Health, health care and ageing in Africa: challenges and opportunities

New health-care policies in South Africa have been targeted primarily towards women, children and the youth, and the elderly are not regarded as a priority. However, older persons are especially heavy consumers of health-care resources generally. Although the improvement of community-based care for older clients, together with improved detection and control of risk factors and chronic disease at the primary level were identified as two principal health priorities in the health reconstmction plan (African National Congress, 1994), there is scant evidence of any implementation of this policy goal. With the dismantling of former apartheid government healthcare structures in the transformation process, to effect a shift from tertiary and secondary care with their curative focus, to primary health care with a preventive focus, dedicated geriatric services have fallen by the wayside. The preventive, curative and rehabilitative needs of older clients have for the main part been integrated into general sessions at community clinics, at the primary care level. Numerous community nurses have been redeployed from geriatric services, for example, to assist with immunization programmes for children. The current geriatric health service dilemma in the country needs to be urgently addressed, and for this there is a need for information on effective service delivery models. However, would the reinstatement of equitable geriatric services for all older South Africans be no more than a pipe dream

The development of a dietary intervention to modify cation content of foods and the evaluation of its effects on blood pressure in hypertensive black South Africans

Includes bibliographical references.Black South Africans are at high risk of hypertension, stroke and blood pressure-related target-organ damage. In South Africa, the limited resources at primary health care level allocated to the prevention, early diagnosis and management of hypertension necessitate a non-pharmacological population-based approach to curb the escalating burden of cardiovascular disease, for which raised blood pressure is an important major contributory risk factor. The series of five studies included in the thesis provide a systematic approach to developing an appropriate nutritional population-based approach to lowering blood pressure in a high risk population. Firstly, valid, reliable, and updated information was obtained to identify habitual intake of sodium, potassium, magnesium and calcium in the target population, using the gold standard method of assessing sodium intake, namely 24-hour urinary excretion collections (Chapter 3). This information was necessary to inform the levels of sodium and other cation modification required in order to obtain a physioligically relevant change in blood pressure. As well as quantitative data on levels of sodium intake, the food sources that are the most important contributors to overall non-discretionary salt intake, and the pattern of intake of these foods, is described (Chapter 4). This data allowed identification of commonly consumed foods that could be targeted for modification on their cation content

Prevalence of household food poverty in South Africa: results from a large, nationally representative survey

Household food insecurity is a major determinant of undernutrition, yet there is little information on its prevalence in the South African population. This paper assesses household food insecurity in South Africa using a quantitative and objective measure, known as food poverty, and provides prevalence estimates by geographic area and socio-economic condition. Secondary data analysis combining two sources: Statistics South Africa's household-based 1995 Income and Expenditure Survey; and the University of Port Elizabeth's Household Subsistence Level series, a nationally-conducted, market-based survey. South Africa. A nationally representative sample of the entire country – stratified by race, province, and urban and non-urban areas – consisting of 28 704 households. A household is defined to be in food poverty when monthly food spending is less than the cost of a nutritionally adequate very low-cost diet. The prevalence of food poverty in South Africa in 1995 was 43%. Food poverty rates were highest among households headed by Africans, followed by coloureds, Indians and whites. Higher food poverty rates were found with decreasing income, increasing household size, and among households in rural areas or those headed by females. The widespread nature of household food insecurity in South Africa is documented here. Prevalence rates by geographic and socio-economic breakdown provide the means for targeting of nutritional interventions and for monitoring progress in this field. The corroboration of these findings with both internal validation measures and external sources suggests that food poverty is a useful, objective measure of household food insecurity

Shellharbour’s food environment

Mapping the food environment helps us understand if everyone can easily get healthy food. The healthiness of Shellharbour food environment matters because it directly impacts the dietary choices of local residents and, consequently, their overall health and well-being

Development, validation and reproducibility of a food frequency questionnaire to measure flavonoid intake in older Australian adults

Aim: To develop and assess the validity and reproducibility of a food frequency questionnaire (FFQ) to measure total flavonoid intake, and individual flavonoid subclasses, in older adults. Methods: Retrospective analysis of flavonoid intake in older adults informed the development of a FFQ to measure flavonoid intake and determine the flavonoid subclasses consumed (anthocyanins, flavan-3-ols, flavones, flavonols and flavanones). Older adults (n = 42, mean age 75.3 8.6 years) attended two interviews 1 month apart where anthropometrics (height and weight), blood pressure (BP), demographic data and a 93-item self-administered FFQ were collected. A 4-day food record (FR) was randomly administered between the two interview dates, and each food item was assigned a flavonoid and flavonoid subclass content using the United States Department of Agriculture flavonoid database. The criterion validity and reproducibility of the FFQ was assessed against a 4-day FR using the Wilcoxon signed-rank sum test, Spearman’s correlation coefficient (r), Bland-Altman Plots and Cohen’s kappa. Results: Total flavonoid intake was determined (median intake FFQ = 919.3 mg/day, FR = 781.4 mg/day). Tests of validity indicated that the FFQ consistently overestimated total flavonoid intake compared with the 4- day FR. There was a significant difference in estimates between the FFQ and the 4-day FR for total flavonoid intake (Wilcoxon signed-rank sum P 0.05; Spearman’s r 0.91, P < 0.001; Bland-Altman plots visually showed small, non-significant bias and wide limits of agreement; and Cohen’s kappa κ = 0.619, P < 0.001), with a small mean percentage difference (6.7%). For individual flavonoid subclasses, the tests of reproducibility between FFQ1 and FFQ2 showed similarly high reproducibility. Conclusions: The developed FFQ appears suitable for satisfactorily ranking individuals according to total flavonoid intake. The FFQ shows limitations for estimating absolute total flavonoid intake and intake of flavonoid subclasses in comparison to a 4-day FR in terms of overestimating intake. Refinement and further validation of this tool may be required

Validation of a food frequency questionnaire in older South Africans

The International Society for Burns Injuries (ISBI) has published guidelines for the management of multiple or mass burns casualties, and recommends that 'each country has or should have a disaster planning system that addresses its own particular needs.' The need for a national burns disaster plan integrated with national and provincial disaster planning was discussed at the South African Burns Society Congress in 2009, but there was no real involvement in the disaster planning prior to the 2010 World Cup; the country would have been poorly prepared had there been a burns disaster during the event. This article identifies some of the lessons learnt and strategies derived from major burns disasters and burns disaster planning from other regions. Members of the South African Burns Society are undertaking an audit of burns care in South Africa to investigate the feasibility of a national burns disaster plan. This audit (which is still under way) also aims to identify weaknesses of burns care in South Africa and implement improvements where necessary

To legislate or not to legislate? A comparison of the UK and South African approaches to the development and implementation of salt reduction programs

The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries

Socioeconomic disadvantage and its implications for population health planning of obesity and overweight, using cross-sectional data from general practices from a regional catchment in Australia

Objectives To identify smaller geographic and region-specific evidence to inform population health planning for overweight and obesity. Design Cross-sectional secondary analysis of data. Setting Primary healthcare-17 general practices located in the Illawarra-Shoalhaven region of New South Wales (NSW). Participants A subset (n=36 674) of the Sentinel Practices Data Sourcing project adult persons data set (n=118 794) that included information on disease status of all adult patients who had height and weight measurements recorded in their electronic health records and had visited the included general practices within the Illawarra-Shoalhaven region of NSW between September 2011 and September 2013. Main outcome measures Age-adjusted odds ratio (aOR) of overweight and obesity was determined for high and low levels of socioeconomic disadvantage based on Socio-Economic Indexes for Areas (SEIFA)-Index of Relative Socio-Economic Disadvantage (IRSD) scores of patients\u27 residential statistical local area. Results In men, overweight was lowest in areas of highest socioeconomic disadvantage (aOR=0.910; 95% CI 0.830 to 0.998; p\u3c0.001); but no statistically significant association with socioeconomic score was found for women. Overall obesity was associated with high socioeconomic disadvantage (aOR=1.292; 95% CI 1.210 to 1.379; p\u3c0.001). Conclusions This type of data analysis reveals multiple layers of evidence that should be assessed for population health approaches to curb the epidemic of obesity and overweight. It strongly highlights the need for preventive health initiatives to be specific to gender and socioeconomic attributes of the target population

\u27While we can, we will\u27: exploring food choice and dietary behaviour amongst independent older Australians

Aim Burgeoning proportions of populations aged over 65 years impose an increased financial burden upon governments for the provision of associated health and aged-care services. Strategies are therefore required to mitigate service demand through the preservation of good health and independence into old age. Nutrition has been acknowledged as a key factor for realisation of this goal. The objective of the present study was to investigate factors responsible for shaping food shopping, cooking and eating behaviours amongst healthy, independently living Australians aged 60 years and over. Methods Eighteen (5 male, 13 female) independently living residents sourced from three low-care Illawarra Retirement Trust (IRT) lifestyle residential facilities volunteered to take part in the present study. All participants were aged 60 years or more and in relatively good health. Semi-structured focus groups were implemented to explore factors influencing the selection, acquisition and preparation of food. Each session was digitally recorded, transcribed verbatim and subsequently examined using content and thematic analysis. Results Ten sub-themes were identified and grouped into three broader themes: adaptation, psychosocial parameters and food landscape. Findings reflect an active self-determination to retain independence, with a focus on the maintenance of favourable nutritional status. A sense of resourcefulness was evident through the development of strategies to overcome potential barriers to healthy eating. Conclusions Factors that influence the food choices of community-living older Australians are complex and multifactorial, and underpinned by a strong desire for independence and control over personal health outcomes. Studies involving larger, more demographically diverse participant groups are required to elicit socially acceptable strategies that will empower older Australians to sustain their health and independence for the longer term