The Pan-University Network for Global Health: framework for collaboration and review of global health needs.

In the current United Nations efforts to plan for post 2015-Millennium Development Goals, global partnership to address non-communicable diseases (NCDs) has become a critical goal to effectively respond to the complex global challenges of which inequity in health remains a persistent challenge. Building capacity in terms of well-equipped local researchers and service providers is a key to bridging the inequity in global health. Launched by Penn State University in 2014, the Pan University Network for Global Health responds to this need by bridging researchers at more than 10 universities across the globe. In this paper we outline our framework for international and interdisciplinary collaboration, as well the rationale for our research areas, including a review of these two themes. After its initial meeting, the network has established two central thematic priorities: 1) urbanization and health and 2) the intersection of infectious diseases and NCDs. The urban population in the global south will nearly double in 25 years (approx. 2 billion today to over 3.5 billion by 2040). Urban population growth will have a direct impact on global health, and this growth will be burdened with uneven development and the persistence of urban spatial inequality, including health disparities. The NCD burden, which includes conditions such as hypertension, stroke, and diabetes, is outstripping infectious disease in countries in the global south that are considered to be disproportionately burdened by infectious diseases. Addressing these two priorities demands an interdisciplinary and multi-institutional model to stimulate innovation and synergy that will influence the overall framing of research questions as well as the integration and coordination of research.

Adolescent alcohol use in rural South African high schools.

OBJECTIVE: To examine psychosocial correlates of lifetime alcohol use among adolescents in rural South African high schools. METHOD: Questionnaires were administered to 1600 students from 20 randomly selected high schools in the Mankweng district within Limpopo province. Self-report data on alcohol use, demographic, environmental and psychosocial variables were collected. RESULTS: About 22% of the students had ever used alcohol. Males were 2.4 times more likely to use alcohol than females. For students who attended religious services, the odds of ever having used alcohol were double those of students who did not attend religious services. The fitted logistic regression model shows that gender, age, ever having smoked a cigarette, ever damaged property, walking home alone at night, easy availability of alcohol, thinking alcohol use was wrong, attending religious services and number of friends who used alcohol are the best predictors of alcohol use among high school students in this setting. CONCLUSION: The results underline the importance of addressing personal, family, peer and school conduct factors as part of alcohol education initiatives. Efforts to prevent alcohol use among rural high school students should focus on changing drinking behaviour and on reducing risk factors for problem drinking.

Effects of the SATZ teacher-led school HIV prevention programmes on adolescent sexual behaviour: cluster randomised controlled trials in three sub-Saharan African sites.

In this study, the effects on young adolescent sexual risk behaviour of teacher-led school HIV prevention programmes were examined in two sites in South Africa (Cape Town and Mankweng) and one site in Tanzania (Dar es Salaam). In Cape Town, Dar es Salaam and Mankweng, 26, 24 and 30 schools, respectively, were randomly allocated to intervention or comparison groups. Primary outcomes were delayed sexual debut and condom use among adolescents aged 12-14 years (grade 8 in South Africa and grades 5 and 6 in Tanzania). In total, 5352, 4197 and 2590 students participated at baseline in 2004 in Cape Town, Dar es Salaam and Mankweng, respectively, and 73% (n = 3926), 88% (n = 3693) and 83% (n = 2142) were retained 12-15 months later. At baseline, 13% (n = 224), 5% (n = 100) and 17% (n = 164) had had their sexual debut, and 44% (n = 122), 20% (n = 17) and 37% (n = 57) of these used a condom at last sex, respectively. In Dar es Salaam, students in the intervention were less likely to have their sexual debut during the study (OR 0.65, 95% CI 0.48-0.87). In Cape Town and Mankweng, the intervention had no impact. The current interventions were effective at delaying sexual debut in Dar es Salaam but not in South Africa, where they need to be supplemented with programmes to change the environment in which adolescents make decisions about sexual behaviour.

Cultural factors and home-brewed alcohol use in a rural community in South Africa.

This paper presents an analysis of the relationship between cultural orientation and home- brewed alcohol use among adolescents in a rural setting. The study involved 1263 students from 30 high schools in Mankweng District in Limpopo Province of South Africa. Boys formed 48% of the sample. Means ages were 16.7 and 16.0 years for boys and girls respectively. A 16 item scale focusing on language, mass media and music preferences was constructed to measure cultural orientations. There was an integration of western and traditional/local activities by respondents who reported having used home-brewed alcohol in the past 12 months. In some respects the sample had western tendencies i.e. English newspapers were read more than no-English newspapers and funky music tended to be preferred to traditional South African music, while in others the reverse was true i.e. Radio Thobela (a radio station that uses vernacular languages) was listened to more than Radio Metro (a radio station that uses English language only). There were significant differences between boys and girls in the use of western media. Older adolescents (18 years or older) used more home brewed alcohol than the younger ones. The concept of culture and its associations with alcohol use invites a critical view on cultural values among adolescents. The positive association with home-brewed alcohol use among secondary school students in our sample has been demonstrated for an orientation towards external cultural influence. Educators and learners need to increase their consciousness on the problematic side of cultural import.

Fear of Stigmatization as Barrier To Voluntary HIV Counselling and Testing In South Africa

Objective: The objective of this qualitative study was to identify psychosocial correlates of HIV voluntary counselling and testing (VCT); with an emphasis on the association between fear of AIDS-related stigma and willingness to have an HIV test. Methods: The study was executed in Limpopo Province at University of Limpopo; Polokwane; South Africa. Focus group interviews were held among 72 students; divided over 10 groups. Results: Results showed that participants had different levels of knowledge about HIV/AIDS and VCT; and that AIDS was still strongly associated with 'death'. Results further demonstrate that HIV/ AIDS related stigma is still a very serious problem in South Africa. Lack of HIV/ AIDS related knowledge; blaming persons with HIV/AIDS for their infection; and the life-threatening character of the disease were seen as the most important determinants of AIDS-related stigma. The main benefit to go for VCT was 'knowing your HIV status'; whereas main barriers for testing were 'fear of being stigmatised' and `fear of knowing your HIV positive status'. Conclusion: Fear of stigmatization is an important barrier to HIV testing and has negative consequences for AIDS prevention and treatment. Interventions to reduce HIV-related stigma are needed in order to foster voluntary HIV counselling and testing in South Africa

Factors at first diagnosis of tuberculosis associated with compliance with the Directly Observed Therapy (DOT) in the Limpopo Province, South Africa.

The aim of this study is to compare and contrast health beliefs, demographic and socio-economic variables, causative beliefs, knowledge, health-seeking behaviour and health provider-patient interaction of compliant and non-compliant tuberculosis patients. The sample included 219 consecutive new sputum-smear and/or culture positive pulmonary tuberculosis patients registered between October 1999 and March 2000 in three hospitals in the Limpopo Province of South Africa. The patients were 144 (65.8%) men and 75 (34.2%) women in the age range of 18 to 79 years (M age 35.9 yr., SD = 12.6). The consultation at first diagnosis was observed and tape-recorded. Thereafter an interview was conducted and a questionnaire was face-to-face administered with the patient including knowledge, causative beliefs, health seeking, and Health Belief Model items. Discriminant analysis between compliant and non-compliant groups after six months follow-up showed that the quality of the health practitioner-patient interaction and causative belief were associated with compliance behaviour whereas knowledge, onset of TB, sociodemographic variables, health care seeking, and health beliefs were not associated.

Rethinking school sanitation and hygiene education curriculum in rural and peri-urban communities in South Africa.

PIP: The provision of appropriate water, sanitation, and hygiene education, especially in schools, is very weak in some areas of South Africa. Inadequate education is one of the biggest obstacles to providing sufficient water in the country. The South African Hygiene Education Project (SASHEP) will be implemented during 1996-98 with the goal of developing a child-oriented sanitation and hygiene education curriculum informed by the perceptions of children and adolescents in primary schools. In the first phase of the project, researchers and educators in the Western Cape, Eastern Cape, Northern, and possibly KwaZulu Natal Provinces will investigate children's perceptions of water, sanitation, and hygiene practices. Child-friendly research approaches, such as the draw-and-write method and focus group discussions, will be used. The perceived needs for water, sanitation, and hygiene education among primary school students will later be used in the development, implementation, and evaluation of the school hygiene education curriculum and extracurricular activities. Curriculum activities will use methods such as the child-to-child approach.^ieng