An analysis of overweight and obesity in South Africa: the case of women of childbearing age

This thesis used nationally representative data from the 2008 - 2017 National Income Dynamics Study, 1998 and 2016 South African Demographic and Health Surveys and 2005/06 and 2010/11 Income and Expenditure Surveys to examine prevalence, socioeconomic inequality, and determinants of overweight and obesity among non-pregnant women of childbearing age (15 to 49 years) (WCBA) in South Africa over time. It also assessed socioeconomic inequality in the intergenerational transmission of overweight and obesity from mothers to their offsprings among 10,735 mother-offspring pairs and decomposed socioeconomic inequality in household ultra-processed food (UPF) product spending in samples of 16,209 households in 2005/06 and 17,217 households in 2010/11. Overweight and obesity in WCBA in South Africa increased between 1998 and 2017 with factors including increased age, self-identifying with the Black African population group, higher educational attainment, residing in an urban area, and wealth contributing to the rise. Smoking had a protective effect on being overweight and obese. Overweight and obesity were also increasingly prevalent among wealthier than poorer WCBA in South Africa between 1998 and 2016. It was found that UPF expenditure increased between 2005/6 and 2010/11, accounting for a substantial share of poorer households' expenditures than their wealthier counterparts over time. Although factors explaining socioeconomic inequality in the intergenerational transmission of overweight and obesity differed by offspring sex, intergenerational overweight and obesity occur more frequently among wealthier mother-offspring pairs than their poorer counterparts. Key factors explaining inequalities in intergenerational overweight and obesity include the mother's socioeconomic status, education and exercise habits. This study improves the empirical understanding of the burgeoning overweight and obesity challenges among women, especially in South Africa, who are likely to transmit them to their offspring. Policy to address these issues should not only be about health services but also focus on the social determinants of health inequalities

The impact of mass media interventions on tuberculosis awareness, health-seeking behaviour and health service utilisation : a systematic review protocol

Introduction: Tuberculosis (TB) is a serious public health problem in many parts of the world. Strategies to curb the spread of TB must match the multifaceted nature of the epidemic. The use of mass media is one of the important strategies in communicating behavioural change in relation to TB prevention and the treatment. However, the benefits of this intervention are unclear. We, therefore, plan to conduct a systematic review on the effects of mass media interventions on TB awareness, health-seeking behaviour and health service utilisation. Methods and analysis: We will preferably include randomised controlled trials (RCTs) in this systematic review. However, non-randomised studies will be included if there is an inadequate number of RCTs. We will perform electronic searches in PubMed, Scopus and other databases, along with manual searches. Articles written (or translated) in English and French and published between 1 January 1980 and 31 October 2013 will be eligible for inclusion in this review. The primary outcomes will be TB knowledge, attitudes and awareness, healthcare-seeking behaviour and service utilisation. The secondary outcomes will include stigma and discrimination against people with TB and the costs of the interventions. We will investigate clinical and statistical heterogeneity and pool studies judged to be clinically and statistically homogeneous. Relative risks will be calculated for dichotomous outcomes and mean differences for continuous outcomes, both with their corresponding 95% CIs. Ethics and dissemination: The systematic review will use data that is not linked to individuals. The review findings may have implications for clinical practice and future research, and will be disseminated electronically and in print through peer-reviewed publications

The impact of HIV status and antiretroviral treatment on TB treatment outcomes of new tuberculosis patients attending co-located TB and ART services in South Africa: a retrospective cohort study

BackgroundThe implementation of collaborative TB-HIV services is challenging. We, therefore, assessed TB treatment outcomes in relation to HIV infection and antiretroviral therapy (ART) among TB patients attending a primary care service with co-located ART and TB clinics in Cape Town, South Africa.MethodsIn this retrospective cohort study, all new TB patients aged ≥ 15years who registered and initiated TB treatment between 1 October 2009 and 30 June 2011 were identified from an electronic database. The effects of HIV-infection and ART on TB treatment outcomes were analysed using a multinomial logistic regression model, in which treatment success was the reference outcome.ResultsThe 797 new TB patients included in the analysis were categorized as follows: HIV- negative, in 325 patients (40.8%); HIV-positive on ART, in 339 patients (42.5%) and HIV-positive not on ART, in 133 patients (16.7%). Overall, bivariate analyses showed no significant difference in death and default rates between HIV-positive TB patients on ART and HIV-negative patients. Statistically significant higher mortality rates were found among HIV-positive patients not on ART compared to HIV-negative patients (unadjusted odds ratio (OR) 3.25; 95% confidence interval (CI) 1.53–6.91). When multivariate analyses were conducted, the only significant difference between the patient categories on TB treatment outcomes was that HIV-positive TB patients not on ART had significantly higher mortality rates than HIV-negative patients (adjusted OR 4.12; 95% CI 1.76–9.66). Among HIV-positive TB patients (n = 472), 28.2% deemed eligible did not initiate ART in spite of the co-location of TB and ART services. When multivariate analyses were restricted to HIV-positive patients in the cohort, we found that being HIV-positive not on ART was associated with higher mortality (adjusted OR 7.12; 95% CI 2.95–18.47) and higher default rates (adjusted OR 2.27; 95% CI 1.15–4.47).ConclusionsThere was no significant difference in death and default rates between HIV-positive TB patients on ART and HIV negative TB patients. Despite the co-location of services 28.2% of 472 HIV-positive TB patients deemed eligible did not initiate ART. These patients had a significantly higher death and default rates

HIV-infected adolescents in southern Africa can achieve good treatment outcomes: results from a retrospective cohort study.

OBJECTIVES: In this study we examine whether adolescents treated for HIV/AIDS in southern Africa can achieve similar treatment outcomes to adults. DESIGN: We have used a retrospective cohort study design to compare outcomes for adolescents and adults commencing antiretroviral therapy (ART) between 2004 and 2010 in a public sector hospital clinic in Bulawayo, Zimbabwe. METHODS: Cox proportional hazards modelling was used to investigate risk factors for death and loss to follow-up (LTFU) (defined as missing a scheduled appointment by ≥3months). RESULTS: One thousand, seven hundred and seventy-six adolescents commenced ART, 94% having had no previous history of ART. The median age at ART initiation was 13.3 years. HIV diagnosis in 97% of adolescents occurred after presentation with clinical disease and a higher proportion had advanced HIV disease at presentation compared with adults [WHO Stage 3/4 disease (79.3 versus 65.2%, P < 0.001)]. Despite this, adolescents had no worse mortality than adults, assuming 50% mortality among those LTFU (6.4 versus 7.3 per 100 person-years, P = 0.75) with rates of loss to follow-up significantly lower than in adults (4.8 versus 9.2 per 100 person-years, P < 0.001). Among those who were followed for 5 years or more, 5.8% of adolescents switched to a second-line regimen as a result of treatment failure, compared with 2.1% of adults (P < 0.001). CONCLUSION: With adolescent-focused services, it is feasible to achieve good outcomes for adolescents in large-scale ART programs in sub-Saharan Africa. However, adolescents are at high risk of treatment failure, which compromises future drug options. Interventions to address poor adherence in adolescence should be prioritized

Overweight and obesity in non-pregnant women of childbearing age in South Africa: subgroup regression analyses of survey data from 1998 to 2017

Background Overweight and obesity in adults are increasing globally and in South Africa (SA), contributing substantially to deaths and disability from non-communicable diseases. Compared to men, women suffer a disproportionate burden of obesity, which adversely affects their health and that of their offspring. This study assessed the changing patterns in prevalence and determinants of overweight and obesity among non-pregnant women in SA aged 15 to 49 years (women of childbearing age (WCBA)) between 1998 and 2017. Methods This paper conducts secondary data analysis of seven consecutive nationally representative household surveys—the 1998 and 2016 SA Demographic and Health Surveys, 2008, 2010–2011, 2012, 2014–2015 and 2017 waves of the National Income Dynamics Survey, containing anthropometric and sociodemographic data. The changing patterns of the overweight and obesity prevalence were assessed across key variables. The inferential assessment was based on a standard t-test for the prevalence. Adjusted odds ratios from logistic regression analysis were used to examine the factors associated with overweight and obesity at each time point. Results Overweight and obesity prevalence among WCBA in SA increased from 51.3 to 60.0% and 24.7 to 35.2%, respectively, between 1998 and 2017. The urban-rural disparities in overweight and obesity decreased steadily between 1998 and 2017. The prevalence of overweight and obesity among WCBA varied by age, population group, location, current smoking status and socioeconomic status of women. For most women, the prevalence of overweight and/or obesity in 2017 was significantly higher than in 1998. Significant factors associated with being overweight and obese included increased age, self-identifying with the Black African population group, higher educational attainment, urban area residence, and wealthier socioeconomic quintiles. Smoking was inversely related to being overweight and obese. Conclusions The increasing trend in overweight and obesity in WCBA in SA demands urgent public health attention. Increased public awareness is needed about obesity and its health consequences for this vulnerable population. Efforts are needed across different sectors to prevent excessive weight gain in WCBA, focusing on older women, self-identified Black African population group, women with higher educational attainment, women residing in urban areas, and wealthy women

Mobile phone text messaging for promoting adherence to anti-tuberculosis treatment: a systematic review protocol

BACKGROUND: In 2010, there were approximately 8.8 million incident cases of tuberculosis (TB) worldwide. The treatment of TB is at least six months long and may be complicated by a high pill burden. In addition, TB patients often do not take their medication on schedule simply because they forget. Mobile phone text messaging has the potential to help promote TB treatment adherence. We, therefore, propose to conduct a review of current best evidence for the use of mobile phone text messaging to promote patient adherence to TB treatment. METHODS: This is a systematic review of the literature. We will preferably include randomized controlled trials (RCTs). However, non-randomized studies (NRS) will be considered if there is an inadequate number of RCTs.We will search PubMed, EMBASE, CINAHL, CENTRAL, Science Citation Index, Africa-Wide Information, and WHOLIS electronic databases for eligible studies available by 30 November 2012 regardless of language or publication status. We will also check reference lists for additional studies, identify abstracts from conference proceedings and communicate with authors for any relevant material.At least two authors will independently screen search outputs, select studies, extract data and assess the risk of bias (using separate criteria for RCTs and NRS); resolving discrepancies by discussion and consensus. We will assess clinical heterogeneity by examining the types of participants, interventions and outcomes in each study and pool studies judged to be clinically homogenous. We will also assess statistical heterogeneity using the chi-square test of homogeneity and quantify it using the I-square statistic. If study results are found to be statistically homogeneous (that is heterogeneity P > 0.1), we will pool them using the fixed-effect meta-analysis. Otherwise, we will use random-effects meta-analysis. We will calculate risk ratios and their corresponding 95% confidence intervals for dichotomous outcomes, and mean differences for continuous outcomes. For other outcomes without quantitative data, a descriptive analysis will be used.DISCUSSION:Our results can be used by researchers and policy-makers to help inform them of the efficacy of mobile phone text messaging interventions to promote patient adherence to TB treatment

Antiretroviral treatment uptake in patients with HIV-associated TB attending co-located TB and ART services

Background. Delivery of integrated care for patients with HIV-associated TB is challenging. We assessed the uptake and timing of antiretroviral treatment (ART) among eligible patients attending a primary care service with co-located ART and TB clinics. Methods. In a retrospective cohort study, all HIV-associated TB patients (≥18 years old) who commenced TB treatment in 2010 were included. Data were analysed using basic descriptive statistics and log-binomial regression analysis. Results. Of a total of 497 patients diagnosed with HIV-associated TB, 274 were eligible to start ART for the first time (median CD4 count, 159 cells/µl). ART was started during TB treatment by 220 (80.3%) patients. Among the 54 (19.7%) who did not start ART, 23 (42.6%) were either lost to follow-up (LTFU) or died before enrolling for ART; 12 (22.2%) were either LTFU or died after enrolling but before starting ART; 5 (9.3%) were transferred out; and 14 (25.9%) only started ART after completion of TB treatment. The median delay between starting TB treatment and starting ART was 51 days (IQR 29 - 77). Overall, only 58.6% of patients started ART within 8 weeks of TB treatment, and 12.7% of those with CD4 count

Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.

OBJECTIVE: To investigate the impact of antiretroviral therapy (ART) on long-term population-level tuberculosis disease (TB) incidence in sub-Saharan Africa. METHODS: We used a mathematical model to consider the effect of different assumptions about life expectancy and TB risk during long-term ART under alternative scenarios for trends in population HIV incidence and ART coverage. RESULTS: All the scenarios we explored predicted that the widespread introduction of ART would initially reduce population-level TB incidence. However, many modelled scenarios projected a rebound in population-level TB incidence after around 20 years. This rebound was predicted to exceed the TB incidence present before ART scale-up if decreases in HIV incidence during the same period were not sufficiently rapid or if the protective effect of ART on TB was not sustained. Nevertheless, most scenarios predicted a reduction in the cumulative TB incidence when accompanied by a relative decline in HIV incidence of more than 10% each year. CONCLUSIONS: Despite short-term benefits of ART scale-up on population TB incidence in sub-Saharan Africa, longer-term projections raise the possibility of a rebound in TB incidence. This highlights the importance of sustaining good adherence and immunologic response to ART and, crucially, the need for effective HIV preventive interventions, including early widespread implementation of ART

Tuberculosis in the news: How do Portuguese media cover TB

Introduction From a public health perspective, media can influence public perceptions towards the severity of an illness, the risks of becoming ill, change seek-care behaviours or reduce disease related stigma. Material and methods With the aim analysing the media coverage of tuberculosis in the Portuguese press, we analyzed all news texts published between 2012 and 2014 in six National newspapers (Expresso, Público and Diário de Notícias – broadsheets; Sol, Jornal de Notícias and Correio da Manhã – tabloids). Our corpus was composed of 10,736 news pieces and 23,495 news sources. We then conducted a quantitative analysis based on descriptive statistics, through the data analysis software SPSS. Results Tumours, HIV-Aids, Influenza, Transplants, Hepatitis, Obesity, Dengue, Mental Disorders and Heart Diseases were the most media covered pathologies, ahead of tuberculosis. Tumours represented 22% of all news, tuberculosis only represented 1.9% – there is a noteworthy difference among media treatment. When it comes to the news themes, Tuberculosis was mainly news due to alarm and risk situations (53.4% of all texts). This also means that stories were usually negative, which may lead to a stigmatization of this disease. Even though the numbers were not very expressive, there was some media attention thrown at prevention. Conclusion Media intervention is a fundamental public health tool that could be more developed – it would be important to understand what are the interventions with higher impact on health and how to better use them.info:eu-repo/semantics/publishedVersio

Antiretroviral treatment uptake in patients with HIV-associated TB attending co-located TB and ART services.

BACKGROUND: Delivery of integrated care for patients with HIV-associated TB is challenging. We assessed the uptake and timing of antiretroviral treatment (ART) among eligible patients attending a primary care service with co-located ART and TB clinics. METHODS: In a retrospective cohort study, all HIV-associated TB patients (≥18 years old) who commenced TB treatment in 2010 were included. Data were analysed using basic descriptive statistics and log-binomial regression analysis. RESULTS: Of a total of 497 patients diagnosed with HIV-associated TB, 274 were eligible to start ART for the first time (median CD4 count, 159 cells/µl). ART was started during TB treatment by 220 (80.3%) patients. Among the 54 (19.7%) who did not start ART, 23 (42.6%) were either lost to follow-up (LTFU) or died before enrolling for ART; 12 (22.2%) were either LTFU or died after enrolling but before starting ART; 5 (9.3%) were transferred out; and 14 (25.9%) only started ART after completion of TB treatment. The median delay between starting TB treatment and starting ART was 51 days (IQR 29 - 77). Overall, only 58.6% of patients started ART within 8 weeks of TB treatment, and 12.7% of those with CD4 counts <50 cells/µl started ART within 2 weeks. CONCLUSIONS: In a setting with co-located TB and ART clinics, delays to starting ART were substantial, and one-fifth of eligible patients did not start ART during TB treatment. Co-location of services alone is insufficient to permit timely initiation of ART; further measures need to be implemented to facilitate integrated treatment