164 research outputs found
Determinants of obesity in an urban township of South Africa
OBJECTIVE: To estimate the prevalence of overweight and obesity, and identify factors associated with Body Mass Index (BMI) and waist
circumference (WC) among adults residing in an urban township in South Africa.
DESIGN: Cross-sectional study.
SETTING: Khayelitsha, a large black township located in Cape Town.
SUBJECTS: 107 males and 530 females, aged ≥ 18 years.
METHODS: The prevalence of overweight/obesity (BMI ³ 25 kg/m2) and abdominal obesity (WC ≥ 94 cm for men and ≥ 80 cm for women),
and their relationship with factors previously found to increase the risk of obesity, such as age, gender, marital status, educational level,
employment status, immigrant status from rural to urban, and physical activity level, were assessed using logistic regression analyses.
RESULTS: The prevalence of obesity (BMI ³ 30 kg/m2) was 53.4% and 18.7%, and that of abdominal obesity was 71.5% and 23.4%, among
women and men respectively. However, more women (21.3%) than men (11.2%) reported walking more than 45 minutes per day. Female
gender and being married were associated with a high BMI and large WC. Recent migration was associated with a smaller WC. The level of
physical activity was not associated with BMI or WC.
CONCLUSIONS: These findings suggest that physical activity may play less of a role in obesity control, or that more than 45 minutes of physical
activity per day is required to reduce the risk of obesity, especially in women. At least among South African women, obesity control focused
on nutritional interventions may be more beneficial than increasing the intensity or duration of physical activity.National Research
Foundation (NRF) and Medical Research Council, Tygerberg, South
Africa
Communication on sexual issues between migrant males and their partners: a study undertaken in rural South Africa
INTRODUCTION: Women stay alone with their children in rural places while their husbands I partners work away from
home for varying periods of time. Such fluctuating migration may cause difficulty in communications and may spread
sexual transmittable infections (STI) and the human immunodeficiency virus (HIV).
OBJECTIVE: This study explored ways in which black women in rural South Africa communicated with partners, who
were migrant workers, on issues related to sexual matters.
Method: This is a qualitative study where four focus groups were utilized to allow the women to describe their
experiences, and to verbalize their feelings, beliefs, and perceptions in this area.
PARTICIPANTS: Four focus groups consisting of six females between the ages of 16 - 48 who had partners that were
employed as migrant labourers and do not live at home.
Setting: A rural area in Hlabisa jurisdiction.
DATA COLLECTION: An interview schedule with open questions were used to facilitate the focus group discussions
Findings: The women, who saw their partners infrequently, were unlikely to communicate with them about sexual
matters, including STI, HIV, and contraception to prevent unintended pregnancy. Poor communication severely
constrained the possibility of reducing the risk of these outcomes. Raising the subject could be interpreted as a
violation of the trust attached to the monogamous relationships of these Zulu women. The women felt they owed their
returning husbands sexual intimacy and refusal was not an option because it was typically countered with force.
CONCLUSION: The desire and need for sexual communication carried a price that was too high for women to pay.
Control of their sexuality was mostly in the hands of their partners, upon whom they were economically and socially
dependent. At this point in the HIV pandemic is it important to cultivate and identify the relevant social, cultural and
behavioural norms that could reduce risk situations that tend to favour the spread of HIV
Impact of the HIV/AIDS pandemic on non-communicable disease prevention
HIV/AIDS continues to ravage sub-Saharan Africa, and in
South Africa accounts for 30% of all mortality, making it the
leading cause of death. The epidemic has had other negative
effects, which have not been fully realised. Among these is the
fact that, paradoxically, the awareness programmes
implemented to prevent major spread of HIV/AIDS have
complicated the prevention of non-communicable diseases
(NCDs)
The translation and cultural adaptation of patient-reported outcome measures for a clinical study involving traditional health providers and bio-medically trained practitioners
This study reports on the cultural and language translation of measures for use with Zulu speakers in South Africa. The translation process was purposefully used to integrate our diverse 14 person study team by employing Community Based Participatory Research (CBPR) strategies. Measures included: the Medical Outcomes Study HIV Health Survey (MOS-HIV), Center for Epidemiologic Studies Depression Scale (CES-D), and Perceived Stress Scale (PSS).
The translation was made complex by the variation in Zulu dialects across regions and even between two cities only forty-five minutes apart. Carefully conceived translations can simultaneously produce good translations and deepen team members’ understanding of each other.National Center for Complementary and Alternative Medicine gran
Estimating the burden of disease attributable to excess body weight in South Africa in 2000
OBJECTIVE: To estimate the burden of disease attributable to
excess body weight using the body mass index (BMI), by age
and sex, in South Africa in 2000.
DESIGN: World Health Organization comparative risk
assessment (CRA) methodology was followed. Re-analysis of
the 1998 South Africa Demographic and Health Survey data
provided mean BMI estimates by age and sex. Population attributable
fractions were calculated and applied to revised
burden of disease estimates. Monte Carlo simulation-modelling
techniques were used for the uncertainty analysis.
SETTING: South Africa.
SUBJECTS. Adults ≥ 30 years of age.
OUTCOME MEASURES. Deaths and disability-adjusted life years
(DALYs) from ischaemic heart disease, ischaemic stroke,
hypertensive disease, osteoarthritis, type 2 diabetes mellitus,
and selected cancers.
RESULTS: Overall, 87% of type 2 diabetes, 68% of hypertensive
disease, 61% of endometrial cancer, 45% of ischaemic stroke,
38% of ischaemic heart disease, 31% of kidney cancer, 24% of
osteoarthritis, 17% of colon cancer, and 13% of postmenopausal
breast cancer were attributable to a BMI ≥ 21 kg/m2. Excess
body weight is estimated to have caused 36 504 deaths (95%
uncertainty interval 31 018 - 38 637) or 7% (95% uncertainty
interval 6.0 - 7.4%) of all deaths in 2000, and 462 338 DALYs
(95% uncertainty interval 396 512 - 478 847) or 2.9% of all
DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in
females was approximately double that in males.
CONCLUSIONS: This study shows the importance of recognising
excess body weight as a major risk to health, particularly
among females, highlighting the need to develop, implement
and evaluate comprehensive interventions to achieve lasting
change in the determinants and impact of excess body weight
Adapting the diabetes prevention program for low and middle-income countries: Protocol for a cluster randomised trial to evaluate lifestyle Africa
Low and middle-income countries like South Africa are experiencing major increases in burden of non-communicable diseases such as diabetes and cardiovascular conditions. However, evidence-based interventions to address behavioural factors related to these diseases are lacking
Increasing resilience to the SARS-CoV-2 virus and other health threats in food-insecure communities
The health of the majority of South Africa’s population is seriously threatened by hunger and micronutrient deficiency, with impaired immune response a real threat, which the current SARSCoV-2 virus pandemic has highlighted. Traditional household food-processing techniques can, amongst other advantages, increase nutrient bioavailability in affordable staple foods and hence provide a way, in part, to alleviate malnutrition for food-insecure communities. In this way, immune defence and pathogen resilience of the food insecure could be enhanced so that they can better survive both COVID-19 and future threats
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
Implementing and Evaluating Community Health Worker-Led Cardiovascular Disease Risk Screening Intervention in Sub-Saharan Africa Communities: A Participatory Implementation Research Protocol
The increasing burden of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD) in low- and middle-income countries (LMICs) poses a considerable threat to public health. Community-driven CVD risk screening, referral and follow-up of those at high CVDs risk is essential to supporting early identification, treatment and secondary prevention of cardiovascular events such as stroke and myocardial infarction. This protocol describes a multi-country study that aims to implement and evaluate a community health worker (CHW)-led CVD risk screening programme to enhance referral linkages within the local primary care systems in sub-Saharan Africa (SSA), using a participatory implementation science approach. The study builds upon a prior community-driven multicentre study conducted by the Collaboration for Evidence-based Health Care and Public Health in Africa (CEBHA+). This is a participatory implementation research. The study will leverage on the CVD risk citizen science pilot studies conducted in the four selected CEBHA+ project countries (viz. Ethiopia, Rwanda, Malawi, and South Africa). Through planned engagements with communities and health system stakeholders, CHWs and lay health worker volunteers will be recruited and trained to screen and identify persons that are at high risk of CVD, provide referral services, and follow-up at designated community health clinics. In each country, we will use a multi-stage random sampling to select and then screen 1000 study participants aged 35–70 years from two communities (one rural and one urban). Screening will be done using a simple validated non-laboratory-based CVD risk assessment mobile application. The RE-AIM model will be used in evaluating the project implementation outcomes, including reach, fidelity, adoption and perceived effectiveness. Developing the capacities of CHWs and lay health worker volunteers in SSA to support population-based, non-invasive population-based CVD risk prevention has the potential to impact on early identification, treatment and secondary prevention of CVDs in often under-resourced communities. Using a participatory research approach to implementing mobile phone-based CHW-led CVD risk screening, referral and follow-up in SSA will provide the evidence needed to determine the effectiveness of CVD risk screening and the potential for scaling up in the wider region
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
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