33 research outputs found
Psychosocial factors associated with tobacco use among a population of medical students in Pretoria
Context: Tobacco use among medical students is of public health concern, given their role as future role models for healthy lifestyles. This study sought to determine the prevalence and determinants of tobacco use and nicotine dependence in medical students in Pretoria. In particular, this study explored the role of sense of coherence â a measure of stress-coping ability â on tobacco use patterns among medical students. Furthermore, we examined the studentsâ knowledge of smoking cessation approaches, their perceptions with regard to the availability and adequacy of tobacco control curricula, and their perception of their role as ârole modelsâ for their patients. Methods: This cross-sectional analytical study, involving undergraduate medical students in their 2nd and 6th year of study at the universities of Pretoria and Limpopo (MEDUNSA), was conducted during August and September 2008. Consenting participants completed a self-administered questionnaire (N=722). Information obtained included: demographic characteristics of respondents, alcohol use, past and current use of various tobacco products, perception of availability and adequacy of training in tobacco control (TC), support for various TC legislation and perception of the role of doctors in smoking cessation. A six-item Antonovskyâs sense of coherence scale (SOC) was also included to measure respondentsâ ability to cope with stress. Nicotine dependence was measured using the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). Data analysis included chi-square statistics, t-test and multiple logistic regression analysis. Level of significance was set at p<0.05. Results: Prevalence of cigarette smoking in medical students was 17.3%. Cigarette smoking was significantly higher among the 6th (21.5%) than among the 2nd year (14.1%) students and was also significantly higher among males (20.4%) than among females (14.4%). In a bivariate analysis, problem drinkers were more likely to be smokers (37.5%) as compared to non-problem drinkers (13%). Compared to non-smokes, smokers were more likely to have a lower SOC [Mean(sd); 26.8 (8.8) vs 28.8 (7.4); p=0.019] and were less likely to attach importance to being seen as a role model by patients. Only 21.9% felt their training curriculum contained TC issues and of these a little over half felt the TC content was inadequate. After controlling for potential confounders, the factors that were independently associated with the current smoking status were, having lower support for TC legislation (OR=0.49; 95% CI= (0.41-0.59) and attaching less importance to being seen as a role model by patients (0.62; 0.41-0.91). Other factors associated with cigarette use included: being a 6th year student (OR=2.17; 95% CI; 1.32-3.58), having a drinking problem (2.17; 1.28-3.68), reporting exposure to others smoking at home (3.29; 1.91-5.66) and having received previous formal training in cessation (0.55; 0.32-0.95). Younger age (0.86; 0.77- 0.97), lower SOC (0.94; 0.90-0.99), and lower level of support for TC legislation (0.56; 0.40-0.79) were independently associated with nicotine dependence. Conclusions: This studyâs findings suggest that tobacco use is prevalent among medical students and tobacco use is strongly associated with alcohol abuse. In addition to offering tobacco cessation services to these students, these findings highlight the need to institute a curriculum on tobacco control that includes not only teaching cessation counselling skills to medical students, but that also encourages them to become advocates for TC legislation and to recognise themselves as important role models in the society. CopyrightDissertation (MMed)--University of Pretoria, 2009.School of Health Systems and Public Health (SHSPH)MMedUnrestricte
Global health in foreign policy in South Africa â Evidence from state actors
Aim: There are currently debates about why South Africa integrates global health into its foreign policy agendas. This study aimed at exploring motivation and interestsâ South African policy actors pursue to advance global health and the processes that lead to such integration.
Methods: The study utilized a mixed-method design from a sample of state policy actors at the National Department of Health of South Africa. Participants were selected purposively and had experience of more than three years participating in various international health activities. All participants completed semi-structured questionnaires. Quantitative data was analysed to determine frequencies and transcribed text was analyzed using qualitative content analysis.
Results: A total of 40 people were invited, of whom 35 agreed to participate. Of the respondents, 89.7% (n=32) strongly argued that health should facilitate âfree movement of people, goods and servicesâ. Majority (79.0%, n= 29) agreed that âdevelopment and equalityâ are the main elements of foreign policy. Of the respondents, majority 77.1% (n=27) agreed that âmoral and human rightsâ are the main elements of foreign policy. Furthermore, 82.8% (n=29) agreed that the country should advance âAfrica regionalism and south-south cooperationâ and 85.7% (n=30) strongly argued for a âwhole-government approachâ in addressing global health challenges. âHIV/AIDSâ and âaccess to medicines agendaâ were the main policy issues advanced. The main domestic factors shaping South Africaâs involvement in global health were its âpolitical leadershipâ and âcapacity of negotiatorsâ.
Conclusion: It is evident that within South Africa, state policy actors are largely concerned with promoting global health interest as a normative value and a goal of foreign policy, namely, human dignity and development cooperation. Furthermore, South Africa drives its global health through building coalition with other state and non-state actors such as civil society. HIV/AIDS, as a policy issue, presents a potential entry point for engagement in global health diplomacy.
 
Dollar value of disability-adjusted life years in South Africa in 2019
Background
To date, no study has estimated the dollar value of DALYs lost from a wide range of diseases and conditions in South Africa. The specific objectives of this study were: (a) to estimate the dollar value of disability-adjusted life-years (DALYs) lost in South Africa in 2019, and (b) to forecast the reductions in the dollar value of DALY losses assuming the United Nations Sustainable Development Goal 3 (SDG3) five disease-specific targets are attained by 2030.
Methods
The study employs the human capital approach to convert the DALYs lost from all causes into their International Dollar (Int 313.5 billion and an average value of Int 155.6 billion (50%) was attributed to communicable, maternal, neonatal, and nutritional diseases (CMNND); Int 37.4 billion (12%) to injuries (INJ). The health conditions related to SDG3 targets 3.1 (maternal mortality), 3.2 (neonatal mortality), 3.3 (CMNND), 3.4 (NCD) and 3.6 (INJ) resulted in DALY losses with a value of 256.4 billion, i.e. 82% of the total monetary value of DALYs lost in 2019. Therefore, achieving the five SDG targets would potentially save South Africa Int$ 139.7 billion per year.
Conclusions
Health development policy-makers should employ this type of evidence when making a case for increased investments into the national health-related systems to bridge the extant gap in the universal health service coverage index for South Africa
Strengthening health systems by health sector reforms
BACKGROUND: The rising burden of disease and weak health systems are being compounded by the persistent
economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global
health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health
systems, including dealing with social, environmental, and economic determinants through multisectoral
responses.
METHODS: A review and analysis of data on strengthening health sector reform and health systems was
conducted. Attention was paid to the goal of health and interactions between health sector reforms and the
functions of health systems. Further, we explored how these interactions contribute toward delivery of health
services, equity, financial protection, and improved health.
FINDINGS: Health sector reforms cannot be developed from a single global or regional policy formula. Any
reform will depend on the countryâs history, values and culture, and the populationâs expectations. Some of
the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a
comprehensive policy package for health sector reforms; improving alignment of planning and coordination;
use of reliable data; engaging âstreet levelâ policy implementers; strengthening governance and leadership; and
allowing a holistic and developmental approach to reforms.
CONCLUSIONS: The process of reform needs a fundamental rather than merely an incremental and evolutionary
change. Without radical structural and systemic changes, existing governance structures and management
systems will continue to fail to address the existing health problems.http://www.globalhealthaction.net.am201
Tobacco industry:a barrier to social justice
Social justice recognises the need for the âthe distribution of wealth, opportunities, and privileges within a societyâ. According to the United Nations, social justice is an underlying principle for peaceful and prosperous coexistence within and among nations. Social justice can also refer to the balance between individuals and society; if we assume that governments play a major role in society, then their obligation to protect individuals from third parties4 (eg, the tobacco industry) becomes one of their key responsibilities in maintaining social justice. Furthermore, the actions of the government in one country can negatively impact social justice in another
Global health in foreign policy in South Africa â Evidence from state actors
Aim: There are currently debates about why South Africa integrates global health into its foreign policy agendas. This study aimed at exploring motivation and interestsâ South African policy actors pursue to advance global health and the processes that lead to such integration.Methods: The study utilized a mixed-method design from a sample of state policy actors at the National Department of Health of South Africa. Participants were selected purposively and had experience of more than three years participating in various international health activities. All participants completed semi-structured questionnaires. Quantitative data was analysed to determine frequencies and transcribed text was analyzed using qualitative content analysis.  Results: A total of 40 people were invited, of whom 35 agreed to participate. Of the respondents, 89.7% (n=32) strongly argued that health should facilitate âfree movement of people, goods and servicesâ. Majority (79.0%, n= 29) agreed that âdevelopment and equalityâ are the main elements of foreign policy. Of the respondents, majority 77.1% (n=27) agreed that âmoral and human rightsâ are the main elements of foreign policy. Furthermore, 82.8% (n=29) agreed that the country should advance âAfrica regionalism and south-south cooperationâ and 85.7% (n=30) strongly argued for a âwhole-government approachâ in addressing global health challenges. âHIV/AIDSâ and âaccess to medicines agendaâ were the main policy issues advanced. The main domestic factors shaping South Africaâs involvement in global health were its âpolitical leadershipâ and âcapacity of negotiatorsâ.Conclusion: It is evident that within South Africa, state policy actors are largely concerned with promoting global health interest as a normative value and a goal of foreign policy, namely, human dignity and development cooperation. Furthermore, South Africa drives its global health through building coalition with other state and non-state actors such as civil society. HIV/AIDS, as a policy issue, presents a potential entry point for engagement in global health diplomacy.  Â
Global health in foreign policy in South Africa â evidence from state actors
AIM : There are currently debates about why South Africa integrates global health into its foreign policy agendas. This study aimed at exploring motivation and interestsâ South African policy actors pursue to advance global health and the processes that lead to such integration.
METHODS : The study utilized a mixed-method design from a sample of state policy actors at the National Department of Health of South Africa. Participants were selected purposively and had experience of more than three years participating in various international health activities. All participants completed semi-structured questionnaires. Quantitative data was analysed to determine frequencies and transcribed text was analyzed using qualitative content analysis.
RESULTS : A total of 40 people were invited, of whom 35 agreed to participate. Of the respondents, 89.7% (n=32) strongly argued that health should facilitate âfree movement of people, goods and servicesâ. Majority (79.0%, n= 29) agreed that âdevelopment and equalityâ are the main elements of foreign policy. Of the respondents, majority 77.1% (n=27) agreed that âmoral and human rightsâ are the main elements of foreign policy. Furthermore, 82.8% (n=29) agreed that the country should advance âAfrica regionalism and south-south cooperationâ and 85.7% (n=30) strongly argued for a âwhole-government approachâ in addressing global health challenges. âHIV/AIDSâ and âaccess to medicines agendaâ were the main policy issues advanced. The main domestic factors shaping South Africaâs involvement in global health were its âpolitical leadershipâ and âcapacity of negotiatorsâ. CONCLUSION : It is evident that within South Africa, state policy actors are largely concerned with promoting global health interest as a normative value and a goal of foreign policy, namely, human dignity and development cooperation. Furthermore, South Africa drives its global health through building coalition with other state and non-state actors such as civil society. HIV/AIDS, as a policy issue, presents a potential entry point for engagement in global health diplomacy.National Department of Health, South Africahttp://www.banglajol.info/index.php/SEAJPHam2016School of Health Systems and Public Health (SHSPH
Population health trends analysis and burden of disease profile observed in Sierra Leone from 1990 to 2017
Additional file 1: Supplementary Figure 1. CMNN and NCD combined
mortality rates. Supplementary Figure 2. Top 10 Diseases for CMNN and
NCD combined. Supplementary Table 1. CMNNs risk factors. Supplementary
Table 2. NCD Risk factors.BACKGROUND : Sierra Leone, in West Africa, is one of the poorest developing countries in the world. Sierra Leone has experienced several recent challenges namely, a civil war from 1991 to 2002, a massive Ebola outbreak from 2014 to 2016, followed by floods and landslides in 2017. In this study, we quantified the burden of disease in Sierra Leone over a 27-year period, from 1990 to 2017. METHODOLOGY : In this descriptive study, we analysed secondary data from the Institute of Health Metrics and Evaluation, Global Burden of Disease (GBD) study. We quantified patterns of burden of disease, injuries, and risk factors in Sierra Leone. We report GBD data and metrics including mortality rates, years of life lost and risk factors for all ages and both sexes from 1990 to 2017. RESULTS : From 1990 to 2017, trends of mortality rates for all ages and sexes have declined in Sierra Leone although mortality rates remain some of the highest when compared to other developing countries. The burden of communicable, maternal, neonatal, and nutritional (CMNN) diseases are greater than the burden of non-communicable diseases (NCDs) due to the prevalence of endemic diseases in Sierra Leone. The most important CMNNs associated with premature mortality included respiratory infections, neglected tropical diseases, malaria, and HIV-Aids. Life expectancy has increased from 37 to 52 years. CONCLUSION : Sierra Leoneâs health status is gradually improving following the civil war and Ebola outbreak. Sierra Leone has a double burden of disease with CMNNs leading and NCDs progressively increasing. Despite these challenges, Sierra Leone has promising initiatives and programs pursuing the Universal Health Coverage 2030 Sustainable Developmental Goals Agenda. There is need for accountability of available resources, clear rules and expected roles for non-governmental organisations to ensure a level playing field for all actors to rebuild the health system.http://www.biomedcentral.com/bmcpublichealtham2023School of Health Systems and Public Health (SHSPH)Statistic
Adherence to rehabilitative programmes by patients living with neurological conditions : a South African context
The number of people living with disabilities is increasing. Good adherence to rehabilitative
programmes is critical for optimal health and health systems in developing countries are under
pressure to meet multiple health needs. Overworked practitioners assume that if the patients fail
to show up for their appointments they have lost interest. The purpose of the study was to explore
reasons for the poor adherence of patients with neurological disorders at rehabilitative services.
This study used a phenomenological approach and purposive sampling. One-on-one interviews
with patients booked to receive therapy at a South African public sector hospital and who failed
to attend therapy were done (n=12). For triangulation purposes interviews were conducted with
patients who had never missed sessions (n=5). A total of eight of the participants from both
groups said that they had not accepted their condition. All five dimensions of adherence
described in the literature were found. The participants gave very positive feedback on the
rehabilitative programmes received at the hospital, but said circumstances beyond their control
had caused them to miss a session. These included fear of losing jobs, unavailability of transport,
and perception of poor services at primary health care clinics when down referred. The reasons
for adherence or lack of it are not easily established. Contributing factors however were noted in
this study. Information obtained from the study will assist health professionals to understand the
patientsâ context and can inform rehabilitation programmes to support adherence.http://www.journals.co.za/content/journal/ajpherd1am2017School of Health Systems and Public Health (SHSPH