Prevention of hypertension and diabetes in an urban setting in South Africa: Participatory action research with community health workers

The project aimed to identify factors that contribute to hypertension and diabetes and to design and implement appropriate local interventions to prevent these non-communicable diseases and promote healthy lifestyles. This was a community-based participatory action research project in which researchers and community health workers (CHWs) were the main participants. The triple A approach to planning interventions was used, that is, the process of assessing the situation, analyzing the findings, and taking action based on this analysis. Both qualitative and quantitative methods were employed. Twenty-two CHWs working in site C, Khayelitsha, a deprived urban area of Cape Town, South Africa, participated in the study. Findings from the situational assessment indicated a lack of knowledge among CHWs and the community about hypertension and diabetes and the risk factors for these non-communicable diseases. Economic constraints and cultural beliefs and practices influenced the community’s food choices and participation in physical activity. On the basis of these findings, a training program was proposed that would provide CHWs with the skills to prevent hypertension and diabetes in their community. A program was developed and piloted by the project team. A health club that focuses on promoting healthy lifestyles is currently being piloted. This paper illustrates the unique involvement of CHWs in a successful participatory action research project on the prevention of hypertension and diabetes and promotion of health in a deprived urban setting. The project emphasizes the importance of involving local people in community-based initiatives to promote health and identifies that the primary role of health services is to develop appropriate skills in the local community, monitor activities, and facilitate a link with primary health services

Factors contributing to poor performance of Directly Observed Treatment Short-course (DOTS) in Mopani District, Limpopo Province, South Africa

The purpose of the study was to assess factors contributing to poor performance of Directly Observed Treatment Short-Course (DOTS) in Mopani district of Limpopo Province, South Africa. An exploratory qualitative approach was used to investigate the factors that contribute to poor performance of the DOTS Strategy. Four focus group discussions were conducted, two with Directly Observed Therapy (DOT) Supporters and two with patients on treatment for more than 6 months. The focus groups (4) discussions were tape-recorded. Data collected were descriptively analyzed using thematic methods. The patients generally found supervision of TB treatment helpful as they were motivated and encouraged to continue treatment. Some of the aspects identified as being unhelpful were the inconvenient times for treatment support and stigma due TB supporters’ visit to patients home. Patients often preferred family members as supporters, whereas health workers favoured trained volunteers as DOT supporters. Other factors affecting DOTS were poverty, food shortage, cultural beliefs, and side-effects of the medication. Patients receiving disability grants prefer to remain uncured so as to continue receiving the grant. Behavioural factors seem to play a major role in noncompliance with TB treatment. The findings of the study support the importance of initial counseling and motivation of patients in improving adherence in the programme. Self-motivation was mentioned rather than the motivation from the DOT supporters. Further exploration of alternative DOTS supporters other than trained volunteer demands further investigation

Community intervention for the emerging epidemic of non-communicable diseases

BACKGROUND: Community health workers (CHWs) are lay people trained to assist with health care in their communities. This study took place at two sites in Khayelitsha, a township in the Cape Peninsula, from 2000 to 2002. OBJECTIVES: To describe the process of developing an intervention programme for primary prevention of noncommunicable diseases (NCDs) in general and cardiovascular disease in particular, targeting CHWs. METHOD: Forty-four CHWs were assigned to either an intervention or a control group. The intervention group, living in Site C, received training on lifestyle modification with emphasis on healthy eating and physical activity, while the control group, living in Site B, did not receive any training until a year later. The process was undertaken in four stages. Stage 1 involved assessment of the CHWs’ risk factors by obtaining anthropometric measurements. CHWs were interviewed and focus group discussions were held on the socio-cultural factors associated with body weight and body image, and barriers to physical activity. Stage 2 involved developing and implementing a training programme for primary prevention of NCDs among CHWs. Stage 3, conducted at Site C, involved a situational assessment of available resources in the community for promoting healthy lifestyles. The fourth and final stage involved the implementation of community interventions by the CHWs. RESULTS: A large percentage of CHWs were overweight and obese, and therefore at risk for NCDs. They had misconceptions about causes and treatment of these diseases, and also lacked knowledge on nutrition and the risk of high fat intake. Easy access to cheap unhealthy food, rather than fresh fruit and vegetables, limited their ability to make healthy food choices. The findings from stage 1 led to a community participatory intervention. CONCLUSIONS: Developing community-targeted interventions for NCDs can be achieved by involving CHWs at the initial stage and utilising a multifaceted approach. Education of community members and CHWs does not guarantee behaviour modification. Unless the environment encourages healthy living, NCDs will continue to be a burden in the poor populations of South Africa.Health Promotion Directorate, Provincial Government of the Western Cap

Obesity among black South African women

Obesity and associated non-communicable diseases such as Type 2 diabetes, hypertension, and ischaemic heart disease were previously thought to be diseases of affluent countries, but they are becoming increasingly prevalent in developing nations. Accessibility to cheap unhealthy food, global trade and market development influence nutrition transition towards diets with high fat and sugar contents. A decrease in physical activity due to urbanisation and other environmental factors such as crime and violence are thought to lead to an increased risk of obesity. Positive beliefs about body weight among black African women, together with the idea of association of thinness with HIV/AIDS virus infection are believed to fuel the obesity epidemic amongst this population This paper describes some of the contributory factors which black South African women are faced with in making choices about healthy living. A multisectoral approach will be needed to fight the epidemic of obesity and associated diseases.National Research Foundation (NRF) and the University of the Western Cap

Ability to manage diabetes – community health workers’ knowledge, attitudes and beliefs

BACKGROUND: Diabetes constitutes a significant health problem in South Africa. Early detection and good management can prevent or delay complications, with national guidelines for diabetes treatment now available to facilitate this. However, problems are being encountered with their implementation and there is evidence that preventive care is still inadequate in South Africa. Community health workers (CHWs) are lay personnel employed to serve as a link between professional health care staff and the community. They visit homes and can be a powerful force for diabetes prevention and adherence to treatment regimens, given appropriate knowledge. METHOD: We conducted a study to evaluate the knowledge, beliefs and attitudes of a group of CHWs serving a poor urban area, using focus groups and personal interviews. RESULTS: The CHWs did not have the requisite knowledge, attitudes and beliefs to make a positive impact on prevention and management of diabetes. For example, they cited eating sugar as a cause of diabetes. They advised folk remedies that purportedly diluted the blood sugar. Their patients took prescribed medication irregularly. Obesity was not considered an important risk factor. Poverty, however, was recognised as an obstacle to proper treatment. CONCLUSION: Training is clearly needed to empower the CHWs with skills to work within their communities to identify risk factors for diabetes and other non-communicable diseases, with emphasis on diet and physical activity.National Research Foundation, and the Provincial Administration of the Western CapeDepartment of HE and Training approved lis

Socio-cultural factors influencing food consumption patterns in the black African population in an urban township in South Africa

The present study was undertaken to examine socio-cultural factors that influence food intake in different groups of people residing in a black township in Cape Town. Focus group discussions and in-depth interviews were used to explore these factors in men, and women of different age groups. Discussions were recorded, transcribed and analysed according to emerging themes. The main findings of the study indicated that in addition to nourishing the body, food is a sign of warmth, acceptance and friendship. Meat consumption on a daily basis is associated with a high socioeconomic status, while consumption of vegetables only is associated with a low socioeconomic status. Eating large portions of food is associated with affordability. Food is used for celebrations, rituals, and for welcoming guests. Food is also used during social occasions when people get together and meet socially. Sweets, ice cream and cakes are consumed on happy occasions. Fatty meat is a sign of generosity; lean meat and black tea is often used during mourning periods. Eating behaviours are learned during socialization, and carried over from generation to generation. There are socially accepted norms and values surrounding people’s understanding of what food is. This information needs to be used in a more constructive way to help people choose food wisely to prevent over nutrition and associated risks. In conclusion, this paper illustrates the impact of socio-cultural factors on eating patterns in this population and emphasizes the need to take these factors into consideration in development of interventions to promote healthy eating

Cochrane corner: beta-blockers for hypertension

Beta-blockers refer to an assorted group of medications that block the action of endogenous catecholamines on beta-adrenergic receptors.1 The ß1 and ß2 receptorsare the primary beta-adrenergic receptors in the human cardiovascular system. Beta- blockers differ in their ß1/ ß2-receptor selectivity and vasodilatory properties. Based on this diversity, beta-blockers have been categorised into first, second and third generation. First-generation beta-blockers, also referred to as non-selective blockers, possess equal affinity for ß1 and ß2 receptors. Second-generation (or selective) beta-blockers exercise more affinity for ß1 than ß2 receptors. Neither of these traditional beta-blockers has vasodilatory properties, which is an intrinsic characteristic of third-generation beta-blockers.IS

Emerging roles and competencies of district and sub-district pharmacists: a case study from Cape Town

District and sub-district pharmacist positions were created during health sector reform in South Africa. High prevalence of HIV/AIDS, tuberculosis and increasing chronic non-communicable diseases have drawn attention to their pivotal roles in improving accessibility and appropriate use of medicines at the primary level. This research describes new roles and related competencies of district and sub-district pharmacists in Cape Town. Between 2008 and 2011, the author (HB) conducted participatory action research in Cape Town Metro District, an urban district in the Western Cape Province of South Africa, partnering with pharmacists and managers of the two government primary health care (PHC) providers. The two providers function independently delivering complementary PHC services across the entire geographic area, with one provider employing district pharmacists and the other sub-district pharmacists. After an initiation phase, the research evolved into a series of iterative cycles of action and reflection, each providing increasing understanding of district and sub-district pharmacists’ roles and competencies. Data was generated through workshops, semi-structured interviews and focus groups with pharmacists and managers which were recorded and transcribed. Thematic analysis was carried out iteratively during the 4-year engagement and triangulated with document reviews and published literature. Five main roles for district and sub-district pharmacists were identified: district/sub-district management; planning, co-ordination and monitoring of pharmaceuticals; information and advice; quality assurance and clinical governance; and research (district pharmacists)/dispensing at clinics (sub-district pharmacists). Although the roles looked similar, there were important differences, reflecting the differing governance and leadership models and services of each provider. Five competency clusters were identified: professional pharmacy practice; health system and public health; management; leadership; and personal, interpersonal and cognitive competencies. Whilst professional pharmacy competencies were important, generic management and leadership competencies were considered critical for pharmacists working in these positions. Similar roles and competencies for district and sub-district pharmacists were identified in the two PHC providers in Cape Town, although contextual factors influenced precise specifications. These insights are important for pharmacists and managers from other districts and sub-districts in South Africa and inform health workforce planning and capacity development initiatives in countries with similar health systems.Web of Scienc

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant