Hypertension and common mental disorders in a nationally-representative sample of South African adults

Includes bibliographical references (leaves 96-98).This thesis examines the associations between self-reported hypertension diagnosis and Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) defined a) anxiety disorders b) depressive disorders and c) comorbid anxiety-depression, both lifetime and 12-month, adjusting for potential confounding variables

Causes and implications of the 2008/2009 Antiretroviral moratorium in the Free State province of South Africa

In November 2008, a moratorium on initiating new patients onto antiretrovirals was enacted by the provincial Department of Health in the Free State. This paper examines the causes and implications of the Free State antiretroviral moratorium in the context of South Africa's provincial expansion of antiretroviral coverage. It argues that financial mismanagement, bureaucratic malfunctioning and a lack of monitoring and evaluation were the root causes of the moratorium. The more immediate causes are also discussed, primarily the change in financial delegations in November 2008, in which Provincial Treasury abruptly prevented health officials from further overspending. As the first official cessation of a provincial antiretroviral programme, the Free State moratorium provided a litmus test for government's reaction to a critical challenge in the provincial ART scale-up. Its therefore provides a valuable case study for the state's response to systematic and health infrastructural problems that have characterised the national roll-out since its inception

The antiretroviral moratorium in the Free State Province of South Africa: Contributing factors and implications

In November 2008, a moratorium on initiating new patients onto antiretroviral (ARV) treatment was enacted by the Provincial Department of Health in the Free State province of South Africa. The moratorium, which was part of a series of cost curtailment measures, lasted for four months. During this time, an estimated thirty additional patients in the province died from AIDS each day. The moratorium contradicted national government’s commitment to scaling-up of ARV treatment to 80% of those in need by 2011. This article uses the health systems components outlined by Harries et al. as crucial to the delivery of quality care as a conceptual framework to assess the causal elements of the antiretroviral moratorium. It examines the factors that contributed to the moratorium, including poor financial management systems, human resource and equipment shortages, weak monitoring and evaluation systems, and bureaucratic malfunctioning. This article describes South Africa’s system of fiscal federalism and its impact on health budgeting. As the first official cessation of provincial roll-out, the moratorium served as a litmus test for government’s reaction to critical challenges in the expansion of the ARV treatment programme at both national and provincial levels. It therefore provides a valuable case study for the state’s response to some of the systematic and health infrastructural problems that have characterised South Africa’s ARV roll-out since its inception

The epidemiology of major depression in South Africa: Results from the South African Stress and Health study

Background. Mental disorders are a major contributor to the burden of disease in all regions of the world. There are limited data on the epidemiology of major depressive disorder in South Africa. Methods. A nationally representative household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to establish a diagnosis of depression. The dataset analysed included 4 351 adult South Africans of all racial groups. Results. The prevalence of major depression was 9.7% for lifetime and 4.9% for the 12 months prior to the interview. The prevalence of depression was significantly higher among females than among males. The prevalence was also higher among those with a low level of education. Over 90% of all respondents with depression reported global role impairment. Conclusion. In comparison with data from other countries, South Africa has lower rates of depression than the USA but higher rates than Nigeria. The findings are broadly consistent with previous findings in South Africa. These findings are the first step in documenting a level of need for care in a context of significant under-funding of mental health services and research in South Africa

The Association between Hypertension and Depression and Anxiety Disorders: Results from a Nationally-Representative Sample of South African Adults

Objective Growing evidence suggests high levels of comorbidity between hypertension and mental illness but there are few data from low- and middle-income countries. We examined the association between hypertension and depression and anxiety in South Africa.Methods Data come from a nationally-representative survey of adults (n = 4351). The Composite International Diagnostic Interview was used to measure DSM-IV mental disorders during the previous 12-months. The relationships between self-reported hypertension and anxiety disorders, depressive disorders and comorbid anxiety-depression were assessed after adjustment for participant characteristics including experience of trauma and other chronic physical conditions.Results Overall 16.7% reported a previous medical diagnosis of hypertension, and 8.1% and 4.9% were found to have a 12-month anxiety or depressive disorder, respectively. In adjusted analyses, hypertension diagnosis was associated with 12-month anxiety disorders [Odds ratio (OR) = 1.55, 95% Confidence interval (CI) = 1.10–2.18] but not 12-month depressive disorders or 12-month comorbid anxiety-depression. Hypertension in the absence of other chronic physical conditions was not associated with any of the 12-month mental health outcomes (p-values all <0.05), while being diagnosed with both hypertension and another chronic physical condition were associated with 12-month anxiety disorders (OR = 2.25, 95% CI = 1.46–3.45), but not 12-month depressive disorders or comorbid anxiety-depression.Conclusions These are the first population-based estimates to demonstrate an association between hypertension and mental disorders in sub-Saharan Africa. Further investigation is needed into role of traumatic life events in the aetiology of hypertension as well as the temporality of the association between hypertension and mental disorders.African and African American Studie

Patterns of substance use in South Africa: results from the South African Stress and Health study

Background. There are limited data on substance use in South Africa. We describe patterns of substance use based on recent, nationally representative data. Methods. Data were derived from the 2002 - 2004 South African Stress and Health (SASH) study. A nationally representative household probability sample of 4 351 adults was interviewed using the paper and pencil version of the World Health Organization Composite International Diagnostic Interview (CIDI). Data are reported for lifetime use, socio-demographic correlates of use, and age of cohort predicting lifetime use for four classes of drugs. Results. The estimate for cumulative occurrence of alcohol use was 38.7%, of tobacco smoking 30.0%, of cannabis use 8.4%, of other drug use 2.0%, and of extra-medical psychoactive drug use 19.3%. There were statistically significant associations between male gender and alcohol, tobacco, cannabis and other drug use. Coloureds and whites were more likely than blacks to have used alcohol, tobacco and other drugs. Clear cohort variations existed in the age of initiation of drug use; these were most marked for other drugs and for extra-medical drug use. Use of all drug types was much more common in recent cohorts, with a similar cumulative incidence of tobacco, alcohol and cannabis use across age cohorts. Conclusions. Epidemiological patterns of use for alcohol, tobacco, cannabis, other drugs and extra-medical drugs provide the first nationally representative data. New findings on race and exploratory data on time trends provide a foundation for future epidemiological work on drug use patterns across birth cohorts and population subgroups in South Africa

Evaluation of a school-based physical activity intervention in Alexandra Township

Objectives. Non-communicable diseases and limited participation in school physical education have become increasing concerns in South Africa. In response to these concerns, a schoolbased physical activity intervention, Healthnutz, was implemented in three primary schools in Alexandra Township, Johannesburg. Evaluation of Healthnutz included assessing its feasibility and acceptability, and short-term changes in learners’ physical fitness, knowledge and attitudes. Methods. To assess feasibility and acceptability, a situational analysis and focus groups with teachers and programme monitors were conducted. Pre-post fitness testing (3-month interval) was conducted with learners, and a questionnaire assessed changes in learners’ knowledge, attitudes, self-efficacy, and perceived barriers to physical activity, in control and intervention schools. Results. At implementation, teachers identified the need for more physical activity in the school environment and were positive about Healthnutz. Follow-up focus group discussions suggested that it was positively impacting teachers, learners and the school in general. Scores for sit and reach (p<0.001), sit ups (p<0.02) and shuttle run (p<0.0001) improved significantly in intervention but not control schools. A significant decrease was observed in learners’ perceived external barriers to physical activity (p<0.0001) along with a positive change in learners’ self-efficacy for physical activity (p<0.05). Conclusions. Healthnutz raised awareness of the importance of physical activity in intervention schools. Findings indicate that even limited exposure to a physical activity intervention can lead to a significant improvement in aspects of learners’ fitness, knowledge, attitudes and perceptions regarding physical activity. Furthermore, training and support of teachers needs to be nonjudgemental and empowering

DSM-IV-defined common mental disorders:association with HIV testing, HIV-related fears, perceived risk and preventive behaviours among South African adults

Background. There are few reports from South Africa on how common mental disorders may be associated with HIVrelated perceptions and behaviours. Methods. Between 2002 and 2004, 4 351 South African adults were interviewed. Psychiatric diagnoses of depression, anxiety and substance abuse disorders were based on the Diagnostic and Statistical Manual, 4th edition (DSM-IV). HIVrelated fears, perceived risk and behaviour change were measured using multi-item scales. We analysed forms of behaviour change that were appropriate for risk reduction (such as changes in sexual behaviour) separately from behaviour changes that were inappropriate to prevent HIV (such as care over things touched or avoiding certain social situations). Results. The presence of any DSM-IV-defined disorder during the previous 12 months was associated with previous HIV testing, increased HIV-related fears, and high levels of perceived risk of HIV. There were no associations between depression, anxiety and substance abuse disorders and appropriate forms of behaviour change for HIV risk reduction. However, individuals with an anxiety or a depressive disorder were more likely to report inappropriate forms of behaviour change. For example, individuals with any depressive and / or anxiety disorders were 1.57 and 1.47 times more likely, respectively, to report avoiding certain social situations to prevent HIV / AIDS compared with those who did not have such disorders (p < 0.01 for both associations). Discussion. The lack of appropriate forms of behaviour change to prevent HIV transmission, despite increased levels of HIV-related fear and perceived risk, underscores the need for HIV risk reduction interventions for individuals living with common mental disorders in South Africa

Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey.

BACKGROUND: HIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world's largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic. METHODS: We conducted a cross-sectional telephonic survey (October-December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact. RESULTS: Nationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month. INTERPRETATION: There was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems

The Association between Hypertension and Depression and Anxiety Disorders: Results from a Nationally-Representative Sample of South African Adults

OBJECTIVE:Growing evidence suggests high levels of comorbidity between hypertension and mental illness but there are few data from low- and middle-income countries. We examined the association between hypertension and depression and anxiety in South Africa. METHODS:Data come from a nationally-representative survey of adults (n = 4351). The Composite International Diagnostic Interview was used to measure DSM-IV mental disorders during the previous 12-months. The relationships between self-reported hypertension and anxiety disorders, depressive disorders and comorbid anxiety-depression were assessed after adjustment for participant characteristics including experience of trauma and other chronic physical conditions. RESULTS:Overall 16.7% reported a previous medical diagnosis of hypertension, and 8.1% and 4.9% were found to have a 12-month anxiety or depressive disorder, respectively. In adjusted analyses, hypertension diagnosis was associated with 12-month anxiety disorders [Odds ratio (OR) = 1.55, 95% Confidence interval (CI) = 1.10-2.18] but not 12-month depressive disorders or 12-month comorbid anxiety-depression. Hypertension in the absence of other chronic physical conditions was not associated with any of the 12-month mental health outcomes (p-values all <0.05), while being diagnosed with both hypertension and another chronic physical condition were associated with 12-month anxiety disorders (OR = 2.25, 95% CI = 1.46-3.45), but not 12-month depressive disorders or comorbid anxiety-depression. CONCLUSIONS:These are the first population-based estimates to demonstrate an association between hypertension and mental disorders in sub-Saharan Africa. Further investigation is needed into role of traumatic life events in the aetiology of hypertension as well as the temporality of the association between hypertension and mental disorders