Household food security and HIV status in rural and urban communities in the Free State province, South Africa

Higher socioeconomic status impacts profoundly on quality of life. Life-event stressors, such as loss of employment, marital separation/divorce, death of a spouse and food insecurity, have been found to accelerate disease progression among people with human immunodeficiency virus (HIV). The objective of this study was to determine significant independent sociodemographic and food security factors associated with HIV status in people from rural and urban communities in the Assuring Health for All study, which was undertaken in rural Trompsburg, Philippolis and Springfontein and urban Mangaung, in the Free State Province of South Africa. Sociodemographic and food security factors associated with HIV status were determined in 886 households. Logistic regression with forward selection (p < 0.05) was used to select significant independent factors associated with HIV status. Variables with a p-value of < 0.15 were considered for inclusion in the model. Adults 25–64 years of age were eligible to participate. Of the 567 rural participants, 97 (17.1%) were HIV-infected, and 172 (40.6%) of the 424 urban participants. A relatively high percentage of respondents had never attended school, while very few participants in all areas had a tertiary education. The unemployment rate of HIV-infected adults was higher than that of HIV-uninfected adults. A high percentage of respondents in all areas reported running out of money to buy food, with this tendency occurring significantly more among urban HIV-infected than HIV-uninfected respondents. In all areas, a high percentage of HIV-infected respondents relied on a limited number of foods to feed their children, with significantly more HIV-infected urban respondents compared to their uninfected counterparts reporting this. Most participants in all areas had to cut the size of meals, or ate less because there was not enough food in the house or not enough money to buy food. During periods of food shortage, more than 50% of respondents in all areas asked family, relatives or neighbours for assistance with money and/or food, which occurred at a higher percentage of HIV-infected rural participants compared to HIV-uninfected rural participants. More than half of all participants reported feeling sad, blue or depressed for two weeks or more in a row. HIV infection was negatively associated with being married (odds ratio 0.20 in rural areas and 0.54 in urban areas), while church membership decreased the likelihood of HIV (odds ratio 0.22 in rural areas and 0.46 in urban areas). Indicators of higher socioeconomic status (having a microwave oven and access to vegetables from local farmers or shops) decreased the likelihood of HIV in rural areas (odds ratios 0.15 and 0.43, respectively). Indicators of lower socioeconomic status such as spending less money on food in the rural sample (odds ratio 3.29) and experiencing periods of food shortages in the urban sample (odds ratio 2.14), increased the likelihood of being HIV-infected. Interventions aimed at poverty alleviation and strengthening values can contribute to addressing HIV infection in South Africa.Keywords: HIV, poverty, food securit

Reported health, lifestyle and clinical manifestations associated with HIV status in people from rural and urban communities in the Free State Province, South Africa

Background: HIV infection impacts heavily on the infected individual’s overall health status.Aim: To determine significant health, lifestyle (smoking and alcohol use) and independent clinical manifestations associated with HIV status in rural and urban communities.Methods: Adults aged between 25 and 64 years completed a questionnaire in a structured interview with each participant. Blood specimens were analysed in an accredited laboratory using standard techniques and controls. Anthropometric measurements were determined using standardised methods.Results: Of the 567 rural participants, 97 (17.1%) were HIV-infected, and 172 (40.6%) of the 424 urban participants. More than half of HIV-infected rural participants used alcohol and more than 40% smoked. Median body mass index (BMI) of HIV-infected participants was lower than that of uninfected participants. Significantly more HIV-infected participants reported experiencing cough (rural), skin rash (urban), diarrhoea (rural and urban), vomiting (rural), loss of appetite (urban) and involuntary weight loss (rural). Significantly more HIV-uninfected participants reported diabetes mellitus (urban) and high blood pressure (rural and urban). In rural areas, HIV infection was positively associated with losing weight involuntarily (odds ratio 1.86), ever being diagnosed with tuberculosis (TB) (odds ratio 2.50) and being on TB treatment (odds ratio 3.29). In the urban sample, HIV infection was positively associated with having diarrhoea (odds ratio 2.04) and ever being diagnosed with TB (odds ratio 2.49).Conclusion: Involuntary weight loss and diarrhoea were most likely to predict the presence of HIV. In addition, present or past diagnosis of TB increased the odds of being HIV-infected. Information related to diarrhoea, weight loss and TB is easy to obtain from patients and should prompt healthcare workers to screen for HIV

Perceptions of mental health care consumers regarding their conditions

Background: Distress is experienced, understood, expressed and communicated differently across various cultures. Individuals assign meaning to their mental health problems from their own personal, social and cultural context. Mental healthcare consumers (MHCCs) often attribute their symptoms to a cultural or spiritual cause, and as a result, tend to visit spiritual or traditional healers before attending psychiatric units. Aim: The aim of the study was to determine patients’ perspectives on mental health – what they perceived to be the cause of mental problems and what they believed the most appropriate treatment options would be. The role of culture, religion and spirituality in patients’ understanding of and coping with mental problems was explored, as well as their attitudes toward their treatment and the perceived effectiveness and appropriateness of the different treatment modalities. Methods: A quantitative survey was done using a questionnaire designed to explore and analyse patients’ cultural and religious beliefs about mental illness and the actions they take in their search for recovery from mental disturbances. The questionnaire was compiled by incorporating demographic information, together with certain items of the World Health Organisation Quality of Life Spiritual, Religious and Personal Beliefs questionnaire, the Cultural Formulation Interview, the Rating of Medication Influences Scale, and the South African Traditional Beliefs Scale. Results: Ninety-four patients (58.5% male) were included in the study, with a mean age of 36 years. The majority of the participants (75.5%) were black people; most were Christian (79.8%), followed by African traditionalists (17.0%), and 41.4% indicated that they were actively involved in their religious communities. Although most (72.0%) believed that faith in God and help from religious leaders (34.4%) could contribute to their mental wellbeing, 29.0% reckoned that keeping their ancestors happy would protect them from sickness and bad luck. Approximately one quarter (22.3%) believed that traditional medicine could be the only cure for mental illness related to bewitchment, and 29.0% believed that Western medicine could worsen such problems. Roughly a third of participants (30.9%) were of the opinion that Western medicine cannot cure mental illness caused by angry ancestors. Conclusion: The impact cultural and religious belief systems have on MHCCs’ perceptions of mental illness has been demonstrated and appeals to the availability of accepta ble mental health care services. Mental healthcare providers’ sensitivity to cultural and religious beliefs will enrich the therapeutic relationship; hence healthcare providers should receive training focusing on the influence these belief systems have on patients’ perceptions of mental illness and their consequent help-seeking behaviour. Likewise, findings of the current study suggest a need for the incorporation of complementary and alternative treatment strategies in the rendering of mental healthcare services. Such inclusion acknowledges MHCCs’ preferences and may reduce the time required to obtain remission and recovery. Although its application has limitations, future research may provide useful insight for the formulation and implementation of interventions that MHCCs believe to be effective

The relationship between obesity, leptin, adiponectin and the components of metabolic syndrome in urban African women, Free State, South Africa

Objectives: Obesity prevalence is increasing worldwide. In South Africa, older and urbanised African women have significantly higher rates of obesity. Limited information is available on the relationship between anthropometric parameters, adipokines and metabolic health status of African women. This study investigated the relationship between obesity, adipokines and the components of metabolic syndrome in urban African women.Methods: This study included 135 urban African women that were 26–63 years of age, identified with metabolic syndrome in the urban leg of the Assuring Health for All in the Free State (AHA-FS) study. To establish anthropometric status, the following measures were taken: body weight, height and waist circumference. Blood was drawn to determine leptin, adiponectin levels and metabolic status.Results: Adiponectin levels in obese women were significantly decreased compared to normal weight women. Leptin levels and leptin:adiponectin ratios (L:A) were increased in the obese group compared to the overweight and normal weight groups. Leptin and L:A showed strong positive correlations with body mass index and waist circumference. Adiponectin levels decreased as the number of components of metabolic syndrome increased. The L:A ratio was significantly lower in women with elevated triglycerides and significantly higher in women with elevated blood glucose levels. Adiponectin levels were significantly lower in women with elevated blood glucose.Conclusion: This study confirms the inverse relationship between adiponectin and leptin with increased body adiposity. Results indicate that waist circumference, fasting blood glucose and triglyceride levels are the metabolic syndrome components most closely associated with altered adiponectin and leptin levels and L:A in urban African women with metabolic syndrome.Keywords: adipokines, adiponectin, components of metabolic syndrome, leptin, L:A ratio, obesit

Antimicrobial susceptibility profile of uropathogens in Maluti Adventist Hospital patients, 2011

Background: Urinary tract infections (UTIs) are amongst the most common infections encountered globally and are usually treated empirically based on bacterial resistance to antibiotics for a given region. Unfortunately in Lesotho, no published studies are available to guide doctors in the treatment of UTIs. Treatment protocols for Western countries have been adopted, which may not be applicable for this region. Aim: To determine the antimicrobial susceptibility profile of uropathogens in outpatients at the Maluti Adventist Hospital. Setting: The study was conducted at the outpatient department of the Maluti Adventist Hospital in Mapoteng, Lesotho. Methods: This was a prospective cross-sectional study using consecutive sampling of patients with clinical symptoms of UTI. Midstream urine samples were screened through chemistry and microscopy, then positive urine samples were cultured. The isolated uropathogens underwent antimicrobial susceptibility testing and inclusion continued until 200 culture samples were obtained. Descriptive statistics were used in the data analysis. Results: The top five cultured uropathogens were Escherichia coli (61.5%), Staphylococcus aureus (14%), Pseudomonasspecies (6.5%), Enterococcus faecalis (5.5%) and Streptococcus agalactiae (5%). The isolated uropathogens showed low sensitivity to cotrimoxazole (32.5% – 75.0%) and amoxicillin (33.2% – 87.5%) and high sensitivity to ciprofloxacin (84.0% – 95.1%) and nitrofurantoin (76.9% – 100%). Conclusion: In the Maluti setting, cotrimoxazole and amoxicillin should be avoided as first-line drugs for the empirical treatment of community-acquired UTI. We recommend the use of nitrofurantoin as first choice

Physical activity levels of HIV-infected individuals in rural and urban communities in Free State Province, South Africa

HIV infection increases fatigue and physical inactivity. This study aimed to determine levels of physical activity associated with HIV infection in individuals from rural and urban communities in the Free State Province, South Africa. Adults aged 25–64 years were eligible to participate. Ninety-seven (17.1%) of the 567 rural and 172 (40.6%) of the 424 urban participants were HIV-infected. Logistic regression with forward selection (p<0.05) was used to select significant independent physical activity levels (PAL) associated with HIV status. Variables with a p-value of <0.15 were considered for inclusion in the model. In urban areas, the median PAL of both males and females fell in the low-active category, while in rural areas HIV-uninfected males and females were more active than HIV-infected participants. In the rural sample, HIV infection was positively associated with being sedentary versus very active (odds ratio 3.18, CI 1.31; 7.70); low active versus very active (odds ratio 2.27, CI 1.08; 4.77); and active versus very active (odds ratio 2.44, CI 1.31; 4.55). Being physically inactive was positively associated with HIV infection in the rural sample of this study, confirming that decreased physical activity is often an outcome of HIV infection.Keywords: HIV; Physical activity; Health benefits; Free State Province, South Afric

Risk-factor profiles for chronic diseases of lifestyle and metabolic syndrome in an urban and rural setting in South Africa

Background: Chronic lifestyle diseases share similar modifiable risk factors, including hypertension, tobacco smoking, diabetes, obesity, hyperlipidaemia and physical inactivity. Metabolic syndrome refers to the cluster of risk factors that increases the risk for developing type 2 diabetes mellitus (DM) and cardiovascular disease.Objectives: The study aimed to assess health status and identify distinct risk-factor profiles for both chronic lifestyle diseases and metabolic syndrome in rural and urban communities in central South Africa.Methods: The investigation formed part of the Assuring Health for All in the Free State (AHA-FS) study. During interviews by trained researchers, household socio-demographic and health information, diet, risk factors (i.e. history of hypertension and/or diabetes) and habits (e.g. smoking and inadequate physical activity levels) were determined. Adult participants underwent anthropometric evaluation, medical examination and blood sampling. Results: The risk-factor profile for chronic lifestyle diseases revealed that self-reported hypertension and physical inactivity were ranked the highest risk factor for the rural and urban groups respectively. The cumulative risk-factor profile showed that 40.1% of the rural and 34.4% of the urban study population had three or more risk factors for chronic lifestyle diseases. Furthermore, 52.2% of rural and 39.7% of urban participants had three or more risk factors for metabolic syndrome.Conclusion: This study confirmed that the worldwide increase in the prevalence of chronic lifestyle diseases can be attributed to a more sedentary lifestyle, illustrated in the urban study population, and increasing obesity. The rural study population had a higher prevalence of risk factors for metabolic syndrome