Training community health workers to screen for cardiovascular disease risk in the community: experiences from Cape Town, South Africa

This article describes a training process to equip community health workers (CHWs) with knowledge and skills to identify individuals at high risk for cardiovascular disease (CVD) in a township in Cape Town.Methods: CHWs were employed by a non-governmental organisation (NGO) primarily focusing on non-communicable diseases (NCDs). They were trained in the theory of CVD, including physiological changes and related risk factors and in obtaining anthropometric and blood pressure measurements. Pre- and post-training tests assessed learning needs and the effectiveness of imparting knowledge about CVD, respectively.Results: Training increased knowledge about CVD risk factors. CHWs were able to screen and identify those at risk for CVD and refer them to health professionals for validation of scores. The initial one-week training was too short, given the amount of information covered. Some CHWs had difficulty with English as the primary instruction medium and as the only language in which tests were offered.Conclusion: Although CHWs could be trained to screen for CVD risk, increased training time was required to impart the knowledge. The language used during training and testing presented challenges for those trainees whose dominant, spoken language was not English

Independent and interactive effects of HIV infection, clinical stage and other comorbidities on survival of children treated for severely malnourished in rural South Africa: A retrospective multi-cohort study

Background. There is still limited to no evidence on the independent and interactive effects of HIV infection, disease stage, baseline disease severity and other important comorbidities on mortality risk among young children treated for severe acute malnutrition (SAM) in South Africa (SA, using the World Health Organization (WHO) recommended treatment modality. Objectives. To determine baseline clinical characteristics among children with SAM and assess whether HIV infection, disease stage, critical illness at baseline and other comorbidities independently and interactively contributed to excess mortality in this sample. Methods. We followed up children aged 6 - 60 months, who were admitted with and treated for SAM at two rural hospitals in SA, and retrospectively reviewed their treatment records to abstract data on their baseline clinical characteristics and treatment outcomes. In total, 454 children were included in the study. Descriptive statistical tests were used to summarise patients' clinical characteristics. Kaplan-Meier failure curves were created for key characteristics and compared statistically using log-rank tests. Univariate and multivariate Cox regression was used to estimate independent and interactive effects. Results. The combined case fatality rate was 24.4%. HIV infection, clinical disease stage, the presence of lower respiratory tract infection, marasmus and disease severity at baseline were all independently associated with excess mortality. The critical stage for higher risk of death was when cases were admitted at WHO stage III. The interactions of two or three of these characteristics were associated with increased risk of death when compared with having none, with HIV infection and critical illness showing the greatest risk (hazard ratio 22, p<0.001). Conclusion. The high HIV prevalence rate in the study setting and the resultant treatment outcomes support the notion that the WHO treatment guidelines should be revised to ensure that mechanisms for effective treatment of HIV comorbidity in SAM are in place. However, a much more rigorous study is warranted to verify this conclusion

A Cross-Sectional Study of Socioeconomic Status and Cardiovascular Disease Risk among Participants in the Prospective Urban Rural Epidemiological (PURE) Study

Background. Cardiovascular diseases (CVDs) are a challenge to populations and health systems worldwide. It is projected that by 2020 about a third of all deaths globally will be caused by CVDs; and that they will become the single leading cause of death by 2030. Empirical evidence suggests that there is socioeconomic patterning in the distribution and prevalence of risk factors for CVD; but the exact nature of this relationship in South Africa remains unclear. Objective. To examine the association between socioeconomic status (SES) and risk factors for CVD in a cohort of adult South Africans living in rural and urban communities.Method. This was a cross-sectional analytical study of baseline data on a population-based cohort of 1 976 SA men and women aged 35 - 70 years who were part of the Cape Town arm of the Prospective Urban and Rural Epidemiology (PURE) Study.Results. We found a complex association between SES and CVD risk factors; its pattern differing between urban and rural participants. Marital status showed the most consistent association with CVD risk in both groups: widowed participants living in urban communities were more likely to be hypertensive as well as diabetic; while single participants in both locations were more likely to use alcohol and tobacco products. Level of education was the only SES variable that had no significant association with any CVD risk factor in either study group. All measured SES variables were significantly different between urban and rural participants (p0.05); with diabetes; obesity and alcohol use significantly more prevalent in urban than in rural participants (p0.05) while hypertension and tobacco use were not (p?0.05). Conclusions. In this cohort of South Africans; there were significant associations between SES and CVD risk; with marked differences in these associations between rural and urban locations. These findings highlight the need to consider SES and area of residence when designing interventions for CVD prevention and control

Perceptions of Body Size and Its Association with HIV/AIDS

Objective: To explore the perception among black South African women that people who are thin are infected with HIV or have AIDS.Setting: Khayelitsha; an urban township in Cape Town.Subjects: 513 women aged 18-65 years.Methods: This was an exploratory study employing both quantitative and qualitative research methodology. Data were collected in two phases. The first phase involved collecting quantitative data among 513 participants. During the second phase; qualitative data were collected in a purposely selected sub-sample of 20 women. For the qualitative data collection; participants were shown eight body figures; ranging from thin to obese; and asked to choose a figure representing the ideal figure; a preferred figure and a figure thought to symbolise health. They were also invited to choose a figure that they thought represented a person infected with HIV or who had AIDS. They had the option of saying that they did not associate any of the figures with people infected with HIV or who had AIDS. Weight and height measurements were also taken. After the quantitative analysis was completed; focus group discussions explored perceptions about body image and the relation to HIV among purposely selected participants. Data were summarised by content based on questions discussed. Results: Sixty-nine per cent of the participants associated a thin figure with a person infected with HIV; or who had AIDS. Only 10.2thought the thin figure symbolised health. Fifty per cent preferred a normal-weight figure; while 34.2thought that normal weight symbolised health. Only 2thought that people in the normal-weight category were infected with HIV or had AIDS.Thirty-four per cent preferred to be overweight and 31thought that being overweight symbolised health. None of the participants thought the overweight figure represented people infected with HIV or who had AIDS. Only 8preferred the obese figure. The results of the qualitative data analysis suggested that participants preferred to be overweight and at risk of acquiring cardiovascular diseases; rather than being thin and stigmatised as a person infected with HIV or who had AIDS.Conclusion: This study revealed that the stigma associated with HIV and AIDS may undermine strategies for prevention of chronic noncommunicable diseases among urban black South African women

Perceptions of Body Size and Its Association with HIV/AIDS

Objective: To explore the perception among black South African women that people who are thin are infected with HIV or have AIDS.Setting: Khayelitsha; an urban township in Cape Town.Subjects: 513 women aged 18-65 years.Methods: This was an exploratory study employing both quantitative and qualitative research methodology. Data were collected in two phases. The first phase involved collecting quantitative data among 513 participants. During the second phase; qualitative data were collected in a purposely selected sub-sample of 20 women. For the qualitative data collection; participants were shown eight body figures; ranging from thin to obese; and asked to choose a figure representing the ideal figure; a preferred figure and a figure thought to symbolise health. They were also invited to choose a figure that they thought represented a person infected with HIV or who had AIDS. They had the option of saying that they did not associate any of the figures with people infected with HIV or who had AIDS. Weight and height measurements were also taken. After the quantitative analysis was completed; focus group discussions explored perceptions about body image and the relation to HIV among purposely selected participants. Data were summarised by content based on questions discussed. Results: Sixty-nine per cent of the participants associated a thin figure with a person infected with HIV; or who had AIDS. Only 10.2thought the thin figure symbolised health. Fifty per cent preferred a normal-weight figure; while 34.2thought that normal weight symbolised health. Only 2thought that people in the normal-weight category were infected with HIV or had AIDS.Thirty-four per cent preferred to be overweight and 31thought that being overweight symbolised health. None of the participants thought the overweight figure represented people infected with HIV or who had AIDS. Only 8preferred the obese figure. The results of the qualitative data analysis suggested that participants preferred to be overweight and at risk of acquiring cardiovascular diseases; rather than being thin and stigmatised as a person infected with HIV or who had AIDS.Conclusion: This study revealed that the stigma associated with HIV and AIDS may undermine strategies for prevention of chronic noncommunicable diseases among urban black South African women