Achieving universal health coverage for people with stroke in South Africa: protocol for a scoping review

Introduction: Stroke is the second most common cause of death after HIV/AIDS and a significant health burden in South Africa. The extent to which universal health coverage (UHC) is achieved for people with stroke in South Africa is unknown. Therefore, a scoping review to explore the opportunities and challenges within the South African health system to facilitate the achievement of UHC for people with stroke is warranted. Methods and analysis: The scoping review will follow the approach recommended by Levac, Colquhoun and O’Brien, which includes five steps: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising and reporting the results. Health Systems Dynamics Framework and WHO Framework on integrated people-centred health services will be used to map, synthesise and analyse data thematically. Ethics and dissemination: Ethical approval is not required for this scoping review, as it will only include published and publicly available data. The findings of this review will be published in an open-access, peer-reviewed journal and we will develop an accessible summary of the results for website posting and stakeholder meetings

Towards universal health coverage for people with stroke in South Africa: a scoping review.

OBJECTIVES: To explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA). SETTING: SA. DESIGN: Scoping review. SEARCH METHODS: We conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results. RESULTS: Fifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available. CONCLUSION: This review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care

Access to health care for people with stroke in South Africa: a qualitative study of community perspectives

Background: Incidence of stroke is increasing in sub‑Saharan Africa. People who survive stroke experience disability and require long‑term care. Health systems in South Africa (SA) are experiencing important challenges, and services in the public health system for people with stroke (PWS) are fragmented. We aimed to explore the perspectives and experiences of PWS related to stroke care services to inform health system strengthening measures. Methods: In‑depth interviews with 16 PWS in urban and rural areas in the Western and Eastern Cape Provinces of SA were conducted between August and October 2020. PWS were recruited through existing research networks, non‑government organisations and organisations of persons with disabilities by snowball sampling. Interviews were transcribed, coded, and thematically analysed. We used the conceptual framework of access to health care as pro‑posed by Levesque et al. to map and inform barriers to accessing health care from the user perspective. Results: PWS recognised the need for health care when they experienced signs of acute stroke. Health literacy on determinants of stroke was low. Challenges to accessing stroke care include complex pathways to care, physical mobility related to stroke, long travel distances and limited transport options, waiting times and out of pocket expenses. The perceived quality of services was influenced by cultural beliefs, attitudinal barriers, and information challenges. Some PWS experienced excellent care and others particularly poor care. Positive staff attitude, perceived competence and trustworthiness went in hand with many technical and interpersonal deficits, such as long waiting times and poor staff attitude that resulted in poor satisfaction and reportedly poor outcomes for PWS. Conclusions: Strategic leadership, governance and better resources at multiple levels are required to address the unmet demands and needs for health care of PWS. Stroke care could be strengthened by service providers routinely providing information about prevention and symptoms of stroke, treatment, and services to patients and their social support network. The role of family members in continuity of care could be strengthened by raising awareness of existing resources and referral pathways, and facilitating connections within services

Collaborative capacity development to complement stroke rehabilitation in Africa

This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke

Photographic measurement of upper-body sitting posture of high school students: A reliability and validity study

<p>Abstract</p> <p>Background</p> <p>All the reported measures of sitting posture, as well as photographs, have one flaw, as these measures are external to the body. These measures use calculations from external bony landmarks to estimate spinal posture, on the understanding that what is being measured externally reflects the shape, health and performance of structures of the underlying spine. Without a comparative measure of the relative position of the structures of the spine, the validity of any external spinal posture measure cannot be established. This paper reports on a study which tests the validity of photographs to measure adolescent sitting posture.</p> <p>Methods</p> <p>The study was conducted in a laboratory at the Department of Human Biology, University of Cape Town. A random sample of 40 adolescents were recruited from the Cape metropolitan schools, to detect differences of three degrees or more between the repeated measures of upright, normal or slouched posture (photographs) and between the posture photographs and LODOX measures. Eligible participants were healthy male and female subjects aged 15 or 16 years old, in Grade 10, and who were undertaking Computer or Computype studies at their schools. Two posture measurement tools were used in the study, namely: Photographs were taken using the Photographic Posture Analysis Method (PPAM) and Radiograph<it>s </it>were taken using the LODOX (LODOX (Pty) Ltd) system. Subjects' posture was assessed in simulated computer workstations. The following angles were measured: the sagittal head angle, cervical angle, protraction/retraction angle, arm angle and the thoracic angle.</p> <p>Results</p> <p>Data from 39 subjects (19 males, 20 females) was used for analysis (17 15-year-olds (7 boys and 10 girls), 22 16-year-olds (12 boys and 10 girls)). All but one photographic angle showed moderate to good correlation with the LODOX angles (Pearson r values 0.67–0.95) with the exception being the shoulder protraction/retraction angle Pearson r values. Bland Altman limits of agreement illustrated a slight bias for all angles. The reliability study findings from repeated photographs demonstrated moderate to good correlation of all angles (ICC values 0.78–0.99).</p> <p>Conclusion</p> <p>The findings of this study suggest that photographs provide valid and reliable indicators of the position of the underlying spine in sitting. Clinically it is important to know whether a patient is showing true progression in relation to a postural intervention. Based on the results of this study, the PPAM can be used in practice as a valid measure of sitting posture.</p

Ergonomic chair design for school computer laboratories in the Cape Metropole, Western Cape, South Africa

Thesis (PhD)--Stellenbosch University, 2013.ENGLISH SUMMARY : Background: Computers have become increasingly accessible in developing countries. Such increased computer usage is also noted in the Western Cape, South Africa. Prolonged posture whilst using computers and a learner‐chair mismatch is associated with spinal pain in adolescents. In South Africa, the prevalence of spinal pain among high school learners has been reported as being about 70%. Consideration of learner anthropometrics and school furniture design is essential to evolving strategies to be adopted to promote adolescent spinal health. Aim: The aim of this project is to determine whether the school computer laboratory chair or a commercially‐available chair matches the anthropometric profile of high school learners and, if not, to develop and test a prototype chair that will also facilitate postural changes, whilst the sitter is using a desktop computer. Methods: This study consisted of two phases. Phase one dealt with the anthropometric match of the learners to their school chair and to commercially‐available chairs. The following body dimensions were measured: stature; popliteal height (PH); buttock‐topopliteal length (BPL) and hip width (HW). These body dimensions were matched with the corresponding chair seat dimensions; and height, depth and width, using standard matching criteria. During Phase two, a prototype chair was designed according to the anthropometric profile of the learners concerned. The chair’s ability to reduce static sitting postures by facilitating postural changes in sitters whilst they are seated at a desktop computer was evaluated. The three‐dimensional (3D) sitting posture of twelve learners was evaluated while they were sitting on the school and the prototype chairs. The anthropometric and 3D data were analysed using descriptive statistics, including means (and standard deviations), medians (and interquartile ranges (IQR)) and ratios. To determine the difference in the number of postural changes between chairs, the Wilcoxon match pair test was used. Results: The sample consisted of 689 male and female learners aged 13 to 18 years, for the anthropometric study (phase 1). Of the learners, 65% to 80% did not match the school chairs’ dimensions. Five commercial chairs offered a good match for the seat height, but neither the seat depth nor the seat width matched 50% of the learners. The prototype chair matched 97% for height, 65% for depth and 60% for seat width. The prototype chair was associated with more postural changes in the frontal and transverse planes for the pelvis (ρ <0.05). Conclusions: This thesis is the first to report on the lower body anthropometric size of high school learners in the Cape Metropole area, Western Cape, South Africa. Neither the school computer laboratory chair nor commercially‐available adjustable computer chairs offered an acceptable fit for the anthropometric profile of the learners. The prototype “Dynamic” chair was consequently developed and provided the best match for the anthropometric profile. The prototype chair was also associated with an increased number of postural changes, particularly of the pelvis. The promising results obtained warrant further exploration of the prototype chair to determine the effect on the musculoskeletal pain experienced by school learners in South Africa.AFRIKAANSE OPSOMMING : Agtergrond: Rekenaars is toenemend in ontwikkelende lande beskikbaar. Hierdie toename in rekenaargebruik is ook in die Wes‐Kaap, Suid‐Afrika, sigbaar. Gebrek aan postuurafwisseling tydens rekenaargebruik en ’n stoel wat nie die fisiese afmetings van die leerder pas nie, kan tot spinale pyn in adolessente lei. ’n Deursnee‐studie in Suid‐Afrika toon dat rugpyn onder meer as 70% van hoërskoolleerlinge in die Wes‐Kaap voorkom. Die antropometrie van leerders en die ontwerp van skoolmeubels is bepalende faktore in die ontwikkeling van strategieë om die spinale gesondheid van adolessente te bevorder. Doel: Om te bepaal of die afmetings van rekenaarstoele wat in skole gebruik word en in die handel beskikbaar is met die antropometriese afmetings van hoërskoolleerlinge ooreenstem; en, indien nie, om ’n prototipe te ontwikkel van ʼn stoel wat posturale beweging tydens rekenaargebruik aanmoedig. Metode: Hierdie studie is in twee fases uitgevoer. In fase 1 is leerders se antropometrie vergelyk met die afmetings van hulle skoolstoele en stoele wat in die handel beskikbaar is. Die volgende liggaamsafmetings is geneem: lengte, popliteale lengte, boud‐tot‐popliteale lengte en heupomtrek. Hierdie afmetings is vergelyk met die volgende ooreenstemmende stoelafmetings: sitplekhoogte, ‐diepte en ‐breedte. Die verhouding tussen die fisiese afmetings van leerlinge en dié van hulle stoele is met behulp van standaarddefinisies bepaal. Tydens fase 2 is 'n prototipe van ʼn stoel wat volgens die optimale afmetings wat in fase 1 verkry is, ontwerp is. Die stoel se vermoë om meer beweging tydens rekenaargebruik aan te moedig, is ondersoek. Twaalf leerders se drie‐dimensionele sitposisie terwyl hulle dieselfde rekenaarverwante taak uitgevoer het, is ontleed. Die meting het 15 minute lank geduur in die skoolstoel, gevolg deur 15 minute in die prototipe. Die driedimensionele antropometriese profiel is beskryf aan die hand van beskrywende statistiek wat die gemiddeld (standaardafwykings), mediaan (en interkwartiel reeks (IKR)) en onderlinge verhoudings insluit. Die verskil in sitpostuurgedrag tussen die meting met die skoolstoel en dié met die prototipe is deur middel van die Wilcoxon‐vergelykende pare ontleed. Resultate: Die steekproef vir fase 1 het uit 689 leerders tussen 13 en 18 jaar bestaan. Uit dié groep het 65% tot 80% nie met die skoolstoele se afmetings ooreengestem nie. Vyf stoele wat in die handel beskikbaar is, se hoogte het goed met die leerders se afmetings vergelyk, maar 50% van die leerders kon op nie een van die stoele in hierdie groep se sitplekdiepte en ‐breedte inpas nie. Die prototipe se hoogte het met 97% van die leerders ooreengestem, en die sitplek se diepte en breedte met onderskeidelik 65% en 60% van die leerders. Gevolgtrekkings: Hierdie navorsing het vir die eerste keer die onderlyf‐antropometrie van veelrassige hoërskoolleerders in die Kaapse Metropool (Wes‐Kaap, Suid‐Afrika) ondersoek. Nóg die stoele wat in die skool se rekenaarlaboratorium gebruik word nóg verstelbare stoele wat in die handel te kry is, toon ’n aanvaarbare ooreenkoms met die antropometriese profiel van die groep plaaslike hoërskoolleerders. Die prototipe is gevolglik ontwikkel, en dít het die naaste met die leerders se antropometrie ooreengestem. Met die prototipe is ’n toename in posturale bewegings aangeteken, vir veral in die pelvis. Hierdie belowende resultate verg verdere navorsing om die effek van hierdie prototipe van ʼn stoel op muskuloskeletale pyn in leerders te bepaal

Measuring the sitting posture of high school learners, a reliability and validity study

Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2007.Objective The objective of this study was to establish the reliability and validity of a Portable Posture Analysis Method (PPAM). Design The design for the reliability section was a repeated measures observational study and the design for the validity section was a correlation study. Background The prevalence of spinal pain among high school learners is high (Murphy et al, 2002). It is also notable that the prevalence of back pain increases across the teenage years (Grimmer & Williams 2000, Burton et al 1996). In South Africa, the preliminary findings of a study conducted by a Physiotherapy masters candidate (Ms L Smith: ethics nr. N05/09/164) indicates that about 74% of high school learners in Cape Town complained of musculoskeletal pain. Posture has been identified by some researchers to be a primary predictor of the development of spinal, particularly upper quadrant pain among computer users (NIOSH 1997, Vieira et al 2004). Measurement of posture poses a real challenge to researchers wanting to accurately evaluate posture in research projects. Considering the practical implications in measuring posture, the validity and reliability of posture measurement are often reported to be poor. Many of these methods of indirect assessment of working posture have been reported on in the literature. These measures include; the goniometer, inclinometer, flexible electrogoniometer, flexicurve and photography (Harrison et al 2005, Christensen 1999, Nitschke et al 1999, Chen & Lee 1997). ..

The prevalence of underweight, overweight and obesity in a multiracial group of urban adolescent schoolchildren in the Cape Metropole area of Cape Town

CITATION: Van Niekerk, S. M., Grimmer, K. & Louw, Q. 2014. The prevalence of underweight, overweight and obesity in a multiracial group of urban adolescent schoolchildren in the Cape Metropole area of Cape Town. South African Journal of Clinical Nutrition, 27(1):18-24.The original publication is available at http://www.sajcn.co.zaAbstract Objective: The objective was to determine the prevalence of underweight, overweight and obesity in high school learners in the Cape Town area. Design: A cross-sectional study was conducted. Setting: High schools in the Cape Metropole Area of the Western Cape. Subjects: A complex cluster sampling procedure was followed. Thirty-six students per school were selected from each randomly selected school. Thirteen- to 18-year-old pupils were eligible for inclusion. Outcome measures: Height and weight measurements. Results: The sample comprised 689 students. There were considerably more underweight adolescent boys than adolescent girls (17.3% boys to 9.9% girls), and double the frequency of overweight adolescent girls than adolescent boys (7.7% girls to 3.5% boys). The 14-year-old boys had the highest prevalence of underweight (55.2%), and the 17-year-old girls the highest prevalence of overweight (22%). The highest prevalence of obesity was found in 15-year-old boys (11.1%), who also demonstrated a relatively high prevalence of underweight (30.2%). Conclusion: This study reported on a substantial percentage of underweight adolescents (27.1%). Noteworthy levels of overweight and obesity in adolescent girls added to the substantial prevalence of underweight in adolescent boys. Africa has enough to contend with in respect of transmissible diseases, without additional lifestyle-based health burdens.http://www.sajcn.co.za/index.php/SAJCN/article/view/778Publisher's versio

The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms : a systematic review

The original publication is available at http://www.biomedcentral.com/1471-2474/13/145Publication of this article was funded by the Stellenbosch University Open Access Fund.Background: Prolonged sitting has been associated with musculoskeletal dysfunction. For desk workers, workstation modifications frequently address the work surface and chair. Chairs which can prevent abnormal strain of the neuromuscular system may aid in preventing musculo-skeletal pain and discomfort. Anecdotally, adjustability of the seat height and the seat pan depth to match the anthropometrics of the user is the most commonly recommended intervention. Within the constraints of the current economic climate, employers demand evidence for the benefits attributed to an investment in altering workstations, however this evidence-base is currently unclear both in terms of the strength of the evidence and the nature of the chair features. The purpose of this study was to evaluate the evidence for the effectiveness of chair interventions in reducing workplace musculoskeletal symptoms. Methods: Pubmed, Cinahl, Pedro, ProQuest, SCOPUS and PhysioFocus were searched. ‘Ergonomic intervention’, ‘chair’, ‘musculoskeletal symptoms’, ‘ergonomics’, ‘seated work’ were used in all the databases. Articles were included if they investigated the influence of chair modifications as an intervention; participants were in predominantly seated occupations; employed a pre/post design (with or without control or randomising) and if the outcome measure included neuro-musculoskeletal comfort and/or postural alignment. The risk of bias was assessed using a tool based on The Cochrane Handbook. Results: Five studies were included in the review. The number of participants varied from 4 to 293 participants. Three of the five studies were Randomised Controlled Trials, one pre and post-test study was conducted and one single case, multiple baselines (ABAB) study was done. Three studies were conducted in a garment factory, one in an office environment and one with university students. All five studies found a reduction in self-reported musculoskeletal pain immediately after the intervention. Bias was introduced due to poor randomization procedures and lack of concealed allocation. Meta-analysis was not possible due to the heterogeneity of the data (differing population, intervention and outcomes across studies). Conclusion: The findings of this review indicate a consistent trend that supports the role of a chair intervention to reduce musculoskeletal symptoms among workers who are required to sit for prolonged periods. However the amount, level and quality of the evidence are only moderate therefore we cannot make strong recommendations until further trials are conducted. The review also highlights gaps: for example in showing whether the effectiveness of a chair intervention has long-term impact, particularly with respect to musculoskeletal symptoms, as well as the recurrence of symptoms and the consequent cost of care.Publishers' Versio

The effect of physical exercise on anxiety in people with parkinson's disease: A systematic review of randomized control trials

BACKGROUND: Anxiety is a prominent disabling non-motor neuropsychiatric complication of Parkinson's disease (PD). Pharmacological treatments for PD and anxiety have drug interactions and negative side effects. Therefore, non-pharmacological interventions such as exercise has been proposed to reduce anxiety in people with PD (PwP). OBJECTIVE: This systematic review aimed to explore the relationship between physical exercise and anxiety in PwP. METHOD: Four databases (PubMed, Embase, Scopus, Ebscohost) were searched without date restrictions. English randomized control trials (RCT) including adults with PD, exposed to physical exercise interventions with anxiety as an outcome variable, were included. Quality was assessed by means of an adapted 9-point PEDro scale. RESULTS: Five of the identified 5547 studies met the inclusion criteria. Sample size ranged between 11-152 participants, totaling 328 participants with majority being male. PD stage ranged from early to moderate, with disease duration ranged between 2.9 and 8.0 years. All studies measured anxiety at baseline and post-intervention. On average studies scored 7/9 (76%) on the PEDro scale. CONCLUSION: There is insufficient evidence to support or refute the effect of exercise on anxiety in PwP due to noted limitations of included studies. There is an urgent need for high-quality RCTs on physical exercise and anxiety in PwP