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Hartnick MD, Marnewick JL, Engel-Hills P, Kemp M, Pretorius K, Lekata S, Uys C. Impact of Chronic Consumption of Herbal Rooibos on Cardiovascular Function in Adults with Cardiovascular Risk. J Med Food 2024. [PMID: 38958559 DOI: 10.1089/jmf.2024.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
The prevalence of cardiovascular disease (CVD) has increased in South Africa, emphasizing the importance of prevention strategies. This study used echocardiography to investigate the impact of Rooibos on cardiovascular function in those at risk of CVD. This research aims to contribute to understanding its effects on reducing cardiovascular risk factors. The study design involved a 12-week randomized, parallel, double-blinded, placebo-controlled dietary intervention trial using capsules containing standardized water-soluble extracts of green and traditional fermented Rooibos alongside a placebo control. Echocardiography was incorporated as a diagnostic imaging tool to assess cardiac function in the participant cohort. Aorta (AO) dimensions showed no significant change in any intervention group. Left atrium (LA) reduced in size from 3.832 ± 0.071 cm to 3.675 ± 0.067 cm (P = 0.01). There was no significant change in LA/AO ratio in any intervention group. Interventricular septum diameter in the placebo group decreased from 1.334 ± 0.030 cm to 1.250 ± 0.025 cm (P = 0.002), with no significance in fermented Rooibos, while green Rooibos resulted in a decrease from 1.282 ± 0.036 cm to 1.186 ± 0.029 cm (P = 0.002). Left ventricle posterior wall (LVPW) showed no significant changes in any of the intervention group. The left ventricle mass in the placebo and green Rooibos groups demonstrated no significance changes, while fermented Rooibos caused a decrease from 204.102 ± 7.102 g to 191.394 ± 6.707 g (P = 0.015). The phytochemical bioactive components, such as the polyphenolic antioxidants present in green and fermented Rooibos, improved cardiovascular function. This study confirms the effectiveness of echocardiography as imaging tool for assessing cardiac function in this particular population. Regular Rooibos consumption may offer promising therapeutic benefits for preventing and managing CVD risk.
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Affiliation(s)
- Maria Diana Hartnick
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula, University of Technology, Cape Town, South Africa
| | - Jeanine L Marnewick
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula, University of Technology, Cape Town, South Africa
| | - Penelope Engel-Hills
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula, University of Technology, Cape Town, South Africa
- Faculty of Health and Wellness Sciences, Cape Peninsula, University of Technology, Cape Town, South Africa
| | - Merlisa Kemp
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula, University of Technology, Cape Town, South Africa
- Faculty of Health and Wellness Sciences, Cape Peninsula, University of Technology, Cape Town, South Africa
| | - Kobus Pretorius
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula, University of Technology, Cape Town, South Africa
- Faculty of Health and Wellness Sciences, Cape Peninsula, University of Technology, Cape Town, South Africa
| | - Stanley Lekata
- Center for Postgraduate Studies, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Corrie Uys
- Center for Postgraduate Studies, Cape Peninsula University of Technology, Cape Town, South Africa
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Ginsburg C, Collinson MA, Pheiffer CF, Gómez-Olivé FX, Harawa S, McGarvey ST, Ohene-Kwofie D, Foster AD, Myroniuk TW, Lurie MN, Tollman SM, White MJ. Cohort Profile: Migrant Health Follow-Up Study (MHFUS) of internal migration in South Africa. Int J Epidemiol 2024; 53:dyae081. [PMID: 38866399 PMCID: PMC11168786 DOI: 10.1093/ije/dyae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/28/2024] [Indexed: 06/14/2024] Open
Affiliation(s)
- Carren Ginsburg
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark A Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/Medical Research Council, South African Population Research Infrastructure Network, Durban, South Africa
| | - Chantel F Pheiffer
- Population Studies and Training Center, Brown University, Providence, RI, USA
- Department of Urban Public Health, University of Massachusetts, Boston, MA, USA
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sadson Harawa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen T McGarvey
- Population Studies and Training Center, Brown University, Providence, RI, USA
- Department of Epidemiology and International Health Institute, School of Public Health, Brown University, Providence, RI, USA
- Department of Anthropology, Brown University, Providence, RI, USA
| | - Daniel Ohene-Kwofie
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew D Foster
- Population Studies and Training Center, Brown University, Providence, RI, USA
| | - Tyler W Myroniuk
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Mark N Lurie
- Population Studies and Training Center, Brown University, Providence, RI, USA
- Department of Epidemiology and International Health Institute, School of Public Health, Brown University, Providence, RI, USA
| | - Stephen M Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael J White
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Population Studies and Training Center, Brown University, Providence, RI, USA
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3
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Nkosi MZP. Patients' experiences in the use of mobile health clinics in KwaMachi rural area of KwaZulu-Natal, South Africa. DIALOGUES IN HEALTH 2024; 4:100164. [PMID: 38516224 PMCID: PMC10953896 DOI: 10.1016/j.dialog.2023.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/04/2023] [Accepted: 12/29/2023] [Indexed: 03/23/2024]
Abstract
Background A study was conducted to evaluate the role of mobile health clinics (MHCs) in providing healthcare services in rural areas, focusing on the population of KwaMachi in KwaZulu Natal, South Africa. The objective of the study was to explore the level of health promotion and health-seeking behaviour in KwaMachi, understand the services provided by the MHCs, and assess the experiences of individuals accessing healthcare through these clinics. Methods The study used qualitative research methods, including face-to-face interviews and focused group discussions. A sample of 20 patients, with equal representation of males and females across different age groups, was selected using purposive and convenience sampling methods. Two themes were developed: positive experiences and negative experiences. The collected data was analyzed using manual thematic analysis. Findings The findings of the study revealed that MHCs serve as the main entry point to the national healthcare system in rural areas, but they offer limited services, which contributes to the ongoing struggle of rural communities to access primary healthcare. While respondents generally had positive experiences with MHCs, some negative aspects need to be addressed. These included concerns about privacy during consultations, the unavailability of essential medications, limited services offered, lack of doctors, and inadequate management of clinical records leading to diagnostic inaccuracies. Conclusion The study highlights the challenges faced by rural communities in accessing healthcare services and the role of MHCs in addressing these challenges Based on these findings, the study concludes that there is a need for sustainable MHC programs that address the specific needs and preferences of the local population. Recommendations These insights are of value to policymakers seeking to enhance the impact of MHCs in improving healthcare access and outcomes in rural areas. By looking at areas of improvement in the services provided by MHCs, including addressing privacy concerns, ensuring the availability of essential medications, and improving the management of clinical records. The study provides valuable insights for policymakers to enhance the effectiveness of MHC programs in rural areas.
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Affiliation(s)
- Ms Zama Portia Nkosi
- Faculty of Social Sciences, School of Sociology and Population Studies, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
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van Rensburg L, Majiet N, Geldenhuys A, King LL, Stassen W. A resuscitation systems analysis for South Africa: A narrative review. Resusc Plus 2024; 18:100655. [PMID: 38770395 PMCID: PMC11103484 DOI: 10.1016/j.resplu.2024.100655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
With a growing incidence in cardiovascular diseases in Africa, including South Africa, and with it a greater incidence of out-of-hospital cardiac arrest (OHCA) there is a need to understand the readiness of these emergency care systems to support a response. Yet, OHCA is expensive and requires comprehensive development across an entire chain of survival in order to gain any benefit in mortality or morbidity. In this narrative review, we provide a resuscitation systems analysis using the Global Resuscitation Alliance's Frame of Survival. We provide evidence or commentary on the elements of the outer frame and inner frame, and make an assessment of the South African system's readiness to support OHCA care, and provide suggestions for priority areas that need to be developed. The South African resuscitation system demonstrates reasonable readiness to respond to OHCA but is characterised by considerable variation and fragmentation. Given the cost ineffectiveness of many interventions and the anticipated rise in OHCA incidence, there is a pressing need for context-specific strategies in South Africa. These strategies should focus on enhancing both outcomes and resource efficiency, while respecting community ethics and sociocultural dynamics.
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Affiliation(s)
| | - Naqeeb Majiet
- Division of Emergency Medicine, University of Cape Town, South Africa
- Emergency Medical Services, Western Cape Department of Health & Wellness, South Africa
| | | | - Lauren Lai King
- Division of Emergency Medicine, University of Cape Town, South Africa
- African Federation for Emergency Medicine, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, South Africa
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5
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Pizzato M, Santucci C, Parazzini F, Negri E, La Vecchia C. Cancer mortality patterns in selected Northern and Southern African countries. Eur J Cancer Prev 2024; 33:192-199. [PMID: 37997906 DOI: 10.1097/cej.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Non-communicable diseases have been rapidly increasing in African countries. We provided updated cancer death patterns in selected African countries over the last two decades. METHODS We extracted official death certifications and population data from the WHO and the United Nations Population Division databases. We computed country- and sex-specific age-standardized mortality rates per 100 000 person-years for all cancers combined and ten major cancer sites for the periods 2005-2007 and 2015-2017. RESULTS Lung cancer ranked first for male cancer mortality in all selected countries in the last available period (with the highest rates in Réunion 24/100 000), except for South Africa where prostate cancer was the leading cause of death (23/100 000). Prostate cancer ranked second in Morocco and Tunisia and third in Mauritius and Réunion. Among Egyptian men, leukemia ranked second (with a stable rate of 4.2/100 000) and bladder cancer third (3.5/100 000). Among women, the leading cancer-related cause of death was breast cancer in all selected countries (with the highest rates in Mauritius 19.6/100 000 in 2015-2017), except for South Africa where uterus cancer ranked first (17/100 000). In the second rank there were colorectal cancer in Tunisia (2/100 000), Réunion (9/100 000) and Mauritius (8/100 000), and leukemia in Egypt (3.2/100 000). Colorectal and pancreas cancer mortality rates increased, while stomach cancer mortality rates declined. CONCLUSION Certified cancer mortality rates are low on a global scale. However, mortality rates from selected screening detectable cancers, as well as from infection-related cancers, are comparatively high, calling for improvements in prevention strategies.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan
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Singh S, Naicker A, Grobbelaar H, Singh ES, Spiegelman D, Shrestha A. Barriers and Facilitators of Implementing a Healthy Lifestyle Intervention at Workplaces in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:389. [PMID: 38673303 PMCID: PMC11050208 DOI: 10.3390/ijerph21040389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
Current evidence indicates that workplace health and wellness programmes provide numerous benefits concerning altering cardiovascular risk factor profiles. Implementing health programmes at workplaces provide an opportunity to engage adults towards positive and sustainable lifestyle choices. The first step in designing lifestyle interventions for the workplace is understanding the barriers and facilitators to implementing interventions in these settings. The barriers and facilitators to implementing lifestyle interventions in the workplace environment was qualitatively explored at two multinational consumer goods companies among seven workplaces in South Africa. Semi-structured in-depth interviews (IDIs) were conducted with ten workplace managers. Five focus group discussions (FGDs) were conducted among workplace employees. The IDI findings revealed that the main facilitators for participation in a lifestyle intervention programme were incentives and rewards, educational tools, workplace support, and engaging lessons. In contrast, the main facilitator of the FGDs was health and longevity. The main barriers from the IDIs included scheduling time for lifestyle interventions within production schedules at manufacturing sites, whereas time limitations, a lack of willpower and self-discipline were the main barriers identified from the FGDs. The findings of this study add to literature on the barriers and facilitators of implementing healthy lifestyle interventions at workplaces and suggest that there is a potential for successfully implementing intervention programmes to improve health outcomes, provided that such efforts are informed and guided through the engagement of workplace stakeholders, an assessment of the physical and food environment, and the availability of workplace resources.
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Affiliation(s)
- Shivneta Singh
- Department of Food and Nutrition, Faculty of Applied Sciences, Durban University of Technology, 70 Steve Biko Road, Musgrave, Berea 4001, South Africa; (A.N.); (H.G.); (E.S.S.)
| | - Ashika Naicker
- Department of Food and Nutrition, Faculty of Applied Sciences, Durban University of Technology, 70 Steve Biko Road, Musgrave, Berea 4001, South Africa; (A.N.); (H.G.); (E.S.S.)
| | - Heleen Grobbelaar
- Department of Food and Nutrition, Faculty of Applied Sciences, Durban University of Technology, 70 Steve Biko Road, Musgrave, Berea 4001, South Africa; (A.N.); (H.G.); (E.S.S.)
| | - Evonne Shanita Singh
- Department of Food and Nutrition, Faculty of Applied Sciences, Durban University of Technology, 70 Steve Biko Road, Musgrave, Berea 4001, South Africa; (A.N.); (H.G.); (E.S.S.)
| | - Donna Spiegelman
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT 06510, USA; (D.S.); (A.S.)
| | - Archana Shrestha
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT 06510, USA; (D.S.); (A.S.)
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7
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Stanton AM, Boyd RL, O’Cleirigh C, Olivier S, Dolotina B, Gunda R, Koole O, Gareta D, Modise TH, Reynolds Z, Khoza T, Herbst K, Ndung’u T, Hanekom WA, Wong EB, Pillay D, Siedner MJ. HIV, multimorbidity, and health-related quality of life in rural KwaZulu-Natal, South Africa: A population-based study. PLoS One 2024; 19:e0293963. [PMID: 38381724 PMCID: PMC10880982 DOI: 10.1371/journal.pone.0293963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/23/2023] [Indexed: 02/23/2024] Open
Abstract
Health-related quality of life (HRQoL) assesses the perceived impact of health status across life domains. Although research has explored the relationship between specific conditions, including HIV, and HRQoL in low-resource settings, less attention has been paid to the association between multimorbidity and HRQoL. In a secondary analysis of cross-sectional data from the Vukuzazi ("Wake up and know ourselves" in isiZulu) study, which identified the prevalence and overlap of non-communicable and infectious diseases in the uMkhanyakunde district of KwaZulu-Natal, we (1) evaluated the impact of multimorbidity on HRQoL; (2) determined the relative associations among infectious diseases, non-communicable diseases (NCDs), and HRQoL; and (3) examined the effects of controlled versus non-controlled disease on HRQoL. HRQoL was measured using the EQ-5D-3L, which assesses overall perceived health, five specific domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and three levels of problems (no problems, some problems, and extreme problems). Six diseases and disease states were included in this analysis: HIV, diabetes, stroke, heart attack, high blood pressure, and TB. After examining the degree to which number of conditions affects HRQoL, we estimated the effect of joint associations among combinations of diseases, each HRQoL domain, and overall health. Then, in one set of ridge regression models, we assessed the relative impact of HIV, diabetes, stroke, heart attack, high blood pressure, and tuberculosis on the HRQoL domains; in a second set of models, the contribution of treatment (controlled vs. uncontrolled disease) was added. A total of 14,008 individuals were included in this analysis. Having more conditions adversely affected perceived health (r = -0.060, p<0.001, 95% CI: -0.073 to -0.046) and all HRQoL domains. Infectious conditions were related to better perceived health (r = 0.051, p<0.001, 95% CI: 0.037 to 0.064) and better HRQoL, whereas non-communicable diseases (NCDs) were associated with worse perceived health (r = -0.124, p<0.001, -95% CI: 0.137 to -0.110) and lower HRQoL. Particular combinations of NCDs were detrimental to perceived health, whereas HIV, which was characterized by access to care and suppressed viral load in the large majority of those affected, was counterintuitively associated with better perceived health. With respect to disease control, unique combinations of uncontrolled NCDs were significantly related to worse perceived health, and controlled HIV was associated with better perceived health. The presence of controlled and uncontrolled NCDs was associated with poor perceived health and worse HRQoL, whereas the presence of controlled HIV was associated with improved HRQoL. HIV disease control may be critical for HRQoL among people with HIV, and incorporating NCD prevention and attention to multimorbidity into healthcare strategies may improve HRQoL.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Ryan L. Boyd
- The Obelus Institute, Washington, DC, United States of America
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Zahra Reynolds
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- DSI-MRC South African Population Research Infrastructure Network (SAPRIN), South African Medical Research Council, Durban, South Africa
| | - Thumbi Ndung’u
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Willem A. Hanekom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Emily B. Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Mark J. Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Chukwuma CI. Antioxidative, Metabolic and Vascular Medicinal Potentials of Natural Products in the Non-Edible Wastes of Fruits Belonging to the Citrus and Prunus Genera: A Review. PLANTS (BASEL, SWITZERLAND) 2024; 13:191. [PMID: 38256745 PMCID: PMC10818484 DOI: 10.3390/plants13020191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
Diabetes mellitus and related metabolic and vascular impairments are notable health problems. Fruits and vegetables contain phenolics that are beneficial to metabolic and oxidative health and useful in preventing associated disease. Scientific evidence has shown that some bioactive phenolics are more abundant in the non-edible parts (especially the peels) of many fruits than in their respective edible tissues. Fruits belonging to the Citrus and Prunus genera are commonly consumed worldwide, including in South Africa, and their non-edible wastes (peel and seed) have been shown to have antioxidative, metabolic and vascular pharmacological potentials and medicinal phytochemistry. It is therefore imperative to evaluate the pharmacological actions and phytochemical properties of the non-edible wastes of these fruits and understand how they could potentially be of medicinal relevance in oxidative, metabolic and vascular diseases, including diabetes, oxidative stress, obesity, hypertension and related cardiovascular impairments. In the absence of a previous review that has concomitantly presented the medicinal potentials of fruits wastes from both genera, this review presents a critical analysis of previous and recent perspectives on the medicinal potential of the non-edible wastes from the selected Citrus and Prunus fruits in metabolic, vascular and oxidative health. This review further exposes the medicinal phytochemistry, while elucidating the underlying mechanisms through the fruit wastes potentiates their therapeutic effects. A literature search was carried out on "PubMed" to identify peer-reviewed published (mostly 2015 and beyond) studies reporting the antidiabetic, antioxidative, antihypertensive, anti-hyperlipidemic and anti-inflammatory properties of the non-edible parts of the selected fruits. The data of the selected studies were analyzed to understand the bioactive mechanisms, bioactive principles and toxicological profiles. The wastes (seed and peel) of the selected fruits had antioxidant, anti-obesogenic, antihypertensive, anti-inflammatory, antidiabetic and tissue protective potentials. Some phenolic acids and terpenes, as well as flavonoids and glycosides such as narirutin, nobiletin, hesperidin, naringin, naringenin, quercetin, rutin, diosmin, etc., were the possible bioactive principles. The peel and seed of the selected fruits belonging to the Citrus and Prunus genera are potential sources of bioactive compounds that could be of medicinal relevance for improving oxidative, metabolic and vascular health. However, there is a need for appropriate toxicological studies.
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Affiliation(s)
- Chika I Chukwuma
- Centre for Quality of Health and Living (CQHL), Faculty of Health and Environmental Sciences, Central University of Technology, Private Bag X20539, Bloemfontein 9300, Free State, South Africa
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9
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Louw CJ, de Haan P, Verpoorte E, Baker P. Efficient Electrochemiluminescence Sensing in Microfluidic Biosensors: A Review. Crit Rev Biomed Eng 2024; 52:41-62. [PMID: 38523440 DOI: 10.1615/critrevbiomedeng.2023049565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Microfluidic devices are capable of handling 10-9 L to 10-18 L of fluids by incorporating tiny channels with dimensions of ten to hundreds of micrometers, and they can be fabricated using a wide range of materials including glass, silicon, polymers, paper, and cloth for tailored sensing applications. Microfluidic biosensors integrated with detection methods such as electrochemiluminescence (ECL) can be used for the diagnosis and prognosis of diseases. Coupled with ECL, these tandem devices are capable of sensing biomarkers at nanomolar to picomolar concentrations, reproducibly. Measurement at this low level of concentration makes microfluidic electrochemiluminescence (MF-ECL) devices ideal for biomarker detection in the context of early warning systems for diseases such as myocardial infarction, cancer, and others. However, the technology relies on the nature and inherent characteristics of an efficient luminophore. The luminophore typically undergoes a redox process to generate excited species which emit energy in the form of light upon relaxation to lower energy states. Therefore, in biosensor design the efficiency of the luminophore is critical. This review is focused on the integration of microfluidic devices with biosensors and using electrochemiluminescence as a detection method. We highlight the dual role of carbon quantum dots as a luminophore and co-reactant in electrochemiluminescence analysis, drawing on their unique properties that include large specific surface area, easy functionalization, and unique luminescent properties.
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Affiliation(s)
- Clementine Juliat Louw
- SensorLab, Chemistry Department, University of the Western Cape, Cape Town, South Africa; Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Pim de Haan
- Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Elisabeth Verpoorte
- Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Priscilla Baker
- Department of Chemistry, University of the Western Cape Bellville, 7535, Republic of South Africa
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10
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Kgasi M, Chimbo B, Motsi L. mHealth Self-Monitoring Model for Medicine Adherence of Patients With Diabetes in Resource-Limited Countries: Structural Equation Modeling Approach. JMIR Form Res 2023; 7:e49407. [PMID: 37870902 PMCID: PMC10628689 DOI: 10.2196/49407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to serious challenges and emphasized the importance of using technology for health care operational transformation. Consequently, the need for technological innovations has increased, thus empowering patients with chronic conditions to tighten their adherence to medical prescriptions. OBJECTIVE This study aimed to develop a model for a mobile health (mHealth) self-monitoring system for patients with diabetes in rural communities within resource-limited countries. The developed model could be based on the implementation of a system for the self-monitoring of patients with diabetes to increase medical adherence. METHODS This study followed a quantitative approach, in which data were collected from health care providers using a questionnaire with close-ended questions. Data were collected from district hospitals in 3 South African provinces that were selected based on the prevalence rates of diabetes and the number of patients with diabetes treated. The collected data were analyzed using smart partial least squares to validate the model and test the suggested hypotheses. RESULTS Using variance-based structural equation modeling that leverages smart partial least squares, the analysis indicated that environmental factors significantly influence all the independent constructs that inform patients' change of behavior toward the use of mHealth for self-monitoring of medication adherence. Technology characteristics such as effort expectancy, self-efficacy, and performance expectancy were equally significant; hence, their hypotheses were accepted. In contrast, the contributions of culture and social aspects were found to be insignificant, and their hypotheses were rejected. In addition, an analysis was conducted to determine the interaction effects of the moderating variables on the independent constructs. The results indicated that with the exception of cultural and social influences, there were significant interacting effects on other independent constructs influencing mHealth use for self-monitoring. CONCLUSIONS On the basis of the findings of this study, we conclude that behavioral changes are essential for the self-monitoring of chronic diseases. Therefore, it is important to enhance those effects that stimulate the behavior to change toward the use of mHealth for self-monitoring. Motivational aspects were also found to be highly significant as they triggered changes in behavior. The developed model can be used to extend the research on the self-monitoring of patients with chronic conditions. Moreover, the model will be used as a basic architecture for the implementation of fully fledged systems for self-monitoring of patients with diabetes.
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Affiliation(s)
- Mmamolefe Kgasi
- Faculty of ICT, Tshwane University of Technology, Pretoria, South Africa
- School of Computing, University of South Africa, Johannesburg, South Africa
| | - Bester Chimbo
- School of Computing, University of South Africa, Johannesburg, South Africa
| | - Lovemore Motsi
- School of Computing, University of South Africa, Johannesburg, South Africa
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11
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Kaylor SA, Singh SA. Clinical outcomes associated with speech, language and swallowing difficulties post-stroke. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2023; 70:e1-e15. [PMID: 37916686 PMCID: PMC10623651 DOI: 10.4102/sajcd.v70i1.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND There is a lack of prospective research in South Africa's speech therapy private sector, specifically, in the acute stroke population. There is a need to understand the quality of speech therapy services and outcomes post-stroke in the private sector. OBJECTIVES This prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), and outcomes post-stroke (i.e. length of hospital stay [LOS], degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). METHOD A prospective design was used to determine the incidence of speech, language, and swallowing conditions post-stroke. Convenience sampling was used to select participants (N = 68). Various statistical tests were used and the alpha level was set at Bonferroni correction p 0.01. RESULTS Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to speech therapy later than 24 h post-admission (52.94%) stayed in hospital for a median of 3 days longer than those who were referred within 24 h (p = 0.042). Dysphagia was significantly associated with moderate to severe physical disability (p 0.01). Dysphagia with aspiration was significantly associated with poor functional level of oral intake, at admission and at discharge (p 0.01). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p 0.01, r = 0.70). CONCLUSION In South Africa's private sector, co-occurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed speech therapy referrals.Contribution: This article contributes data on speech therapy services, communication and swallowing disorders post-stroke, and outcomes in South Africa's private sector.
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Affiliation(s)
- Stephanie A Kaylor
- Department of Communication Sciences and Disorders, Faculty of Health and Rehabilitation Sciences, University of Cape Town, Cape Town.
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12
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Teuteberg N, Barnard MM, Fernandez A, Cloete K, Mukosi M, Pitcher R. The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa. Cureus 2023; 15:e47616. [PMID: 38021905 PMCID: PMC10667617 DOI: 10.7759/cureus.47616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000 people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103 vs. 8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103 vs. 16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions. The medium- and long-term clinical impacts of decreased imaging are still to be defined.
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Affiliation(s)
- Nolene Teuteberg
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, ZAF
| | - Michelle M Barnard
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Department of Health and Wellness, Cape Town, ZAF
| | - Amanda Fernandez
- Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Government Department of Health and Wellness, Cape Town, ZAF
| | - Keith Cloete
- Department of Health and Wellness, Western Cape Government, Cape Town, ZAF
| | - Matodzi Mukosi
- Department of Health and Wellness, Western Cape Government, Cape Town, ZAF
| | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, ZAF
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13
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Mkhwanazi TW, Modjadji P, Mokgalaboni K, Madiba S, Roomaney RA. Multimorbidity, Treatment, and Determinants among Chronic Patients Attending Primary Health Facilities in Tshwane, South Africa. Diseases 2023; 11:129. [PMID: 37873773 PMCID: PMC10594487 DOI: 10.3390/diseases11040129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023] Open
Abstract
The growing burden of non-communicable diseases amidst the largest burden of HIV in South Africa leads to disease combinations of multimorbidity with the complexity of care. We conducted a cross-sectional study to assess multimorbidity, medication adherence, and associated factors among out-patients with chronic diseases in primary health care (PHC) facilities in Tshwane, South Africa. A structured questionnaire was used to collect data on comorbidities and medication adherence, along with socio-demographic and lifestyle factors. Logistic regression models were used to analyse the determinants of multimorbidity and medication adherence. In all 400 patients with chronic diseases (mean age: 47 ± 12 years) living in poor environments, common chronic conditions were hypertension (62%), diabetes (45%), HIV (44%), TB (33%), hypercholesterolemia (18%), and gout (13%). The proportion of concordant comorbidity (i.e., diseases with similar risk profiles and management) was 72%, more than 28% of discordant comorbidity (i.e., diseases not related in pathogenesis or management). Most patients had two coexisting chronic conditions (75%), while few had more than two chronic conditions (23%) and single-occurring conditions (2%). Prevalence rates for common multimorbidity patterns were 25% (HIV and TB), 17% (hypertension and diabetes), 9% (hypertension, diabetes, and hypercholesterolemia), and 2% (hypertension diabetes and HIV), while medication adherence was estimated at 74%. In multivariate analysis, multimorbidity was associated with an older age and lower socio-economic status, while medication non-adherence was associated with a younger age and socio-economic factors. The study highlights the presence of multimorbidity among primary care patients attributed to hypertension, diabetes, HIV, and TB in South Africa with non-adherence to medication in one-third of patients. Policies are needed for education on multimorbidity with a need to optimize lifestyle modifications, perhaps proactive outreach or nursing contact with high-risk patients with public-health-sensitive conditions, such as HIV and/or TB, as well as patients with a history of non-adherence to medications. Considerations should be given to the development of a medication adherence scale for multiple chronic conditions beyond assessing adherence to a single index medication.
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Affiliation(s)
- Thandiwe Wendy Mkhwanazi
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
| | - Kabelo Mokgalaboni
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Roodepoort 1709, South Africa
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
| | - Rifqah Abeeda Roomaney
- Burden of Disease Research Unit, South African Medical Research Council, Parowvallei, Tygerberg, Cape Town 7505, South Africa
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Naidoo KL, Dladla S, Mphahlele RE, Mosler G, Muyemayema S, Ssemata AS, Mkutumula E, Adeyeye OO, Goodman O, Kuyinu Y, Nantanda R, Addo-Yobo E, Owusu SK, Arhin B, Ticklay I, Mujuru HA, Grigg J, Masekela R. A cross-country qualitative analysis of teachers' perceptions of asthma care in sub-Saharan Africa. NPJ Prim Care Respir Med 2023; 33:31. [PMID: 37741822 PMCID: PMC10517916 DOI: 10.1038/s41533-023-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
Asthma is the most common chronic respiratory disease among school-going adolescents worldwide. However, the burden of severe asthma is highest in Sub-Saharan Africa. This study aimed to explore teachers' perceptions of asthma care across six African countries. We conducted focus group discussions (FGDs) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. FGDs were conducted in Kumasi(Ghana), Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda), and Harare (Zimbabwe) between 01 November 2020 and 30 June 2021. We identified two key themes related to asthma care; barriers to asthma care and suggestions to improve the care of adolescents with asthma. Barriers reported by teachers included a lack of knowledge and skills among themselves, adolescents, and caregivers. In addition, some traditional beliefs of teachers on asthma exacerbated challenges with asthma care in schools. Regarding suggestions, most teachers identified a need for all-inclusive asthma training programmes for teachers, adolescents and caregivers, focusing on acute episodes and mitigating triggers. Utilising teachers with personal experiences with asthma to advocate and support these initiatives was suggested. Further suggestions included the need for annual screening to enable early identification of adolescents with asthma and clarify restrictions on teachers administering asthma medications. Teachers across African schools identify multiple barriers to asthma care. Structured school education programs and annual asthma screening are key to addressing some barriers to care.
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Affiliation(s)
- Kimesh Loganathan Naidoo
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Sindisiwa Dladla
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Reratilwe Ephenia Mphahlele
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Gioia Mosler
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sophie Muyemayema
- Child and Adolescent Health Unit (CAHU), Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Andrew Sentoogo Ssemata
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Mkutumula
- Malawi Liverpool Wellcome Programme, Queen Elizabeth Central Hospital, College of Medicine, Chichiri, Malawi
| | - Olayinka Olufunke Adeyeye
- Lagos State University College of Medicine Ikeja, Lagos, Nigeria
- Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Olayinka Goodman
- Lagos State University College of Medicine Ikeja, Lagos, Nigeria
- Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Yetunde Kuyinu
- Lagos State University College of Medicine Ikeja, Lagos, Nigeria
- Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Emmanuel Addo-Yobo
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Bernhard Arhin
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ismail Ticklay
- Child and Adolescent Health Unit (CAHU), Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
- Parirenyatwa Group of Hospitals, Causeway, Harare, Zimbabwe
| | - Hilda Angela Mujuru
- Child and Adolescent Health Unit (CAHU), Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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15
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Myburgh H, Meehan SA, Wademan DT, Osman M, Hesseling AC, Hoddinott G. TB programme stakeholder views on lessons from the COVID-19 response in South Africa. Public Health Action 2023; 13:97-103. [PMID: 37736584 PMCID: PMC10446663 DOI: 10.5588/pha.23.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/21/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The global COVID-19 pandemic has reversed many of the hard-won gains made in TB programmes and the associated reduction in the number of TB deaths, case notifications and incidence over the last three decades. Modelling estimates show that the impact will be lasting. There are global calls to recover the shortfalls along the TB care cascade that have resulted from COVID-19, with the recognition that the COVID-19 response holds lessons to inform more robust and comprehensive TB programmes and services. OBJECTIVE To explore lessons from response measures to the COVID-19 pandemic in two high TB burden South African provinces. DESIGN This was an exploratory qualitative study. We conducted interviews with TB programme stakeholders (managers and facility-level staff: n = 35) between February and June 2022. RESULTS We identified eight facilitators of the COVID-19 response, including political will, rapid policy development, multi-sectoral collaboration, patient-centred models of care delivery, community engagement, mHealth and telehealth technologies, rigorous contact tracing and widespread mask wearing. Political will was singled out as a critical driver of the response. CONCLUSION Leveraging COVID-19 inspired collaborations, technologies and avenues for health service delivery is an opportunity to maximise benefits for the TB programme. Reinvestment in national TB programmes and political prioritisation of TB are critical.
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Affiliation(s)
- H Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam; Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Human Sciences, Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Houle B, Clark SJ, Kabudula CW, Gómez-Olivé FX, Angotti N, Schatz E, Tilstra AM, Mojola SA, Menken J. The effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019: a data note. BMC Res Notes 2023; 16:213. [PMID: 37700363 PMCID: PMC10498573 DOI: 10.1186/s13104-023-06478-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES South Africa is experiencing both HIV and hypertension epidemics. Data were compiled for a study to identify effects of HIV and high systolic blood pressure on mortality risk among people aged 40-plus in a rural South African area experiencing high prevalence of both conditions. We aim to release the replication data set for this study. DATA DESCRIPTION The research data comes from the 2010-11 Ha Nakekela (We Care) population-based survey nested in the Agincourt Health and socio-Demographic Surveillance System (AHDSS) located in the northeast region of South Africa. An age-sex-stratified probability sample was drawn from the AHDSS. The public data set includes information on individual socioeconomic characteristics and measures of HIV status and blood pressure for participants aged 40-plus by 2019. The AHDSS, through its annual surveillance, provided mortality data for nine years subsequent to the survey. These data were converted to person-year observations and linked to the individual-level survey data using participants' AHDSS census identifier. The data can be used to replicate Houle et al. (2022) - which used discrete-time event history models stratified by sex to assess differential mortality risks according to Ha Nakekela measures of HIV-infection, HIV-1 RNA viral load, and systolic blood pressure.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australia.
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Samuel J Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Angotti
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, American University, Washington, D.C, USA
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health, University of Missouri, Columbia, MO, USA
| | - Andrea M Tilstra
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, and Nuffield College, University of Oxford, Oxford, UK
| | - Sanyu A Mojola
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, School of Public and International Affairs, and Office of Population Research, Princeton University, Princeton, NJ, USA
| | - Jane Menken
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
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Watson ED, Moosa S, Janse Van Rensburg DC, Schwellnus M, Lambert EV, Stoutenberg M. Task-Shifting: Can Community Health Workers Be Part of the Solution to an Inactive Nation? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6675. [PMID: 37681815 PMCID: PMC10487434 DOI: 10.3390/ijerph20176675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Background: In low-to-middle income countries (LMICs), there is a growing burden of non-communicable diseases (NCDs) placing strain on the facilities and human resources of healthcare systems. Prevention strategies that include lifestyle behavior counseling have become increasingly important. We propose a potential solution to the growing burden of NCDs through an expansion of the role for community health workers (CHWs) in prescribing and promoting physical activity in public health settings. This discussion paper provides a theoretical model for task-shifting of assessment, screening, counseling, and prescription of physical activity to CHWs. Five proposed tasks are presented within a larger model of service delivery and provide a platform for a structured, standardized, physical activity prevention strategy aimed at NCDs using CHWs as an integral part of reducing the burden of NCDs in LMICs. However, for effective implementation as part of national NCD plans, it is essential that CHWs received standardized, ongoing training and supervision on physical activity and other lifestyle behaviors to optimally impact community health in low resource settings.
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Affiliation(s)
- Estelle D. Watson
- Department of Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland 1023, New Zealand
| | - Shabir Moosa
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
| | - Dina C. Janse Van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Martin Schwellnus
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Estelle V. Lambert
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Department of Human Biology, Division of Research Unit for Exercise Science and Sports Medicine, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, 7700, South Africa
| | - Mark Stoutenberg
- Department of Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
- College of Public Health, Temple University, Philadelphia, PA 19122, USA
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Owusu MF, Adu J, Dortey BA. "I tell you, getting data for this is hell"-Exploring the use of evidence for noncommunicable disease policies in Ghana. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002308. [PMID: 37616207 PMCID: PMC10449463 DOI: 10.1371/journal.pgph.0002308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
After several years of over concentration on communicable diseases, Ghana has finally made notable strides in the prevention of NCDs by introducing key policies and programmes. Evident shows that there is limited NCD-related data on mortality and risk factors to inform NCD policy, planning, and implementation in Ghana. We explored the evidence base for noncommunicable disease policies in Ghana. A qualitative approach was adopted using key informant interviews and documents as data sources. An adaptation of the framework method for analysing qualitative data by Gale and colleagues' (2013) was used to analyse data. Our findings show that effort has been made in terms of institutions and systems to provide evidence for the policy process with the creation of the Centre for Health Information Management and the District Health Information Management System. Although there is overreliance on routine facility data, policies have also been framed using surveys, burden of disease estimates, monitoring reports, and systematic reviews. There is little emphasis on content analysis, key informant interviews, case studies, and implementation science techniques in the policy process of Ghana. Inadequate and poor data quality are key challenges that confront policymakers. Ghana has improved its information infrastructure but access to quality noncommunicable disease data remains a daunting challenge. A broader framework for the integration of different sources of data such as verbal autopsies and natural experiments is needed while strengthening existing systems. This, however, requires greater investments in personnel and logistics at national and district levels.
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Affiliation(s)
- Mark Fordjour Owusu
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Joseph Adu
- Department of Health and Rehabilitation, Western University, London, Ontario, Canada
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Badianyama M, Mutyaba A, Nel S, Tsabedze N. ST-segment elevation myocardial infarction heart of Charlotte one-year (STEMI HOC-1) study: a prospective study protocol. BMC Cardiovasc Disord 2023; 23:396. [PMID: 37568090 PMCID: PMC10422761 DOI: 10.1186/s12872-023-03416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is a clinically distinguishable yet lethal sequela of ischaemic heart disease (IHD). In sub-Saharan Africa (SSA), death due to acute STEMI is increasing. In South Africa, there is a paucity of data available on the clinical outcomes of acute STEMI within one year for individuals treated in the public healthcare sector. This study primarily seeks to determine the one-year all-cause mortality rate of acute STEMI. The study also assesses the value of serum cardiac biomarkers of myocardial damage and serum uric acid in predicting all-cause mortality in STEMI. METHODS This is a single-centre observational prospective cohort of all consecutive individuals presenting with an acute STEMI to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa. Research data will be sourced on admission through electronic medical records, blood laboratory results and coronary angiography reports, and at follow-up through periodic telephonic interviews and standardised echocardiograms. At least 355 eligible participants will be continuously followed over one year, and clinical outcomes will be measured 30 days, three months, six months and one year after the index hospitalisation. DISCUSSION This study provides insights into the demographic, risk factors and clinical profiles of individuals with STEMI in South Africa. Its findings may improve the risk stratification, prognostication, and therapeutic management of STEMI patients in our setting. By comparing the clinical outcomes between the different coronary reperfusion strategies, our results may guide clinicians in providing better patient treatment, particularly in sub-Saharan Africa, where access to percutaneous coronary intervention may be limited. Furthermore, the study offers insights into the routine use of baseline serum uric acid as a potential low-cost prognostic biomarker of all-cause mortality in STEMI. Finally, this study's findings may be of public health significance to local policymakers to aid in reinforcing primary prevention strategies and developing structured referral networks for timely coronary reperfusion of acute STEMI.
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Affiliation(s)
- Marheb Badianyama
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 2193, Johannesburg, South Africa
| | - Arthur Mutyaba
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 2193, Johannesburg, South Africa
| | - Samantha Nel
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 2193, Johannesburg, South Africa
| | - Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 2193, Johannesburg, South Africa.
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20
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Boden R, Majiet I, Balde I, Naledi T, Panieri E, Cairncross L, Maswime S. Surgical training and capacity development in the South African internship programme. S Afr Med J 2023; 113:17-21. [PMID: 37882121 DOI: 10.7196/samj.2023.v113i8.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Indexed: 10/27/2023] Open
Abstract
Medical practitioners in South Africa manage a quadruple burden of disease. Junior doctors, who contribute significantly to the health workforce, must complete 2 years of internship training and 1 year of community service work in state health facilities after graduation to register as an independent medical practitioner. The aim of this article is to give a critical appraisal of the current national internship programme and why it was implemented, and outline suggestions for future changes. There is a compelling need to train competent, confident doctors while ensuring that the requirements and demands of our health system remain a central concern.
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Affiliation(s)
- R Boden
- Medical intern, Pietermaritzburg Hospital Complex, KwaZulu-Natal Province, South Africa.
| | - I Majiet
- Medical intern, Paarl Hospital, Western Cape Province, South Africa.
| | - I Balde
- Medical intern, Klerksdorp/Tshepong Hospital Complex, North West Province, South Africa.
| | - T Naledi
- Deputy Dean: Health Services, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - E Panieri
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - L Cairncross
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
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21
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Mathunjwa M, Shaw I, Moran J, Sandercock GR, Brown GA, Shaw BS. Implementation of a Community-Based Mind-Body (Tae-Bo) Physical Activity Programme on Health-Related Physical Fitness in Rural Black Overweight and Obese Women with Manifest Risk Factors for Multimorbidity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6463. [PMID: 37569005 PMCID: PMC10419135 DOI: 10.3390/ijerph20156463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
Non-communicable diseases (NCDs) are the leading cause of death globally, particularly impacting low- and middle-income countries and rural dwellers. Therefore, this programme aimed to investigate if a community-based mind-body PA programme implemented in a low-resource setting could improve health-related physical fitness outcomes. Black overweight or obese adult women (25 ± 4.7 years) with a body mass index (BMI) > 25 kg·m-2 recruited from a rural settlement in South Africa with manifest risk factors for multimorbidity were assigned to a 10-week waiting-to-treat non-exercising control group (n = 65) or a community-based mind-body programme (n = 60) consisting of 45-60 min, thrice-weekly Tae-Bo. The intervention resulted in significant (p ≤ 0.05) improvements in body weight (p = 0.043), BMI (p = 0.037), and waist (p = 0.031) and hip circumferences (p = 0.040). Flexibility was found to be significantly increased at mid- and post-programme (p = 0.033 and p = 0.025, respectively) as was static balance (mid: p = 0.022; post: p = 0.019), hand grip strength (mid: p = 0.034; post: p = 0.029), sit-up performance (mid: p = 0.021; post: p = 0.018), and cardiorespiratory endurance (mid: p = 0.017; post: p = 0.011). No significant change was found in sum of skinfolds following the programme (p = 0.057). Such a community-based mind-body programme presents an opportunity to level health inequalities and positively improve health-related physical fitness in low-resource communities irrespective of the underlying barriers to participation.
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Affiliation(s)
- Musa Mathunjwa
- Department of Human Movement Science, University of Zululand, KwaDlangezwa 3886, South Africa;
| | - Ina Shaw
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK; (I.S.); (J.M.); (G.R.S.)
| | - Jason Moran
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK; (I.S.); (J.M.); (G.R.S.)
| | - Gavin R. Sandercock
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK; (I.S.); (J.M.); (G.R.S.)
| | - Gregory A. Brown
- Physical Activity and Wellness Laboratory, Department of Kinesiology and Sports Science, University of Nebraska Kearney, Kearney, NE 68849, USA;
| | - Brandon S. Shaw
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK; (I.S.); (J.M.); (G.R.S.)
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22
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Davies L, Milner DA, Shulman LN, Kyokunda L, Bedada A, Vuylsteke P, Masalu N, Jackson P, Jennings N, Odunlami A, Mtshali P, Dugan U. Analysis of Cancer Research Projects in Sub-Saharan Africa: A Quantitative Perspective on Unmet Needs and Opportunities. JCO Glob Oncol 2023; 9:e2200203. [PMID: 37290022 PMCID: PMC10497259 DOI: 10.1200/go.22.00203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/27/2023] [Accepted: 03/16/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE To evaluate the scope and types of cancer research projects in sub-Saharan Africa (SSA) to identify research gaps and inform future efforts. METHODS This retrospective observational study summarized information on cancer research projects in SSA from the International Cancer Research Partnership (ICRP) between 2015 and 2020, alongside 2020 cancer incidence and mortality data from the Global Cancer Observatory. SSA cancer research projects were identified as led by investigators in SSA countries, or by investigators in non-SSA countries with collaborators in SSA, or in database keyword searches. Projects from the Coalition for Implementation Research in Global Oncology (CIRGO) were also summarized. RESULTS A total of 1,846 projects were identified from the ICRP database, funded by 34 organizations in seven countries (only one, Cancer Association of South Africa, based in SSA); only 156 (8%) were led by SSA-based investigators. Most projects focused on virally induced cancers (57%). Across all cancer types, projects were most frequently related to cervical cancer (24%), Kaposi sarcoma (15%), breast cancer (10%), or non-Hodgkin lymphoma (10%). Gaps were observed for several cancers with higher incidence/mortality burden in SSA; for example, prostate cancer accounted for only 4% of projects but 8% of cancer-related deaths and 10% of new cases. Approximately 26% were dedicated to etiology. Treatment-related research declined over the study period (14%-7% of all projects), while projects related to prevention (15%-20%) and diagnosis/prognosis (15%-29%) increased. Fifteen CIRGO projects were identified; seven were relevant across multiple cancer types, and 12 focused either wholly or partially on cancer control (representing 50% of the total research effort). CONCLUSION This analysis shows notable discrepancies between cancer burden and research projects and identifies opportunities for future strategic investments in cancer care in SSA.
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Affiliation(s)
- Lynne Davies
- International Cancer Research Partnership, Cardiff, United Kingdom
| | | | | | - Lynnette Kyokunda
- Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Alemayehu Bedada
- Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Peter Vuylsteke
- Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Nestory Masalu
- Catholic University of Health and Allied Sciences, Bugando Medical Center, Mwanza, Tanzania
| | - Paul Jackson
- Cancer Australia, Strawberry Hills, NSW, Australia
| | | | | | | | - Ute Dugan
- Parker Institute for Cancer Immunotherapy, San Francisco, CA
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23
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Wiebe LE, Alvesson HM, Stassen W. Companion restrictions in the emergency department during COVID-19: physician perceptions from the Western Cape, South Africa. BMJ Open 2023; 13:e070982. [PMID: 37147101 PMCID: PMC10163331 DOI: 10.1136/bmjopen-2022-070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES To determine emergency department (ED) physicians' perceptions regarding hospital companions being prohibited from accompanying the patient during COVID-19. DESIGN Two qualitative datasets were combined. Data collected included voice recordings, narrative interviewing and semistructured interviews. A reflexive thematic analysis was conducted and guided by the Normalisation Process Theory. SETTING Six hospital EDs in the Western Cape, South Africa. PARTICIPANTS Convenience sampling was used to recruit a total of eight physicians working full time in the ED during COVID-19. RESULTS The lack of physical companions provided an opportunity for physicians to assess and reflect on a companion's role in efficient patient care. Physicians perceived that the COVID-19 restrictions illuminated that patient companions engaged in the ED as providers contributing to patient care by providing collateral information and patient support, while simultaneously engaging as consumers detracting physicians from their priorities and patient care. These restrictions prompted the physicians to consider how they understand their patients largely through the companions. When companions became virtual, the physicians were forced to shift how they perceive their patient, which included increased empathy. CONCLUSION The reflections of providers can feed into discussions about values within the healthcare system and can help explore the balance between medical and social safety, especially with companion restrictions still being practised in some hospitals. These perceptions illuminate various tradeoffs physicians had to consider throughout the pandemic and may be used to improve companion policies when planning for the continuation of the COVID-19 pandemic and future disease outbreaks.
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Affiliation(s)
- Lauren E Wiebe
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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24
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Selohilwe O, Fairall L, Bhana A, Kathree T, Zani B, Folb N, Lund C, Thornicroft G, Petersen I. Challenges and opportunities for implementation and dissemination of a task- sharing counselling intervention for depression at primary health care level in South Africa. Int J Ment Health Syst 2023; 17:7. [PMID: 36998053 PMCID: PMC10064738 DOI: 10.1186/s13033-023-00575-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/08/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The treatment gap for mental health services is a growing public health concern. A lay-counselling service located at primary health care (PHC) level could potentially help to close the large treatment gap for common mental disorders in South Africa. The aim of this study was to understand multilevel factors contributing to implementation and potential dissemination of such a service for depression at PHC level. METHODS Process qualitative data of the lay-counselling service for patients with depressive symptoms was collected alongside a pragmatic randomized controlled trial evaluating a collaborative care model that included a lay-counselling service for patients with depressive symptoms. Semi-structured key informant interviews (SSI) were conducted with a purposive sample of PHC providers (lay-counsellors, nurse practitioners, operational managers), lay-counsellor supervisors, district and provincial managers, and patients in receipt of services. A total of 86 interviews were conducted. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection as well as Framework Analysis to determine barriers and facilitators for implementation and dissemination of the lay-counselling service. RESULTS Facilitators identified include supervision and support available for counsellors; person focused counselling approach; organizational integration of the counsellor within facilities. Barriers included lack of organizational support of the counselling service, including lack of counselling dedicated space; high counsellor turnover, resulting in a counsellor not available all the time; lack of an identified cadre to deliver the intervention in the system; and treatment of mental health conditions including counselling not included within mental health indicators. CONCLUSIONS Several system level issues need to be addressed to promote integration and dissemination of lay-counselling services within PHC facilities in South Africa. Key system requirements are facility organizational readiness for improvement of integration of lay-counselling services; formal recognition of counselling services provided by lay counsellors as well as inclusion of lay counselling as a treatment modality within mental health treatment data element definitions and the need for diversification of the roles of psychologists to include training and supervision of lay counsellors was also emphasized.
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Affiliation(s)
- One Selohilwe
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
- Health Systems Research Unit, South African Medical Research Centre, Durban, 4091, South Africa
| | - Tasneem Kathree
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Naomi Folb
- Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
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van Pinxteren M, Mbokazi N, Murphy K, Mair FS, May C, Levitt N. The impact of persistent precarity on patients' capacity to manage their treatment burden: A comparative qualitative study between urban and rural patients with multimorbidity in South Africa. Front Med (Lausanne) 2023; 10:1061190. [PMID: 37064034 PMCID: PMC10098191 DOI: 10.3389/fmed.2023.1061190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Background People living with multimorbidity in low-and middle-income countries (LMICs) experience a high workload trying to meet the demands of self-management. In an unequal society like South Africa, many people face continuous economic uncertainty, which can impact on their capacity to manage their illnesses and lead to poor health outcomes. Using precariousness - the real and perceived impact of uncertainty - as a lens, this paper aims to identify, characterise, and understand the workload and capacity associated with self-management amongst people with multimorbidity living in precarious circumstances in urban and rural South Africa. Methods We conducted qualitative semi-structured interviews with 30 patients with HIV and co-morbidities between February and April 2021. Patients were attending public clinics in Cape Town (Western Cape) and Bulungula (Eastern Cape). Interviews were transcribed and data analysed using qualitative framework analysis. Burden of Treatment Theory (BoTT) and the Cumulative Complexity Model (CuCoM) were used as theoretical lenses through which to conceptualise the data. Results People with multimorbidity in rural and urban South Africa experienced multi-faceted precariousness, including financial and housing insecurity, dangerous living circumstances and exposure to violence. Women felt unsafe in their communities and sometimes their homes, whilst men struggled with substance use and a lack of social support. Older patients relied on small income grants often shared with others, whilst younger patients struggled to find stable employment and combine self-management with family responsibilities. Precariousness impacted access to health services and information and peoples' ability to buy healthy foods and out-of-pocket medication, thus increasing their treatment burden and reducing their capacity. Conclusion This study highlights that precariousness reduces the capacity and increases treatment burden for patients with multimorbidity in low-income settings in South Africa. Precariousness is both accumulative and cyclic, as financial insecurity impacts every aspect of peoples' daily lives. Findings emphasise that current models examining treatment burden need to be adapted to accommodate patients' experiences in low-income settings and address cumulative precariousness. Understanding treatment burden and capacity for patients in LMICs is a crucial first step to redesign health systems which aim to improve self-management and offer comprehensive person-centred care.
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Affiliation(s)
- Myrna van Pinxteren
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nonzuzo Mbokazi
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Katherine Murphy
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Frances S. Mair
- School of Health and Well-Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Carl May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR North Thames Applied Research Collaboration, London, United Kingdom
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Hariparshad S, Bhimma R, Nandlal L, Jembere E, Naicker S, Assounga A. The prevalence of chronic kidney disease in South Africa - limitations of studies comparing prevalence with sub-Saharan Africa, Africa, and globally. BMC Nephrol 2023; 24:62. [PMID: 36944928 PMCID: PMC10029276 DOI: 10.1186/s12882-023-03109-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a globally significant non-communicable disorder. CKD prevalence varies between countries and within a country. We compared the prevalence rates of CKD in South Africa with sub-Saharan Africa, Africa, and globally. METHODS We registered a systematic review with the International Prospective Register of Systematic Reviews for prevalence studies reporting CKD stages III-V from 2013 to 2021. The analysis sought to explain any significant differences in prevalence rates. The R statistical package was used for data analysis. Comparisons included measures of effect size due to the large sample sizes analysed. We also compared sex differences in prevalence rates, common aetiologies, and type of study methodologies employed. RESULTS Eight studies were analysed, with two from each region. The matched prevalence rates of CKD between the various regions and South Africa showed significant differences, except for one comparison between South Africa and an African study [p = 0.09 (95% CI - 0.04-0.01)]. Both sub-Saharan African studies had a higher prevalence than South Africa. One study in Africa had a higher prevalence, while the other had a lower prevalence, whilst one Global study had a higher prevalence, and the other had a lower prevalence compared to South Africa. The statistical differences analysed using the Cramer's V test were substantially less than 0.1. Thus, differences in comparisons were largely due to differences in sample sizes rather than actual differences. CONCLUSION Variable prevalence rates between regions included disparities in sample size, definitions of CKD, lack of chronicity testing and heterogeneous laboratory estimations of eGFR. Improved consistency and enhanced methods for diagnosing and comparing CKD prevalence are essential.
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Affiliation(s)
- Sudesh Hariparshad
- Department of Nephrology, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Rajendra Bhimma
- Department of Paediatrics and Child Health, College of Health Sciences, Mandela School of Medicine, Nelson R, University of KwaZulu-Natal, Durban, South Africa
| | - Louansha Nandlal
- Discipline of Optics and Imaging, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Edgar Jembere
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Alain Assounga
- Department of Nephrology, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Adeniji FIP, Obembe TA. Cardiovascular Disease and Its Implication for Higher Catastrophic Health Expenditures Among Households in Sub-Saharan Africa. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:59-67. [PMID: 36945240 PMCID: PMC10024946 DOI: 10.36469/001c.70252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Background: Cardiovascular diseases (CVDs) impose an enormous and growing economic burden on households in sub-Saharan Africa (SSA). Like many chronic health conditions, CVD predisposes families to catastrophic health expenditure (CHE), especially in SSA due to the low health insurance coverage. This study assessed the impact of CVD on the risks of incurring higher CHE among households in Ghana and South Africa. Methods: The World Health Organization (WHO) Study on Global AGEing and Adult Health (WHO SAGE), Wave 1, implemented 2007-2010, was utilized. Following standard procedure, CHE was defined as the health expenditure above 5%, 10%, and 25% of total household expenditure. Similarly, a 40% threshold was applied to household total nonfood expenditure, also referred to as the capacity to pay. To compare the difference in mean CHE by household CVD status and the predictors of CHE, Student's t-test and logistic regression were utilized. Results: The share of medical expenditure in total household spending was higher among households with CVD in Ghana and South Africa. Households with CVD were more likely to experience greater CHE across all the thresholds in Ghana. Households who reported having CVD were twice as likely to incur CHE at 5% threshold (odds ratio [OR], 1.946; confidence interval [CI], 0.965-1.095), 3 times as likely at 10% threshold (OR, 2.710; CI, 1.401-5.239), and 4 times more likely to experience CHE at both 25% and 40% thresholds, (OR, 3.696; CI, 0.956-14.286) and (OR, 4.107; CI, 1.908-8.841), respectively. In South Africa, households with CVD experienced higher CHE across all the thresholds examined compared with households without CVDs. However, only household CVD status, household health insurance status, and the presence of other disease conditions apart from CVD were associated with incurring CHE. Households who reported having CVD were 3 times more likely to incur CHE compared with households without CVD (OR, 3.002; CI, 1.013-8.902). Conclusions: Our findings suggest that CVD predisposed households to risk of higher CHE. Equity in health financing presupposes that access to health insurance should be predicated on individual health needs. Thus, targeting and prioritizing the health needs of individuals with regard to healthcare financing interventions in SSA is needed.
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Affiliation(s)
- Folashayo Ikenna Peter Adeniji
- Department of Health Policy & Management, Faculty of Public Health, College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Taiwo Akinyode Obembe
- Department of Health Policy & Management, Faculty of Public Health, College of Medicine University of Ibadan, Ibadan, Nigeria
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28
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Choongo J, Apenteng B, Nkemjika S, Telfair J. Social ecological approach to factors influencing perinatal mental health service provision among providers in Bulloch County, GA. Women Health 2023; 63:229-240. [PMID: 36710486 DOI: 10.1080/03630242.2023.2169806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Perinatal mental illness pertains to pregnancy-related mental health complications, which could last as long as one year post-delivery. Despite the high prevalence of PMI, there remains a poor accessibility and utilization of mental health services, especially in the rural America. Hence, using the Social Ecological Model (SEM), we aim to identify factors influencing perinatal mental health service provision among providers in Bulloch County, GA. Using a random sampling method, we recruited 15 mental health providers in Bulloch County through professional networks who completed open-ended surveys between January 31 and March 5 of 2021. The open-ended survey was guided by the SEM constructs, which included Individual, Interpersonal, Organizational, Community, and Policy factors. The Qualitative thematic analysis was conducted using NVivo software. Major barriers among providers include lack of available resources and lack of rapport among patients and providers. Major facilitator themes included increase in mental health screening, rapport building, education, and awareness. This study suggests the introduction of group therapies in public communal areas is helpful. Findings from this study will be useful in developing tailored interventions to address barriers to perinatal mental health-care utilization experienced by both women and perinatal mental health-care providers.
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Affiliation(s)
- Janet Choongo
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Bettye Apenteng
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Stanley Nkemjika
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA.,Department of Behavioral Sciences and Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Joseph Telfair
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA.,Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA.,Office for Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
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29
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Ekrikpo U, Obiagwu P, Chika-Onu U, Yadla M, Karam S, Tannor EK, Bello AK, Okpechi IG. Epidemiology and Outcomes of Glomerular Diseases in Low- and Middle-Income Countries. Semin Nephrol 2023; 42:151316. [PMID: 36773418 DOI: 10.1016/j.semnephrol.2023.151316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Glomerular diseases account for a significant proportion of chronic kidney disease in low-income and middle-income countries (LMICs). The epidemiology of glomerulonephritis is characterized inadequately in LMICs, largely owing to unavailable nephropathology services or uncertainty of the safety of the kidney biopsy procedure. In contrast to high-income countries where IgA nephropathy is the dominant primary glomerular disease, focal segmental glomerulosclerosis is common in large populations across Latin America, Africa, Middle East, and South East Asia, while IgA nephropathy is common in Chinese populations. Despite having a high prevalence of known genetic and viral risk factors that trigger focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis also is common in adults and children in some African countries. Treatment of glomerular diseases in adults and children in LMICs largely is dependent on corticosteroids in combination with other immunosuppressive therapy, which often is cyclophosphamide because of its ready availability and low cost of treatment, despite significant adverse effects. Partial and/or complete remission status reported from studies of glomerular disease subtypes vary across LMIC regions, with high rates of kidney failure, mortality, and disease, and treatment complications often reported. Improving the availability of nephropathology services and ensuring availability of specific therapies are key measures to improving glomerular disease outcomes in LMICs.
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Affiliation(s)
- Udeme Ekrikpo
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Patience Obiagwu
- Department of Paediatrics, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ugochi Chika-Onu
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Manjusha Yadla
- Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India
| | - Sabine Karam
- Division of Nephrology, University of Minnesota, Minnesota, MN; Division of Nephrology, Faculty of Medicine and Medical Sciences, University of Balamand, Balamand, Lebanon
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Canada; Division of Nephrology, University of Cape Town, Cape Town, South Africa.
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van Zyl S, Kruger WH, Walsh CM. Chronic diseases of lifestyle curriculum: Students' perceptions in primary health care settings. Afr J Prim Health Care Fam Med 2023; 15:e1-e10. [PMID: 36744458 PMCID: PMC9900301 DOI: 10.4102/phcfm.v15i1.3775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Community-based primary health care (PHC) forms the foundation of healthcare in South Africa. Medical programmes need to equip future health practitioners to face the challenges of the rising burden of chronic diseases of lifestyle (CDL) in different communities. Community-based education (CBE) contributes to developing knowledge, skills and attitudes appropriate to the challenges experienced in the PHC context. AIM To explore medical students' perceptions of the current CDL curriculum and related programmes during CBE rotations. SETTING The study was conducted among fourth- and fifth-year medical students at the University of the Free State, South Africa. METHODS Focus group discussions were conducted and data were analysed thematically. RESULTS Themes included perceptions of the CDL curriculum, relevance thereof for the PHC setting and barriers and challenges to implementing PHC programmes. This study identified foundational CDL content that needs to be incorporated or revisited at strategic points. Participants identified the need to contextualise educational programmes and focus on affordable, culturally acceptable and holistic healthcare prevention strategies. Barriers and challenges included high patient load, resource constraints, the lack of continuous care and focus on communicable diseases. Community-based education rotations were described as meaningful opportunities to develop professional attributes, competencies and skills. CONCLUSION This study identified foundational concepts to consider at key points throughout the curriculum. Incorporating creative and reflective learning activities in CDL modules can prepare students for the realities of PHC settings.Contribution: This study provides insight into medical students' perceptions of the CDL curriculum and informs future curriculum content for CDL modules.
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Affiliation(s)
- Sanet van Zyl
- Department of Basic Medical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Willem H. Kruger
- Department of Community Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Corinna M. Walsh
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Bartels CA, Lambert EV, Young MEM, Kolbe-Alexander T. If You Build It Will They Come? Park Upgrades, Park Use and Park-Based Physical Activity in Urban Cape Town, South Africa-The SUN Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2574. [PMID: 36767941 PMCID: PMC9916099 DOI: 10.3390/ijerph20032574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/18/2023]
Abstract
The development and upgrade of recreational public spaces are key government strategies to increase opportunities for physical activity (PA) and enhance social interaction and community cohesion. This study aimed to evaluate differences in park use and park-based PA in recently upgraded/developed parks (intervention, n = 4) against established parks (control, n = 4) and in regional parks in high- and low-income settings (n = 2). Additionally, associations between target area features, park use and PA were identified. Direct observation of park use and attributes was conducted using the System for Observing Play and Recreation in Communities (SOPARC) over four months. Despite more park users in intervention parks (2519 vs. 1432), control park visitors were 48% more likely to be engaged in PA (p < 0.001). Similarly, while high-income park users attracted more visitors (2135 vs. 1111), they were 79% less likely to be engaged in any PA compared with low-income park visitors. The likelihood of both use of and PA by gender and age differed by features. Active recreation features in intervention parks attracted more users than the same features in control parks. In this study, upgraded or newly developed parks attracted more visitors but not necessarily overall greater levels of physical activity.
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Affiliation(s)
- Clare A. Bartels
- Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Estelle V. Lambert
- Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Marié E. M. Young
- Department of Sport, Recreation and Exercise Science, Faculty of Community and Health Science, University of the Western Cape, Cape Town 7535, South Africa
| | - Tracy Kolbe-Alexander
- Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD 4305, Australia
- Centre for Health Research, University of Southern Queensland, Ipswich, QLD 4305, Australia
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Hyle EP, Martey EB, Bekker LG, Xu A, Parker RA, Walensky RP, Middelkoop K. Diet, physical activity, and obesity among ART-experienced people with HIV in South Africa. AIDS Care 2023; 35:71-77. [PMID: 34913762 PMCID: PMC9200895 DOI: 10.1080/09540121.2021.2012556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
The prevalence of non-communicable diseases (NCDs) is increasing in South Africa, in part due to poor nutrition, physical inactivity, and obesity. We characterized the habits and understanding of diet, exercise, and obesity among people with HIV (PWH) taking antiretroviral therapy (ART). We conducted a cross-sectional study of ART-experienced PWH attending an HIV community health center near Cape Town, South Africa. We included PWH currently prescribed ART, older than 21y, and not pregnant. We collected demographic and clinical information and interviewed participants regarding their behaviors and knowledge related to diet, physical activity, and obesity. From March 2015 - February 2016, we enrolled 458 participants. Self-reported diets were low in nutritional diversity: 202 reported eating only starch and protein without vegetable/fruit in the prior 24 h. Although most participants (96%) acknowledged that exercise had health benefits, only 215 participants engaged in daily 30-minute walking or exercise. One quarter of participants recognized nocontributors to obesity, and almost 20% identified no health problems associated with obesity. Participants had diets low in nutritional diversity, modest exercise habits, and limited understanding of the impact of obesity on health. Further understanding of barriers to improving diet and exercise and reducing obesity are essential, especially as PWH age.
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Affiliation(s)
- Emily P. Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard University Center for AIDS Research (CFAR), Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily B. Martey
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine and Department of Medicine Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ai Xu
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Robert A. Parker
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard University Center for AIDS Research (CFAR), Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Rochelle P. Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard University Center for AIDS Research (CFAR), Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine and Department of Medicine Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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van Pinxteren M, Mbokazi N, Murphy K, Mair FS, May C, Levitt NS. Using qualitative study designs to understand treatment burden and capacity for self-care among patients with HIV/NCD multimorbidity in South Africa: A methods paper. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231168041. [PMID: 37057034 PMCID: PMC10088413 DOI: 10.1177/26335565231168041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Background Low- and middle-income countries (LMICs), including South Africa, are currently experiencing multiple epidemics: HIV and the rising burden of non-communicable diseases (NCDs), leading to different patterns of multimorbidity (the occurrence of two or more chronic conditions) than experienced in high income settings. These adversely affect health outcomes, increase patients' perceived burden of treatment, and impact the workload of self-management. This paper outlines the methods used in a qualitative study exploring burden of treatment among people living with HIV/NCD multimorbidity in South Africa. Methods We undertook a comparative qualitative study to examine the interaction between individuals' treatment burden (self-management workload) and their capacity to take on this workload, using the dual lenses of Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) to aid conceptualisation of the data. We interviewed 30 people with multimorbidity and 16 carers in rural Eastern Cape and urban Cape Town between February-April 2021. Data was analysed through framework analysis. Findings This paper discusses the methodological procedures considered when conducting qualitative research among people with multimorbidity in low-income settings in South Africa. We highlight the decisions made when developing the research design, recruiting participants, and selecting field-sites. We also explore data analysis processes and reflect on the positionality of the research project and researchers. Conclusion This paper illustrates the decision-making processes conducting this qualitative research and may be helpful in informing future research aiming to qualitatively investigate treatment burden among patients in LMICs.
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Affiliation(s)
- Myrna van Pinxteren
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| | - Nonzuzo Mbokazi
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| | - Katherine Murphy
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
| | - Frances S Mair
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; NIHR North Thames Applied Research Collaboration, London, UK
| | - Carl May
- School of Health and Well-Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, South Africa
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Nizeyimana E, Joseph C, Louw QA. Organizational readiness and rehabilitation professionals' views on integrating telerehabilitation into service delivery and students' clinical training: A qualitative study. Digit Health 2023; 9:20552076231212314. [PMID: 38025095 PMCID: PMC10631339 DOI: 10.1177/20552076231212314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To assess the readiness of healthcare institutions that serve as clinical platforms for Stellenbosch University' rehabilitation students, and to explore the opinions of rehabilitation professionals regarding the integration of telerehabilitation (TR) into service delivery and students clinical training. Methods This study employed a qualitative research design and involved the participation of fourteen rehabilitation managers. Semi-structured interviews were conducted using both face-to-face and online platforms. Thematic analysis was employed to analyse the collected data. Results The readiness for implementing TR services varies across different dimensions. Facilities faced challenges related to funding for TR equipment and the absence of policies and guidelines, indicating a lack of financial and governance readiness. Rehabilitation professionals demonstrated high attitudinal readiness but low technical readiness due to a lack of knowledge and skills. Rehabilitation students particularly lacked practical experience, confidence, clinical reasoning and decision-making skills further contributing to low technical readiness. Conclusion Health care institutions are generally not ready for a successful implementation of TR. To improve the readiness, senior management should actively participate and provide financial support, develop policies, guidelines and training programs for rehabilitation professionals. Educational institutions should incorporate TR program into curricula to prepare students to gain practical experience and familiarity with the use of TR technology for their future clinical practice.
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Affiliation(s)
- Eugene Nizeyimana
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Conran Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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Bodley N, Dorward J, Naidoo J, Letsoalo M, Ramsaroop K, Sayed F, Sookrajh Y, Drain PK, Garrett N. Diagnostic Accuracy of the Alere Afinion AS100 Point-of-Care Assay to Screen for Noncommunicable Diseases Among People Living With HIV. J Acquir Immune Defic Syndr 2023; 92:e1-e3. [PMID: 36126185 PMCID: PMC9742175 DOI: 10.1097/qai.0000000000003098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Nicola Bodley
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu–Natal, Durban, South Africa
| | - Jienchi Dorward
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu–Natal, Durban, South Africa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jessica Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu–Natal, Durban, South Africa
| | - Marothi Letsoalo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu–Natal, Durban, South Africa
| | - Kaminee Ramsaroop
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu–Natal, Durban, South Africa
| | - Fathima Sayed
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu–Natal, Durban, South Africa
| | - Yukteshwar Sookrajh
- eThekwini Municipality Health Unit, eThekwini Municipality, Durban, South Africa
| | - Paul K Drain
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA
- Department of Medicine, School of Medicine, University of Washington, Seattle, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu–Natal, Durban, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Community Assessment for a Low-Carbohydrate Nutrition Education Program in South Africa. Nutrients 2022; 15:nu15010067. [PMID: 36615724 PMCID: PMC9824893 DOI: 10.3390/nu15010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022] Open
Abstract
Eat Better South Africa (EBSA) is an organization that provides low-carbohydrate, high-fat (LCHF) nutrition and health education programs for women from under-resourced South African communities. Community assessments are essential to explore participants' potential facilitators and challenges of adhering to new dietary behaviours and should be implemented before any dietary interventions. This study is a qualitative community assessment to enable the EBSA program to better meet potential participants' needs and explore their willingness to enrol in the EBSA program. Sixty women from two communities in the Western Cape were interviewed through six focus group discussions. A thematic analysis was conducted using NVivo 12 software, and four themes were developed around the women's (1) role within the households; (2) dietary behaviour; (3) health perceptions; and (4) willingness to participate in an LCHF program. Women mentioned that they were responsible for cooking and shopping for their households. They expressed their understanding of healthy and unhealthy behaviours and their dietary patterns. Some women showed concerns about LCHF diets, but others wanted to learn more due to their knowledge of other people's positive experiences with the diet. There was a general desire to become healthy. However, the women anticipated dietary behaviour change to be challenging. Those challenges mostly revolved around their socioeconomic environments. The findings are intended to inform EBSA (or other nutrition interventions) on what to consider when implementing their interventions in these communities.
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Nsibande DF, Magasana V, Zembe W, Kindra G, Mogashoa M, Goga A, Ramokolo V. Health facility users' knowledge, perceptions, and practices about infant feeding in the context of option B+ in South Africa: a qualitative study. Int Breastfeed J 2022; 17:89. [PMID: 36539742 PMCID: PMC9764699 DOI: 10.1186/s13006-022-00526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND HIV and sub-optimal infant feeding practices remain important threats to child growth, development, and survival in low- and middle-income countries. To our knowledge, few studies have explored health service users' perspective of infant feeding in the context of WHO Option B+ policy to prevent vertical HIV transmission (PMTCT). This paper is a sub-analysis of qualitative data from a mixed-methods multi-level process evaluation of Option B+ implementation in South Africa (SA). In this study we explored health facility users' infant feeding knowledge, perceptions, and practices one year after SA adopted the 2016 updated World Health Organization prevention of mother-to-child transmission of HIV Option B+ infant feeding guidelines. METHODS Nineteen focus group discussions (FGDs) were held with six groups of men and women whose infants were aged < 6 months. Participants were attending randomly selected primary health care facilities within six purposively selected priority districts. The six groups included in the FGDs were: (i) adolescent girls and young women living with HIV (WHIV), (ii) adolescent girls and young women not living with HIV (WNHIV), (iii) older postnatal WHIV (iv) older postnatal WNHIV (v) pregnant women, and (vi) men. Data collection took place between April and December 2018. Data analysis involved coding and thematic framework analysis. RESULTS Women and men have suboptimal knowledge of the recommended breastfeeding duration and exclusive breastfeeding, especially for HIV-exposed infants. Most women received sub-optimal infant feeding counselling and mixed messages from health care workers. Fewer WHIV initiated breastfeeding at birth compared to WNHIV. Most parents believed that HIV-exposed infants should be breastfed for 6 months and many postnatal women on antiretroviral drugs and younger mothers lacked confidence to breastfeed beyond 6 months. Mixed feeding was predominant among all women due to individual, family, and socio-structural barriers. Many men were supportive on infant feeding; however, they lacked the appropriate information and skills to influence their partners' infant feeding decisions. CONCLUSIONS Differences in breastfeeding practices between WHIV and WNHIV are highly influenced by the lack of knowledge of infant feeding policy recommendations. Multiple-level factors deter many mothers from adhering to recommended guidelines. Appropriate ongoing infant feeding counselling and breastfeeding support are required for women and their partners.
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Affiliation(s)
- Duduzile Faith Nsibande
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
| | - Vuyolwethu Magasana
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
| | - Wanga Zembe
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Gurpreet Kindra
- grid.513001.6United States Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Mary Mogashoa
- grid.513001.6United States Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Ameena Goga
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa ,grid.49697.350000 0001 2107 2298Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Vundli Ramokolo
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
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Naicker I, Suleman F, Perumal-Pillay VA. A quantitative comparison of essential cardiovascular medicines from countries in the Southern African Development Community to the WHO model essential medicines list. J Pharm Policy Pract 2022; 15:97. [PMID: 36482421 PMCID: PMC9733348 DOI: 10.1186/s40545-022-00494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Globally, cardiovascular disease (CVD) is a leading cause of death and disproportionately affects low- and middle-income countries (LMICs). The WHO Model List of Essential Medicines (WHO EML) is a tool for improving accessibility and availability of medicines. This study compared the 2021 WHO EML CVDs basket of medicines with latest available national essential medicines list (NEMLs) for South Africa and 15 Southern African Development Community (SADC) countries to assess consistency in CVDs medicine listing. METHODS This descriptive, desktop review study compared SADC NEMLs. A comparator list was extracted by combining cardiovascular medicines listed in the 2021 WHO EML for adults and children. SADC country NEMLs were obtained from the WHO Essential Medicines and Health Products Information Portal. Consistency of NEMLs was calculated as a percentage coverage of CVD medicines listed in the 2021 WHO EML. SA hospital and primary health care (PHC) level NEMLs were included as separate formularies. RESULTS The SA hospital level NEML scored 70% consistency with the 2021 WHO EML. Tanzania (84%), Namibia (81%) and Angola (79%) scored the highest consistency. The mean consistency for SADC NEMLs was 66%. The lowest scoring country was Eswatini at 26%. The SA PHC NEML scored 35%. The least listed medicines were beta-blockers, angiotensin receptor blockers (ARBs), clopidogrel (43%) and paediatric formulations (furosemide (21%); digoxin (43%)). Individual antihypertensive medicines were most commonly listed. Botswana and Lesotho were the only countries to list a single pill combination (SPC) for the treatment of hypertension. CONCLUSIONS This comparison indicates that South Africa and most SADC countries are aligned with 2021 WHO EML recommendations. The inclusion of age-appropriate formulations for children as well as ARBs and SPC for the treatment of hypertension may improve patient adherence and cardiovascular outcomes in these countries. More frequent updates to NEMLs should improve consistency. NEMLs were not available for two countries, and these therefore did not form part of this study. Country health expenditure in ranking the consistency of NEMLs was not accounted for. LMICs adopting the essential medicine list strategy should consider imposing minimum consistency thresholds to the WHO EML to improve accessibility and availability of CVD medicines. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ian Naicker
- grid.16463.360000 0001 0723 4123Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000 South Africa
| | - Fatima Suleman
- grid.16463.360000 0001 0723 4123College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Velisha Ann Perumal-Pillay
- grid.16463.360000 0001 0723 4123Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000 South Africa
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Legenza L, Coetzee R, Rose WE, Esack T, Crombie K, Mina M, Safdar N, Barnett SG. Application of consolidated framework for implementation research to improve Clostridioides difficile infection management in district hospitals. Res Social Adm Pharm 2022; 18:4100-4111. [PMID: 35981939 PMCID: PMC9891768 DOI: 10.1016/j.sapharm.2022.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 06/08/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) contributes the global threats of drug resistant infections, healthcare acquired infections and antimicrobial resistance. Yet CDI knowledge among healthcare providers in low-resource settings is limited and CDI testing, treatment, and infection prevention measures are often delayed. OBJECTIVES to develop a CDI intervention informed by the local context within South African public district level hospitals, and analyze the CDI intervention and implementation process. METHODS A CDI checklist intervention was designed and implemented at three district level hospitals in the Western Cape, South Africa that volunteered to participate. Data collection included a retrospective medical records review of patients hospitalized with C. difficile test orders during the 90 days post-implementation. Patient outcomes and checklist components (e.g. antibiotics) were collected. Qualitative interviews (n = 14) and focus groups (n = 6) were conducted with healthcare providers on-site. The Consolidated Framework for Implementation Research (CFIR) and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) were applied to collected data and observations in order to identify drivers and barriers to implementation and understand differences in uptake. RESULTS One of the three hospitals displayed high intervention uptake. Highly relevant CFIR constructs linked to intervention uptake included tension for change, strong peer intervention champions, champions in influential leadership positions, and the intervention's simplicity (CFIR construct: complexity). Tension for change, a recognized need to improve CDI identification and treatment, at the high uptake hospital was also supported by an academic partnership for antimicrobial stewardship. CONCLUSIONS This research provides a straight-forward health systems strengthening intervention for CDI that is both needed and uncomplicated, in an understudied low resource setting. Intervention uptake was highest in the hospital with tension for change, influential champions, and existing academic partnerships. Implementation in settings with fewer academic connections requires further testing of collaborative implementation strategies and proactive adaptations.
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Affiliation(s)
- Laurel Legenza
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States; University of the Western Cape School of Pharmacy, Robert Sobukwe, Cape Town, 7535, South Africa.
| | - Renier Coetzee
- University of the Western Cape School of Pharmacy, Robert Sobukwe, Cape Town, 7535, South Africa; University of the Western Cape School of Public Health, Robert Sobukwe, Cape Town, 7535, South Africa
| | - Warren E Rose
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States
| | - Tasneem Esack
- Victoria Hospital, Wynberg, Cape Town, 7800, South Africa
| | - Kenneth Crombie
- University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - Megan Mina
- University of Cape Town, Rondebosch, Cape Town, 7700, South Africa; General Justice Gizenga Mpanza Regional Hospital, KwaDukuza, KwaZulu-Natal, 4450, South Africa
| | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, United States
| | - Susanne G Barnett
- University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States
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Myroniuk TW, White MJ, Madhavan S. Post-migration emotional well-being among Black South Africans. SSM - MENTAL HEALTH 2022; 2:100173. [PMID: 36776725 PMCID: PMC9910329 DOI: 10.1016/j.ssmmh.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Internal migration has been an institutionalized part of life for Black South Africans from the 1800s, when men left their rural homes to work in mines, through apartheid and into the present. Like other settings in the Global South, we know surprisingly little about the emotional well-being of migrants, especially in sub-Saharan African contexts. We investigate changes in the emotional well-being of 2281 working-age Black South Africans after migration, drawing on four waves of data, from 2008 to 2015, from the nationally representative National Income Dynamics Study. Fixed-effects regressions show that migrants exhibit changes in life satisfaction as well as proclivity towards depression but that these outcomes vary by distance of move and type of move-moving within or between provinces. As South Africa's health policies expand beyond addressing infectious diseases, it is important to consider mental health particularly of those who face the necessity of migration to sustain a livelihood.
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Affiliation(s)
| | - Michael J. White
- Brown University, Department of Sociology, Population Studies & Training Center, USA
| | - Sangeetha Madhavan
- University of Maryland, Department of African American Studies, Department of Sociology, Maryland Population Research Center, USA
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Carpenter B, Nyirenda M, Hanass-Hancock J. Disability, a priority area for health research in South Africa: an analysis of the burden of disease study 2017. Disabil Rehabil 2022; 44:7839-7847. [PMID: 34783620 DOI: 10.1080/09638288.2021.2000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Disabilities are increasing globally, which is attributed to the overall ageing of populations in affluent countries. This trend may differ in low and middle-income countries. This paper assesses the change over time in Years Lived with Disability (YLD) for South Africa and how this compares to regional and global trends. MATERIALS AND METHODS This secondary analysis of the Global Burden of Disease Study 2017 dataset describes the observed contribution of YLD to Disability-Adjusted Life Years (DALYs) per 100 000 people over the period 1990-2016, and forecast to 2030 using simple linear prediction. South African trends are compared to global and sub-Saharan African (SSA) trends to highlight the effect of HIV and policy implications. RESULTS Globally, the contribution of YLD to DALYs has increased from ±21.7% in 1990 to ±34% by 2016, with high socio-demographic index countries having a higher contribution (49%). HIV, mental health, musculoskeletal, neurological, and sense organ disorders are the five main contributors to YLD in South Africa (54%). Removing the effects of HIV/AIDS and sexually transmitted infections on YLD, South Africa's trend appears similar to the global trend, yet opposite to the SSA trend. CONCLUSION Our analysis shows there is a growing burden of disability in South Africa. Differences in trends with the regional and global patterns can be attributed to the high burden of HIV and non-communicable diseases in South Africa. Therefore, strategies are urgently needed to increase integration of disability and rehabilitation services into chronic HIV and non-communicable disease management. This calls for disability screening to identify functional limitations in routine data collection and case management.IMPLICATIONS FOR REHABILITATIONSouth Africa has experienced an increase in disability prevalence over time.This requires strengthening of services such as mental health interventions, physiotherapy, optometry, and audiology, and linking major disease clusters, such as HIV and the NCDs, to rehabilitation services.The greatest contributors towards disability adjusted life years in South Africa are currently mental disorders (13.8%), HIV and sexually transmitted infections (11.8%), musculoskeletal disorders (10.4%), neurological disorders (8.2%), and sense organ diseases (7.5%).Routine data collection and case management needs to include disability screening to identify developing functional limitations.
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Affiliation(s)
- Bradley Carpenter
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa.,School of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Makandwe Nyirenda
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Jill Hanass-Hancock
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa.,School of Health Science, University of KwaZulu-Natal, Durban, South Africa
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Petersen I, Selohilwe O, Georgeu-Pepper D, Ras CJ, Zani B, Petrus R, Anderson L, Mntambo N, Kathree T, Bhana A, Thornicroft G, Fairall L. A collaborative care package for depression comorbid with chronic physical conditions in South Africa. BMC Health Serv Res 2022; 22:1465. [PMID: 36457094 PMCID: PMC9717432 DOI: 10.1186/s12913-022-08874-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION A task-sharing collaborative care model for integrated depression care for South Africa's burgeoning primary health care population with chronic conditions was developed and tested through two pragmatic cluster randomized controlled trials. One trial focused on patients with hypertension and was located in one district where a collaborative care model was co-designed with district stakeholders. The other trial, focused on patients on antiretroviral treatment, was located in the same district site, with the addition of a second neighbouring district, without adaptation of the original model. This paper describes the package used to implement this model, and implementation outcomes across the two sites, and summarises lessons and challenges. METHODS The Template for Intervention Description and Replication (TIDieR) framework, adapted for complex health systems interventions, was used to describe components of the package. Additional elements of 'modifications made' and 'actual implementation' introduced in the 'Getting messier with TIDieR' framework, were used to describe implementation outcomes in terms of reach, adoption and implementation across the two trial districts. RESULTS In the absence of a co-design process to adapt the model to the context of the second site, there was less system level support for the model. Consequently, more project employed human resources were deployed to support training of primary care nurses in identification and referral of patients with depression; and supervise co-located lay counsellors. Referrals to co-located lay counselling services were more than double in the second site. However, uptake of counselling sessions was greater in the first site. This was attributed to greater in-vivo supervision and support from existing mental health specialists in the system. There was greater reliance on online supervision and support in the second site where geographical distances between clinics were larger. CONCLUSION The need for in-country co-designed collaborative care models, and 'implementation heavy' implementation research to understand adaptations required to accommodate varying in-country health system contexts is highlighted.
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Affiliation(s)
- Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College, Mazisi Kunene Road, Durban, 4001 South Africa
- Institute for Global Health, University College London, London, UK
| | - One Selohilwe
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College, Mazisi Kunene Road, Durban, 4001 South Africa
| | | | - Christy-Joy Ras
- Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Ruwayda Petrus
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College, Mazisi Kunene Road, Durban, 4001 South Africa
- School of Applied Human Sciences, University of KwaZulu-Natal, Howard College, Mazisi Kunene Road, Durban, 4001 South Africa
| | - Lauren Anderson
- Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Ntokozo Mntambo
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College, Mazisi Kunene Road, Durban, 4001 South Africa
- School of Applied Human Sciences, University of KwaZulu-Natal, Howard College, Mazisi Kunene Road, Durban, 4001 South Africa
| | - Tasneem Kathree
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College, Mazisi Kunene Road, Durban, 4001 South Africa
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College, Mazisi Kunene Road, Durban, 4001 South Africa
- Health Systems Research Unit, South African Medical Research Council, 491 Peter Mokaba Ridge, Overport, Durban, South Africa
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
- Global Health Institute, King’s College London, London, UK
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Denardo D, Mojola SA, Schatz E, Gómez-Olivé FX. Antiretroviral therapy and aging as resources for managing and resisting HIV-related stigma in rural South Africa. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100148. [PMID: 36687383 PMCID: PMC9851406 DOI: 10.1016/j.ssmqr.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The widespread roll-out of antiretroviral therapy (ART) in Africa has contributed to a large population of adults aging with HIV. However, little is known about how HIV-related stigma interacts with aging in the ART era. This study uses in-depth interviews with middle-aged and older South Africans living with HIV to explore stigma-related experiences and response strategies. Participants describe a persistence of stigma which requires the deployment of a range of common and age-based stigma management and resistance strategies. We find that participants minimize their exposure to stigma through selective disclosure of their HIV status; neutralize HIV-related stigma through comparisons to chronic illnesses common among older adults, and deflect stigma through asserting an ART-adherent identity and othering younger non-adherent adults. Overall, our study highlights the roles of ART and aging as resources for managing and resisting HIV-related stigma.
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Affiliation(s)
- Danielle Denardo
- Social and Behavioral Sciences, Soka University of America, Aliso Viejo, CA, USA,Corresponding author.. 1.949.480.4216, 1 University Drive, Aliso Viejo, CA, 92656, USA, (D. Denardo)
| | - Sanyu A. Mojola
- Department of Sociology, School of Public and International Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa,Department of Public Health and Department of Women’s & Gender Studies, University of Missouri, Columbia, MO, USA
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
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Referral of District Level Operations to Regional Hospitals in South Africa. J Surg Res 2022; 278:149-154. [DOI: 10.1016/j.jss.2022.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
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Payne CF, Houle B, Chinogurei C, Herl CR, Kabudula CW, Kobayashi LC, Salomon JA, Manne-Goehler J. Differences in healthy longevity by HIV status and viral load among older South African adults: an observational cohort modelling study. Lancet HIV 2022; 9:e709-e716. [PMID: 36179754 PMCID: PMC9553125 DOI: 10.1016/s2352-3018(22)00198-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The population of people living with HIV in South Africa is rapidly ageing due to increased survivorship attributable to antiretroviral therapy (ART). We sought to understand how the combined effects of HIV and ART have led to differences in healthy longevity by HIV status and viral suppression in this context. METHODS In this observational cohort modelling study we use longitudinal data from the 2015 baseline interview (from Nov 13, 2014, to Nov 30, 2015) and the 2018 longitudinal follow-up interview (from Oct 12, 2018, to Nov 7, 2019) of the population-based study Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) to estimate life expectancy and disability-free life expectancy (DFLE) of adults aged 40 years and older in rural South Africa. Respondents who consented to HIV testing, responded to survey questions on disability, and who were either interviewed in both surveys or who died between survey waves were included in the analysis. We estimate life expectancy and DFLE by HIV status and viral suppression (defined as <200 copies per mL) using Markov-based microsimulation. FINDINGS Among the 4322 eligible participants from the HAALSI study, we find a clear gradient in remaining life expectancy and DFLE based on HIV serostatus and viral suppression. At age 45 years, the life expectancy of a woman without HIV was 33·2 years (95% CI 32·0-35·0), compared with 31·6 years (29·2-34·1) a woman with virally suppressed HIV, and 26·4 years (23·1-29·1) for a woman with unsuppressed HIV; life expectancy for a 45 year old man without HIV was 27·2 years (25·8-29·1), compared with 24·1 years (20·9-27·2) for a man with virally suppressed HIV, and 17·4 years (15·0-20·3) for a man with unsuppressed HIV. Men and women with viral suppression could expect to live nearly as many years of DFLE as HIV-uninfected individuals at ages 45 years and 65 years. INTERPRETATION These results highlight the tremendous benefits of ART for population health in high-HIV-prevalence contexts and reinforce the need for continued work in making ART treatment accessible to ageing populations. FUNDING National Institutes of Health.
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Affiliation(s)
- Collin F Payne
- School of Demography, Research School of Social Sciences, The Australian National University, Canberra, ACT, Australia; Center for Population and Development Studies, Harvard T H Chan School of Public Health, Cambridge, MA, USA.
| | - Brian Houle
- School of Demography, Research School of Social Sciences, The Australian National University, Canberra, ACT, Australia; MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Chido Chinogurei
- Centre for Infectious Diseases and Epidemiology Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joshua A Salomon
- Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, CA, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Center for Population and Development Studies, Harvard T H Chan School of Public Health, Cambridge, MA, USA
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M'bouaffou F, Buch E, Olorunju S, Thsehla E. Perceived knowledge of scheme members and their satisfaction with their medical schemes: a cross-sectional study in South Africa. BMC Public Health 2022; 22:1700. [PMID: 36071514 PMCID: PMC9454120 DOI: 10.1186/s12889-022-14106-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background South Africa has a dual healthcare system comprising of private and public sectors covering 16% and 84% of the population, respectively. Medical schemes are the primary source of health insurance in the private sector. The aim of this study was to assess members of medical schemes' perceived knowledge and satisfaction with their medical schemes. Methods A cross-sectional survey was conducted using a stratified systematic sample of members of 22 open medical schemes. Medical schemes members completed an online questionnaire on knowledge and satisfaction with their medical schemes. We calculated a composite perceived knowledge and satisfaction score. Descriptive, bivariate and multivariate analysis was conducted. Results A total of 336 members of medical schemes participated in this study. Respondents generally perceived themselves to have good knowledge of their medical schemes. Eighty-one percent of participants were satisfied with the quality of services received from their designated service providers (DSPs), however, only 9% were satisfied with accessibility of doctors under their DSP arrangement. Twenty-five percent of respondents were satisfied with scheme contributions and only 46% were satisfied with the prescribed minimum benefit package. Conclusion Medical schemes remain a key element of private healthcare in South Africa. The analysis shows that medical schemes, should put more effort into the accessibility of general practitioner under their designated service providers. Furthermore, the prescribed minimum benefits should be reviewed to provide a comprehensive benefits basket without co-payment for members as recommended by the Medical Schemes Act Amendment Bill of 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14106-8.
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Affiliation(s)
- Francis M'bouaffou
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Eric Buch
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Steve Olorunju
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Evelyn Thsehla
- SAMRC/WITS Centre for Health Economics and Decision Science, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Mansfield BS, Bhana S, Raal FJ. Dyslipidemia in South African patients with hypothyroidism. J Clin Transl Endocrinol 2022; 29:100302. [PMID: 35898802 PMCID: PMC9309410 DOI: 10.1016/j.jcte.2022.100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/21/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Brett S. Mansfield
- Division of Endocrinology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Corresponding author at: Division of Endocrinology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
| | - Sindeep Bhana
- Division of Endocrinology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederick J. Raal
- Division of Endocrinology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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David NJ, Bresick G, Moodaley N, Von Pressentin KB. Measuring the impact of community-based interventions on type 2 diabetes control during the COVID-19 pandemic in Cape Town – A mixed methods study. S Afr Fam Pract (2004) 2022; 64:e1-e9. [PMID: 36073102 PMCID: PMC9452916 DOI: 10.4102/safp.v64i1.5558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Neal J David
- Division of Family Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, Metro District Health Services, Western Cape Department of Health, Cape Town.
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Ogunsakin RE, Ginindza TG. Bayesian Spatial Modeling of Diabetes and Hypertension: Results from the South Africa General Household Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158886. [PMID: 35897258 PMCID: PMC9331550 DOI: 10.3390/ijerph19158886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023]
Abstract
Determining spatial links between disease risk and socio-demographic characteristics is vital in disease management and policymaking. However, data are subject to complexities caused by heterogeneity across host classes and space epidemic processes. This study aims to implement a spatially varying coefficient (SVC) model to account for non-stationarity in the effect of covariates. Using the South Africa general household survey, we study the provincial variation of people living with diabetes and hypertension risk through the SVC model. The people living with diabetes and hypertension risk are modeled using a logistic model that includes spatially unstructured and spatially structured random effects. Spatial smoothness priors for the spatially structured component are employed in modeling, namely, a Gaussian Markov random field (GMRF), a second-order random walk (RW2), and a conditional autoregressive (CAR) model. The SVC model is used to relax the stationarity assumption in which non-linear effects of age are captured through the RW2 and allow the mean effect to vary spatially using a CAR model. Results highlight a non-linear relationship between age and people living with diabetes and hypertension. The SVC models outperform the stationary models. The results suggest significant provincial differences, and the maps provided can guide policymakers in carefully exploiting the available resources for more cost-effective interventions.
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Affiliation(s)
- Ropo E. Ogunsakin
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa;
- Correspondence:
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa;
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa
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Coordination Models for Cancer Care in Low- and Middle-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137906. [PMID: 35805565 PMCID: PMC9265683 DOI: 10.3390/ijerph19137906] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
Background: The coordination of cancer care among multiple providers is vital to improve care quality and ensure desirable health outcomes across the cancer continuum, yet evidence is scarce of this being optimally achieved in low- and middle-income countries (LMICs). Objective: Through this scoping review, our objective was to understand the scope of cancer care coordination interventions and services employed in LMICs, in order to synthesise the existing evidence and identify key models and their elements used to manage and/or improve cancer care coordination in these settings. Methods: A detailed search strategy was conducted, aligned with the framework of Arksey and O’Malley. Articles were examined for evidence of coordination interventions used in cancer care in LMICs. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension Guidelines for Scoping Reviews, which included a checklist and explanation. The PRISMA flow diagram was utilised to report the screening of results. Data were extracted, categorised and coded to allow for a thematic analysis of the results. Results: Fourteen studies reported on coordination interventions in cancer care in LMICs. All studies reported a positive impact of cancer coordination interventions on the primary outcome measured. Most studies reported on a patient navigation model at different points along the cancer care continuum. Conclusions: An evidence-based and culturally sensitive plan of care that aims to promote coordinated and efficient multidisciplinary care for patients with suspicion or diagnosis of cancer in LMICs is feasible and might improve the quality of care and efficiency.
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