Establishing a health promotion and development foundation in South Africa.

South Africa has a 'quadruple burden of disease'. One way to reduce this burden, and address the social determinants of health and social inequity, could be through health promotion interventions driven by an independent Health Promotion and Development Foundation (HPDF). This could provide a framework to integrate health promotion and social development into all government and civil society programmes. On priority issues, the HPDF would mobilise resources, allocate funding, develop capacity, and monitor and evaluate health promotion and development work. Emphasis would be on reducing the effects of poverty, inequity and unequal development on disease rates and wellbeing. The HPDF could also decrease the burden on the proposed National Health Insurance (NHI) system. We reflect on such foundations in other countries, and propose a structure for South Africa's HPDF and a dedicated funding stream to support its activities. In particular, an additional 2% levy on alcohol and tobacco products is proposed to be utilised to fund the HPDF.

Knowledge, attitudes and practices related to healthy childbearing in the West Coast/Winelands.

INTRODUCTION: Many of the known risk factors associated with low birth weight (LBW) infants, such as socio-economic status, ethnicity, genetic makeup, and obstetric history, are not within a woman's immediate control. However, there are many things that a woman can do to improve her chances of having a normal healthy child. Lifestyle behaviours, such as cigarette smoking, nutrition and the use of alcohol, play an important role in determining the growth of the foetus. There is a high rate of low birth weight infants born to women living and working on the farms in the Western Cape. Very little is known about the knowledge, attitudes and practices of the women living and working on the farms that may be influencing their pregnancy outcomes. The aim of this qualitative exploratory study was to establish the knowledge, attitudes and practices of reproductive age women related to lifestyle factors such as alcohol use, smoking and nutrition, and the perceptions of these factors by health care workers, in Stellenbosch and Vredendal areas (small towns in the Western Cape). METHODS: Four methods of data collection were employed: focus groups and individual interviews with women on farms, and focus groups and semi-structured interviews with health workers. All focus groups and interviews were recorded, transcribed, and then coded to form themes. Findings were then triangulated across data collection methods. RESULTS: Participants described high levels of use of alcohol and cigarettes by women living on the farms in general, and in pregnancy, despite reasonable levels of awareness of the dangers to the foetus. Regarding nutrition, women have a fairly good sense of eating in a balanced way during pregnancy, but affording this on very low wages is difficult. Many ideas regarding how to increase healthy lifestyles were offered, ranging from environmental improvements, such as access to recreational facilities and handwork classes, to more contact with health services, and improvement in conditions of employment. CONCLUSION: This study highlights the lifestyle factors related to LBW infants on farms, and proposes that these should be addressed collectively by all the relevant sectors in the community. Although some of these processes have been initiated, there are gaps in the health services, which should be addressed immediately to provide women with opportunities to ensure acceptable pregnancy outcomes.