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.

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.

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.

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.

Challenges of Providing Home Care for a Family Member with Serious Chronic Mental Illness: A Qualitative Enquiry.

The South African Mental Health Act of 2002 advocates the de-institutionalization of treatment of patients with mental disorders, so that the mental health care users or patients are treated in their communities. Although this approach is often used to discharge patients from hospital, no feasibility assessments are conducted to ascertain adequate care for these patients. The objective of the study was to explore the experiences of family members who provide home care for patients with serious mental disorders. A qualitative explorative design was used to interview 20 primary caregivers whose family members were readmitted to a public psychiatric hospital in Pretoria. Data were analysed using NVivo version 11. The findings are that caring for patients with serious mental illness at home is difficult, sometimes unbearable, because the families have to deal with violence perpetrated by the patients, safety concerns, financial difficulties and emotional turmoil, and wish that the patients would be kept in institutions. The absence of required skills and resources to care for the mentally ill at home exposes the patients and their families to emotional, financial and social difficulties, and results in unfavourable outcomes for both the patients and their families.