Healthcare attendance patterns by pregnant women in Durban, South Africa

Background: High rates of perinatal mortality and morbidity and maternal mortality in South Africa remain a major problem. The Saving Mothers and Saving Babies Reports identified patient-related factors as possible causes. Among the patient-related factors was non-attendance, or attendance late in pregnancy, for antenatal care in public hospitals. It would appear that pregnant women confirm their pregnancies by visiting general practitioners, but do not attend antenatal care in the public sector. Aim: The aim of this study was to determine healthcare attendance patterns among pregnant women in Durban, South Africa. Method: This was a descriptive study. Participants were recruited and categorised into “early booker”, “late booker” and “unbooked in labour” groups. All the participants were interviewed individually using a structured questionnaire. Results: The majority of participants presented for formal “booking” late in pregnancy; 47.9% “booked” at a gestational age of six months after the last menstrual period. Among the “early bookers”, the majority (94.4%) had confirmed their pregnancy by four months of amenorrhoea, and 60.6% of these confirmed their pregnancies within the public health sector. All the “early bookers” began antenatal care prior to the 20th week of gestation. A total of 66.9% of the “late bookers” and 66.7% of the “unbooked” women also had their pregnancies confirmed at four months amenorrhoea, but 49.0% of the “late bookers” and 59.8% of the “unbooked” women confirmed their pregnancies in the private health sector. The “late bookers” also showed a delay of two to three months between confirming the pregnancy and booking visits. Of the women in this study, 49% visited a general practitioner (GP) to confirm the pregnancy after two to four months of amenorrhoea. This figure rose to 53.0% if only the “late bookers” and the “unbooked” were analysed. Further, 35.3% visited a GP more than once, either for antenatal care or because of ill health. Conclusion: It is imperative for GPs to understand the role of antenatal care and to refer pregnant women appropriately.South African Family Practice Vol. 48 (10) 2006: pp. 17-17

Localized cyclical variations in immunoproteins in the female genital tract and the implications on the design and assessment of mucosal infection and therapies.

PROBLEM: Fluctuating hormones regulate reproductive processes in the female genital tract. Consequent changes in the local immunological environment are likely to affect cellular interaction with infectious agents and the assessment of therapies that target mucosal infections. METHOD OF STUDY: We compared Softcup and Weck-Cel sampling protocols and assessed the changes in the concentrations of 39 soluble proteins with menstrual cycle progression in the mucosal and peripheral compartments. RESULTS: We demonstrate that the mucosal immunological profile is distinct from serum with inflammatory and migratory signatures that are localized throughout the cycle. The analytes highlighted in the mucosal compartment were generally highest at the follicular phase with a tendency to fall as the cycle progressed through ovulation to the luteal phase. CONCLUSION: Our results underscore the need to consider these localized cyclical differences in studies aimed at assessing the outcome of disease and the efficacy of mucosal vaccines and other therapies

Rural-urban disparities in the nutritional status of younger adolescents in Tanzania

Research on geographic differences in health focuses largely on children less than five years; little is known about adolescents—and even less regarding younger adolescents—a vulnerable group at a critical stage of the life course. Africa’s rapid population growth and urbanization rates, coupled with stagnant rates of undernutrition, further indicate the need for country-specific data on rural-urban health disparities to inform development policies. This study examined rural-urban disparities in body mass index-for-age-and-sex (BAZ) and height-for-age-and-sex z-scores (HAZ) among younger adolescents in Tanzania. Participants were randomly selected adolescents aged 10–14 years (N = 1,125) residing in Kilosa (rural) and Moshi (urban) districts of Tanzania. Individual and household-level data were collected using surveys and anthropometric data was collected on all adolescents. Age, sex, household living conditions, and assets were self-reported. BAZ and HAZ were calculated using the WHO reference guide. The prevalence of undernutrition was 10.9% among rural and 5.1% among urban adolescents (p\u3c0.001). Similarly, stunting prevalence was greater in rural (64.5%) than urban (3.1%) adolescents (p\u3c0.001). After adjusting for covariates, rural residence was significantly and inversely associated with BAZ (B = -0.29, 95% CI: -0.52, -0.70, p = 0.01), as well as with HAZ (B = -1.79, 95% CI: -2.03, -1.54, p\u3c0.001). Self-identified males had lower BAZ (B = -0.23, 95% CI: -0.34, -0.11, p\u3c0.001) and HAZ (B = -0.22, 95% CI: -0.35, -0.09, p = 0.001) than self-identified female adolescents. Rural-urban disparities in nutritional status were significant and gendered. Findings confirm place of residence as a key determinant of BAZ and HAZ among younger adolescents in Tanzania. Targeted gender-sensitive interventions are needed to limit growth faltering and improve health outcomes in rural settings

Using a treatment partner and text messaging to improve adherence to psychotropic medication: A qualitative formative study of service users and caregivers in Cape Town, South Africa

Objective: Poor adherence to medications, including psychotropic medications contributes to the burden of disease. Mental health service users (MHSU) may also not attend follow-up appointments at their health care facilities where they could discuss adherence with their health care provider. This paper reports on preliminary qualitative research preceding a randomised controlled trial that aims to improve adherence to psychotropic medication and to follow up treatment visits. The intervention will entail the support of individuals with serious mental disorder by a treatment partner and short message service (SMS) text messaging. Methods: The preliminary research reported in this paper aimed to extract views about the intervention from both mental health service users (MHSU) and caregivers through focus group discussions and individual interviews. Data were analysed using ATLAS TI qualitative software.Results: The caregivers interviewed were all mothers of MHSU who took measures to encourage adherence. They held mixed opinions on whether the treatment partner should be a family member. Most participants expressed the view that due to living conditions, family members were natural treatment partners, but others stated that they would prefer a treatment partner who was not a family member. Similarly, while most MHSU supported the idea of a treatment partner, a minority were concerned that a treatment partner may potentially be too controlling and compromise their autonomy. The vast majority of participants supported SMS text messaging as a means of reminding MHSU to take their medication and attend followup appointments. One participant mentioned the importance of broader social inclusion issues that should be  incorporated in the intervention.Conclusion: Qualitative research may provide useful insights for the design of interventions of this nature related to social inclusion randomised control trials with its focus on adherence.Keywords: Mental illness; Treatment partner; Social inclusion; Community care; Mobile phone

Cultural intermediaries and the circuit of culture : the digital ambassadors project in Johannesburg, South Africa

Abstract: The question raised by Cheney and Christensen (2001) as to “what a non-Western, nonmanagerial and non-rationalist form of public relations will look like” (p.182), together with the call made by Gregory (2014) for public relations practitioners (PRPs) to be active social change agents, motivated this paper. The aim of this research is to follow a culture-centred approach and apply the circuit of culture (Curtin & Gaither, 2005) to investigate the meanings that young people (aged 18 to 34), as cultural intermediaries, ascribe to their participation in a digital empowerment project implemented by the City of Johannesburg, South Africa. This research forms part of a larger, ongoing multi-disciplinary research project..

Influence of the Ce :YAG amount on structure and optical properties of Ce :YAG-PMMA composites for white LED

Ce:YAG-poly(methyl methacrylate) (PMMA) composites were prepared by using a melt compounding method, adding several amounts of Ce:YAG in the range 0.1–5wt.%. The optical properties of the obtained composites and of the composites combined with a blue LED were measured to investigate the effect of the amount of Ce:YAG on the resulting emitted light in view of possible application in white LED manufacture. An increase in Ce:YAG amount caused an increase in the emission and a shift of 15 nm, influencing the white LED performance. The structure and morphology of the composites were studied. The results show that the interaction between the two components, observed by using solid state NMR experiments, are the responsible for the observed shift.The authors acknowledge the University of Palermo, FFR 2012–2013 –ATE 0594 and CORI201

Improving adherence in mental health service users with severe mental illness in South Africa: a pilot randomized controlled trial of a treatment partner and text message intervention vs. treatment as usual

Objectives: Medication non-adherence is a significant problem in treatment of severe mental disorders and is associated with poor clinical outcomes and increased demand on services. Task-shifting interventions incorporating mobile health may improve adherence in mental health service users in low- and middle-income countries. Seventy-seven participants were recruited from a psychiatric hospital in Cape Town, with 42 randomized to receive the intervention and 35 to treatment as usual. Intervention pairs underwent treatment-partner contracting and psychoeducation, and received monthly text message reminders of clinic appointments. Primary outcomes were intervention acceptability and feasibility. Secondary outcome for efficacy were adherence to clinic visit; relapse; quality of life; symptomatic relief and medication adherence. Results: Treatment partner and psychoeducation components were acceptable and feasible. The text message component was acceptable but not feasible in its current form. Efficacy outcomes favoured the intervention but did not reach statistical significance. A treatment-partner intervention is acceptable and feasible in a low- and middle-income setting. Work is needed to ensure that additional components of such interventions are tailored to the local context. Appropriately powered efficacy studies are needed. Trial Registration PACTR PACTR201610001830190, Registered 21 October 2016 (Retrospectively registered

Recruitment of high risk women for HIV prevention trials: baseline HIV prevalence and sexual behavior in the CAPRISA 004 tenofovir gel trial

<p>Abstract</p> <p>Background</p> <p>Young women in sub-Saharan Africa bear a disproportionate burden of HIV infection compared to men but have limited options to reduce their HIV risk. Microbicides could fill an important HIV prevention gap for sexually active women who are unable to successfully negotiate mutual monogamy or condom use.</p> <p>Purpose</p> <p>This paper describes the baseline sample characteristics in the CAPRISA 004 trial which assessed the safety and effectiveness of the vaginal microbicide, 1% tenofovir gel for HIV prevention in South Africa.</p> <p>Methods</p> <p>This analysis assessed the baseline demographic, clinical and sexual behavior data of women screened and enrolled into the trial. The characteristics were summarized using descriptive summary measures; expressed as means and percent for categorical variables.</p> <p>Results</p> <p>HIV prevalence at screening was 25.8% [95% Confidence Interval (CI):23.9-27.7). Of the 889 eligibly enrolled women who contributed follow-up data, rural participants recruited from a family planning (FP) clinic were younger, more likely to be living apart from their regular partner, reported lower coital frequency, had lower condom use (p < 0.001). In contrast, urban participants recruited from a sexually transmitted disease (STD) clinic reported higher numbers of lifetime sexual partners, new partners in the last 30 days and receiving money in exchange for sex (p < 0.001).</p> <p>Conclusion</p> <p>The populations selected provide suitable diverse target groups for HIV prevention intervention studies.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00441298">NCT 00441298</a></p