The burden of cardiovascular disease in Sub-Saharan Africa

The burden of cardiovascular disease (CVD) in Africa is growing and changing in nature. From the predominance of rheumatic heart disease and cardiomyopathies 50 years ago to hypertensive heart disease and haemorrhagic stroke in the past 25 years. Albeit at low prevalence, an increase in incidence of ischaemic heart disease is now being seen, particularly in urban areas. These changes in the extent and nature of CVD are thought to be the result of the so-called “epidemiological transition”. The challenge for health promotion and prevention is to accelerate the course of that transition and blunt its magnitude in order to avoid the massive epidemics of CVD that were seen in Europe and the USA in the mid-twentieth century

South Africa's Experience of the Closure of the Cellulose Sulphate Microbicide Trial

The researchers who conducted the cellulose sulphate microbicide trial share the lessons they learned from the trial's early closure

A decade of tobacco control: The South African case of politics, health policy, health promotion and behaviour change

BACKGROUND: The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown. OBJECTIVE: To describe the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners. METHODS: Four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) were conducted in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. We assessed the prevalence of current smoking (having smoked a cigarette on ≥1 day in the 30 days preceding the survey) and smoking-related attitudes and behaviours. RESULTS: Over the 12-year survey period current smoking among learners declined from 23.0% (1999) to 16.9% (2011) - a 26.5% reduction. Reductions in smoking prevalence were less pronounced amongst girls and amongst black learners. We observed an increase in smoking prevalence amongst learners between 2008 and 2011. Smoking-related attitudes and behaviours showed favourable changes over the survey period. CONCLUSION: These surveys demonstrate that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth

Defining Research to Improve Health Systems

Robert Terry and colleagues present working definitions of operational research, implementation research, and health systems research within the context of research to strengthen health systems

Welcome address: Rheumatic heart disease is a neglected disease of poverty requiring a multisectoral approach for control and eradication

No Abstract. South African Medical Journal Vol. 96(3) 2006: 231-23

The Implications of the Developmental Origins of Health and Disease on Public Health Policy and Health Promotion in South Africa

The developmental origins of health and disease (DOHaD) hypothesis states that environmental influences in utero and in early life can determine health and disease in later life through the programming of genes and/or altered gene expression. The DOHaD is likely to have had an effect in South Africa during the fifty years of apartheid; and during the twenty years since the dawn of democracy in 1994. This has profound implications for public health and health promotion policies in South Africa, a country experiencing increased prevalence of noncommunicable diseases (NCDs) and risk factors and behaviours for NCDs due to rapid social and economic transition, and because of the DOHaD. Public health policy and health promotion interventions, such as those introduced by the South African Government over the past 20 years, were designed to improve the health of pregnant women (and their unborn children). They could in addition, through the DOHaD mechanism, reduce NCDs and their risk factors in their offspring in later life. The quality of public health data over the past 40 years in South Africa precludes the possibility of proving the DOHaD hypothesis in that context. Nevertheless, public health and health promotion policies need to be strengthened, if South Africa and other low and middle income countries (LMICs) are to avoid the very high prevalence of NCDs seen in Europe and North America in the 50 years following the Second World War, as a result of socio economic transition and the DOHaD