corroborates the intricate patterns of genetic variation found in South African taxa and provides novel insight into historical processes affecting species distributed across Namibia.     

Developing wetland inventories in southern Africa: A review

The status of wetland inventory effort and availability of maps and other data sources is reviewed for the ten countries of southern Africa: Angola, Bostwana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. The aims and strategies for inventory are discussed and the main survey methods compared. Prior to commissioning new inventory work careful collation of existing maps and imagery is recommended together with targeting of strategic inventory at Province level, reserving high resolution effort only for certain important sites.     

Effects of Community-Based Natural Resource Management on Household Welfare in Namibia

Biodiversity conservation, as an environmental goal, is increasingly recognized to be connected to the socioeconomic well-being of local communities. The development of a widespread community-based natural resource management (CBNRM) program in Namibia makes it an ideal location to analyze the connection between conservation and socioeconomic well-being of local communities. Namibia’s CBNRM program involves the formation of communal conservancies within rural communities and previous studies have found it to be successful on both ecological and economic fronts. In order to broaden the understanding of the program’s impact to include social factors, we have conducted a comparative analysis to determine the effects of this program on household welfare outcomes. Data from two rounds of the Namibia Demographic and Health Surveys (2000 and 2006/07) and quasi-experimental statistical methods were used to evaluate changes in various health, education and wealth outcomes of those living in conservancies, relative to non-conservancy comparison groups. Regression results indicate mixed effects of the conservancy program at the household level. The program had positive effects on some health outcome variables, including bednet ownership, which was twice as likely to increase over time in conservancy compared to non-conservancy households. Program impacts were negative for education outcomes, with the proportion of school attendance of conservancy children being 45% less likely to increase over time than non-conservancy children. Wealth outcome results were inconclusive. Our findings highlight the importance of analyzing community conservation programs at a variety of scales when evaluating overall impact, as community-level benefits may not necessarily extend down to the household level (and vice versa).     

Exposure and Risk Factors to Coxiella burnetii,Spotted Fever Group and Typhus Group Rickettsiae,and Bartonella henselae among Volunteer Blood Donors in Namibia

Background

The role of pathogen-mediated febrile illness in sub-Saharan Africa is receiving more attention, especially in Southern Africa where four countries (including Namibia) are actively working to eliminate malaria. With a high concentration of livestock and high rates of companion animal ownership, the influence of zoonotic bacterial diseases as causes of febrile illness in Namibia remains unknown.

Methodology/Principal Findings

The aim of the study was to evaluate exposure to Coxiella burnetii, spotted fever and typhus group rickettsiae, and Bartonella henselae using IFA and ELISA (IgG) in serum collected from 319 volunteer blood donors identified by the Blood Transfusion Service of Namibia (NAMBTS). Serum samples were linked to a basic questionnaire to identify possible risk factors. The majority of the participants (64.8%) had extensive exposure to rural areas or farms. Results indicated a C. burnetii prevalence of 26.1% (screening titre 1∶16), and prevalence rates of 11.9% and 14.9% (screening titre 1∶100) for spotted fever group and typhus group rickettsiae, respectively. There was a significant spatial association between C. burnetii exposure and place of residence in southern Namibia (P<0.021). Donors with occupations involving animals (P>0.012), especially cattle (P>0.006), were also significantly associated with C. burnetii exposure. Males were significantly more likely than females to have been exposed to spotted fever (P<0.013) and typhus (P<0.011) group rickettsiae. Three (2.9%) samples were positive for B. henselae possibly indicating low levels of exposure to a pathogen never reported in Namibia.

Conclusions/Significance

These results indicate that Namibians are exposed to pathogenic fever-causing bacteria, most of which have flea or tick vectors/reservoirs. The epidemiology of febrile illnesses in Namibia needs further evaluation in order to develop comprehensive local diagnostic and treatment algorithms.     

Suspended cultivation of Gracilaria in the sea

Suspended rope cultivation systems for Gracilaria or Gracilariopsis can be seeded from spores but vegetative propagation is used for those which are currently commercially successful. Such systems and methods have been recently developed for the shallow lagoon areas around Lüderitz, Namibia and deeper open water sites off the Araya Peninsula, Venezuela. Various sites, substrata, depths and seeding methods have been assessed and have resulted in average commercial growth rates of about 3.5% per day. Netlon ‘Superope’ has been demonstrated to be more suitable than laid rope as a substratum for outplanted vegetative Gracilaria gracilis in Namibia as it does not compress the thalli as they grow. An efficient method, using hooks, has been developed to ‘seed’ the Superope. There is a very low incidence of algal epiphytism: mainly Ceramium and Ulva sp. In Venezuela, pilot rope cultivation systems for Gracilariopsis tenuifrons proved successful and have good commercial prospects.     

Comparing the effect of modeled climatic variables on the distribution of African horse sickness in South Africa and Namibia

Africa horse sickness (AHS) is a lethal disease of horses with a seasonal occurrence that is influenced by environmental conditions that favor the development of Culicoides midges (Diptera: Ceratopogonidae). This study compared and evaluated the relationship of various modeled climatic variables with the distribution and abundance of AHS in South Africa and Namibia. A comprehensive literature review of the historical AHS reported data collected from the Windhoek archives as well as annual reports from the Directorate of Veterinary services in Namibia were conducted. South African AHS reported data were collected from the South African Department of Agriculture, Forestry, and Fisheries. Daily climatic data were extracted for the time period 1993–2011 from the ERA‐interim re‐analysis dataset. The principal component analysis of the complete dataset indicated a significant statistical difference between Namibia and South Africa for the various climate variables and the outbreaks of AHS. The most influential parameters in the distribution of AHS included humidity, precipitation, evaporation, and minimum temperature. In South Africa, temperature had the most significant effect on the outbreaks of AHS, whereas in Namibia, humidity and precipitation were the main drivers. The maximum AHS cases in South Africa occurred at temperatures of 20–22° C and relative humidity between 50–70%. Furthermore, anthropogenic effects must be taken into account when trying to understand the distribution of AHS.     

Species richness and conservationof Namibian freshwater macro-invertebrates,fish and amphibians

Namibia is an arid country but has a diverse array of wetland habitats ranging from ephemeral water bodies and rain-pools, artesian springs supporting small perennial pools and streams, to the large perennial rivers of the north-east with their associated floodplains. These rivers drain wetter areas north of Namibia and contribute many tropical species to Namibia's wetlands. There are 778 described species of macro-invertebrates representing eight phyla with 81 endemics. Many invertebrates still have to be identified or described but presently the greatest endemism occurs among the Ostracoda (18 species), Coleoptera (17), Diptera (14), Anostraca (six) and Amphipoda (five species). In total, Namibia has 50 species of frog with three endemics. No caecilians or salamanders occur in Namibia. There are 114 species of freshwater fish with five endemics. Most Namibian wetlands occur outside protected areas. Over-exploitation of wetland resources and flow regulation are currently major threats, but new environmental legislation being formulated is based on the goal of sustainable use.     

Prospects for biological control of cactus weeds in Namibia

Australia and South Africa have a long history of sharing successful biocontrol agents for cactus weeds but other countries, such as Namibia, could also benefit. There are four biological control agents that are widely utilised in South Africa and/or Australia for the control of 10 invasive alien Cactaceae in Namibia.     

Coat colour in dogs: identification of the Merle locus in the Australian shepherd breed

Background

A panel of 37 rabies virus isolates were collected and studied, originating mainly from the northern and central regions of Namibia, between 1980 and 2003.

Results

These virus isolates demonstrated a high degree of genetic similarity with respect to a 400 bp region of the nucleoprotein gene, with the virus isolates originating from kudu antelope (n = 10) sharing 97.2–100% similarity with jackal isolates, and 97–100% similarity with those isolated from domestic dogs. Phylogenetic analysis suggested that these viruses were all of the canid rabies biotype of southern Africa. The viruses from kudu were closely associated with jackal isolates (n = 6), bat-eared fox isolates (n = 2) and domestic dog isolates (n = 2) at the genetic level and identical at the amino acid level, irrespective of the year of isolation.

Conclusion

These data suggest that jackal and kudu may form part of the same epidemiological cycle of rabies in Namibian wildlife, and might demonstrate the close-relationship between rabies virus strains that circulate within Namibia and those that circulate between Namibia and its neighbouring countries such as Botswana and South Africa.     

Savanna trees in Namibia—Factors controlling their distribution at the arid end of the spectrum

This study reviewed the distribution of ten common savanna trees in Namibia. Tree distributions were investigated in relation to bioclimatic, topographic and edaphic variables at a national scale. The factors of importance at these broad geographic scales appeared to be rainfall, substrate and, likely, the incidence of frost. Baikiaea plurijuga, Burkea africana, Guibourtia coleosperma and Pterocarpus angolensis seem to reach their bioclimatic limits in Namibia.At the local level, plant traits become important and contribute to explaining distribution patterns. High water and/or nitrogen use efficiency (Acacia erioloba, Colophospermum mopane), dual water obtaining strategies (Faidherbia albida), fire tolerance (e.g. Acacia species, Burkea africana and Pterocarpus angolensis) and drought tolerance (Boscia albitrunca) are some key attributes providing additional explanations for current distributions.Amongst the selected trees and at broad geographic scales, below-ground adaptations are governed by rainfall regime in combination with coarse-textured soils, whereby shallow-rooted trees prevail in the Kalahari sandveld. Deep-rooted species are found largely on non-sandy soils. Physiological performance of many trees appears to be directly linked to rainfall regime and trees may hence show varying performance throughout their distribution range. Insight into plant functional attributes of trees in Namibia is required to develop appropriate management strategies in the light of climate change. Modelling climate change impacts should consider the relative contribution of bioclimatic versus local environmental factors that explain the current distribution patterns of the selected trees.     

Spatio‐temporal shifts of the dynamic Cape fur seal population in southern Africa,based on aerial censuses (1972–2009)

A time series of aerial censuses of Cape fur seal colonies, spanning four decades (1972–2009) and three countries (South Africa, Namibia, and Angola), was analyzed to assess spatio‐temporal changes in population numbers. A weighted quantile regression approach was used to estimate trends in pup counts that were used as proxies for numbers of older animals at breeding colonies. There was a 74% increase in the number of breeding colonies over the study period, from 23 in 1973 to 40 in 2009. There was also a significant northward shift in the distribution of the breeding population. This was largely attributable to events in the northern part of the population's range coinciding with Namibia, where seal numbers declined at most colonies in the south of Namibia while several new breeding colonies developed in the northern part of Namibia and one in southern Angola. Despite range expansion and the development of new colonies, the overall size of the population in 2009 was similar to that of the early 1990s, according to the pup count models. Potential mechanisms for the observed changes, and their management implications, are discussed.     

First record of Otozoum from Namibia

The first incontrovertible Otozoum moodii of Gondwana is described from the Etjo Formation (Waterberg Plateau, Namibia). Distinct Otozoum trackways and isolated footprints are reported from the Omuramba Omambonde tracksite, in the Otjozondjupa Region (North–central Namibia). Previously known only from North America, Europe and possibly Lesotho, the occurrence of Otozoum is a definitive time constraint for an Early Jurassic age of the Etjo Formation. The presence of Otozoum in the hyperarid facies and specifically in interdune setting of the Etjo Formation is in accordance with previous claims of environmental selectivity for this ichnomorph.     

Species richness and biogeography of non-acarine arachnids in Namibia

A total of 821 species, 296 genera, and 69 families of non-acarine arachnids (Araneae, Solifugae, Scorpiones, Pseudoscorpiones, Opiliones and Amblypygi) are presently known from Namibia. Patterns of spider, solifuge and scorpion species richness and endemism are summarized relative to the 14 major Namibian types of vegetation. Spiders are most speciose in the higher rainfall areas, solifuges in the dry areas, and scorpions in rocky areas. Namibia probably has the world's greatest diversity of solifuges. Many arachnids endemic to Namibia are associated with the Namib Desert sand dunes.