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

Maternal alcohol use during pregnancy in a general national population in South Africa

Objective: Alcohol use in pregnancy is linked with various negative health effects on the infant. The aim of this study was to examine the prevalence of maternal alcohol use during pregnancy and socio-demographic and health correlates. Methods: Data of ever-pregnant women from the cross-sectional 'South African National Health and Nutrition Examination Survey (SANHANES-1) 2011­2012' were analysed. The sample included 5089 adolescents and adult women aged 15­55 years. They responded to questions on alcohol use, socio-demographic and health indicators. Results: The results indicated that 3.7% (95.0% confidence interval [CI] = 3.1, 4.5) of South African women had engaged in alcohol use during their pregnancy. In adjusted analysis, being mixed race, not employed, poor self-rated health status, ever been diagnosed with tuberculosis and having partial post-traumatic stress disorder were found to be associated with alcohol use during pregnancy. Conclusions: The study findings suggest links between socio-demographic and health variables and prenatal alcohol use, which may have public health policy implications

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

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.

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.