Experiences of families living with Nyaope users in Tshwane, Gauteng province.

Background: Nyaope is one of the commonly used drugs in many low socio-economic communities in South Africa. Because of its highly addictive properties, the vast majority of users are not able to quit, which results in long-term difficulties for their families. Aim: The aim of this study was to explore and describe the experiences of families living with nyaope users in a township in Tshwane Metropolitan Municipality. Setting: Data were collected at the Social Development Centre, which serves a variety of social needs of families, including the various needs of families whose problems emanate from nyaope use. The family members were recruited from the registry of the centre. Methods: A qualitative design and in-depth interviews were used to collect data from a sample of family members who were purposively sampled. NVIvo 12 was used for thematic analysis of the data. Results: Three major themes emerged from the data, these being, consequences of nyaope use on the family, family interventions, and coping strategies. Conclusion: Although the families have devised interventions and developed coping strategies, nyaope use remains a serious mental health challenge in affected families. Contribution: The study highlighted the negative impact of nyaope on the social and mental health of the families. The assistance offered at Social Development is broad and general for substance abuse, but does little to mitigate the complex difficulties brought about by nyaope use.

Burden of Care of Family Caregivers for People Diagnosed with Serious Mental Disorders in a Rural Health District in Kwa-Zulu-Natal, South Africa.

An estimated 6% of the world population has serious mental illness, with one in four families having a member with some form of psychiatric disorder, who is mostly cared for by their relatives within a family setting. Although care-giving in a home setting is reported to be associated with significant mental distress, the burden of such distress is rarely measured. The purpose of this study was to quantify the burden of care among family caregivers of relatives with serious mental disorders, as well as to explore possible associations between the caregiver burden of care and a range of caregiver and Mental Health Care User (MHCU) variables in a rural district in Kwa-Zulu Natal, South Africa. The Zarit Burden Interview (ZBI) scale was used to collect data from 357 caregivers, and STATA 14 was used to analyze data. The ages of the sample ranged from 18 to 65 years, with a mean of 50.29, and the majority (86%) were female and unemployed (83%). The ZBI scores ranged from 8 to 85, with a mean of 41.59. The majority (91%) were found to be affected by family caregiver burden, which ranged from mild to severe. Using the Pearson Chi-square test of association (p = 0.05), variables that were significantly associated with the burden of care were clinically related (caregiver self-reported depression, MHCU diagnosis, recent relapse of the MHCU), socio-economic (caregiver family monthly income, MHCU disability grant status and MHCU employment status) and socio-demographic (MHCU gender and MHCU level of education). The prevalence of the burden of care is high and severe, and the scarcity of resources in families and communities contributes to the high burden of care in these rural communities.

Prevalence and Risk Factors for Anxiety Symptoms among Student Nurses in Gauteng Province of South Africa.

Background: Globally, mental disorders are common among nursing students; therefore, effective prevention and early detection are urgently needed. However, the prevalence rate of anxiety symptoms has not been investigated in South African nursing colleges. Aim: The study aimed to assess the prevalence of anxiety symptoms and their sociodemographic risk factors among nursing students in Gauteng province, South Africa. Methods: This cross-sectional descriptive study was conducted at Chris Hani Baragwanath and SG Lourens nursing colleges in the first week of June 2022. A purposeful sampling technique selected the third- and fourth-year nursing students aged ≥ 18 years registered at the two nursing colleges. The seven-item Generalised Anxiety Disorder scale was used to assess anxiety symptoms. Results: The prevalence of anxiety symptoms was 74.7% (95% confidence interval: 69.9-78.9). Being a student at nursing college B, being in the fourth academic year of study and use of substances were identified as predictors of anxiety symptoms in these nursing students. Conclusions: The prevalence of anxiety symptoms in this study is relatively high, with predictors of developing anxiety being a student at nursing college B, in the fourth academic year and current use of psychoactive substances were predictors of anxiety symptoms. These findings highlight the need to develop interventions and strategies to promote mental health assessments and management to prevent and reduce the problem of mental disorders among nursing students.

Symptoms of Depression, Anxiety and Their Co-Occurrence among Orphaned Children in Sekhukhune District, Limpopo Province.

Although both short- and long-term psychological challenges, specifically depression and anxiety, have been reported among orphans, there is a dearth of studies that quantify these disorders in rural settings. The aim of the study was to screen for symptoms of depression, anxiety and their co-occurrence among orphaned school-going children in rural Limpopo province, South Africa. Data were collected among primary school children in 10 schools in two villages in Limpopo province. The Revised Child Anxiety and Depression Scale (RCADS) was used to screen for symptoms of depression, anxiety and their co-occurrence among 308 orphaned learners in the selected schools. A questionnaire was used to collect socio-demographic data. STATA 13 was used to analyse the data. Descriptive statistics were used to determine the symptoms and severity of depression, anxiety and their co-occurrence. The sample of 308 consisted of the majority (60.71%) residing in Maandagshoek and being female (54.22%). Their ages ranged from 8 to 12 years, with a mean of 10.51 years. The prevalence of symptoms of depression, anxiety and co-occurrence of anxiety and depression were 23.05%, 34.09% and 32.14%, respectively. The prevalence of mental health symptoms was high among the sample. There is a need to expand the care of orphans to include mental health and not just limit their care to provide food to vulnerable children.

Facilitators and barriers associated with breastfeeding among mothers attending primary healthcare facilities in Mpumalanga, South Africa.

Introduction: Despite the health benefits of breastfeeding for both the mother and the child, early cessation of breastfeeding remains a public health problem in South Africa, attributed to contextual barriers and facilitators. Within the context of Mpumalanga province, which is characterized by low breastfeeding rates and high infant mortality rates in children under 5 years, we explored the facilitators and barriers to breastfeeding among mothers attending the three primary health facilities in Ermelo. Methods: Using a semi-structured interview guide suggested by the socio-ecological model, three focus group discussions and 12 in-depth interviews were conducted among mothers selected using a purposive sampling. Transcripts from audiotaped and transcribed verbatim interviews were assessed through thematic analysis using NVivo version 10. Results: Mothers were aged between 18 and 42 years and from poor sociodemographic backgrounds. At the individual level, mothers valued breastfeeding facilitated by their commitment, maintaining it, eating healthy foods, and having sufficient breast milk. However, returning to work, insufficient breast milk, misconceptions about breastfeeding, and interference with social life were the barriers for mothers to breastfeed continuously. At the interpersonal level, the family was identified as the main form of support to breastfeeding mothers; however, family interference was also identified as a barrier. At the community level, mothers shared some family beliefs and practices but were still split between societal and cultural norms and traditional beliefs as facilitators or barriers to breastfeeding. At the organizational level, most mothers valued the support provided by healthcare workers on childcare and techniques for breastfeeding at the health facilities. They did however articulate concerns on the miscommunication some healthcare workers offered regarding breastfeeding, which negatively influenced their infant feeding practices. Discussion: Intervention efforts should focus on behaviour change to educate and equip mothers to overcome the barriers that are within their control. Such interventions should further focus on family-centered education and strengthening the proficiency of healthcare workers on advising breastfeeding mothers.

Parental Stress in Raising a Child with Developmental Disabilities in a Rural Community in South Africa.

Although acceptable levels of parental stress are experienced by all parents who raise children, this stress is substantially higher among parents who raise children with developmental disabilities. Sociodemographic determinants further exacerbate parental stress among parents in rural communities, which are disadvantaged in many ways. This study aimed to quantify parental stress among mothers and female caregivers of children with developmental disorders and investigate factors associated with such stress in rural Kwa-Zulu Natal, South Africa. A cross-sectional quantitative survey was used, in which the Parenting Stress Index-Short Form (PSI-SF) and a sociodemographic questionnaire was administered to mothers and caregivers who were raising children aged 1 to 12 years old who were living with developmental disabilities. The PSI-SF scores were used, where a total score of ≤84 percentile was categorised as normal/no parenting stress, 85-89 percentile was categorised as high parental stress, and scores of ≥90 were classified as clinically significant. The sample of 335 participants consisted of 270 (80.6%) mothers and 65 (19.4%) caregivers. Their ages ranged from 19 to 65 years, with a mean of 33.9 (±7.8) years. The children were mostly diagnosed with delayed developmental milestones, communication difficulties, epilepsy, cerebral palsy, autism, ADHD, cognitive impairment, sensory impairments, and learning difficulties. The majority (52.2%) of the participants reported very high-clinically significant stress levels (≥85%ile). The four factors that independently and significantly predicted high parental stress were the advanced age of mothers and caregivers (p = 0.002, OR 2.3, 95% CI 1.34-3.95), caring for a child with multiple diagnoses (p = 0.013, OR 2.0, 95% CI 1.16-3.50), non-school enrolment of the child (p = 0.017, OR 1.9, 95% CI 1.13-3.46), and frequent hospital visits (p = 0.025, OR 1.9, 95% CI 1.09-3.44). At the subscale level, child non-enrolment in a school was found to independently predict parent distress (PD) and parent-child dysfunctional interaction (P-CDI). Frequent hospital visits were statistically and significantly associated with the difficult child (DC) and P-CDI subscales. The study established high parental stress in mothers and caregivers raising children with developmental disabilities. Lack of access to school was an independent factor that consistently increased parental stress. There is a need for support and directed intervention programs aimed at supporting mothers and caregivers of children with developmental disabilities, which will enhance their parenting abilities.

The Profile of Bullying Perpetrators and Victims and Associated Factors among High School Learners in Tshwane District, South Africa.

Although bullying in South African schools remains a current public health and education discussion, the view has been limited to acts of criminality, and not much has been done to identify risk factors for being bullying perpetrators and victims in a school environment. This study used a cross sectional quantitative survey to determine the profile of bullying perpetrators and victims among high school learners in a township in Pretoria. The Illinois Bully Scale was used to screen for bullying perpetration and victimization, whilst the Patient Health Questionnaire-9 and the Beck Anxiety Inventory were used to screen for depression and anxiety symptoms, respectively, among the sample of learners. STATA version 14 was used for data analysis. The sample of 460 consisted of 69% females with a mean age of 15 years. The 73.91% of learners who fitted the categories of bullying consisted of 21.96% victims, 9.57% perpetrators, and 42.39% perpetrator-victims. The Pearson Chi2 test of association found a significant association between being a bullying victim and reported lack of people who loved and cared for the learner. Being a bullying perpetrator was associated with anxiety symptoms of the learner and home alcohol use, while being a perpetrator -victim was associated with lack of family love and care, the school attended, as well as depression and anxiety symptoms. Using multivariate logistic regression, being a perpetrator-victim was associated with depression symptoms, anxiety symptoms, and home use of alcohol whilst being a perpetrator was associated with lack of anxiety symptoms. The study concluded that anxiety, depression, and the home environment are strongly associated with bullying, and most learners fitted the category of being both perpetrators and victims.

Pre-morbid cardiometabolic risks among South Africans living in informal settlements.

AIM: Numerous studies have been conducted on cardiometabolic risk factors in South Africa. However, not much has been done in informal settlement populations faced with their own set of health risks. This study screened for pre-morbid cardiometabolic risks and associated factors among adults living in informal settlements in South Africa. METHODS: A cross-sectional study used the WHO STEPwise questionnaire to collect data on demography, anthropometry, blood pressure, and glucose and cholesterol levels (n = 329). Cardiometabolic risks were based on the criteria considered by the International Diabetes Federation and the National Cholesterol Education Program Adult Treatment Panel III. Data were analysed using STATA 14. RESULTS: The median age of the participants was 35 (25-42) years. Cardiometabolic risk factors among the participants were hypertension (66%), overweight/obesity (45%), abdominal obesity (46%), and elevated cholesterol (15%) and glucose levels (7%). The metabolic syndrome was found in 17% of the participants, with a high prevalence observed among participants aged 35-59 years (28%) and ≥ 60 years (40%). The metabolic syndrome was significantly associated with gender [males, adjusted odds ratio (AOR) = 0.4, 95% CI: 0.20-0.90] and age, 35-59 years (AOR = 5.07, 95% CI: 2.24-11.23) and ≥ 60 years (AOR = 6.57, 95% CI; 1.57-27.54). CONCLUSIONS: Prevalent cardiometabolic risk factors in informal settlements indicate the need for routine screening for all the components of the metabolic syndrome at the primary healthcare level.

Prevalence and severity of anxiety symptoms among family members of nyaope users in Tshwane, South Africa.

Background: Nyaope is a strongly addictive novel psychoactive substance that is commonly used in predominantly black townships in South Africa. The undesired behaviours of the users result in family members developing mental health challenges. Nyaope users often commit petty crimes, including stealing from families and neighbours. Aim: The aim of this study was to quantify anxiety symptoms among family members of nyaope users in Tshwane, South Africa. Setting: Data were collected from nine townships within Tshwane Metropolitan Municipality. Methods: The quantitative cross-sectional survey used the General Anxiety Disorder (GAD-7) tool to quantify anxiety symptoms, and a questionnaire was used to collect sociodemographic data from a sample of 390 participants. Results: The ages of the participants ranged from 18 years to 87 years, with a mean of 47 years. The mothers to the nyaope users were the biggest group at 35% (n = 138). The prevalence of anxiety symptoms was 73% (n = 286) of the total sample and ranged from mild (41.8, n = 163), moderate (14.62, n = 57) and severe (16.92%, n = 66). The Pearson chi-square test identified significant associations between anxiety symptoms and the gender of the participant (p = 0.001), the age of the nyaope user and the period of nyaope use (p = 0.008). Multivariate regression model indicated gender and place of residence as a significant variable in the development of anxiety symptoms (p = 0.01). Conclusion: Nyaope use is a risk factor for the development of anxiety for family members of nyaope users with the highest proportion reporting mild symptoms. Contribution: There is a need to develop interventions for mental health support for families of nyaope users.

Views of community health workers on the integration of a physiotherapist into a ward-based outreach team.

Background: Due to changes in the disease profile and lifestyle of individuals in South Africa, the limited health care facilities available have experienced congestion and overcrowding, affecting health care service delivery. Ward-based outreach team (WBOT) programmes were implemented to strengthen primary health care, improve access and alleviate the congestion occurring at these facilities. However, WBOTs have limitations in terms of medical knowledge and rehabilitative skills. Objective: To explore the views of community health workers (CHWs) on the integration of physiotherapists into WBOTs. Method: A qualitative research design making use of focus group discussions (FGDs) was used. Through purposive sampling, 58 CHWs who were members of WBOTs were recruited. The WBOTs were from 10 selected primary health care centres in the Tshwane district, Region 2. Six FGDs were conducted. The audio-recorded data were transcribed verbatim. The transcripts were transported into NVivo 12 for thematic analysis. Results: The views of the CHWs were that the WBOTs can benefit from having a physiotherapist as a member of the team. The WBOTs do not have adequate skills to attend to the physiotherapy needs of communities. People in the community have challenges in accessing physiotherapy services, and physiotherapy services can enhance the performance of the WBOTs by providing training to the WBOTs and providing clinical services to community members. Conclusion: Community-based rehabilitative services with a physiotherapist as part of the WBOTs can enhance and strengthen the services of the WBOTs, which can improve the treatment outcomes for communities. Clinical implications: The WBOTS will be empowered to provide clinical services to the vulnerable people in the community that they serve.

A comparative study of postnatal depression and associated factors in Gauteng and Free State provinces, South Africa.

BACKGROUND: The factors contributing to probable postnatal depression (PND), a type of clinical depression that can affect woman after childbirth, are socially derived. Therefore, variations among groups of women necessitate studies in different communities. AIM: This study compared the prevalence of PND and associated factors among women attending postnatal services facilities. SETTING: The study setting included Tshwane Municipal district in Gauteng province (GP) and Fezile Dabi District (FS) in Free State province (FSP), South Africa. METHODS: A total of 477 mothers within 12 weeks of giving birth were recruited by convenient sampling in health facilities. A self-developed questionnaire was used to obtain information on socio-demographics, obstetric history, and children's characteristics. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data on depression symptoms, with a score of ≥ 13 used as a cut-off for probable PND. Data were analysed using STATA 14. Multivariate logistic regression was used to determine association between probable PND and various covariates. RESULTS: The overall mean age of women was 28 ± 6 years. The overall prevalence rate of PND was 22%, slightly higher in FS (23%) than in GP (21%). Most participants living in GP were married, had tertiary education, were employed and from the households with income of more than R8000.00. A chi-square test showed that planned pregnancy was significantly higher in GP compared with FS (p ≤ 0.001). Multivariate logistic regression showed that support from a partner or husband decreased the odds of a probable PND in GP (adjusted odd ratio [AOR] 0.37; 95% confidence interval [CI] [95%CI: 0.14-0.96; p = 0.041] and in the FS [AOR = 0.14, 95%CI: 0.05-0.40; p ≤ 0.001]). Significant associations of probable PND with several factors - planned pregnancy, baby age, support in difficult times, partner or husband drinking alcohol and stressful events - were more common in the FSP than in the GP. CONCLUSION: The prevalence of probable PND and its associated risk factors in the GP and the FS indicates the need for routine screening and targeted interventions in both urban and rural settings.Contribution: The results confirm that the prevalence of PND is similar in both rural and urban areas, and that pregnancy planning remains a challenge in the FS, which calls for increased efforts to revive family planning programmes in primary health care facilities.

Depression Symptoms among Family Members of Nyaope Users in the City of Tshwane, South Africa.

Substance abuse brings major negative social and health impacts in South Africa. Nyaope, a cocktail drug commonly used in the Tshwane townships, has been well documented to be highly addictive and very difficult to quit. The resultant difficulties include financial, social, and mental, specifically depression and anxiety. This study aims to quantify the depression levels among family members with nyaope users in Tshwane, South Africa. The study used a quantitative cross-sectional design to collect data in nine Tshwane communities. The patient health questionnaire-9 (PHQ-9) screening tool and demographic data collection questionnaires were used to collect data from a sample of 390 male and female family members who included mothers, fathers, grandparents, aunts, uncles, partners, and siblings of nyaope users, and who share a home with them. The ages of the participants ranged from 18 to 87 years, with a mean age of 47 years, while the ages of the nyaope users ranged from 17 to 55 years, with a mean age of 30 years. Depression scores ranged from 0 to 27 with a mean of 7. Depressive symptoms, as measured by the PHQ-9 scores of 5 and above, were reported by 49% of the sample. The levels of depression symptoms ranged from mild to severe, and the severity was higher among female, unemployed, and single participants. As with many others, these participants were not diagnosed and therefore were not treated. The study, therefore, identified that living with nyaope users is associated with the development of different levels of depression symptoms and has resulted in reduced quality of life among family members. The study recommends interventions that intentionally focus on families who live with individuals who are addicted to nyaope. Those interventions should focus on screening and treatment of depression and other mental disorders.

Poorly controlled hypertension among adults treated for hypertension in Tshwane District, South Africa.

Background: Adequate control of hypertension (HTN) is essential to prevent complications such as cardiovascular and kidney diseases. Despite the use of established clinical protocols on the treatment of HTN in primary health facilities in South Africa, the HTN of many patients remains poorly controlled. The objectives of this study were to determine the prevalence of poorly controlled HTN as well as identify related associated risk factors in a sample of adult attendees in primary health care facilities. Methods: A cross-sectional study was conducted among adult hypertension clinic attendees at primary health care facilities in Tshwane District, South Africa. Data were collected using the WHO Stepwise instrument on chronic disease risk factor surveillance and anthropometric and blood pressure (BP) measurements. Stata Version 13 was used for data analysis. Results: Of the 327 patients who participated in the study, 72.2% were female and 27.8% were male. Their mean age was 56 years (SD = 10.8 years). The prevalence of uncontrolled HTN was 58%, with the mean systolic BP and diastolic BP of 142.18 and 87.43, respectively. The prevalence of poorly controlled HTN increased with age. Factors associated with poorly controlled HTN were age, gender, being unemployed, source of income, smoking, alcohol use, lack of physical activity, and skipping of medication. By multi-variate analysis, both the mean systolic and diastolic blood pressures were found to be significantly associated with poorly controlled BP. Conclusion: The high prevalence of poorly controlled BP among patients who are on treatment suggests the need to re-consider the appropriateness of the current integrated management and treatment of HTN used in primary health care facilities in South Africa. The results suggest that the established clinical protocols and standard treatment for HTN are not beneficial for all patients and that physicians should use the treatment response of individual patients to make clinical decisions.

Substance abuse among high school learners in a rural education district in the Free State province, South Africa.

BACKGROUND: In South Africa, many studies conducted on substance abuse among in-school youth focus on urban areas. However, anecdotal evidence suggests that rural areas are experiencing an increase in substance abuse, though there is dearth of studies in these areas. METHODS: This study used a quantitative design to collect data from 629 high school learners who were in Grades 10 and 11 in public schools in rural Free State Province, to determine the prevalence of, and factors associated with substance use. RESULTS: The sample consisted of 46% males and 54% females. Their ages ranged from 14 to 20 years, with a mean of 16.9 years. The prevalence of substance abuse was 47% (n = 295) with alcohol consumption, cigarette and dagga smoking being the most common substances used. Socio-demographically, age and gender were significantly associated with substance abuse. While behavioural variables of physical fights, serious problems with parents and friends, poor academic performance, trouble with police, having sex without condom, and having sex and regretted the next day were significantly associated with substance abuse (p = 0.05). CONCLUSION: The prevalence of substance abuse is very high for this rural school community, which highlights the need to pay attention to rural schools regarding substance abuse challenges.

Neglecting Maternal Depression Compromises Child Health and Development Outcomes, and Violates Children's Rights in South Africa.

The intention of the South African Children's Act 38 of 2005 is to provide guarantees for the protection and promotion of optimum health and social outcomes for all children. These guarantees are the provision of basic nutrition, basic health care and social services, optimal family or parental care, as well as protection from maltreatment, neglect and abuse services. However, despite these guarantees, child and maternal mortality remain high in South Africa. The literature identifies maternal depression as a common factor that contributes to negative health and social outcomes for both mothers and their children. Despite the availability of easy-to-use tools, routine screening for maternal depression is not carried out in public health services, which is the source of services for the majority of women in South Africa. The results are that the mothers miss out on being diagnosed and treated for maternal depression, which results in negative child outcomes, such as malnutrition, as well as impacts on mental, social and physical health, and even death. The long-term impacts of untreated maternal depression include compromised child cognitive development, language acquisition and deviant behaviors and economic disadvantage in later life. The author concludes that the neglect of screening for, and treatment of maternal depression therefore violates the constitutional rights of the affected children, and goes against the spirit of the Constitution. The author recommends that maternal and child health services integrate routine screening for maternal depression, which will not only satisfy the Constitutional mandate, but also improve the health and developmental outcomes of the children and reduce child mortality.

Undiagnosed Hypertension in a Workplace: The Case of a Logistics Company in Gauteng, South Africa.

A large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular diseases in South Africa. A workplace may either mitigate or accentuate the risk factors for hypertension. A cross sectional study was conducted to determine the prevalence of undiagnosed hypertension and associated factors among 312 employees in a Logistics Company, South Africa. A modified, validated, self-administered WHO STEPwise questionnaire was used to collect data on demography, lifestyle factors, anthropometry and blood pressure (BP). Hypertension was defined at BP ≥ 140/90 mmHg. Data was analysed using STATA 14. Mean age of employees was 40 ± 10 years, with a 50% prevalence of undiagnosed hypertension. No significant association was observed between occupation and undiagnosed hypertension, except for high prevalence of undiagnosed hypertension among truck drivers and van assistants (43%), and general workers (27%), having higher odds of increased waist-to-height ratio. Hypertension was associated with age (OR = 2.3, 95%CI; 1.21-4.27), alcohol use (AOR = 1.8, 95%CI; 1.05-2.93), waist circumference (AOR = 2.3, 95%CI; 1.29-4.07) and waist-to-height-ratio (AOR = 3.7, 95%CI; 1.85-7.30). Improved and effective workplace health programs and policies are necessary for management of undiagnosed hypertension among employees. Longitudinal studies on mediation of occupation in association of demographic and lifestyle factors with hypertension in workplaces are needed.

Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa.

Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.

Social and Demographic Factors Associated with Postnatal Depression Symptoms among HIV-Positive Women in Primary Healthcare Facilities, South Africa.

BACKGROUND: Mothers living with HIV are at risk for mental health problems, which may have a negative impact on the management of their HIV condition and care of their children. Although South Africa has a high prevalence of HIV, there is a dearth of studies on sociodemographic predictors of postnatal depression (PND) among HIV-positive women in South Africa, even in KwaZulu Natal, a province with the highest prevalence of HIV in the country. OBJECTIVE: The objective of the study was to determine sociodemographic factors associated with the prevalence of postnatal depression symptoms among a sample of HIV-positive women attending health services from primary healthcare facilities in Umhlathuze District, KwaZulu Natal. METHODS: A quantitative cross-sectional survey was used to collect data from 386 HIV-positive women who had infants aged between 1 and 12 weeks. The Edinburgh Postnatal Depression Scale (EPNDS), to which sociodemographic questions were added, was used to collect data. RESULTS: The prevalence of PND symptoms among this sample of 386 HIV-positive women was 42.5%. The age of the mothers ranged from 16 to 42 years, with a mean of 29 years. The majority of the mothers were single or never married (85.5%; n = 330), living in a rural setting (81.9%; n = 316%), with a household income of less than R 2000 (estimated 125 USD) per month (64.9%; n = 120). The government child support grant was the main source of income for most of the mothers (53%; n = 183). PND symptoms were significantly associated with the participant's partner having other sexual partners (p-value < 0.001), adverse life events (p-value = 0.001), low monthly income (p-value = 0.015), and being financially dependent on others (p-value = 0.023). CONCLUSION: The prevalence of PND symptoms among the sample is high, with a number of social and demographic factors found to be significantly associated with PND. This requires the consideration of sociodemographic information in the overall management of both HIV and postnatal depression. Addressing the impact of these factors can positively influence the health outcomes of both the mother and the baby.

Substance use amongst high school learners in the south of Johannesburg: Is this the new norm?

BACKGROUND: Substance use amongst high school learners is common in South Africa, with related risky behaviours and outcomes. Because of the social and geographical trends, studies in various parts of the country are essential to contribute to the understanding of the overall picture. The purpose of this study was to determine the prevalence of substance use, as well as the factors associated with substance use in a sample of high school learners in a suburb south of Johannesburg. METHODS: A quantitative cross-sectional survey, by using a self-administered questionnaire, was conducted amongst 308 learners in four high schools. The parents of all the learners provided consent for their children to participate in the study. RESULTS: The sample consisted of 308 learners who were in grades 8-12, with a mean age of 16.3. The majority (57%, n = 177) were females and 43% (n = 131) were males. The prevalence of substance use was 31% (n = 94), with 52% (n = 49) of those who use substances being male, compared with 48% (n = 45) females. Of those who used substances, 69% (n = 65) used alcohol, 10% (n = 9) smoked dagga, 5% (n = 5) smoked cigarettes, 7% (n = 7) used other substances and 46% (n = 43) were polyusers. Age, missing school because of illness, use of leisure time and friends using substances were significantly associated with the use of substances (p 0.05). CONCLUSION: The prevalence of substance use was high at 31%, which is of concern because the use of legal psychoactive substances remains illegal for minors. The risky factors associated with the use of substances highlight the threat that this behaviour has on the social well-being and educational outcomes of the learners.

Clinical and Obstetric Risk Factors for Postnatal Depression in HIV Positive Women: A Cross Sectional Study in Health Facilities in Rural KwaZulu-Natal.

Postnatal depression (PND) remains underdiagnosed and undertreated in different socio-economic backgrounds in South Africa. This study determined the prevalence of and clinical and obstetric risk factors for PND symptoms among HIV positive women in health facilities in a rural health district in South Africa. The Edinburgh Postnatal Depression Scale was used to measure PND from 386 women who had delivered a live infant. More than half (58.5%) tested HIV positive during the current pregnancy. The prevalence of PND symptoms was 42.5%. Logistic regression analysis yielded significant associations between clinical and obstetric variables of pre-term baby (p-value < 0.01), baby health status p-value < 0.01), baby hospitalization, (p-value < 0.01), and knowing the baby's HIV status (p-value = 0.047). Maternal variables associated with PND were level of education (p-value < 0.01), monthly income (p-value < 0.01), and source of income (p-value = 0.05). At multivariate analysis, none of the clinical and obstetrical risk factors were independently associated with the PND. The high prevalence of PND symptoms underscore the need to integrate routine screening for PND in prevention of mother to child transmission of HIV programmes to enable early diagnosing and treatment of PND.