Intimate partner violence and HIV treatment adherence in urban South Africa: Mediating role of perinatal common mental disorders.

Background: Antiretroviral therapy (ART) has potential to eliminate perinatal HIV infections, but adherence to ART in late pregnancy and postpartum is often suboptimal. Intimate partner violence (IPV) may influence non-adherence among perinatal women living with HIV (WWH), but few quantitative studies have examined this over time or explored mechanisms for this association. Methods: We used secondary data from a parent trial in Johannesburg comprising WWH from the control arm (n=63) and WWH ineligible for the trial (n=133). Trained nurse researchers administered questionnaires at first antenatal visit on past-year psychological, physical, and/or sexual IPV (WHO instrument), socio-demographics (age, food security, education), and perinatal common mental symptoms of depression (Hospital Anxiety and Depression Screener-d); anxiety (HADS-a); post-traumatic stress disorder (PTSD; Harvard Trauma Questionnaire). At endline visit 2-4 months postpartum, nurse researchers assessed self-reported ART adherence using a visual analog scale (with ≥95% considered "good"). We fitted structural equation models (SEM) in MPlus to explore direct and indirect effects of IPV on ART adherence. Results: Of 196 perinatal WWH, 53.1% reported IPV exposure at baseline. The majority of participants (85.7%) had good perinatal ART adherence. In adjusted models, IPV at baseline was associated with halved odds of good adherence (aOR=0.51, 95%CI=0.20-0.96). IPV was associated with higher adjusted odds of probable depression (aOR=4.64), anxiety (aOR=2.85), and PTSD (aOR=3.42). In SEM, IPV had a direct (standardized coef=-0.22) and indirect effect (coef=-0.05) on ART via common mental disorders. The total effect of IPV on perinatal adherence was of moderate size (coef= -0.27) and the model had good fit (CFI=0.972; TLI=0.969; RMSEA=0.045; SRMR=0.076). Conclusion: IPV was longitudinally associated with perinatal ART non-adherence in part due to its relationship with mental health symptomology. Addressing IPV within clinical care has potential to improve perinatal mental health, maternal HIV outcomes, and HIV-free infant survival.

Experiences of workplace bullying among academics in a health sciences faculty at a South African university.

BACKGROUND: Workplace bullying and other negative workplace behaviours are problems that need to be addressed across many work settings, including at universities. OBJECTIVES: To examine the prevalence of bullying among academics, and factors associated with bullying, in a faculty of health sciences (FHS) of a South African university. METHODS: All academic staff, except senior managers, were invited to participate by completing a self-administered, web-based questionnaire hosted on REDCap. In adition to sociodemographic information, the survey collected information on bullying, and the factors associated with experiences of workplace bullying. Survey data were exported to Stata 13 for analysis. The data were weighted to take account of the distribution of staff in the FHS. Chi-square tests and a multiple logistic regression model for bullying were utilised. RESULTS: The majority of study participants were white (52%), female (70%) and South African (85%). Bullying in the workplace was experienced by 58% of respondents, of whom 44% experienced bullying more than once, and 64% of participants had witnessed bullying. Being female (adjusted odds ratio (aOR) 1.83; 95% confidence interval (CI) 1.14 - 2.93; p<0.05) and being jointly appointed as both a clinician in a health facility and an academic in the university (aOR 1.73; 95% CI 1.29 - 2.32; p<0.001) increased the odds of experiencing workplace bullying. CONCLUSIONS: A combination of strategies is needed, including clear FHS policies to prevent bullying, training in bullying prevention and critical diversity, and positive practice environments.

Evidence for high sugar content of baby foods in South Africa.

BACKGROUND: Early-life exposure to excess sugar affects eating behaviour and creates a predisposition to non-communicable diseases (NCDs). While reducing sugar consumption has been high on the public health agenda, little is known about the sugar content of baby foods. OBJECTIVES: To describe and analyse the sugar content of baby foods in South Africa (SA). METHODS: A cross-sectional study was conducted to analyse the sugar content of baby foods. The study sample included commercially available baby foods targeted at children aged <12 months, sold in supermarkets and by other major retailers in SA. Primary data were obtained from the packaging, and sugar content was compared with recommended intake guidelines. Bivariate analyses were conducted to determine whether there were any associations between the sugar content, added sugar and the characteristics of foods. RESULTS: Over 70% of products were sweet in taste, with one in four containing added sugars. Sugar content was high in 78% of the foods sampled. Over 80% of cereals and pureed desserts contained added sugar. Fewer than 10% of pureed composite meal and pureed fruit and vege-table categories contained added sugar. Most products adhered to SA labelling standards, but none had front-of-pack nutritional information. CONCLUSIONS: The SA baby food market is characterised by products with a high sugar content, promoting an environment that encourages development of sweet-taste preferences and in the long term contributing to the rising burden of NCDs. There is an urgent need for mandatory regulation of sugar in baby foods.

International Nurses Day and press coverage in South Africa.

BACKGROUND: In some countries, nursing's appeal as a profession is diminishing, partly due to poor press coverage and the media's portrayal of an over-loaded, poorly paid profession. The media is important for shaping public perceptions and raising policy issues. International Nurses Day gives nurses an opportunity to profile their critical contribution to quality health care. AIM: To determine the influence of this commemorative day on press coverage about nursing by examining whether there was a difference in the proportion of South African press articles on nursing between January-April and May-June 2010. METHODS: A quantitative content analysis was conducted of all press articles mentioning 'nursing' or 'nurse/s' in the South African lay press from 1 January-31 June 2010. Articles were coded for theme, slant and prominence, and inter-coder reliability was assessed. Descriptive statistics with chi square or Fisher's exact tests were used to compare the two time periods. RESULTS: We identified 242 articles in 95 publications. The month of May had almost double the press coverage of January. International Nurses Day articles were mainly positive, and appeared in May to June in weekly community publications rather than in daily national and regional newspapers. When they were excluded, most articles portrayed nursing negatively. LIMITATIONS: The 6-month period may not be representative of the entire year. Only the dominant topic was coded, which possibly influenced the analysis. CONCLUSION: International Nurses Day positively influenced the extent and slant of press coverage. Efforts to sustain coverage beyond the event through strategic partnerships and media engagement should be strengthened. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The media's portrayal of nurses and nursing may influence the choice of nursing as a career. International Nurses Day is an opportunity to portray nursing positively. Media training may help nurses to advocate for their profession in the media.

Women's experiences of and preferences for services after rape in South Africa: interview study.

OBJECTIVES: To describe aspects of delivery of health services after rape, including trade-offs, that would most influence choice of service, and to compare views of patients who had used such services with views of members of the community who may be future users or may have experienced barriers to service use. DESIGN: Discrete choice analysis of stated preferences with interviews. Attributes included travel time to the service, availability of HIV prophylaxis, number of returns to the hospital, medical examination, and counselling skills and attitude of the provider. SETTING: One rural and one urban site in South Africa. PARTICIPANTS: 319 women: 155 who had been raped and four carers recruited through health facilities and 160 comparable women recruited from the community. Of these, 156 were from an urban site and 163 from a rural site. MAIN OUTCOME MEASURES: Strength of preferences over a range of attributes through the estimation of a benefit function through random effects probit modelling. RESULTS: Factors such as the availability of prophylactic treatment for HIV infection and having a sensitive healthcare provider who could provide counselling are more important in women's decisions to seek care after rape than the travel time necessary to access those services. CONCLUSION: Our findings support the need for holistic rape services.