Divergent spatial patterns in the prevalence of the human immunodeficiency virus (HIV) and syphilis in South African pregnant women

An analysis of the ecological association between the human immunodeficiency virus (HIV) and syphilis was undertaken using joint mapping modelling based on data from South African national HIV and syphilis sentinel surveillance surveys carried out between 2007 and 2009. The syphilis prevalence, taken as proxy for sexual behaviour and increased HIV transmission, was first used with health district-level deprivation and population density as a covariate in a HIV prevalence spatial regression model and, secondly, together with HIV as a bivariate outcome. HIV was more highly prevalent in deprived and populated urban areas than elsewhere, while syphilis had a high prevalence in less deprived and less populated rural areas. Spatially, the HIV prevalence was lowest in the southwestern and highest in the northeastern parts of the country. This was in discordance to the syphilis prevalence, which revealed negative correlations with the HIV prevalence. Considerable variations across the districts remained after adjusting for the contextual covariate factors. Divergent spatial patterns between HIV and syphilis were identified, regarding both observed and unobserved covariate effects. The differing disease-specific spatial prevalence patterns may point to inconsistent successes in interventions between the two diseases. Overall, the results emphasize the need to develop and test plausible aetiological hypotheses relating to ecological correlations and causes of the disease-specific interjectory between the district

Secular trends in risk behaviour of Cape Town grade 8 students

Objective. To compare prevalence rates of selected risk behaviours and age of first intercourse of grade 8 students in Cape Town between 1997 and 2004. Design. Cross-sectional surveys in 1997 and 2004. Survival analysis was used to estimate the cumulative incidence of first intercourse. The log-rank statistic was used to compare the survival distributions. When comparing data from the two studies we used a logistic regression model with the factors year, race and age group to test the difference in reported risk behaviours between 1997 and 2004 within each gender. Setting. Public high schools in Cape Town. Subjects. Multistage cluster samples of 1 437 and 6 266 grade 8 students in 1997 and 2004 respectively. Outcome measures. Ever having had sexual intercourse; for those that had, whether any method was used to prevent pregnancy or disease at last intercourse, and (if so) what was used; use of tobacco, alcohol and marijuana; violence-related behaviours; and suicidal behaviour. Results. There was a significant delay in first intercourse in 2004 compared with 1997. For males, levels of condom use were lower in 2004 than in 1997, while for females levels of injectable contraceptive use were lower. There were significant increases in past month use of cigarettes for males and marijuana for both genders. Rates of perpetration of violence behaviour remained stable or decreased from 1997 to 2004, while the rate of suicidal behaviour for males increased. Conclusions. School-based interventions that address sexual risk behaviours should be expanded to include other risk behaviours

Sexual behaviour of Cape Townhigh-school students

Objectives. To document prevalence rates for selected aspects of sexual behaviour among Cape Town high-school students and to conduct a survival analysis of age at first intercourse. Design. Cross-sectional survey. Setting. State high schools in Cape Town. Subjects. A multistage cluster sample of 2 740 grade 8 and 11 students at 39 schools. Outcome measures. Ever having had sexual intercourse; for those who had, age at first intercourse, number of partners during the previous 12 months, time since last intercourse; and, at last intercourse, whether the partner had been known for more than 7 days, whether any method was used to prevent pregnancy or disease, and (if so) what was used. Results. Overall, 29.9% had participated in sexual intercourse, with a higher proportion among males and those in grade 11. By the age of 14 years, 23.4% of males and 5.5% of females had participated in sexual intercourse. By the age of 19 years, these proportions were 71.8% and 58.2% respectively. The median time since last intercourse was 4 weeks, the median number of partners in the past year was 1, and 78.4% had known their most recent partner for more than 7 days. At their last coital episode, 65.4% had used contraception, and the most common methods were condoms and injectable steroids, which were used by 67.7% and 43.2% respectively. Conclusions. The proportion of sexually active students has increased since 1990. Intervention programmes should commence in primary school. Large numbers of students are at risk for pregnancy and sexually transmitted infections

Psychometric properties of the Self-Esteem Questionnaire for South African adolescents

This article describes two studies investigating the reliability and factorial validity of scores on the Self-Esteem Questionnaire (SEQ) for assessing self-evaluations relating to peers, school, family, sports/athletics, body image and global self-worth in South African adolescents. Participants were 900 learners enrolled in Grades 8 and 11 at public schools in Cape Town, and 116 Grades 8 and 11 learners attending independent schools. The results provided general support for the six-factor structure proposed by DuBois, Felner, Brand, Phillips and Lease (1996) and indicated that SEQ scores have good internal consistency and adequate test-retest reliability for English-speaking South Africans. However, minor revisions are needed for all scale scores to have acceptable internal consistency when translated into isiXhosa or Afrikaans

Leisure boredom and high school dropout in Cape Town, South Africa

This prospective cohort study investigated whether leisure boredom predicts high school dropout. Leisure boredom is the perception that leisure experiences do not satisfy the need for optimal arousal. Participants completed a self-report questionnaire which included the Leisure Boredom Scale. The original cohort of grade 8 students (n ¼ 303) was followed up twice at 2-yearly intervals. Of the 281 students at the second follow-up, 149 (53.0%) students had dropped out of school. The effect of leisure boredom on dropout was investigated using logistic regression taking into account the clustering effect of the schools in the sampling strategy, and adjusting for age, gender and racially classified social group. Leisure boredom was a significant predictor of dropout (OR ¼ 1.08; 95% CI: 1.01–1.15) in students 14 years and older, but not so in younger students (OR ¼ 1.0; 95% CI: 0.95–1.05). The study has shown that measuring leisure boredom in grade 8 students can help identify students who are more likely to drop out of school. Further research is needed to investigate the longitudinal association between leisure boredom and school dropout.Web of Scienc

The epidemic of obesity in South Africa: a study in a disadvantaged community.

Objective: The objective of this study was: 1) to determine the anthropometric profile of adults In Mamre, a small town In South Africa, which has a population of mixed ancestry ("colored" people of Afro-Euro-Malay-Khoisan ancestry); and 2) to determine the change In this profile between 1989 and 1996. Design: Cross-sectional surveys conducted In random samples of adults In 1989 and 1996. Participants: The subjects were 684 women and 529 men In 1989, and 546 women and 430 men In 1996, aged 15 and older. Main Outcome Measures; The following measurements were recorded: height, weight, and circumference of waist, hips, and mid-upper arm. Results: Based on data from the 1996 survey, 32% of women are obese (body mass index [BMI] ;;: 30) at ages 25-44 years, rising to 49% at ages 45-64 years. A much lower prevalence of obesity is seen in men: 14"10 at ages 35-64 years. Obesity levels significantly increased in women between the two surveys (P=.015): up from 44% in 1989 to 49% in 1996 at ages 45-64 years. There was an Increase In the prevalence of overweight (BMI 25-29.9) in men, though not in obesity. Mean 8MI increased by about 3% In women and 2% in men between 1989 and 1996. Conclusions; This study conducted among people of mixed ancestry living In a disadvantaged community In South Africa shows that half of middle-aged women are obese. A rising trend In 8MI was seen in adults of both sexes between 1989 and 1996. This trend may be explained by factors associated with rural-urban transition, Including electrification, reduced physical activity, and Increasing availability of energy-dense food

A prospective study of methamphetamine use as a predictor of high school non-attendance in Cape Town, South Africa

Publication of this article was funded by the Stellenbosch University Open Access Fund.Background: This prospective study investigated the association between life-long methamphetamine and other drug use and high school non-attendance, in a sample of high school students in Cape Town, South Africa. Methods: A random sample of 1535 high school students completed a baseline questionnaire in 2006, and were asked to complete a follow-up questionnaire 12 months later. The questionnaire included questions on substance use, including tobacco, alcohol, methamphetamine and cannabis use, demographic factors, and questions relating to school attendance and performance. Results: Forty-three percent of the students surveyed at baseline did not complete a follow-up questionnaire after 12 months. Compared with students who were not using selected substances, an adjusted logistic regression model showed that life-time methamphetamine use in addition to other substances was significantly associated with non-attendance (OR = 2.58, 95% CI: 1.24 - 5.36) when other non-substance use factors (repeating a year at school and being older than the norm for current grade) were taken into account. Conclusions: Early identification of students with methamphetamine and other substance use problems, and a supportive rather than punitive school policy, may be valuable in improving high school completion and student retention rates.Peer Reviewe

A food-based dietary strategy lowers blood pressure in a low socio-economic setting: a randomised study in South Africa

OBJECTIVE: To assess the impact of a food-based intervention on blood pressure (BP) in free-living South African men and women aged 50-75 years, with drug-treated mild-to-moderate hypertension. METHODS: A double-blind controlled trial was undertaken in eighty drug-treated mild-to-moderate hypertensive subjects randomised to an intervention (n 40) or control (n 40) arm. The intervention was 8-week provision of six food items with a modified cation content (salt replacement (SOLO ), bread, margarine, stock cubes, soup mix and a flavour enhancer) and 500 ml of maas (fermented milk)/d. The control diet provided the same quantities of the targeted foods but of standard commercial composition and 500 ml/d of artificially sweetened cooldrink. FINDINGS: The intervention effect estimated as the contrast of the within-diet group changes in BP from baseline to post-intervention was a significant reduction of 6.2 mmHg (95 % CI 0.9, 11.4) for systolic BP. The largest intervention effect in 24 h BP was for wake systolic BP with a reduction of 5.1 mmHg (95 % CI 0.4, 9.9). For wake diastolic BP the reduction was 2.7 mmHg (95 % CI -0.2, 5.6). CONCLUSIONS: Modification of the cation content of a limited number of commonly consumed foods lowers BP by a clinically significant magnitude in treated South African hypertensive patients of low socio-economic status. The magnitude of BP reduction provides motivation for a public health strategy that could be adopted through lobbying of the food industry by consumer and health agencies

An approach for evaluating early and long term mother-to-child transmission of HIV (MTCT) in low and middle income countries: a South African experience

Abstract Background Eliminating mother-to-child transmission of HIV is a global public health target. Robust, feasible methodologies to measure population level impact of programmes to prevent mother-to-child transmission of HIV (PMTCT) are needed in high HIV prevalence settings. We present a summary of the protocol of the South African PMTCT Evaluation (SAPMTCTE) with its revision over three repeated rounds of the survey, 2010–2014. Methods Three cross sectional surveys (2010, 2011–2012 and 2012–2013) were conducted in 580 primary health care immunisation service points randomly selected after stratified multistage probability proportional to size sampling. All infants aged 4–8 weeks receiving their six-week immunisation at a sampled facility on the day of the visit were eligible to participate. Trained research nurses conducted interviews and took infant dried blood spot (iDBS) samples for HIV enzyme immunoassay (EIA) and total nucleic acid polymerase chain reaction (PCR) testing. Interviews were conducted using mobile phones and iDBS were sent to the National Health Laboratory for testing. All findings were adjusted for study design, non-response, and weighted for number of South African live-birth in each study round. In 2012 a national closed cohort of these 4 to 8-week old infants testing EIA positive (HIV Exposed Infants) from the 2012–2013 cross-sectional survey was established to estimate longer-term PMTCT impact to 18 months. Follow-up analyses were to estimate weighted cumulative MTCT until 18 months, postnatal MTCT from 6 weeks until 18 months and a combined outcome of MTCT-or-death, using a competing risks model, with death as a competing risk. HIV-free survival was defined as a child surviving and HIV-negative up to 18 months or last visit seen. A weighted cumulative incidence analysis was conducted, adjusting for survey design effects. Discussion In the absence of robust high-quality routine medical recording systems, in the context of a generalised HIV epidemic, national surveys can be used to monitor PMTCT effectiveness; however, monitoring long-term outcomes nationally is difficult due to poor retention in care