Efficacy, acceptability and feasibility of mhealth technology in promoting adherence to anti-diabetic therapy and glycaemic control among diabetic patients in Eastern Cape, South Africa”

Background: Diabetes mellitus is a disease of a significant public health concern and a leading cause of death and disability worldwide. In Africa, South Africa ranks second among countries with the highest burden of diabetes, and with a poor level of glycaemic control. mHealth technology is an innovative and cost-effective measure of promoting health and the use of text messaging for fostering health is evolving. In South Africa, there is hardly any study involving the use of mobile health technology, including text messaging for promoting health among diabetic patients. Purpose: The aim of this study was to determine the efficacy, feasibility and acceptability of mHealth in promoting adherence and glycaemic control among diabetic patients in resource-poor settings of the Eastern Cape Province of South Africa. Also, the study assessed the impact of text messaging on knowledge, selfmanagement behaviour, self-efficacy and health-related quality of life. Methodology: The study adopted a multi-centre, two-arm, parallel, randomised controlled trial design. Participants were randomly assigned to the intervention (n=108) and control arm (n=108). Participants’ socio-demographic information was obtained using the widely validated WHO STEPwise questionnaire, and a selfdeveloped questionnaire, including previously validated measurement scales were used to obtain information on adherence, self-management behaviour, self-efficacy and health-related quality of life. Participants in the intervention arm received daily text messages related to diabetes management and care for six months. Data were collected at baseline and six months post-intervention. Blood glucose, blood pressure and anthropometric measurements followed standard procedure. Mixed-model analysis was used to assess the impact of the SMS on random blood glucose while xi | P a g e linear and bivariate logistic regression were used to assess for effect on other clinical outcomes. Results: The mean age of the participants was 60.64 (SD± 11.58) years. The majority of the study participants had secondary level of education (95.3%) and earned 1500 to 14200 Rand per month (67.7%). For both the intervention and the control group, majority never used tobacco (98.10% vs 94.40%) or alcohol (88.00% vs 87.00%). Both arms of the study showed improvement in the primary outcome (blood glucose level), with no significant difference, the mean adjusted difference in blood glucose from baseline to six months post-intervention was 0.26 (-0.81 to 1.32), p=0.634. Also, the intervention did not have a significant effect on the secondary outcomes (knowledge, medication adherence, dietary adherence, adherence to physical activity, healthrelated quality of life, self-management behaviour and diabetes distress). Similarly, the intervention did not have any significant effect on secondary clinical outcomes such as weight (p=0.654), body mass index (p=0.439), systolic (p=0.610) and diastolic blood pressure (p=0.535). An overwhelming majority of the participants (90.74%) were pleased with the intervention and felt it was helpful. Of those who took part in the intervention, 91% completed the follow-up study after six months. Conclusion: The use of SMS is a highly acceptable and feasible adjunct to standard clinical care in the promotion of health among diabetic patients in this study setting. Although there was a little improvement, the efficacy of a unidirectional text messaging in promoting health outcomes in this study setting is still doub

Central obesity and normal-weight central obesity among adults attending healthcare facilities in Buffalo City Metropolitan Municipality, South Africa: a cross-sectional study

Background: Central obesity (CO) confers a significant threat on the cardio-metabolic health of individuals, independently of overall obesity. Disparities in the measures of fat distribution lead to misclassification of individuals who are at risk of cardio-metabolic diseases. This study sought to determine the prevalence and correlates of central obesity and normal-weight central obesity among adults attending selected healthcare facilities in Buffalo City Metropolitan Municipality (BCMM), South Africa, assess their health risk and examine the association between central obesity and cardio-metabolic diseases among adults with normal weight, measured by body mass index (BMI). Methods: A cross-sectional survey of 998 adults was carried out at the three largest outpatient clinics in BCMM. Overall and central obesity were assessed using BMI, waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHTR). The WHO STEPwise questionnaire was used for data collection. Blood pressure and blood glucose were measured. Normal-weight central obesity was defined as CO among individuals with normal weight, as assessed by BMI. Health risk levels were assessed using the National Institute for Health and Clinical Excellence (NICE) BMI-WC composite index. Bivariate and multivariate analyses were used to determine the prevalence of CO, normal-weight central obesity and the predictors of CO. Results: The mean age of participants was 42.6 (\ub1 16.5) years. The prevalence of CO was 67.0, 58.0 and 71.0% by WC, WHR and WHTR, respectively. The prevalence of normal-weight central obesity was 26.9, 36.9 and 29.5% by WC, WHR and WHTR, respectively. About 41% of the participants had a very high health risk, 13% had increased risk or high risk and 33% had no health risk. Central obesity was significantly associated with hypertension but not associated with diabetes among those with normal weight (by BMI). Female sex, age over 30 years, marriage, secondary or tertiary level of education, nonsmoking status, diabetes and hypertension significantly predicted central obesity among the study participants. Conclusion: The prevalence of central obesity among the study participants is high, irrespective of the defining criteria. One in three adults of normal weight had central obesity. Body mass index should therefore not be used alone for clinical assessment by healthcare workers in the study setting

Adult binge drinking: rate, frequency and intensity in Buffalo City Metropolitan Municipality, South Africa

This study was conducted to explore views about the execution of powers and functions of the police in the light of related challenges. This study made use of data from a total of 83 adult participants (a survey involving 73 individuals, and 10 in-depth interviews), including males and females of diverse occupational backgrounds from Bindura and Mount Darwin policing districts in Zimbabwe. A closed-ended, mostly Likert-scale-based questionnaire was used to collect data about the prevalent forms of police abuse of powers and functions, while an in-depth interview guide was provided to harvest information qualitatively. Findings reveal that police officers abuse their powers through unlawful arrests, arbitrary search and seizure, excessive use of force, unlawful methods of investigation, and ill treatment of detainees. Though not as prevalent as other forms of abuse, malicious criminal prosecution and partisan policing were also cited.K EYWOR DS: powers, abuse, function, police, Zimbabw

Beyond health care providers’recommendations: understandinginfluences on infant feeding choices ofwomen with HIV in the Eastern Cape,South Africa

Background: Despite the array of studies on infant feeding practices of HIV-infected women, gaps still exist in the understanding of the underlying reasons for their infant feeding choices. Potential for behavioural change exists, especially in the light of the 2016 updated World Health Organization guideline on HIV and infant feeding. The aim of this paper is to determine the rate of adoption of exclusive breastfeeding in this cohort, examine the determinants of infant feeding choices of HIV-infected women and assess the underlying reasons for these choices. Methods: This was a mixed methods study conducted between September 2015 and May 2016. It analyses the quantitative and qualitative data of 1662 peripartum women enrolled in the East London Prospective Cohort Study across three large maternity services in the Eastern Cape. Women with HIV reported their preferred choices of infant feeding. In addition, participants explained the underlying reasons for their choices. Descriptive and inferential statistics summarised the quantitative data, while thematic content analysis was performed on qualitative data. Results: Of the 1662 women with complete responses, 80.3% opted to exclusively breastfeed their babies. In the adjusted model, up to grade 12 education level (AOR: 1.81; 95% CI: 1.14, 2.86), rural/peri-urban residence (AOR:1.44; 95% CI: 1.05, 1.96), alcohol use (AOR: 1.65; 95% CI: 1.25, 2.18), negative or unknown HIV status at booking (AOR:1.85; 95% CI:1.27, 2.70), currently married (AOR:1.43; 95% CI:1.01, 2.02) and WHO Clinical Stage 2–4 (AOR:1.77; 95% CI: 1.15, 2.72) were significantly associated with the decision to exclusively breastfeed. Health care providers’ recommendations, perceived benefits of breastfeeding, unaffordability of formula feeding, and coercion were the underlying reasons for wanting to breastfeed; while work/school-related demands, breast-related issues, and fear of infecting the baby influenced their decision to formula feed. Conclusion: The majority of HIV-infected women chose to breastfeed their babies in the Eastern Cape. Following up on these women to ensure they breastfeed exclusively, while also addressing their possible concerns, could be an important policy intervention. Future studies should focus on how early infant feeding decisions change over time, as well as the health outcomes for mother and child. Keywords: Exclusive breastfeeding, Infant feeding practice, infant formula feeding, HIV-infected peripartum women, South Africa, WHO guidelin