HIV prevention transformed : the new prevention research agenda.

We have entered a new era in HIV prevention whereby priorities have expanded from biomedical discovery to include implementation, effectiveness, and the effect of combination prevention at the population level. However, gaps in knowledge and implementation challenges remain. In this Review we analyse trends in the rapidly changing landscape of HIV prevention, and chart a new path for HIV prevention research that focuses on the implementation of effective and efficient combination prevention strategies to turn the tide on the HIV pandemic

Food choices and macro- and micronutrient intake of Sowetans with chronic heart failure

Thesis (MPhil (Rehabilitation))--University of Stellenbosch, 2011.ENGLISH ABSTRACT: In South Africa, rapid urbanisation and epidemiological transition have left the black urban population vulnerable to diseases of lifestyle such as chronic heart failure. This is in part due to the fact that changes in dietary patterns during urbanization play an important role in the increase of risk factors of these diseases. However, there is a lack of information on dietary choices of black urban populations. Therefore the current study evolved to describe the food choices and macro-and micronutrient intake of black, urban Sowetans, newly diagnosed with chronic heart failure, who attended the outpatient cardiac clinic at Chris Hani Baragwanath Hospital. A descriptive study methodology that made use of quantitative methods of data collection was used. Study participants comprised Sowetans with chronic heart failure who attended the Chris Hani Baragwanath Hospital outpatient cardiac clinic for the first time. Consecutive sampling followed by stratified random sampling was used to identify study participants. Participants were stratified for gender. Hundred persons participated in the study. Data was collected through the Food Frequency Questionnaire, a demographic questionnaire and measuring of height and weight. Data from the FFQ's was analysed for macro- and micronutrient intake by using the MRC "Food Finder 3‟ programme. Data were analysed by a statistician using StatSoft, Inc. (2009) STATISTICA, version 9.0. A p value of 0.05 was seen as statistically significant. The most significant clinical finding is an inadequate intake of certain micro nutrients and excessive salt consumption. Study participants continued to eat the more traditional carbohydrate foods. These staples were supplemented by highly refined carbohydrate sources, such as added sugar, sweets and chocolates, cakes, biscuits and cold drinks. Women ate significantly more maltabella (p=0.04), sweets and chocolates (p=0.01) than men, while men consumed significantly more, meat (p=0.01), milk and milk products (p=0.04), additional salt (p=0.02) and take away foods (p=0.05). Both genders had inadequate intake of Vitamin D [men 4 mcg/day (p=0.00), and women, 4 mcg/day (p=0.01)], selenium, [46 mcg/day (p=0.03) and 32 mcg/day (p=0.00)], folate [215 mcg/day (p=0.00) and 179 mcg/day (p=0.00)] and Vitamin C [71 mg/day (p=0.05) and 66 mg/day (p=0.07)]. Women had an inadequate intake of iron of 9 mg/day (P=0.00). It is recommended that dietary health promotion packages are developed and targeted specifically at this high risk community. Key words: Chronic heart failure, black, urban, food choices, macro-and micronutrients.AFRIKAANSE OPSOMMING: Die swart stedelike bevolking in Suid Afrika gaan gebuk onder 'n al groter wordende risiko vir leefstyl siektes soos kroniese hartversaking. Dit kan gedeeltelik toegeskryf word aan veranderinge in dieet patrone as gevolg van verstedeliking en die epidemiologiese oorgang. Daar is egter nie genoeg inligting oor die voedselkeuses van swart stedelike bevolkingsgroepe nie. Die huidige studie het dus ontwikkel uit die behoefte om die voedselkeuses en mikro- en makronutrient inname van swart, stedelike Soweto inwoners wat nuut gediagnoseer is met hartversaking en die buitepasiënt kardiologie kliniek by Chris Hani Baragwanath Hospitaal bygewoon het, te bepaal. Daar was gebruik gemaak van 'n beskrywende studie metodologie wat gebruik gemaak het van kwantitatiewe metodes van data insameling. Deelnemers aan die studie het bestaan uit swart inwoners van Soweto met kroniese hartversaking wat die buitepasiënt kardiologie kliniek by Chris Hani Baragwanath Hospitaal vir die eerste keer bygewoon het. 'n Opeenvolgende steekproef, gevolg deur gestratifiseerde steekproefneming was gebruik om die studie deelnemers te identifiseer. Deelnemers was gestratifiseer volgens geslag. Eenhonderd pesone het aan die studie deelgeneem. Data is ingesamel deur gebruik te maak van die Voedsel Frekwensie Vraelys, a demografiese vraelys en die meet van lengte en gewig. Data van die Voedsel Frekwensie Vraelyste was ge-analiseer vir mikro-en makronutrient inname met die MRC ”Food Finder 3” program. Data is ge-analiseer deur 'n statistikus met die „StatSoft, Inc. (2009) STATISTICA, version 9.0‟. 'n P waarde van 0.05 is gesien as statisties beduidend. Mees beduidendste kliniese bevinding was die ontoereikende inname van sekere mikro-nutriënte en die verhoogde inname van sout. Studie deelnemers het nog steeds die meer tradisionele koolhidraat voedsels geëet. Hierdie stapel voedsels was aangevul deur hoogs verfynde bronne van koolhidrate, soos ekstra suiker, lekkergoed en sjokolade, koek, koekies en koeldrank. Die vrouens het beduidend meer maltabella (p=0.01), lekkergoed en sjokolade (p=0.01) geëet as mans, terwyl mans beduidend meer vleis (p=0.01), melk en melkprodukte (p=0.04), bygevoegde sout (p=0.02) en wegneem kosse (p=0.05) ingeneem het. Beide geslagte het ontoereikende innames van vitamiene D [mans 4 mcg/dag (p=0.00), en vrouens, 4 mcg/dag (p=0.01)], selenium [46 mcg/dag (p=0.03) en 32 mcg/dag (p=0.00)], foliensuur [215 mcg/dag (p=0.00) en 179 mcg/dag (p=0.00)] en vitamiene C [71 mg/dag (p=0.05) en 66 mg/dag (p=0.07)]. Vrouens het 'n ontoereikende inname van yster van 9 mg/dag (p=0.00) gehad. Daar word aanbeveel dat gesonde voedingsprogramme ontwikkel word, spesifiek gemik op hierdie bevolkingsgroep. Sleutelwoorde: Kroniese hartversaking, swart, verstedeliking, voedselkeuses, makro- en mikronutriënte

Anthropometric profiles of 8–11 year old children from a low-income setting in South Africa

Abstract Background Communities in low-to-middle income countries undergoing rapid urbanisation as well as nutrition transition are particularly at risk for associated health issues such as overweight and obesity. South Africa has a double-burden of both under- and over-nutrition, creating some uncertainty as to where to direct healthcare interventions. Therefore, providing anthropometric data in vulnerable populations, such as in early childhood, is much needed. Methods This observational study assessed height, weight, head circumference and age-adjusted BMI in 1785 Grade 4 (9.5 ± 0.7 years old) learners from 12 schools in two different areas in South Africa. Results Overall, the results of this study found a higher prevalence of overnutrition (>95th percentile for age-adjusted BMI) than undernutrition (<15th percentile for age-adjusted BMI), 27.3% versus 12.4% respectively. Although the boys were significantly older and taller than the girls in this sample, there were no significant sex differences between boys and girls for BMI (19.9 kg/m2 ± 6.0 vs 20 kg/m2 ± 5.8, p = 0.59). Significant differences were found between peri-urban and urban areas for undernutrition (16.1% versus 9.5%, p < 0.001) and overnutrition (9.7% versus 41.2%, p < 0.001). Conclusion South African children living in urban areas are particularly vulnerable to high rates of overweight and obesity. Therefore, interventions that are area and context specific are needed to address the issues of malnutrition in South Africa

Short message service (SMS) as an educational tool during pregnancy : A literature review

Background: In many low- and middle-income countries, access to health information during pregnancy is poor. The rapid adoption of mobile phones in these countries has created new opportunities for disseminating such information. Objective: This paper reviews existing information on the use of short message services (SMSs) as a feasible tool to transmit health education information. Methods: The PubMed, Cochrane library, EMBASE and Google scholar databases were searched for studies in which mobile phone SMSs were used to promote health education during pregnancy. Studies of adult women, from any setting, who received SMS health education messages during their pregnancy, were included, irrespective of study design. Results: The analysis of results followed a narrative synthesis approach, a textual approach involving a synthesis of findings from multiple studies. The synthesis was developed manually, based on the extraction of data. All studies demonstrated use or interest in SMS technology to facilitate health information messaging. Findings from several studies showed that pregnant women were both receptive and willing to use SMS technology to enhance their health. In Zanzibar, the effect of SMS on skilled delivery rates and access to emergency healthcare was assessed. The effects SMS alerts had on hospital deliveries and SMS interventions had on facility use during pregnancy were assessed in Rwanda. Conclusion: The review highlights the practicality and willingness of utilising SMS technology to promote or enhance health education

Short message service (SMS) as an educational tool during pregnancy : A literature review

Background: In many low- and middle-income countries, access to health information during pregnancy is poor. The rapid adoption of mobile phones in these countries has created new opportunities for disseminating such information. Objective: This paper reviews existing information on the use of short message services (SMSs) as a feasible tool to transmit health education information. Methods: The PubMed, Cochrane library, EMBASE and Google scholar databases were searched for studies in which mobile phone SMSs were used to promote health education during pregnancy. Studies of adult women, from any setting, who received SMS health education messages during their pregnancy, were included, irrespective of study design. Results: The analysis of results followed a narrative synthesis approach, a textual approach involving a synthesis of findings from multiple studies. The synthesis was developed manually, based on the extraction of data. All studies demonstrated use or interest in SMS technology to facilitate health information messaging. Findings from several studies showed that pregnant women were both receptive and willing to use SMS technology to enhance their health. In Zanzibar, the effect of SMS on skilled delivery rates and access to emergency healthcare was assessed. The effects SMS alerts had on hospital deliveries and SMS interventions had on facility use during pregnancy were assessed in Rwanda. Conclusion: The review highlights the practicality and willingness of utilising SMS technology to promote or enhance health education

Prognostic Value of HPV E6/E7 mRNA Assay in Women with Negative Colposcopy or CIN1 Histology Result: A Follow-Up Study

Pap test, and especially HPV DNA test, identify a large group of women who do not have any clinically relevant lesions, i.e., CIN2+ (Cervical Intraepithelial Neoplasia grade 2 or worse), but who are at greater risk of getting lesions in the future. The follow up of these women needs new biomarkers with prognostic value. The objective of this study is to evaluate the prognostic value of E6/E7 mRNA over-expression assay (PreTect HPV-Proofer, Norchip) for 5 HR-HPV types (16, 18, 31, 33, and 45) for progression to CIN2+ after a negative colposcopy. This prospective study, conducted at four Italian centres, enrolled 673 women with either a negative colposcopy or a negative or CIN1 histology. The clinical end-point was histological confirmation of CIN2+. Women were classified at baseline according to mRNA results and managed according to local colposcopy protocols. At least one conclusive follow-up test was obtained for 347 women (25 months average lapse since recruitment, range 5-74). Only seven CIN2+ were detected during follow up, three among the 82 women positive for mRNA at baseline, two among the 250 negative (Fisher exact test, p = 0.02), and two among the 12 with an invalid test. Absolute CIN2+ risk was 6.7/1,000 person/years in the whole cohort. The absolute CIN2+ risk was 18.4/1,000 person/years and 3.6/1,000 person/years in mRNA-positive and mRNA-negative women, respectively. In conclusion, E6/E7 mRNA overexpression appears to be a good candidate as a prognostic biomarker to manage HR-HPV DNA-positive women with negative colposcopy or histology, particularly in order to decrease follow-up intensity in those who are negative