Rural­urban health disparities among older adults in South Africa

Background: There are limited studies assessing rural­urban disparities among older adults in Africa including South Africa. Aim: This study explores rural­urban health disparities among older adults in a population-based survey in South Africa. Setting: Data for this study emanated from the 2008 study on 'Global Ageing and Adult Health (SAGE) wave 1' (N= 3280) aged 50 years or older in South Africa. Methods: Associations between exposure variables and outcome variables (health status variables and chronic conditions) were examined through bivariate analyses and multivariable logistic regression. Results: Rural dwellers were more likely to be older, black African and had lower education and wealth than urban dwellers. Rural and urban dwellers reported a similar prevalence of self-rated health status, quality of life, severe functional disability, arthritis, asthma, lung disease, hypertension, obesity, underweight, stroke and/or angina, low vision, depression, anxiety and nocturnal sleep problems. Adjusting for socio-demographic and health risk behaviour variables, urban dwellers had a higher prevalence of diabetes (OR: 2.36, 95%CI:1.37, 4.04), edentulism (OR: 2.79, 95% CI: 1.27, 6.09) and cognitive functioning (OR: 1.91, 95% CI: 1.27, 2.85) than rural dwellers. Conclusion: There are some rural­urban health disparities in South Africa, that is, urban dwellers had a higher prevalence of diabetes, edentulism and cognitive functioning than rural ones. Understanding these rural­urban health variations may help in developing better strategies to improve health across geolocality in South Africa

High physical activity is associated with post-traumatic stress disorder among individuals aged 15 years and older in South Africa

Background: Some research seems to suggest that physical activity (PA) was beneficial for post-traumatic stress disorder (PTSD).Aim: This study examined the association between levels of PA and PTSD among individuals 15 years and above in South Africa.Setting: Community-based survey sample representative of the national population in South Africa. Methods: In all, 15 201 individuals (mean age 36.9 years) responded to the cross-sectional South African National Health and Nutrition Examination Survey (SANHANES-1) in 2012.Results: One in five (20.1%) of participants reported exposure to at least one traumatic event in a lifetime, and 2.1% were classified as having a PTSD, 7.9% fulfilled PTSD re-experiencing criteria, 3.0% PTSD avoidance criteria and 4.3% PTSD hyperarousal criteria. Almost half (48.1%) of respondents had low PA, 17.4% moderate PA and 34.5% high PA. In logistic regression analysis, adjusted for age, sex, population group, employment status, residence status, number of trauma types, problem drinking, current tobacco use, sleep problems and depressive symptoms, high PA was associated with PTSD (odds ratio [OR] = 1.75, confidence interval [CI] = 1.11­2.75), PTSD re-experiencing symptom criteria (OR = 1.43, CI = 1.09­1.86) and PTSD avoidance symptom criteria (OR = 1.74, CI = 1.18­2.59), but high PA was not associated with PTSD hyperarousal symptom criteria. In generalised structural equation modelling, total trauma events had a positive direct and indirect effect on PTSD mediated by high PA, and high PA had a positive indirect effect on PTSD, mediated by psychological distress and problem drinking.Conclusion: After controlling for relevant covariates, high PA was associated with increased PTSD symptomatology

Daily tobacco use and problem drinking among urban adults in South Africa: a longitudinal study

Introduction: there is a lack of longitudinal studies investigating daily tobacco use and problem drinking in Africa. The aim of this study was to explore the prevalence of daily tobacco use and problem drinking and to determine the factors associated with daily tobacco use and problem drinking among urban dwellers in a longitudinal study in South Africa.Methods: electronic interview data were collected from 2213 adults (mean age 45.7 years, SD=15.1; range 20-97) at time 1 (baseline assessment) and Time 2 (12 months follow-up assessment) from one urban centre in South Africa.Results: daily tobacco use only, was at time 1 24.0% and at time 2 23.4%, a decrease of 0.5%. Problem drinking only was at time 1 19.6% and at time 2 21.1%, an increase of 1.5%. Concurrent daily tobacco use and problem drinking increased from time 1 9.5% to 10.3% at time 2, an increase of 0.8%. In longitudinal regression analyses, being male and being born in current city were significantly associated with all three substance use indicators (daily tobacco use; problem drinking; and concurrent daily tobacco use and problem drinking). In addition, older age, not currently married, lower education, underweight and higher levels of perceived stress were associated with daily tobacco use and younger age was associated with problem drinking.Conclusion: high prevalence of daily tobacco use and problem drinking were found among urban dwellers and several socio-demographic (being male, being born in the city, not married and lower education) and health variables (being underweight and perceived stress) were identified which can guide substance use intervention programmes for this population

The association of nutrition behaviors and physical activity with general and central obesity in Caribbean undergraduate students / Asociación de los comportamientos nutricionales y la actividad física con la obesidad general y central en estudiantes de pregrado del Caribe

OBJECTIVE: To quantify the prevalence of obesity and obesity-related factors in a crosssectional, observational study of Caribbean students using the results of three recent surveys of health behavior among undergraduates in Barbados, Grenada, and Jamaica. METHODS: A total of1 578 Caribbean undergraduate students from Barbados, Grenada, and Jamaica (ages 18-30 years) completed questionnaires and had physical measurements recorded. Multivariable logistic regression was used to estimate odds ratios (ORs) for the association of nutrition behaviors with prevalence of obesity (body mass index > 30 kg/m² ); elevated waist-to-height ratio (W/ht) (> 0.50); and high waist circumference (WC) (> 88 cm in females, > 102 cm in males). Models were adjusted for age, year in university, socioeconomic status, and sex. RESULTS: There was a higher prevalence of obesity (13% versus 10%), high WC (21% versus 7%), and high W/ht (35% versus 25%) in females relative to males. Compared to females, males had reduced odds of obesity (OR 0.46), high WC (OR 0.22), and high W/ht (OR 0.61) (P < 0.05 for all). Both females (46%) and males (24%) reported high levels of physical inactivity. Fruit and vegetable consumption was low (approximately two servings per day). Many students reported avoiding fatty foods (40%); this behavior was associated with high W/ht (OR 1.68), obesity (OR 1.90), and high WC (OR 1.82) (P < 0.05 for all). Irregular breakfast consumption, age, and year of study were also positively associated with obesity. Physical activity was not significantly associated with any obesity measure. CONCLUSIONS: There was a low prevalence of healthy behaviors and a high prevalence of obesity in this sample of Caribbean young adults.

OBJETIVO: Cuantificar la prevalencia de la obesidad y los factores relacionados con esta mediante un estudio transversal y de observación de estudiantes del Caribe, que utilizó los resultados de tres encuestas recientes sobre comportamientos con respecto a la salud en estudiantes de pregrado de Barbados, Granada y Jamaica. MÉTODOS: Un total de 1 578 estudiantes de pregrado caribeños de Barbados, Granada y Jamaica, de 18 a 30 años de edad, completaron cuestionarios y se sometieron a una serie de mediciones antropométricas, que fueron registradas. Se utilizó un modelo de regresión logística multivariable para calcular las razones de posibilidades (OR) de las asociaciones de los comportamientos nutricionales con la prevalencia de obesidad (índice de masa corporal > 30 kg/m²); índice cintura-talla (ICT) elevado (> 0,5); y circunferencia de la cintura (CC) elevada (> 88 cm en mujeres, > 102 cm en hombres). Los modelos se ajustaron para la edad, el número ordinal del curso universitario, la situación socioeconómica y el sexo. RESULTADOS: Se observó una mayor prevalencia de obesidad (13 frente a 10%), CC más elevada (21 frente a 7%) e ICT más elevado (35 frente a 25%) en las mujeres que en los hombres. En comparación con las mujeres, los hombres mostraron menores probabilidades de obesidad (OR 0,46), CC elevada (OR 0,22) e ICT elevado (OR 0,61) (P < 0,05 para todos ellos). Tanto las mujeres (46%) como los hombres (24%) notificaron altos niveles de inactividad física. El consumo de frutas y verduras era bajo (aproximadamente de dos raciones por día). Muchos estudiantes notificaron que evitaban los alimentos grasos (40%); este comportamiento se asoció con ICT elevado (OR 1,68), obesidad (OR 1,90) y CC elevada (OR 1,82) (P < 0,05 para todos ellos). El consumo irregular en el desayuno, la edad y el número ordinal del curso universitario también se asociaron positivamente con la obesidad. La actividad física no se asoció significativamente con ninguna medición de obesidad. CONCLUSIONES: En esta muestra de adultos jóvenes del Caribe se observó una baja prevalencia de comportamientos saludables y una alta prevalencia de obesidad.

Prevalence of suicidal behaviour & associated factors among tuberculosis patients in public primary care in South Africa.

Background & objectives: In spite of the high prevalence of tuberculosis worldwide, there are only a few studies on its psychiatric complications such as suicidal behaviour. We undertook this study to assess the prevalence of suicidal behaviour and its associated factors among tuberculosis patients in public primary care in South Africa. Methods: In a cross-sectional survey conducted in three provinces of South Africa new TB and new re-treatment patients were assessed within one month of anti-tuberculosis treatment. The sample included 4900 (54.5% men and women 45.5%) consecutively selected tuberculosis patients from 42 public primary care clinics in three districts in South Africa. Results: A total of 322 patients (9.0%) reported suicidal ideation and 131 (3.1%) had a history of a suicide attempt. In multivariate analysis female gender [Odds Ratio (OR)= 0.56, Confidence Interval (CI)= 0.43-0.74], psychological distress (OR=2.36, CI=1.04-2.29), post-traumatic stress disorders (PTSD) (OR=4.98, CI=3.76-6.59), harmful alcohol use (OR=1.97, CI=1.25-3.09) and being a TB re-treatment patient (OR=1.76, CI=1.32-2.34) were associated with suicidal ideation, and psychological distress (OR=3.27, CI=1.51-7.10), PTSD symptoms (OR=4.48, CI=3.04-6.61) and harmful alcohol use (OR=3.01, CI=1.83-4.95) were associated with a suicide attempt. Interpretation & conclusions: Our findings suggest that co-morbid illnesses of psychological distress, PTSD and harmful alcohol use and HIV infection should be assessed in TB patients under TB control programmes to prevent suicidal behaviour. Clinicians should be aware about suicidality in tuberculosis patients to reduce mortality.

Socioeconomic Factors in Adherence to HIV Therapy in Low- and Middle-income Countries.

It is not clear what effect socioeconomic factors have on adherence to antiretroviral therapy (ART) among patients in low- and middle-income countries. We performed a systematic review of the association of socioeconomic status (SES) with adherence to treatment of patients with HIV/AIDS in low- and middleincome countries. We searched electronic databases to identify studies concerning SES and HIV/AIDS and collected data on the association between various determinants of SES (income, education, occupation) and adherence to ART in low- and middle-income countries. From 252 potentially-relevant articles initially identified, 62 original studies were reviewed in detail, which contained data evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 15 studies (41.7%), 10 studies (20.4%), and 3 studies (11.1%) respectively out of 36, 49, and 27 studies reviewed. One study for income, four studies for education, and two studies for employment found a negative and significant association with adherence to ART. However, the aforementioned SES determinants were not found to be significantly associated with adherence in relation to 20 income-related (55.6%), 35 education-related (71.4%), 23 employment/occupational status-related (81.5%), and 2 SES-related (100%) studies. The systematic review of the available evidence does not provide conclusive support for the existence of a clear association between SES and adherence to ART among adult patients infected with HIV/ AIDS in low- and middle-income countries. There seems to be a positive trend among components of SES (income, education, employment status) and adherence to antiretroviral therapy in many of the reviewed studies.

Screening and Brief Intervention for Intimate Partner Violence Among Antenatal Care Attendees at Primary Healthcare Clinics in Mpumalanga Province; South Africa

Background. It has been found that pregnant women experience a higher rate of intimate partner violence (IPV) than women who are not pregnant. This paper presents findings of a brief IPV intervention provided to pregnant women attending prevention of mother-to-child transmission of HIV services. Methods. Eighteen community workers were recruited and trained in assessment of and intervention for abuse during pregnancy. These were implemented for 10 months at 16 primary healthcare facilities in the Thembisile sub-district; Nkangala district; Mpumalanga Province; South Africa. Results. A total of 2 230 pregnant women were screened for abuse; 7.2 (160) screened positive and received a brief intervention. This was a 20-minute session on safety behaviours and strategies for dealing with the abuse; including referral to local support services. Eighty-four women attended a follow-up interview 3 months after the intervention. The mean danger assessment score of 6.0 before intervention fell significantly to 2.8 after 3 months. Conclusion. The brief intervention provided to these women contributed to a significant reduction in the level of IPV

Antiretrovirals and the use of traditional, complementary and alternative medicine by HIV patients in Kwazulu-Natal, South Africa: a longitudinal study

Abstract: The aim of this prospective study (20 months) was to assess HIV patients' use of Traditional, Complementary and Alternative Medicine (TCAM) and its effect on ARV adherence at three public hospitals in KwaZulu-Natal, South Africa. Seven hundred and thirty-five (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation, 519 after 6 months, 557 after 12 and 499 after 20 months on antiretroviral therapy (ART). Results indicate that following initiation of ARV therapy the use of herbal therapies for HIV declined significantly from 36.6% prior to ARV therapy to 8.0% after 6 months, 4.1% after 12 months and 0.6% after 20 months on ARVs. Faith healing methods (including spiritual practices and prayer) declined from 35.8% to 22.1%, 20.8% and 15.5%, respectively. In contrast, the use of micronutrients (vitamins, etc.) significantly increased from 42.6% to 78.2%. The major herbal remedies that were used prior to ART were unnamed traditional medicine, followed by imbiza (Scilla natalensis planch), canova (immune booster), izifozonke (essential vitamins mixed with herbs), African potato (Hypoxis hemerocallidea), stametta (aloe mixed with vitamins and herbs) and ingwe (tonic). Herbal remedies were mainly used for pain relief, as immune booster and for stopping diarrhea. As herbal treatment for HIV was associated with reduced ARV adherence, patient's use of TCAM should be considered in ARV adherence management

Illicit drug use in South Africa: Findings from a 2008 national population-based survey

Objective. The aim of this secondary analysis of the South African National HIV; Incidence; Behaviour and Communication (SABSSM) 2008 survey is to provide current data on illicit drug use that could assist in the development and implementation of effective substance abuse policies and intervention programmes aimed at these populations in South Africa.Method. A multistage random population sample of 15 828 people age ?15 (56.3 women) was included in the survey. Illicit drug use was assessed by 2 sections of the Alcohol; Smoking and Substance use Involvement Screening Test (ASSIST). Frequency analyses for different age groups; geolocality; educational level; income; and population group were calculated; as were odds ratios for these variables regarding combined illicit drug use.Results. Current cannabis use was reported by 3.3 of the population sample - 6.1 of the men and 1.2 of the women - and the use of combined all-other illicit drugs (cocaine; amphetamines; inhalants; sedatives; hallucinogens; opiates) was reported by 1.8 of the participants. Coloured men (14.3) were most likely; and Indian or Asian women (0.6) least likely; to be cannabis users. Illicit drug use (combined) among men was associated with the 20 - 34 year age group and the coloured and white population groups; and among women in the younger age groups; the coloured and white population groups; and low and higher income.Conclusion. An increase of cannabis and other illicit drug prevalence rates was observed from 2005 (2.1) to 2008 (3.3) in the population sample. Multilevel interventions are required to target illicit drug users; in addition to creating awareness in the general population of the problems associated with illicit drug use. There is a need to address illicit drug use in national and provincial policy planning and intervention efforts and; in terms of treatment; a need to ensure that treatment practitioners are adequately trained to address illicit drug use. Future prospective studies are necessary to assess the impact of illicit drug use

Epidemiology of drug abuse treatment in South Africa

Background. The aim of the study was to explore the epidemiology of drug abuse treatment in South Africa. Methods. Treatment demand statistics were analysed from South African National Council on Alcoholism and Drug Dependence and the South African Community Epidemiology Network on Drug Use records; and a rapid situation assessment was conducted. Twenty-one key informant interviews were conducted in all 9 provinces among provincial substance abuse co-ordinators, and one manager per treatment centre from a sample of treatment centres. Three focus groups were conducted and 46 self-administered questionnaires were distributed among inpatients at 2 selected treatment centres in Free State and North West provinces. Qualitative data were analysed using grounded theory, and quantitative data analysed using SPSS. Results.Treatment records show that the most frequent substance of abuse was alcohol (51), followed by cannabis (21), crack/cocaine (9.6), heroin/opiates (7.9), methamphetamine (Tik) (4.5), prescription/over-thecounter drugs (2.0), and cannabis/mandrax (1.7). More substance abusers were male, of lower education, white or black, than were female, more highly educated; coloured and Indian/Asian. Key informant interviews showed that females are the 'hidden' substance abusers and tend not to be identified in research statistics and at treatment centres. Poverty, unemployment, lack of recreational facilities, being surrounded by substance abusers; and long work shifts were also mentioned as factors contributing to substance abuse. The age of initiation of substance abuse using non-drugs such as glue was 9 years old; alcohol 10 - 12 years old, dagga 11 -12 years old, poly-drug use (alcohol, tobacco and dagga) 14 years old, and harder drugs such as cocaine and heroin at 16 - 17 years old, as reported by key informants. Family care and support, improved socio-economic conditions and increased law enforcement would help to discourage substance abuse. Conclusion. Prevention interventions and policies in South Africa should focus on reducing substance abuse by targeting the 'at risk populations' identified in this study

Patients consulting traditional health practioners in the context of HIV/AIDS in urban areas in Kwazulu-Natal, South Africa

The purpose of this study is to assess patients consulting full-time traditional health practitioners (THPs) and the practice of THPs after they had been trained on Human Immunodeficiency Virus (HIV)/ Sexually Transmitted Infections (STI) prevention and care. The sample included 222 patients interviewed when exiting a THP's practice (n=17) in purposefully chosen two urban sites in KwaZulu-Natal. Results indicate that at post training evaluation the majority of the THPs were involved in HIV/STI management and most had low levels of HIV risk practices at the workplace. Major self-reported reasons for consulting the THP included a complex of supernatural or psychosocial problems; chronic conditions, acute conditions, generalized pain, HIV and other STIs. Overall, patients including HIV positive (n=18) patients had moderate knowledge of Antiretroviral Therapy (ART). A number of HIV positive patients were using traditional medicine and ART concurrently, dropped out of ART because of side effects and were using traditional medicine for HIV

Traditional healers and nurses: a qualitative study on their role on sexually transmitted infections including HIV and AIDS in Kwazulu-Natal, South Africa

The aim of this study was to investigate the role of traditional healers in sexually transmitted infections including HIV/AIDS and collaboration between the traditional and biomedical health care systems as seen by nurses and traditional healers. A convenient sample of 15 professional nurses and 15 traditional healers were interviewed using a semi-structured questionnaire. Qualitative analyses identified the following themes: (1) attitude and respect, (2) collaboration between traditional healers and nurses, (3) control/regulation of (traditional) health practices, (4) training needs of healers and nurses. The main results indicated that the professional nurses had mixed attitudes towards traditional healers, mostly negative (e.g. lacked training; used expired medicines, gave improper dosages, and kept poor or no records), but, also positive, such as contributing to the management of opportunistic infections (STIs). The traditional healers also had mixed attitudes towards nurses. The traditional healers believed that nurses undermined their work (did not accept their efficacy in treatment and consequently did not refer patients). Notably, most of the traditional healers were willing to learn and refer patients to clinics and hospitals; while this was not true for the nurses

Perceptions of tuberculosis: attributions of cause, suggested means of risk reduction, and preferred treatment in the Limpopo province, South Africa.

Despite the availability of effective treatment regimens, exceptionally high rates of tuberculosis persist in South Africa. A better understanding of public perceptions of tuberculosis is important for the improvement of the existing tuberculosis-control programmes. This study was aimed at investigating public perceptions about causes, suggested means of risk reduction, and preferred treatment of tuberculosis. The cross-sectional study included a sample of 80 community members from four different age groups chosen by quota sampling in a semi-urban community. Results indicated that 13.75% of the community members reported biomedical causes of tuberculosis, 35% suggested biomedical methods as a means for risk reduction, and 91.25% preferred medical treatment. Significant gender but not age difference was found. Women reported more often than men a biomedical cause of tuberculosis. A number of misconceptions about the cause and risk reduction of tuberculosis were also mentioned. The results suggest that people in a semi-urban area of the Limpopo province have limited knowledge and understanding of tuberculosis. It is suggested that healthcare workers provide services for increasing basic knowledge about causes and risk reduction of tuberculosis of the population in every age group.

Attitudes towards HIV-antibody testing and people with AIDS among university students in India, South Africa and United States.

CONTEXT: Stigmatizing attitudes toward persons with AIDS (PWAs) may reduce people's willingness to have themselves tested for Human Immunodeficiency Virus (HIV)--thereby increasing the risk of transmission. AIMS: To examine attitudes towards (HIV) testing and determinants of attitudes towards PWAs. SETTINGS AND DESIGN: A cross-sectional. MATERIAL AND METHODS: 600 first-year university students from South India, South African and America filled in a self-administered questionnaire. Main outcome measures included an Attitudes towards HIV-Antibody Testing Scale and Readiness to engage in personal forms of contact with People With AIDS. RESULTS indicate that the majority of American and South African students and only 10 percent of the Indian students had been sexually active in the past 12 months. Almost one fifth of the American and South African participants but only 10% of the Indian students admitted to having had an HIV test. American students had a much more positive attitudes toward HIV testing than South African and Indian students. Regression analysis for the Indian student sample identified blaming, irritation and negative attitudes toward homosexuals as independent predictors of readiness to engage in personal contact with PWAs, while the regression analyses for both South African and American students identified pity and irritation as independent predictors of contact readiness with PWAs. Positive HIV testing attitudes were positively associated with contact readiness with PWAs. CONCLUSION: The findings are important for the role of HIV testing and counselling in campus AIDS programmes. The findings reveal important factors related to HIV testing and suggest strategies for developing effective HIV/AIDS counselling programmes in universities.