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Pillay M, Kara R, Govindasamy P, Motala R. Food security and disability in South Africa: an analysis of General Household Survey data. Disabil Rehabil 2024:1-9. [PMID: 39140161 DOI: 10.1080/09638288.2024.2388264] [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: 01/11/2023] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE We investigated the relationship between disability and food security in South Africa using data from the General Household Survey (GHS). MATERIALS AND METHODS Regression models were utilised with GHS data (2014-2018) to gauge the likelihood of food insecurity (the dependent variable) among individuals with disabilities. Socioeconomic and demographic traits of the 2018 GHS sample were analysed. All estimates were weighted and represented nationally at the individual level. RESULTS In this study population (32 187) of food insecure people, 9.64% are disabled. Food insecurity impacts more Black people with disabilities (91%) versus those without disabilities (90%), and disabled women (65%) versus nondisabled women (58%). Most reside in KwaZulu-Natal. Those with disability grants lower food insecurity odds, while child support grant recipients face higher odds. Household size and education are significant predictors, while marital status and gender are not. CONCLUSION This study data justifies the need for disability-inclusive food security programmes in South Africa, especially amid crises like COVID-19. Significantly, there is a nil data finding about people with eating/swallowing disabilities whose needs intersect with food security. This emphasises the need for inclusive data collection that operates within a food sovereignty framework to increase the visibility of people with disabilities.
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Affiliation(s)
- Mershen Pillay
- Disciplines of Audiology and Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Durban, KZN, South Africa
- Speech and Language Therapy, Institute of Education, Massey University, Auckland, New Zealand
| | - Reesha Kara
- Institute of Social and Economic Research, Rhodes University, South Africa
| | | | - Razia Motala
- Specialist Speech Language Pathologist, Sidra Medicine, Doha, Qatar
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Maart RA, Ernstzen DV, Mji G, Morris LD. Understanding the value of rehabilitation: Perspectives from South African Stakeholders. Afr J Disabil 2024; 13:1406. [PMID: 39114451 PMCID: PMC11304207 DOI: 10.4102/ajod.v13i0.1406] [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: 02/05/2024] [Accepted: 04/21/2024] [Indexed: 08/10/2024] Open
Abstract
Background The need for rehabilitation in South Africa has doubled between 1990 and 2017 and is expected to increase in the coming years. However, the rehabilitation needs of South Africans (and globally) remain largely unmet. Establishing a common understanding of the value of rehabilitation can inform clinical practice and policymaking to achieve Universal Health Coverage (UHC). Objectives This study aims to explore the value of rehabilitation services in South Africa's public healthcare sector by gathering perspectives from stakeholders. The goal is to inform policy decisions related to the implementation of National Health Insurance (NHI) in South Africa. Method The study used a phenomenological approach and interpretivist paradigm. Semi-structured interviews were conducted face-to-face, online, or telephonically with 12 stakeholders from various rehabilitation sectors. The value of rehabilitation was analysed and categorised into five main categories: context, service delivery, patient outcomes, economic and financial components, and collaboration within and between sectors. Results The value of rehabilitation was found to be multifaceted, because of the varying health, economic, and social challenges faced by many South Africans. Conclusion The study identified components of value-based rehabilitation that should be prioritised in the proposed NHI of South Africa. Future research should explore all stakeholder perspectives, including patients, and provide empirical evidence of rehabilitation's economic and societal value. Contribution We highlight priority areas that are central to the value of rehabilitation in South Africa and other low- and middle-income countries (LMICs). Tailoring rehabilitation services to patient and community needs is crucial for achieving value-based care. Given South Africa's commitment to the United Nations Convention on the Rights of Persons with Disabilities, prioritising rehabilitation remains essential.
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Affiliation(s)
- Rentia A Maart
- Department of Rehabilitation and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dawn V Ernstzen
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gubela Mji
- Division of Disability and Rehabilitation Studies, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Linzette D Morris
- Department of Rehabilitation Sciences, College of Health Sciences, Qatar University, Doha, Qatar
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3
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Yao YG, Lu L, Ni RJ, Bi R, Chen C, Chen JQ, Fuchs E, Gorbatyuk M, Lei H, Li H, Liu C, Lv LB, Tsukiyama-Kohara K, Kohara M, Perez-Cruz C, Rainer G, Shan BC, Shen F, Tang AZ, Wang J, Xia W, Xia X, Xu L, Yu D, Zhang F, Zheng P, Zheng YT, Zhou J, Zhou JN. Study of tree shrew biology and models: A booming and prosperous field for biomedical research. Zool Res 2024; 45:877-909. [PMID: 39004865 PMCID: PMC11298672 DOI: 10.24272/j.issn.2095-8137.2024.199] [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: 06/17/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024] Open
Abstract
The tree shrew ( Tupaia belangeri) has long been proposed as a suitable alternative to non-human primates (NHPs) in biomedical and laboratory research due to its close evolutionary relationship with primates. In recent years, significant advances have facilitated tree shrew studies, including the determination of the tree shrew genome, genetic manipulation using spermatogonial stem cells, viral vector-mediated gene delivery, and mapping of the tree shrew brain atlas. However, the limited availability of tree shrews globally remains a substantial challenge in the field. Additionally, determining the key questions best answered using tree shrews constitutes another difficulty. Tree shrew models have historically been used to study hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, myopia, and psychosocial stress-induced depression, with more recent studies focusing on developing animal models for infectious and neurodegenerative diseases. Despite these efforts, the impact of tree shrew models has not yet matched that of rodent or NHP models in biomedical research. This review summarizes the prominent advancements in tree shrew research and reflects on the key biological questions addressed using this model. We emphasize that intensive dedication and robust international collaboration are essential for achieving breakthroughs in tree shrew studies. The use of tree shrews as a unique resource is expected to gain considerable attention with the application of advanced techniques and the development of viable animal models, meeting the increasing demands of life science and biomedical research.
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Affiliation(s)
- Yong-Gang Yao
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan 650204, China. E-mail:
| | - Li Lu
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Rong-Jun Ni
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan 610044, China
| | - Rui Bi
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Ceshi Chen
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Jia-Qi Chen
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
| | - Eberhard Fuchs
- German Primate Center, Leibniz Institute of Primate Research, Göttingen 37077, Germany
| | - Marina Gorbatyuk
- Department of Optometry and Vision Science, School of Optometry, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Hao Lei
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan, Hubei 430071, China
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China
| | - Hongli Li
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Chunyu Liu
- Soong Ching Ling Institute of Maternity and Child Health, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Long-Bao Lv
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
| | - Kyoko Tsukiyama-Kohara
- Transboundary Animal Diseases Center, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima-city, Kagoshima 890-8580, Japan
| | - Michinori Kohara
- Department of Microbiology and Cell Biology, Tokyo Metropolitan Institute of Medical Science, Tokyo 156-8506, Japan
| | | | - Gregor Rainer
- Department of Medicine, University of Fribourg, Fribourg CH-1700, Switzerland
| | - Bao-Ci Shan
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Fang Shen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
| | - An-Zhou Tang
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530000, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, Guangxi 530000, China
| | - Jing Wang
- Department of Neurobiology, School of Basic Medical Sciences, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Wei Xia
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530000, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, Guangxi 530000, China
| | - Xueshan Xia
- School of Public Health, Kunming Medical University, Kunming, Yunnan 650500, China
| | - Ling Xu
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Dandan Yu
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Feng Zhang
- Soong Ching Ling Institute of Maternity and Child Health, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Ping Zheng
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Yong-Tang Zheng
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), and National Resource Center for Non-Human Primates, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Jumin Zhou
- Key Laboratory of Genetic Evolution and Animal Models, Yunnan Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650204, China
| | - Jiang-Ning Zhou
- CAS Key Laboratory of Brain Function and Diseases, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230027, China
- Institute of Brain Science, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
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Closson K, Dong E, Zulu B, Dietrich JJ, Zharima C, Jesson J, Pakhomova T, Beksinska M, Kaida A. 'Life became harder with COVID-19': exploring the experiences of the COVID-19 pandemic among youth living in eThekwini district, South Africa. BMC Public Health 2024; 24:1922. [PMID: 39020372 PMCID: PMC11256542 DOI: 10.1186/s12889-024-19238-7] [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: 11/10/2023] [Accepted: 06/24/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND In South Africa, pervasive age and gender inequities have been exacerbated by the COVID-19 pandemic and public health response. We aimed to explore experiences of the COVID-19 pandemic among youth in eThekwini district, South Africa. METHODS Between December 2021-May 2022 we explored experiences of the COVID-19 pandemic on youth aged 16-24 residing in eThekwini, South Africa. We collated responses to the open-ended question "Has the COVID-19 pandemic affected you in any other way you want to tell us about?" in an online survey focused on understanding the pandemic's multi-levelled health and social effects. We used a thematic analysis to summarise the responses. RESULTS Of 2,068 respondents, 256 (12.4%, median age = 22, 60.9% women) completed the open-ended survey question (11% in isiZulu). Results were organized into three main themes encompassing (1) COVID-19-related loss, fear, grief, and exacerbated mental and physical health concerns; (2) COVID-19-related intensified hardships, which contributed to financial, employment, food, education, and relationship insecurities for individuals and households; and (3) positive effects of the pandemic response, including the benefits of government policies and silver linings to government restrictions. CONCLUSIONS We found that South African youth experienced significant grief and multiple losses (e.g., death, income, job, and educational) during the COVID-19 pandemic. Trauma-aware interventions that provide economic and educational opportunities must be included in post-COVID recovery efforts.
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Affiliation(s)
- Kalysha Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
- Center of Gender Equity and Health, University of California San Diego, La Jolla, CA, United States.
| | - Erica Dong
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Bongiwe Zulu
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Janan J Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa
- African Social Sciences Unit of Research and Evaluation (ASSURE), Wits Health Consortium, Johannesburg, South Africa
| | - Campion Zharima
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Julie Jesson
- Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Tatiana Pakhomova
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mags Beksinska
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Ricci C, Kruger IM, Kruger HS, Breet Y, Moss SJ, van Oort A, Bester P, Pieters M. Determinants of mortality status and population attributable risk fractions of the North West Province, South African site of the international PURE study. Arch Public Health 2024; 82:102. [PMID: 38970128 PMCID: PMC11225367 DOI: 10.1186/s13690-024-01336-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/29/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Mortality data and comparative risk assessments from sub-Saharan Africa are limited. There is an urgent need for high quality population health surveys to be conducted, to improve the national health surveillance system. Our aim was to perform a comparative risk assesment and report on the mortality status and cause of death data of participants from a South African site of the international Prospective Urban Rural Epidemiology study. METHODS 1 921 Black participants were included, with a median observational time of 13 years resulting in 21 525 person-years. We performed a comparative risk assessment considering four health status domains: locality (rural vs. urban), socio-economic status (SES) (education and employment), lifestyle factors (physical activity, smoking and alcohol consumption) and prevalent diseases (human immunodeficiency virus (HIV), type 2 diabetes mellitus and hypertension). Next, population-attributable fractions (PAFs) were calculated to determine the mortality risk attributable to modifiable determinants. RESULTS 577 all-cause deaths occurred. Infectious diseases (28.1% of all deaths) were the most frequent cause of death, followed by cardiovascular disease (CVD) (22.4%), respiratory diseases (11.6%) and cancer (11.1%). The three main contributors to all-cause mortality were HIV infection, high SES and being underweight. HIV infection and underweight were the main contributors to infectious disease mortality and hypertension, the urban environment, and physical inactivity to CVD mortality. HIV had the highest PAF, followed by physical inactivity, alcohol and tobacco use and hypertension (for CVD mortality). CONCLUSION This African population suffers from a quadruple burden of disease. Urban locality, high SES, prevalent disease (HIV and hypertension) and lifestyle factors (physical inactivity, tobacco and alcohol use) all contributed in varying degrees to all-cause and cause-specific mortalities. Our data confirm the public health importance of addressing HIV and hypertension, but also highlights the importance of physical inactivity, tobacco use and alcohol consumption as focal points for public health strategies to produce the most efficient mortality reduction outcomes.
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Affiliation(s)
- Cristian Ricci
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North- West University, Potchefstroom, South Africa
| | - Iolanthe M Kruger
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North- West University, Potchefstroom, South Africa
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Yolandi Breet
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- Centre of Excellence for Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Sarah J Moss
- Physical activity, Sport and Recreation Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Abie van Oort
- Physical activity, Sport and Recreation Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Petra Bester
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North- West University, Potchefstroom, South Africa
| | - Marlien Pieters
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, 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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7
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Swanzen R, Aydin KSNK, Brown N, Patel M, Gydien T, Mauree AP. Navigating the Hidden Curriculum: Reflections from Graduates of a Multidisciplinary Postgraduate Diploma in Pediatric Palliative Care. J Palliat Med 2024; 27:720-726. [PMID: 38593445 DOI: 10.1089/jpm.2023.0470] [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] [Indexed: 04/11/2024] Open
Abstract
Discovering some of the impact of the hidden curriculum (HC) while doing a postgraduate diploma in pediatric palliative care (PPC) in South Africa (SA), six graduates reflected on their formal and informal learning. To navigate the HC the transformative learning theory is used as a bridge connecting the formal and informal learning between interprofessional education where diversity is an enabler to enhance learning outcomes and shift perspectives to enhance patient care. The graduates were guided through the stages of the competency model to reflect on their learning experience. The authors believe that the experiential lessons reflected on, both clinical and psychosocial, can assist with not only strengthening the particular multidisciplinary needs of students, but also to align the HC and formal curricula. These lessons can also aid toward upscaling the need for PPC education in the SA context.
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Affiliation(s)
- Rika Swanzen
- The Independent Institute of Education, Varsity College, Waterfall Campus, Deputy Dean: Research, Midrand, South Africa
| | | | | | - Mehnaaz Patel
- Private Practice, Johannesburg, Gauteng, South Africa
| | | | - Angidi Pillay Mauree
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Ross JM, Greene C, Broshkevitch CJ, Dowdy DW, van Heerden A, Heitner J, Rao DW, Roberts DA, Shapiro AE, Zabinsky ZB, Barnabas RV. Preventing tuberculosis with community-based care in an HIV-endemic setting: a modelling analysis. J Int AIDS Soc 2024; 27:e26272. [PMID: 38861426 PMCID: PMC11166187 DOI: 10.1002/jia2.26272] [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: 05/19/2023] [Accepted: 04/30/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Antiretroviral therapy (ART) and tuberculosis preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase the uptake of ART and TPT to prevent TB in settings with a high burden of HIV-associated TB, particularly among men. METHODS We developed a gender-stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15-59 in KwaZulu-Natal, South Africa. We drew model parameters from a community-based ART initiation and resupply trial in sub-Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community-based ART and TPT care programmes during 2018-2027, assuming that community-based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e. ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for 10 years. We projected the number of TB cases, deaths and disability-adjusted life years (DALYs) averted relative to standard, clinic-based care. We calculated programme costs and incremental cost-effectiveness ratios from the provider perspective. RESULTS If community-based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3%-34.1%) and TB mortality by 34.6% (range 24.8%-42.2%) after 10 years. Increasing both ART and TPT uptake through community-based ART with TPT care could reduce TB incidence by 29.7% (range 23.9%-36.0%) and TB mortality by 36.0% (range 26.9%-43.8%). Community-based ART with TPT care reduced gender disparities in TB mortality rates, with a projected 54 more deaths annually among men than women (range 11-103) after 10 years of community-based care versus 109 (range 41-182) in standard care. Over 10 years, the mean cost per DALY averted by community-based ART with TPT care was $846 USD (range $709-$1012). CONCLUSIONS By substantially increasing coverage of ART and TPT, community-based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV-associated TB and reduce TB gender disparities.
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Affiliation(s)
- Jennifer M. Ross
- Division of Allergy and Infectious DiseasesDepartment of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Chelsea Greene
- Department of Industrial and Systems EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Cara J. Broshkevitch
- Department of EpidemiologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - David W. Dowdy
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Alastair van Heerden
- Centre for Community Based ResearchHuman Sciences Research CouncilPietermaritzburgSouth Africa
- SAMRC/Wits Developmental Pathways for Health Research UnitUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Jesse Heitner
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
| | - Darcy W. Rao
- Bill & Melinda Gates FoundationSeattleWashingtonUSA
| | - D. Allen Roberts
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Adrienne E. Shapiro
- Division of Allergy and Infectious DiseasesDepartment of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Zelda B. Zabinsky
- Department of Industrial and Systems EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Ruanne V. Barnabas
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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9
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Bolarinwa OA. Inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018. BMC Womens Health 2024; 24:317. [PMID: 38824536 PMCID: PMC11143664 DOI: 10.1186/s12905-024-03167-z] [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: 05/22/2023] [Accepted: 05/28/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Inequalities in modern contraceptive use among women in low-income countries remain a major public health challenge. Eliminating or reducing the inequalities in modern contraceptive use among women could accelerate the achievement of Sustainable Development Goals, Targets 3.7 & 5.6. Thus, this study examined the inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018. METHODS This study employed the World Health Organisation's Health Equity Assessment Toolkit to analyse the 2003 and 2018 Nigeria Demographic Health Surveys. Modern contraceptive use was aggregated using five equity stratifiers: age, economic status, educational level, place, and region of residence among women of reproductive aged 15 to 49, with a sample size of 5,336 and 29,090 for 2003 and 2018, respectively. Inequality was measured in this study using difference (D), ratio (R), population-attributable risk (PAR), and a population-attributable fraction (PAF). RESULTS The study shows an increase in modern contraceptive use among women of reproductive age in Nigeria from 8.25% in 2003 to 12.01% in 2018, with the use being more prominent among women of reproductive age 20-49 and those in the richest economic quintile. In both surveys, women with primary education showed the most upward increase in modern contraceptive use. Women residing in the urban areas also show an upward use of modern contraceptives use. The study further highlights inequality gaps, with age being a substantial factor, while economic status and sub-national regions showed mild to marginal inequality gaps. Finally, the educational level of women of reproductive age in Nigeria significantly shows inequality in modern contraceptive use, with a PAF of 129.11 in 2003 and 65.39 in 2018. CONCLUSION The inequality gap in modern contraceptive use among women of reproductive age in Nigeria between 2003 and 2018 reported in this study includes age, education, wealth quintile, residence, and region-related inequalities. The study highlights the need for policies and programmes that target the groups with low use of modern contraceptives to promote equity in family planning services.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health, York St John University, London, UK.
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa.
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10
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Dixon J, de Vries S, Fleischer C, Bhaumik S, Dymond C, Jones A, Ross M, Finn J, Geduld H, Steyn E, Lategan H, Hodsdon L, Verster J, Mukonkole S, Doubell K, Baidwan N, Mould-Millman NK. Preventable trauma deaths in the Western Cape of South Africa: A consensus-based panel review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003122. [PMID: 38728269 PMCID: PMC11086906 DOI: 10.1371/journal.pgph.0003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024]
Abstract
Injury causes 4.4 million deaths worldwide annually. 90% of all injury-related deaths occur in low-and-middle income countries. Findings from expert-led trauma death reviews can inform strategies to reduce trauma deaths. A cohort of trauma decedents was identified from an on-going study in the Western Cape Province of South Africa. For each case, demographics, injury characteristics, time and location of death and postmortem findings were collected. An expert multidisciplinary panel of reviewed each case, determined preventability and made recommendations for improvement. Analysis of preventable and non-preventable cases was performed using Chi-square, Fisher's exact, and Wilcoxon signed rank tests. A rapid qualitative analysis of recommendations was conducted and descriptively summarized. 138 deaths (48 deceased-on-scene and 90 pre- or in-hospital deaths) were presented to 23 panelists. Overall, 46 (33%) of deaths reviewed were considered preventable or potentially preventable. Of all pre- and in-hospital deaths, late deaths (>24 hours) were more frequently preventable (22, 56%) and due to multi-organ failure and sepsis, compared to early deaths (≤24 hours) with 32 (63%) that were non-preventable and due to central nervous system injury and haemorrhage. 45% of pre and in-hospital deaths were preventable or potentially preventable. The expert panel recommended strengthening community based primary prevention strategies for reducing interpersonal violence alongside health system improvements to facilitate high quality care. For the health system the panel's key recommendations included improving team-based care, adherence to trauma protocols, timely access to radiology, trauma specialists, operative and critical care.
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Affiliation(s)
- Julia Dixon
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Shaheem de Vries
- Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Chelsie Fleischer
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Smitha Bhaumik
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Chelsea Dymond
- Colorado Permanente Medical Group, Denver, Colorado, United States of America
| | - Austin Jones
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Madeline Ross
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Julia Finn
- University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Heike Geduld
- Stellenbosch University, Cape Town, South Africa
| | - Elmin Steyn
- Stellenbosch University, Cape Town, South Africa
| | | | | | | | | | | | - Navneet Baidwan
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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11
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Burger JW, Mafuze B, Brooker J, Patricios JS. Championing mental health: sport and exercise psychiatry for low- and middle-income countries using a model from South Africa. Br J Sports Med 2024; 58:519-521. [PMID: 38599682 DOI: 10.1136/bjsports-2024-108248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Affiliation(s)
- James W Burger
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
- HIV Mental Health Research Group, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Bonginkosi Mafuze
- Department of Psychiatry, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Janine Brooker
- Department of Psychiatry, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Alan J Flisher Centre for Public Mental Health, Cape Town, South Africa
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Bhaumik S, Suresh K, Lategan H, Steyn E, Mould-Millman NK. The new injury severity score underestimates true injury severity in a resource-constrained setting. Afr J Emerg Med 2024; 14:11-18. [PMID: 38173687 PMCID: PMC10761343 DOI: 10.1016/j.afjem.2023.12.001] [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] [Received: 09/04/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Background The new injury severity score (NISS) is widely used within trauma outcomes research. NISS is a composite anatomic severity score derived from the Abbreviated Injury Scale (AIS) protocol. It has been postulated that NISS underestimates trauma severity in resource-constrained settings, which may contribute to erroneous research conclusions. We formally compare NISS to an expert panel's assessment of injury severity in South Africa. Methods This was a retrospective chart review of adult trauma patients seen in a tertiary trauma center. Randomly selected medical records were reviewed by an AIS-certified rater who assigned an AIS severity score for each anatomic injury. A panel of five South African trauma experts independently reviewed the same charts and assigned consensus severity scores using a similar scale for comparability. NISS was calculated as the sum of the squares of the three highest assigned severity scores per patient. The difference in average NISS between rater and expert panel was assessed using a multivariable linear mixed effects regression adjusted for patient demographics, injury mechanism and type. Results Of 49 patients with 190 anatomic injuries, the majority were male (n = 38), the average age was 36 (range 18-80), with either a penetrating (n = 23) or blunt (n = 26) injury, resulting in 4 deaths. Mean NISS was 16 (SD 15) for the AIS rater compared to 28 (SD 20) for the expert panel. Adjusted for potential confounders, AIS rater NISS was on average 11 points (95 % CI: 7, 15) lower than the expert panel NISS (p < 0.001). Injury type was an effect modifier, with the difference between the AIS rater and expert panel being greater in penetrating versus blunt injury (16 vs. 7; p = 0.04). Crush injury was not well-captured by AIS protocol. Conclusion NISS may under-estimate the 'true' injury severity in a middle-income country trauma hospital, particularly for patients with penetrating injury.
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Affiliation(s)
- Smitha Bhaumik
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Krithika Suresh
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Hendrick Lategan
- Department of Surgery, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elmin Steyn
- Department of Surgery, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nee-Kofi Mould-Millman
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
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13
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Zhang J, Zhang Y. Decomposing differences in the chronic disease condition between rural and urban older adults in China: a cross-sectional analysis. Front Public Health 2024; 11:1298657. [PMID: 38249386 PMCID: PMC10797097 DOI: 10.3389/fpubh.2023.1298657] [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: 09/22/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
Background With the increasing in aging in China, there has been an increase in older adults suffering from chronic diseases. However, little is known about the differences in chronic disease conditions between rural and urban older adults. The objective of this study is to identify chronic disease conditions and investigate the factors that cause differences in chronic disease conditions between urban and rural older adults. Methods The data are from the fourth wave of the China Health and Retirement Longitudinal Study. The coarsened exact matching (CEM) method was used to reduce the biases for a comparative study. After the CEM method, this study included 5,927 participants aged 60 and above. Chronic disease condition was used as the indicator to measure the health of older adults. Specifically, Fairlie's decomposition analysis was carried out to discover the differences in chronic disease conditions between urban and rural older adults. Results The study showed that the proportion of those suffering from chronic diseases was significantly higher among urban older adults (51.26%) than rural older adults (46.56%). In those suffering from chronic diseases, there were significant differences in gender, education level, minorities, religiosities, duration of sleep, drinking alcohol, social activity, insurance, and socioeconomic status between rural and urban older adults, while in those not suffering from chronic diseases, there were significant differences in age, education level, marital status, drinking alcohol, social activity, insurance, region, and socioeconomic status between rural and urban older adults. For rural older adults, those who were widowers [Odds ratios (OR): 1.267], who drink alcohol (OR: 1.421), and having government medical insurance (OR: 4.869) had higher odds of having chronic diseases. However, those who were in high school and above (OR: 0.802), reporting a duration of sleep of 4-8 h (OR: 0.745) or above 8 h (OR: 0.649), having social activity (OR: 0.778), and having the most affluent socioeconomic status (OR: 0.778) had lower odds of having chronic diseases. As for urban older adults, those who were aged 65-74 years (OR: 1.246) and had government medical insurance (OR: 2.362) had higher odds of having chronic diseases. Fairlie's decomposition analysis indicated that 23.57% of the differences in chronic diseases conditions could be traced to duration of sleep, drinking alcohol, social activity, and region. Conclusion This study illustrated that the proportion of chronic diseases was higher among urban older adults than rural older adults. Considering duration of sleep, drinking alcohol, region, social activity, and region, the study demonstrated health differences between urban and rural older adults and provided evidence for policy-making to narrow the health gap between urban and rural areas.
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Affiliation(s)
- Jian Zhang
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Yuan Zhang
- School of Law and Public Administration, China Three Gorges University, Yichang, China
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14
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Ndwandwe D, Ndlovu M, Mayeye A, Luphondo N, Muvhulawa N, Ntamo Y, Dludla PV, Wiysonge CS. Trends in Vaccine Completeness in Children Aged 0-23 Months in Cape Town, South Africa. Vaccines (Basel) 2023; 11:1782. [PMID: 38140186 PMCID: PMC10747087 DOI: 10.3390/vaccines11121782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services. METHODS Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey. RESULTS AND DISCUSSION The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence. CONCLUSIONS The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Musawenkosi Ndlovu
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Asanda Mayeye
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Nomahlubi Luphondo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Ndivhuwo Muvhulawa
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
| | - Yonela Ntamo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Phiwayinkosi V. Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, Empangeni 3886, South Africa
| | - Charles S. Wiysonge
- Vaccine Preventable Diseases Programme, Universal Health Coverage/Communicable and Non-Communicable Diseases Cluster, World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo;
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15
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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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Manyi-Loh CE, Lues R. A South African Perspective on the Microbiological and Chemical Quality of Meat: Plausible Public Health Implications. Microorganisms 2023; 11:2484. [PMID: 37894142 PMCID: PMC10608972 DOI: 10.3390/microorganisms11102484] [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: 06/30/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Meat comprises proteins, fats, vitamins, and trace elements, essential nutrients for the growth and development of the body. The increased demand for meat necessitates the use of antibiotics in intensive farming to sustain and raise productivity. However, the high water activity, the neutral pH, and the high protein content of meat create a favourable milieu for the growth and the persistence of bacteria. Meat serves as a portal for the spread of foodborne diseases. This occurs because of contamination. This review presents information on animal farming in South Africa, the microbial and chemical contamination of meat, and the consequential effects on public health. In South Africa, the sales of meat can be operated both formally and informally. Meat becomes exposed to contamination with different categories of microbes, originating from varying sources during preparation, processing, packaging, storage, and serving to consumers. Apparently, meat harbours diverse pathogenic microorganisms and antibiotic residues alongside the occurrence of drug resistance in zoonotic pathogens, due to the improper use of antibiotics during farming. Different findings obtained across the country showed variations in prevalence of bacteria and multidrug-resistant bacteria studied, which could be explained by the differences in the manufacturer practices, handling processes from producers to consumers, and the success of the hygienic measures employed during production. Furthermore, variation in the socioeconomic and political factors and differences in bacterial strains, geographical area, time, climatic factors, etc. could be responsible for the discrepancy in the level of antibiotic resistance between the provinces. Bacteria identified in meat including Escherichia coli, Listeria monocytogenes, Staphylococcus aureus, Campylobacter spp., Salmonella spp., etc. are incriminated as pathogenic agents causing serious infections in human and their drug-resistant counterparts can cause prolonged infection plus long hospital stays, increased mortality and morbidity as well as huge socioeconomic burden and even death. Therefore, uncooked meat or improperly cooked meat consumed by the population serves as a risk to human health.
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Affiliation(s)
- Christy E. Manyi-Loh
- Centre of Applied Food Sustainability and Biotechnology, Central University of Technology, Bloemfontein 9301, South Africa;
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Mthombeni TC, Burger JR, Lubbe MS, Julyan M. Antibiotic prescribing to inpatients in Limpopo, South Africa: a multicentre point-prevalence survey. Antimicrob Resist Infect Control 2023; 12:103. [PMID: 37717012 PMCID: PMC10505321 DOI: 10.1186/s13756-023-01306-z] [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: 06/03/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Electronic continuous surveillance databases are ideal for monitoring antibiotic use (ABU) in hospitalised patients for antibiotic stewardship programmes (ASP). However, such databases are scarce in low-resource settings. Point prevalence surveys (PPS) are viable alternatives. This report describes ABU and identifies ASP implementation improvement areas in Limpopo Province, South Africa. METHODS This cross-sectional descriptive study extracted patient-level ABU data from patients' files using a modified global PPS tool. Data were collected between September and November 2021 at five regional hospitals in Limpopo Province, South Africa. All patients in the wards before 8 a.m. on study days with an antibiotic prescription were included. Antibiotic use was stratified by Anatomic Therapeutic Chemical and Access, Watch, Reserve classifications and presented as frequencies and proportions with 95% confidence intervals (CI). Associations between categorical variables were assessed using the chi-square test. Cramér's V was used to assess the strength of these associations. RESULTS Of 804 inpatients surveyed, 261 (32.5%) (95% CI 29.2-35.7) were prescribed 416 antibiotics, 137 were female (52.5%) and 198 adults (75.9%). One hundred and twenty-two (46.7%) patients received one antibiotic, 47.5% (124/261) received two, and 5.7% (15/261) received three or more antibiotics. The intensive care units had a higher ABU (68.6%, 35/51) compared to medical (31.3%, 120/384) and surgical (28.5%, 105/369) wards (p = 0.005, Cramér's V = 0.2). Lower respiratory tract infection (27.4%, 104/379), skin and soft tissue infections (SST) (23.5%, 89/379), and obstetrics and gynaecology prophylaxis (14.0%, 53/379) were the common diagnoses for antibiotic prescriptions. The three most prescribed antibiotic classes were imidazoles (21.9%, 91/416), third-generation cephalosporins (20.7%, 86/416) and combination penicillin (18.5%, 79/416). Access antibiotics accounted for 70.2% (292/416) of prescriptions and Watch antibiotics for 29.6% (123/416) (p = 0.110, Cramér's V = 0.1). Reasons for prescribing and treatment plans were documented in 64.9% (270/416) (95% CI 60.3-69.5) and 21.4% (89/416) (95% CI 17.3-25.3) of prescriptions, respectively. CONCLUSIONS The study serves as a baseline for ABU surveillance at the five regional hospitals in Limpopo Province. Lack of documentation indicates poor prescribing practices; ASP should address gaps by deploying evidence-based, multifaceted and stepwise interventions.
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Affiliation(s)
- Tiyani Comfort Mthombeni
- Medicine Usage in South Africa (MUSA), North-West University Potchefstroom Campus, Potchefstroom, South Africa
| | - Johanita Riétte Burger
- Medicine Usage in South Africa (MUSA), North-West University Potchefstroom Campus, Potchefstroom, South Africa.
| | - Martha Susanna Lubbe
- Medicine Usage in South Africa (MUSA), North-West University Potchefstroom Campus, Potchefstroom, South Africa
| | - Marlene Julyan
- Medicine Usage in South Africa (MUSA), North-West University Potchefstroom Campus, Potchefstroom, South Africa
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Ross JM, Greene C, Bayer CJ, Dowdy DW, van Heerden A, Heitner J, Rao DW, Roberts DA, Shapiro AE, Zabinsky ZB, Barnabas RV. Preventing tuberculosis with community-based care in an HIV-endemic setting: a modeling analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.21.23294380. [PMID: 37662260 PMCID: PMC10473784 DOI: 10.1101/2023.08.21.23294380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Introduction Antiretroviral therapy (ART) and TB preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase uptake of ART and TPT to prevent TB in settings with a high burden of HIV-associated TB, particularly among men. Methods We developed a gender-stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15-59 in KwaZulu-Natal, South Africa. We drew model parameters from a community-based ART initiation and resupply trial in sub-Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community-based ART and TPT care programs during 2018-2027, assuming that community-based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e., ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for ten years. We projected the number of TB cases, deaths, and disability-adjusted life years (DALYs) averted relative to standard, clinic-based care. We calculated program costs and incremental cost-effectiveness ratios from the provider perspective. Results If community-based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3% - 34.1%) and TB mortality by 36.0% (range 26.9% - 43.8%) after ten years. Increasing both ART and TPT uptake through community-based ART with TPT care could reduce TB incidence by 29.7% (range 23.9% - 36.0%) and TB mortality by 36.0% (range 26.9% - 43.8%). Community-based ART with TPT care reduced gender disparities in TB mortality rates by reducing TB mortality among men by a projected 39.8% (range 32.2% - 46.3%) and by 30.9% (range 25.3% - 36.5%) among women. Over ten years, the mean cost per DALY averted by community-based ART with TPT care was $846 USD (range $709 - $1,012). Conclusions By substantially increasing coverage of ART and TPT, community-based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV-associated TB and reduce TB gender disparities.
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Affiliation(s)
- Jennifer M. Ross
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA
| | - Chelsea Greene
- Department of Industrial and Systems Engineering, University of Washington, Seattle, USA
| | - Cara J. Bayer
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Jesse Heitner
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA
| | | | - D. Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Adrienne E. Shapiro
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Zelda B. Zabinsky
- Department of Industrial and Systems Engineering, University of Washington, Seattle, USA
| | - Ruanne V. Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
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Qiu P, He H, Zhao Y, Yang Z, Li S, Ni P, Guo Y, Ji C, Zhang C, Zhang H, Zhou C, Wang B. Global disease burden attributed to unsafe sex in 204 countries and territories from 1990 to 2019: results from the Global Burden of Disease Study 2019. Sci Rep 2023; 13:12900. [PMID: 37558737 PMCID: PMC10412620 DOI: 10.1038/s41598-023-40001-2] [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: 04/06/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
Unsafe sex has become a public safety problem that endangers society, and research on deaths and disability-adjusted life years (DALYs) related to unsafe sex is valuable for global policy-making. We aimed to estimate the deaths and DALYs attributable to unsafe sex by country, gender, age group, and sociodemographic status from 1990 to 2019. We extracted data on disease burden from the Global Disease Burden 2019 (GBD 2019) database for unsafe sex, including deaths, DALYs and age-standardized rates (ASRs). Comparative analyses were performed on data about deaths, DALYs and the responding ASRs attributable to unsafe sex in different countries and regions using the Social Demographic Index (SDI). The global age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) attributable to unsafe sex were 11.98 (95% uncertainty intervals (UI): 10.97-13.52) per 100,000 people and 570.78 (95% UI: 510.24-658.10) per 100,000 people, respectively. Both the ASMRs and ASDRs were the highest in southern sub-Saharan Africa and lowest in Australasia and decreased with increasing SDI levels. About unsafe-sex-related disease, HIV/AIDS has the highest ASMR [8.48 (95% UI: 7.62-9.95)/100,000 people] and ASDR [447.44 (95% UI: 394.82-533.10)/100,000 people], followed by Cervical cancer [ASMR: 3.40 (95% UI: 2.90-3.81)/100,000 people and ASDR: 107.2 (95% UI: 90.52-119.43)/100,000 people] and sexually transmitted infections excluding HIV [ASMR: 0.10 (95% UI: 0.08-0.11)/100,000 people and ASDR: 16.14 (95% UI: 10.51-25.83)/100,000 people]. The death and DALY burden caused by these three diseases were more serious in the over 75 years old age group. The 40-44 age group for men and the 35-39 age group for women had the highest population of unsafe sex-related deaths and DALYs, respectively. In addition, the burden of unsafe sex in women was more serious than those in men. Unsafe sex is an important risk factor for global disease burden and a leading cause of substantial health loss. We found that the risk of ASMRs and ASDRs attributable to unsafe sex had negative correlation with SDI levels. These results demonstrate that the need for revised policies that focus on efforts to reduce overall unsafe sex worldwide.
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Affiliation(s)
- Pei Qiu
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuting Zhao
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zejian Yang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shouyu Li
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Peng Ni
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yujie Guo
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chao Ji
- School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chenchen Zhang
- Department of Clinical Laboratory, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Huimin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China
| | - Can Zhou
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China.
| | - Bo Wang
- Center for Translational Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Western Rd., Xi'an, 710061, Shaan'xi, China.
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an, China.
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Zharima C, Griffiths F, Goudge J. Exploring the barriers and facilitators to implementing electronic health records in a middle-income country: a qualitative study from South Africa. Front Digit Health 2023; 5:1207602. [PMID: 37600481 PMCID: PMC10437058 DOI: 10.3389/fdgth.2023.1207602] [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: 04/17/2023] [Accepted: 07/06/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction As more countries are moving towards universal health care, middle-income countries in particular are trying to expand coverage, often using public funds. Electronic health records (EHR) are useful in monitoring patient outcomes, the performance of providers, and so the use of those public funds. With the multiple institutions or departments responsible for providing care to any individual, rather than a single record, an EHR is the interface through which to view data from a digital health information eco-system that draws on data from many different sources. South Africa plans to establish a National Health Insurance fund where EHRs will be essential for monitoring outcomes, and informing purchasing decisions. Despite various relevant policies and South Africa's relative wealth and digital capability, progress has been slow. In this paper, we explore the barriers and facilitators to implementing electronic health records in South Africa. Methods In this qualitative study, we conducted in-depth interviews with participants including academics, staff at parastatals, managers in the private health sector, NGO managers and government staff at various levels. Results The Western Cape provincial government over a 20-year period has managed to develop a digital health information ecosystem by drawing together existing data systems and building new systems. However, despite having the necessary policies in place and a number of stand-alone population level digital health information systems, several barriers still stand in the way of building national electronic health records and an efficient digital health ecosystem. These include a lack of national leadership and conflict, a failure to understand the scope of the task required to achieve scale up, insufficient numbers of technically skilled staff, failure to use the tender system to generate positive outcomes, and insufficient investment towards infrastructural needs such as hardware, software and connectivity. Conclusion For South Africa to have an effective electronic health record, it is important to start by overcoming the barriers to interoperability, and to develop the necessary underlying digital health ecosystem. Like the Western Cape, provincial governments need to integrate and build on existing systems as their next steps forward.
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Affiliation(s)
- Campion Zharima
- Centre for Health Policy, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Frances Griffiths
- Centre for Health Policy, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Medical School, University of Warwick, Warwick, United Kingdom
| | - Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Hove J, Mabetha D, van der Merwe M, Twine R, Kahn K, Witter S, D'Ambruoso L. Participatory action research to address lack of safe water, a community-nominated health priority in rural South Africa. PLoS One 2023; 18:e0288524. [PMID: 37498863 PMCID: PMC10374036 DOI: 10.1371/journal.pone.0288524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Despite international evidence supporting community participation in health for improved health outcomes and more responsive and equitable health systems there is little practical evidence on how to do this. This work sought to understand the process involved in collective implementation of a health-related local action plan developed by multiple stakeholders. METHODS Communities, government departments and non-government stakeholders convened in three iterative phases of a participatory action research (PAR) learning cycle. Stakeholders were involved in problem identification, development, and implementation of a local action plan, reflection on action, and reiteration of the process. Participants engaged in reflective exercises, exploring how factors such as power and interest impacted success or failure. RESULTS The local action plan was partially successful, with three out of seven action items achieved. High levels of both power and interest were key factors in the achievement of action items. For the achieved items, stakeholders reported that continuous interactions with one another created a shift in both power and interest through ownership of implementation processes. Participants who possessed significant power and influence were able to leverage resources and connections to overcome obstacles and barriers to progress the plan. Lack of financial support, shifting priorities and insufficient buy-in from stakeholders hindered implementation. CONCLUSION The process offered new ways of thinking and stakeholders were supported to generate local evidence for action and learning. The process also enabled exploration of how different stakeholders with different levels of power and interest coalesce to design, plan, and act on evidence. Creation of safe spaces was achievable, meanwhile changing stakeholders' level of power and interest was possible but challenging. This study suggests that when researchers, service providers and communities are connected as legitimate participants in a learning platform with access to information and decision-making, a shift in power and interest may be feasible.
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Affiliation(s)
- Jennifer Hove
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
- Institute of Applied Health Sciences, Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom
| | - Denny Mabetha
- Cochrane South Africa, South African Medical Research Council (MRC), Cape Town, South Africa
| | | | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Scotland, United Kingdom
| | - Lucia D'Ambruoso
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
- Institute of Applied Health Sciences, Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Public Health, National Health Service (NHS) Grampian, Scotland, United Kingdom
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
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Floridia M, Galluzzo CM, Orlando S, Luhanga R, Mphwere R, Kavalo T, Andreotti M, Amici R, Ciccacci F, Marazzi MC, Giuliano M. Micronutrient and Nutritional Status of HIV-Exposed and HIV-Unexposed Malawian Infants in the First Year of Life: Assessment of Ferritin, Vitamin A, and D Status and Its Association with Growth. Nutrients 2023; 15:3282. [PMID: 37513701 PMCID: PMC10386663 DOI: 10.3390/nu15143282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Breastfed Malawian infants from Human Immunodeficiency Virus (HIV)-uninfected and HIV-infected women who received antiretroviral therapy were followed until 12 months of age, allowing us to evaluate plasma levels of ferritin, vitamin A (as retinol-binding protein, RBP), and vitamin D (25(OH)D) at six months, as well as nutritional status and growth between six and 12 months. Ferritin and RBP levels were adjusted for inflammation. The study included 88 infants, 63 of whom were part of a recent cohort (2019-2021) that included 49 HIV-exposed but uninfected (HEU) and 14 HIV-unexposed and uninfected (HUU) infants, as well as 25 infants (all HEU) from an earlier cohort (2008-2011). No differences were observed between HEU and HUU infants regarding micronutrient levels, anthropometric indexes, growth, and rates of stunting, being underweight, or wasting. HEU infants from the earlier cohort, when compared to more recent HEU infants, had significantly worse anthropometric measures at six months and inferior growth between six and twelve months. Overall, ferritin deficiency involved 68.6% of infants, while vitamin A and vitamin D deficiency involved 8% and 1.2% of infants, respectively. Micronutrient deficiencies were not associated with HIV exposure, cohort, stunting, being underweight, or wasting. At six months, stunting, being underweight, and wasting involved 25.0%, 2.7% and 2.8% of infants, respectively, with no differences related to HIV exposure. Ferritin deficiency at six months was associated with inferior subsequent growth. In this small observational study conducted in Malawian infants, no major nutritional gap was observed between HIV-exposed and HIV-unexposed infants, though the study highlighted specific nutritional deficiencies that deserve attention. High rates of stunting and ferritin deficiency were observed in the first year of life in Malawian infants, irrespective of maternal HIV status; a significant association between ferritin deficiency and worse subsequent growth was found. Vitamin A and vitamin D deficiencies were much less frequent. Based on the data observed, nutritional interventions should give priority to the correction of ferritin deficiency and chronic undernutrition.
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Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | | | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Robert Mphwere
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre P.O. Box 30355, Malawi
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Fausto Ciccacci
- UniCamillus, Department of Medicine, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy
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Manyi-Loh CE, Okoh AI, Lues R. Occurrence and Multidrug Resistance in Strains of Listeria monocytogenes Recovered from the Anaerobic Co-Digestion Sludge Contained in a Single Stage Steel Biodigester: Implications for Antimicrobial Stewardship. Microorganisms 2023; 11:microorganisms11030725. [PMID: 36985298 PMCID: PMC10056191 DOI: 10.3390/microorganisms11030725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
L. monocytogenes is a zoonotic foodborne pathogen with inherent adaptability to tolerate environmental and physiological stresses, thereby causing severe disease outbreaks. Antibiotic resistant foodborne pathogens are a challenge to the food industry. A total of 18 samples were pooled from a bio-digester co-digesting swine manure/pinewood sawdust, and evaluated for the occurrence of bacterium plus total viable counts using the spread plate method. The recovered bacterial isolates were presumptively identified by growth on selective medium and confirmed by biochemical characterisation, leading to the isolation of 43 L. monocytogenes. The isolates were characterized based on their susceptibility to antibiotics via the Kirby-Bauer disc diffusion technique against a panel of 14 antibiotics. Equally, the multiple antibiotic resistance (MAR) index was calculated, and MAR phenotypes generated. The bacterial counts were between 102 and104 cfu/mL. Complete susceptibility (100%) was demonstrated to ampicillin, gentamicin and sulfamethoxazole, which are the drugs of choice in the treatment of listeriosis. In addition, intermediate sensitivity occurred at 25.58% to cefotaxime, and the highest resistance (51.16%) was exhibited against nalidixic acid. The MAR index ranged from 0 to 0.71. Overall, 41.86% of the Listeria isolates displayed multidrug resistance, with 18 different MAR phenotypes, demonstrating CIP, E, C, TET, AUG, S, CTX, NA, AML, NI as the greatest MAR phenotype. It can be concluded that the isolates yielding MAR > 0.2 originated from the farm, where antibiotics had been in routine use. Therefore, strict monitoring of antibiotics use in the farm is crucial to mitigate further increase in antibiotic resistance amongst these bacterial isolates.
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Affiliation(s)
- Christy Echakachi Manyi-Loh
- Centre of Applied Food Sustainability and Biotechnology (CAFSaB), Central University of Technology, Bloemfontein 9301, South Africa
- Correspondence: ; Tel.: +27-738324268
| | - Anthony Ifeanyin Okoh
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice 5700, South Africa;
- Department of Environmental Health Sciences, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 26666, United Arab Emirates
| | - Ryk Lues
- Centre of Applied Food Sustainability and Biotechnology (CAFSaB), Central University of Technology, Bloemfontein 9301, South Africa
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Risk, lifestyle and non-communicable diseases of poverty. Global Health 2023; 19:13. [PMID: 36864476 PMCID: PMC9978269 DOI: 10.1186/s12992-023-00914-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/16/2023] [Indexed: 03/04/2023] Open
Abstract
Common discourse in public health and preventive medicine frames non-communicable diseases, including cardiovascular and metabolic diseases, as diseases of 'lifestyle'; the choice of terminology implies that their prevention, control and management are amenable to individual action. In drawing attention to global increases in the incidence and prevalence of non-communicable disease, however, we increasingly observe that these are non-communicable diseases of poverty. In this article, we call for the reframing of discourse to emphasize the underlying social and commercial determinants of health, including poverty and the manipulation of food markets. We demonstrate this by analysing trends in disease, which indicate that diabetes- and cardiovascular-related DALYS and deaths are increasing particularly in countries categorized as low-middle to middle levels of development. In contrast, countries with very low levels of development contribute least to diabetes and document low levels of CVDs. Although this might suggest that NCDs track increased national wealth, the metrics obscure the ways in which the populations most affected by these diseases are among the poorest in many countries, and hence, disease incidence is a marker of poverty not wealth. We also illustrate variations in five countries - Mexico, Brazil, South Africa, India and Nigeria - by gender, and argue that these differences are associated with gender norms that vary by context rather than sex-specific biological pathways.We tie these trends to shifts in food consumption from whole foods to ultra-processed foods, under colonialism and with continued globalization. Industrialization and the manipulation of global food markets influence food choice in the context of limited household income, time, and household and community resources. Other factors that constitute risk factors for NCDs are likewise constrained by low household income and the poverty of the environment for people with low income, including the capacity of individuals in sedentary occupations to engage in physical activity. These contextual factors highlight extremely limited personal power over diet and exercise. In acknowledging the importance of poverty in shaping diet and activity, we argue the merit in using the term non-communicable diseases of poverty and the acronym NCDP. In doing so, we call for greater attention and interventions to address structural determinants of NCDs.
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Govender S, Vallabhjee AL, Charles CR, Roesch D, Balton S. Bridging the Access Gap: The Telepractice Experience of Speech Therapists and Audiologists at a Public Health Care Facility in South Africa. Int J Telerehabil 2022; 14:e6517. [PMID: 38026559 PMCID: PMC10681049 DOI: 10.5195/ijt.2022.6517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
South Africa is a low to middle income country (LMIC) with a population of 60 million people. The public health sector serves more than 80% of the population. Chris Hani Baragwanath Academic Hospital is a central level public health care facility situated in Gauteng. The Speech Therapy and Audiology Department provides insight into their telepractice services through a qualitative approach. The onset of the COVID-19 pandemic resulted in therapists exploring telepractice as a sustainable model of service delivery. Therapists and patients encountered many challenges to the implementation of telepractice, however, the commitment of therapists ensured that creative solutions were developed. A comprehensive needs analysis at public health institutions is required to ensure the sustainability of telepractice. A hybrid model (telepractice and in-person consults) holds the potential to reduce the financial burden on patients and increase access to quality patient-centered care.
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Affiliation(s)
- Shelissa Govender
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Annika L. Vallabhjee
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Chenay R. Charles
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Darike Roesch
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Sadna Balton
- Department of Speech Therapy and Audiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
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Ntinga X, Musiello F, Keter AK, Barnabas R, van Heerden A. The Feasibility and Acceptability of an mHealth Conversational Agent Designed to Support HIV Self-testing in South Africa: Cross-sectional Study. J Med Internet Res 2022; 24:e39816. [PMID: 36508248 PMCID: PMC9793294 DOI: 10.2196/39816] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/28/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND HIV testing rates in sub-Saharan Africa remain below the targeted threshold, and primary care facilities struggle to provide adequate services. Innovative approaches that leverage digital technologies could improve HIV testing and access to treatment. OBJECTIVE This study aimed to examine the feasibility and acceptability of Nolwazi_bot. It is an isiZulu-speaking conversational agent designed to support HIV self-testing (HIVST) in KwaZulu-Natal, South Africa. METHODS Nolwazi_bot was designed with 4 different personalities that users could choose when selecting a counselor for their HIVST session. We recruited a convenience sample of 120 consenting adults and invited them to undertake an HIV self-test facilitated by the Nolwazi_bot. After testing, participants completed an interviewer-led posttest structured survey to assess their experience with the chatbot-supported HIVST. RESULTS Participants (N=120) ranged in age from 18 to 47 years, with half of them being men (61/120, 50.8%). Of the 120 participants, 111 (92.5%) had tested with a human counselor more than once. Of the 120 participants, 45 (37.5%) chose to be counseled by the female Nolwazi_bot personality aged between 18 and 25 years. Approximately one-fifth (21/120, 17.5%) of the participants who underwent an HIV self-test guided by the chatbot tested positive. Most participants (95/120, 79.2%) indicated that their HIV testing experience with a chatbot was much better than that with a human counselor. Many participants (93/120, 77.5%) reported that they felt as if they were talking to a real person, stating that the response tone and word choice of Nolwazi_bot reminded them of how they speak in daily conversations. CONCLUSIONS The study provides insights into the potential of digital technology interventions to support HIVST in low-income and middle-income countries. Although we wait to see the full benefits of mobile health, technological interventions including conversational agents or chatbots provide us with an excellent opportunity to improve HIVST by addressing the barriers associated with clinic-based HIV testing.
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Affiliation(s)
- Xolani Ntinga
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Franco Musiello
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Alfred Kipyegon Keter
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Ruanne Barnabas
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Charumbira MY, Berner K, Louw QA. Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15636. [PMID: 36497710 PMCID: PMC9735592 DOI: 10.3390/ijerph192315636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 05/05/2023]
Abstract
A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.
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Affiliation(s)
- Maria Y. Charumbira
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, South Africa
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28
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Overview. S Afr Med J 2022; 112:556-570. [PMID: 36458357 DOI: 10.7196/samj.2022.v112i8b.16648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND South Africa (SA) faces multiple health challenges. Quantifying the contribution of modifiable risk factors can be used to identify and prioritise areas of concern for population health and opportunities for health promotion and disease prevention interventions. OBJECTIVE To estimate the attributable burden of 18 modifiable risk factors for 2000, 2006 and 2012. METHODS Comparative risk assessment (CRA), a standardised and systematic approach, was used to estimate the attributable burden of 18 risk factors. Risk exposure estimates were sourced from local data, and meta-regressions were used to model the parameters, depending on the availability of data. Risk-outcome pairs meeting the criteria for convincing or probable evidence were assessed using relative risks against a theoretical minimum risk exposure level to calculate either a potential impact fraction or population attributable fraction (PAF). Relative risks were sourced from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study as well as published cohort and intervention studies. Attributable burden was calculated for each risk factor for 2000, 2006 and 2012 by applying the PAF to estimates of deaths and years of life lost from the Second South African National Burden of Disease Study (SANBD2). Uncertainty analyses were performed using Monte Carlo simulation, and age-standardised rates were calculated using the World Health Organization standard population. RESULTS Unsafe sex was the leading risk factor across all years, accounting for one in four DALYs (26.6%) of the estimated 20.6 million DALYs in 2012. The top five leading risk factors for males and females remained the same between 2000 and 2012. For males, the leading risks were (in order of descending rank): unsafe sex; alcohol consumption; interpersonal violence; tobacco smoking; and high systolic blood pressure; while for females the leading risks were unsafe sex; interpersonal violence; high systolic blood pressure; high body mass index; and high fasting plasma glucose. Since 2000, the attributable age-standardised death rates decreased for most risk factors. The largest decrease was for household air pollution (-41.8%). However, there was a notable increase in the age-standardised death rate for high fasting plasma glucose (44.1%), followed by ambient air pollution (7%). CONCLUSION This study reflects the continued dominance of unsafe sex and interpersonal violence during the study period, as well as the combined effects of poverty and underdevelopment with the emergence of cardiometabolic-related risk factors and ambient air pollution as key modifiable risk factors in SA. Despite reductions in the attributable burden of many risk factors, the study reveals significant scope for health promotion and disease prevention initiatives and provides an important tool for policy makers to influence policy and programme interventions in the country.
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Jardim CGR, Zamani R, Akrami M. Evaluating the Impact of the COVID-19 Pandemic on Accessing HIV Services in South Africa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911899. [PMID: 36231201 PMCID: PMC9565529 DOI: 10.3390/ijerph191911899] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 05/21/2023]
Abstract
Progress has been made towards controlling the Human Immunodeficiency Virus (HIV) epidemic in South Africa. However, the emergence of coronavirus disease 2019 (COVID-19) has disrupted access to health care. This systematic review aims to evaluate the impact of the pandemic on accessing HIV services at a primary health care (PHC) level in South Africa. HIV services that have been significantly impacted are highlighted, and recommendations for future public health emergencies are made. Three databases were searched in January 2022. The studies included were those that reported on HIV services at a PHC level in South Africa. From the searches, 203 papers were identified, of which 34 full texts were screened. Eleven studies met the inclusion criteria and were included in this review. Overall, decreases in HIV testing, positive HIV tests, and initiation of antiretroviral therapy (ART) were reported. Resilience of ART provision was reported, meaning that adherence to treatment was sustained throughout the pandemic. The findings showed that HIV services at private PHC facilities were unaffected, however, an overall decrease in HIV services at public PHC facilities was reported, excluding antenatal care which showed resilience.
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Affiliation(s)
| | - Reza Zamani
- Medical School, College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK
- Correspondence: (R.Z.); (M.A.)
| | - Mohammad Akrami
- Department of Engineering, University of Exeter, Exeter EX4 4QF, UK
- Correspondence: (R.Z.); (M.A.)
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Clarsen B, Nylenna M, Klitkou ST, Vollset SE, Baravelli CM, Bølling AK, Aasvang GM, Sulo G, Naghavi M, Pasovic M, Asaduzzaman M, Bjørge T, Eggen AE, Eikemo TA, Ellingsen CL, Haaland ØA, Hailu A, Hassan S, Hay SI, Juliusson PB, Kisa A, Kisa S, Månsson J, Mekonnen T, Murray CJL, Norheim OF, Ottersen T, Sagoe D, Sripada K, Winkler AS, Knudsen AKS. Changes in life expectancy and disease burden in Norway, 1990–2019: an analysis of the Global Burden of Disease Study 2019. THE LANCET PUBLIC HEALTH 2022; 7:e593-e605. [PMID: 35779543 PMCID: PMC9253891 DOI: 10.1016/s2468-2667(22)00092-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
Background Methods Findings Interpretation Funding
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