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The aim of the study was to examine the mental well-being of audiologists in the midst of the COVID-19 pandemic. A cross-sectional online survey was conducted during the COVID-19 pandemic, between 23 June and 13 August 2020. A self-report survey included screening measures for psychological distress (PHQ-4: anxiety and depression) and loneliness (UCLA-3). 239 audiologists from around the world. The prevalence of psychological distress was 12.1% (subscales for anxiety 16.3% and depression 10.4%), and loneliness 32.2%. Depression and loneliness were higher in those participants self-reporting perceived job insecurity, with psychological distress (anxiety and depression) higher in those from South Africa. Accessibility to Employee Assistance Programs (EAPs) appears to be a protective factor. Well-being interventions, such as EAPS, are needed to support audiologists during challenging times like the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Despite HIV testing having improved globally, men remain disproportionately less likely to test for HIV. While violence against women (VAW) and HIV risk have a strong association among women, few studies explore men around VAW perpetration, risky-sexual behaviour, and HIV testing. Males aged 18–42 years were recruited from a peri-urban settlement near Johannesburg, South Africa. Data were from an endline of a trial. We used logistic regression to assess odds of non-HIV testing using STATA 13. At endline, 1508 men participated in the study. Of these nearly one-third (31.6%, n = 475) had not tested for HIV in the past year. HIV non-testing was significantly lower among men who were single, older, did not complete high school and were less food secure. VAW perpetration retained a significant association with HIV non-testing after controlling for socio-demographics (AOR = 0.73, 95%CI = 0.58–0.93). In multivariate models, HIV non-testing was also associated with inconsistent condom use (AOR = 0.64, 95%CI = 0.48–0.85), problem drinking (AOR = 0.72, 95%CI = 0.55–0.94) and reporting of all four risky sexual behaviours (AOR = 0.70, 95%CI = 0.49–1.01). Data suggests that one-third of men who never test for HIV in this setting may represent a high-risk group. Future campaigns could consider behaviour change around non-violence, relationship quality, and gender norms alongside HIV testing. [ABSTRACT FROM AUTHOR]

The mental health of adolescents (10–19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa are some of the highest in the world. Experiencing pregnancy and living with HIV during adolescence have both been found to be associated with poor mental health within separate explorations. Yet, examinations of mental health among adolescents living with HIV who have experienced pregnancy/parenthood remain absent from the literature. As such, there exists no evidence-based policy or programming relating to mental health for this group. These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV. Analyses utilise data from interviews undertaken with 723 female adolescents drawn from a prospective longitudinal cohort study of adolescents living with HIV (n = 1059) and a comparison group of adolescents without HIV (n = 467) undertaken within the Eastern Cape Province, South Africa. Detailed study questionnaires included validated and study specific measures relating to HIV, adolescent motherhood, and mental health. Four self-reported measures of mental health (depressive, anxiety, posttraumatic stress, and suicidality symptomology) were used to explore the concept of likely common mental disorder and mental health comorbidities (experiencing two or more common mental disorders concurrently). Chi-square tests (Fisher's exact test, where appropriate) and Kruskal Wallis tests were used to assess differences in sample characteristics (inclusive of mental health status) according to HIV status and motherhood status. Logistic regression models were used to explore the cross-sectional associations between combined motherhood and HIV status and, likely common mental disorder/mental health comorbidities. 70.5% of participants were living with HIV and 15.2% were mothers. 8.4% were mothers living with HIV. A tenth (10.9%) of the sample were classified as reporting a probable common mental disorder and 2.8% as experiencing likely mental health comorbidities. Three core findings emerge: (1) poor mental health was elevated among adolescent mothers compared to never pregnant adolescents (measures of likely common mental disorder, mental health comorbidities, depressive, anxiety and suicidality symptoms), (2) prevalence of probable common mental disorder was highest among mothers living with HIV (23.0%) compared to other groups (Range:8.5–12.8%; Χ2 = 12.54, p = 0.006) and, (3) prevalence of probable mental health comorbidities was higher among mothers, regardless of HIV status (HIV & motherhood = 8.2%, No HIV & motherhood = 8.2%, Χ2 = 14.5, p = 0.002). Results identify higher mental health burden among adolescent mothers compared to never-pregnant adolescents, an increased prevalence of mental health burden among adolescent mothers living with HIV compared to other groups, and an elevated prevalence of mental health comorbidities among adolescent mothers irrespective of HIV status. These findings address a critical evidence gap, highlighting the commonality of mental health burden within the context of adolescent motherhood and HIV within South Africa as well as the urgent need for support and further research to ensure effective evidence-based programming is made available for this group. Existing antenatal, postnatal, and HIV care may provide an opportunity for mental health screening, monitoring, and referral. [ABSTRACT FROM AUTHOR]

Globally, chronic diseases place a tremendous burden on health care systems all over the world. The increased prevalence of chronic diseases is mainly influenced by industrialization and decreased levels of physical activity. A cross-sectional qualitative and quantitative pilot survey, using a self-administered questionnaire and focus group discussions, was conducted with 73 students to assess the need for and feasibility of a health promotion program for university students at a rural South African university. The results of this survey suggest that there is a need for a health promotion program aimed at young adults who attend university. [ABSTRACT FROM AUTHOR]

Background: The study was conducted in the Dikgale Health and Demographic Surveillance System (DHDSS) site where we have observed increasing obesity levels, particularly in women, despite evidence of high physical activity (PA) and a relatively low daily energy intake. Objective: This study aimed to assess the socio-demographic, behavioural and biological determinants of body mass index (BMI) in adult residents permanently residing in the DHDSS. Methods: A cross-sectional study was conducted in which socio-demographic, behavioural and biological characteristics from 1143 participants (aged 40–60 years) were collected using a paper questionnaire and standard anthropometric measures. Human immunodeficiency virus (HIV) testing was performed on all participants except those who indicated that they had tested positive. Chi-square and Mann-Whitney tests were used to analyze categorical and continuous variables, respectively, while hierarchical multivariate regression was used to analyze predictors of BMI. Results: The median age of women and men was 51 (46–56) and 50 (45–55) years, respectively. The prevalence of overweight-obesity was 76% in women and 21% in men. A significant negative association of BMI with HIV and smoking and a significant positive association with socio-economic status (SES) was observed in both sexes. In women, BMI was negatively associated with sleep duration (p = 0.015) and age (p = 0.012), but positively associated with sugar-sweetened beverages (SSBs) (p = 0.08). In men, BMI was negatively associated with alcohol use (p = 0.016) and positively associated with being married (p < 0.001). PA was not associated with BMI in either sexes. Full models explained 9.2% and 20% of the variance in BMI in women and men, respectively. Conclusion: BMI in DHDSS adults is not associated with physical inactivity but is associated wealth, marital status, sleep, smoking, alcohol use, and HIV status. Future studies should explore the contribution of nutrition, stunting, psycho-social and genetic factors to overweight and obesity in DHDSS. [ABSTRACT FROM AUTHOR]

In this paper, we investigated the relationship between traditional masculine ideology, body image discrepancy, self-esteem, and the pursuit of muscularity in a sample of school going boys. Constructs were measured using the Traditional Masculine Ideology Scale, Lynch and Zellner's Body Figure Drawings (1999), Rosenberg's Self-Esteem Inventory, and the Drive for Muscularity Scale. Questionnaires were administered to 508 boys, from Grades 10, 11, and 12, at a public single-sex high school in KwaZulu-Natal, South Africa. Analysis revealed significant positive correlations between traditional masculine ideology, the pursuit for muscularity, and body image discrepancy. Indian school boys experienced body image discrepancy more severely than their Black and White counterparts in the sample. Further, there was a significant use of muscle supplements and steroids by school going boys. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) has been highlighted as one of the challenges to the effectiveness of the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs in rural areas in South Africa. This study aimed at assessing the prevalence of prenatal and postnatal physical as well as psychological IPV, and corresponding time-invariant and time-varying predictors, among HIV-positive women attending PMTCT services in rural South Africa. The Conflict Tactics Scale (CTS) was used to assess IPV at four time points prenatal and postnatal. This study highlighted high levels of physical and psychological IPV experienced by HIV-infected women during pregnancy and in the first year after childbirth. Time-invariant predictors and time-varying predictors of physical IPV and psychological IPV were individual, social, and behavioral factors. Multi-dimensional evidence-based interventions are needed to deal with the high levels of prenatal and postnatal physical as well as psychological IPV experienced by these women. [ABSTRACT FROM AUTHOR]

Childhood hypertension drives hypertension in later life; hence, assessing blood pressure in children is an important measure to determine current and future cardiovascular health. There is, however, a paucity of childhood blood pressure data, particularly for sub-Saharan Africa. This study explores blood pressure and associations with age, sex, socioeconomic status, physical activity, fitness, and cardiovascular risk markers. In the 'Disease, Activity and Schoolchildren's Health' (DASH) study, a cross-sectional analysis was conducted in disadvantaged neighbourhoods in the Eastern Cape province of South Africa. Assessments included blood pressure, accelerometer-measured physical activity, physical fitness, and cardiovascular risk markers. The study consisted of 785 children (383 boys, 402 girls, M = 12.4±0.9 years). Overall, 18% of the children were classified as hypertensive, while 20% were either overweight/obese, and almost four out of ten children did not meet global daily physical activity recommendations. Hypertensive children were more likely to be overweight/obese, χ2 (2,785) = 14.42, p < 0.01, but only if they did not meet physical activity recommendations, χ2 (2,295) = 11.93, p < 0.01. Considering the moderating effect which sufficient activity has on the relationship between hypertension and body weight, more emphasis should be placed on early primary health intervention and education strategies. [ABSTRACT FROM AUTHOR]

Diversifying land use of monoculture forestry plantations in land restitution projects in South Africa is critical in achieving a multipurpose production system. The objective of this study was to investigate potential land use options desired by land claimant beneficiaries. A random sampling technique was used to select 351 and 170 beneficiary households in Livubu and Tzaneen communities in Limpopo Province, respectively. Data were collected using household questionnaires and focus group discussions. Descriptive analysis, Chi-square test, Binary logistic regression and Friedman test were used to analyze the data. The study revealed that over 80% of the beneficiaries desired to diversify land use in both study communities and the potential land use options were found to be linked directly with socio-economic factors. There was a significant difference among the potential land-use options for both Livubu (p <.001) and Tzaneen (p <.001) communities. The predominant desired land-use option was agriculture and the least was animal grazing. Due to the poverty of the communities, it is necessary to identify and evaluate the best land-use options for implementation. Additionally, the government should build the capacity, skills and knowledge of beneficiaries on how to diversify land uses to accommodate their socio-economic needs, as articulated in the Agroforestry Strategy. [ABSTRACT FROM AUTHOR]

Home visiting by community health workers (CHW) improves child outcomes in efficacy trials, there is however limited evidence of impact evaluating CHW programmes when operating outside of a research project. A CHW programme, previously demonstrated efficacious in a peri-urban township, was evaluated in a deeply rural context in a non-randomised comparative cohort study. Two non-contiguous, rural areas in the Eastern Cape of South Africa of about equal size and density were identified and 1469 mother-infant pairs were recruited over 33 months. In one area, CHWs conducted perinatal home visits (intervention group). Mothers in the comparison group received standard clinic care. Maternal and child outcomes were compared between the groups at one year. Mothers in the intervention group had significantly fewer depressive symptoms than mothers in the comparison group. Children of intervention mothers attained a higher proportion of their developmental milestones, compared to children in the comparison group. There were no other significant differences between mothers and children in the two groups. It is important to establish key parameters for implementing efficacious CHW programmes, especially as the numbers of CHWs are rapidly increased and are becoming critical components of task-shifting strategies of health departments in low and middle income countries (LMIC). [ABSTRACT FROM AUTHOR]

Background: Coordinating care is a defining characteristic of high quality primary care. Currently, very little is known about coordination of care in South Africa's primary care setting. The Vula Mobile app was introduced in 2018 to assist with referring patients from primary care facilities to the Eerste River District Hospital (ERDH) emergency centre. The aim of this study was to evaluate the use of the app and its effect on coordination of care and capacity building of staff. Methods: Convergent mixed methods were used with quantitative data collected from hospital records and the Vula Mobile database, and with qualitative data collected from health professionals in primary care and the district hospital. Results: Out of 13 321 patients seen in the emergency centre of the district hospital over the 6-month study period, only 1932 (14.5%) of the patients were referred with Vula. Most of these referrals were accepted (85.5%). Sometimes, advice was given to (35.0%) or additional information was requested (27.4%) from the referring doctor. There was little use of Vula in providing other feedback (0.6%). The introduction of the Vula app led to a decrease in the number of inappropriately referred patients (6.7% to 4.2%, p = 0.004). Doctors using the Vula app perceived that it improved care coordination and had the potential for useful feedback. Conclusion: Vula improved coordination of patients referred from primary care facilities in the Metro Health Services to the district hospital, but missed the opportunity to support continuing professional development and learning. Utilisation of the Vula app should be increased and its potential to provide feedback should be enhanced. Attention should be given to reducing the number of patients self-referred or referred without using the Vula app. [ABSTRACT FROM AUTHOR]

Substance use is a recognized risk factor for HIV acquisition, transmission and progression in South Africa. Persons who use drugs (PWUD) and access specialist substance abuse treatment centers (SSATCs) are a potentially critical target group for HIV services because of the severity of their substance use and associated health risks. SSATCs represent an opportunity for integrated programming, particularly HIV testing services (HTS), to reach PWUD who are at an increased risk of or living with HIV. This analysis of national SSATC admission data explores self-reported HIV testing and associated factors to identify coverage gaps and integration opportunities. The South African Community Epidemiology Network on Drug Use (SACENDU) collects routine surveillance data to monitor national treatment admission trends in alcohol and other drug use. SACENDU data from 2012 to 2017 was analyzed using chi-square test of independence and logistic regression to examine associations between HTS, demographic characteristics and substances of use. Of 87,339 treatment admissions, 47.5% (n = 41,481) of patients had not accessed HTS in the prior 12 months. HTS was reported less frequently by patients whose primary substance of use was cannabis or those with polysubstance use (36.9% and 41.1%, respectively). None of the substance use sub-groups reported a testing rate above 70%. Compared to specific reference groups, logistic regression showed those with lower odds of HTS were: 15–19 years (OR = 0.59); had primary-level education (OR = 0.51); were scholars/learners (OR = 0.27); and primarily cannabis users (OR = 0.64). Patients whose primary drug was heroin had higher odds of testing (OR = 2.45) as did those who injected drugs (OR = 2.86). Given the low coverage and decreased odds of self-reported HTS among sub-groups of patients in SSATCs, the integration of HIV services for PWUD should be a priority in South Africa and a focus of the national HIV strategy. [ABSTRACT FROM AUTHOR]

Both specific forms of violence and polyvictimization have been associated with an increased risk for negative mental health outcomes in youth. Despite evidence of gender differences in trauma experience and impact, gender patterns in the comparative contribution of specific violence exposures versus polyvictimization to mental health outcomes have seldom been explored. The few existing studies have all been conducted in high-income countries, while there is a dearth of research from lower and middle-income countries. This study examined the contribution of witnessed and direct community violence, domestic violence, sexual abuse, and different levels of polyvictimization to the severity of posttraumatic stress disorder (PTSD) and depression in a clinic sample of children and adolescents (n = 310) in South Africa. Although polyvictimization rates were high across both genders, polyvictimization posed differential risks for boys and girls. For girls, higher levels of polyvictimization, but not individual violence types, predicted both PTSD and depression severity. For boys, polyvictimization did not predict PTSD or depression severity. Higher levels of victimization in the community predicted PTSD severity among boys, while no forms of violence predicted depression. The findings confirm the value of examining gender patterns in the risk for posttraumatic sequelae posed by exposure to specific and cumulative forms of violence. Implications for interventions with youth in high-violence contexts such as South Africa are considered. [ABSTRACT FROM AUTHOR]

Discriminatory behavior seems to persist in nursing in South Africa despite the presence of antidiscriminatory legislation. Little is known on the views of nurses on discrimination related to their basic rights in the workplace. The objective of this article is to report findings of discriminatory behavior among nurses regarding race, gender, sexual orientation, age, disability, religion, and marital status. A cross-sectional descriptive survey (containing open- and close-ended questions) was conducted in public and private hospitals in the Western Cape and Gauteng provinces of South Africa and n = 573 (response rate 83%) registered nurses participated in the study. Most participants reported discrimination due to race (n = 97, 17.4%) and age (n = 58,10.4%). Statistically significant differences were found in that African nurses reported more discrimination in relation to religion than other races. A statistically significant difference was found in the responses to gender—more males than female nurses reported discriminatory behavior. Qualitative data reflected suggestions of hetero negativity among male nurses and that sexual orientation might enhance the promotion of those like oneself. Younger nurses are treated less respectful, while older nurses reported reduced developmental opportunities. African nurses described more discrimination due to race and are treated with disdain. Staff shortages, nurse staffing, and shift work seemingly enhance discriminatory practices with off duties. Nurses in the hospital environment seem to experience discrimination in relation to basic human rights resulting from an indifference among nurse management to uphold such rights. [ABSTRACT FROM AUTHOR]

This study, a secondary analysis of the HPTN 068 randomized control trial, aimed to quantify the association of father and male presence with HIV incidence and first pregnancy among 2533 school-going adolescent girls and young women (AGYW) in rural South Africa participating in the trial between March 2011 and April 2017. Participants' ages ranged from 13–20 years at study enrollment and 17–25 at the post-intervention visit. HIV and pregnancy incidence rates were calculated for each level of the exposure variables using Poisson regression, adjusted for age using restricted quadratic spline variables, and, in the case of pregnancy, also adjusted for whether the household received a social grant. Our study found that AGYW whose fathers were deceased and adult males were absent from the household were most at risk for incidence of first pregnancy and HIV (pregnancy: aIRR = 1.30, Wald 95% CI 1.05, 1.61, Wald chi-square p = 0.016; HIV: aIRR = 1.27, Wald 95% CI 0.84, 1.91, Wald chi-square p = 0.263) as compared to AGYW whose biological fathers resided with them. For AGYW whose fathers were deceased, having other adult males present as household members seemed to attenuate the incidence (pregnancy: aIRR = 0.92, Wald 95% CI 0.74, 1.15, Wald chi-square p = 0.462; HIV: aIRR = 0.90, Wald 95% CI 0.58, 1.39, Wald chi-square p = 0.623) such that it was similar, and therefore not statistically significantly different, to AGYW whose fathers were present in the household. [ABSTRACT FROM AUTHOR]

Intimate partner violence, nonpartner sexual violence, and physical and sexual violence against children are significant public health issues in South Africa. Theory suggests that experiencing violence in childhood plays a role in propensity to perpetrate violence or vulnerability to violence in adulthood. Most research to date on this topic has been conducted in high-resource countries or within urban or high-risk populations. We explore the relationship between violence in childhood and violence in adulthood in a community-based sample of 18- to 49-year-old adults in rural South Africa using data from a population-based survey (N = 1,044) in North West province in 2014. We measured childhood violence before age 15 years, experience of nonpartner sexual violence in adulthood, and IPV victimization and perpetration in the last 12 months. We conducted multivariate logistic regression; gender was tested as an effect modifier. All estimates are weighted to the subdistrict population. More women (2.7%) than men (0.8%) reported childhood forced sex, whereas fewer women (2.0%) than men (7.9%) reported childhood physical violence. Women and men reported similar rates of IPV victimization (6.8% vs. 5.4%), IPV perpetration (3.3% vs. 4.8%), and forced sex by a nonpartner (1.6% vs. 1.2%). We found that men and women who experienced childhood violence (combined physical and/or sexual) were significantly more likely to experience forced sex by a nonpartner (men: adjusted odds ratio [aOR] = 5.53, 95% confidence interval [CI] = [1.27, 24.0], p <.05; women: aOR = 51.1, 95% CI = [10.58, 246.3], p <.01) compared with those who did not experience childhood violence. They were also 2.5 times as likely to perpetrate recent IPV (aOR = 2.5, 95% CI = [0.97, 6.7], p =.06) or experience recent IPV (aOR = 2.5, 95% CI = [0.9, 6.9], p =.07), although this finding was marginally significant. These results align with the literature from other settings and population groups. [ABSTRACT FROM AUTHOR]

This article reports a one-year study examining the effect of a smartphone meditation app (M-App) in alleviating burnout and promoting resilience among chaplains working in hospices of older adults in Asian and African cities (N1 = 96; N2 = 85). Results indicated that chaplains who used the M-App exhibited lesser emotional exhaustion and depersonalization as burnout markers and higher personal achievement and resilience as compared to leisure app (L-App) users. The M-App was effective (Cohen's d range = 3.08–5.07, p =.001) for the intervention cohort. Male chaplains, highly qualified, attached to assisted living hospices, who used the M-App once-twice a day, perused both videos and learning sessions and self-practiced regularly, reported lower emotional exhaustion and depersonalization and higher personal achievement and resilience post-test. M-App usage behavior mediated the relationship between demographic and hospice related moderators and outcomes. [ABSTRACT FROM AUTHOR]

Neurocognitive impairment (NCI) associated with the human immunodeficiency virus (HIV) remains prevalent amongst people living with HIV. Testing for HIV-associated NCI in routine clinical care is limited in South Africa and reasons for this are unclear. We conducted an online survey amongst healthcare workers (HCW) to assess HIV-associated NCI knowledge and current practices. The final sample included four hundred surveys (n=400). Chi-square analyses were used to explore HCW knowledge of HIV-associated NCI and screening tools. One-way ANOVA was used to compare mean responses between HCW categories. We observed low awareness of HIV-associated NCI terminology and screening tools. HCW seldom suspected NCI among patients and screening practices were uncommon. Referrals for further NCI investigations were never requested. HCW expressed a desire to receive further training to identify HIV associated NCI. The current study highlights the context of HIV-associated NCI knowledge and practices among front-line HIV HCW in resource-limited settings. [ABSTRACT FROM AUTHOR]

Inadequate toilet facilities may increase women's risk of experiencing non-partner sexual violence. We sought to assess the association between young (18–24 year-olds) women's access to toilets and past year non-partner rape experience, in deprived communities in South Africa. Data came from cross-sectional, population-based survey from poor communities from four health districts in two provinces, namely, City of Johannesburg, and Ekurhuleni in Gauteng, and eThekwini and uMgungundlovu, in KwaZulu-Natal. Descriptive, unadjusted and adjusted associations, were estimated in STATA/IC16, accounting for study design. In total, 10,635 young women provided data on toilet access. Past year non-partner rape prevalence was 5.7%. In adjusted analyses, those reporting a shared toilet were more likely to report past year experience of non-partner rape (adjusted odds ratio: 1.45, 95% confidence intervals [1.17, 1.80]), compared to those with their own toilet indoors. Improving access to private, secure toilets is an important component for the prevention of non-partner sexual violence. [ABSTRACT FROM AUTHOR]

Objective: To describe the developmental risks, and its influence, in young children from a low-income South African community. Method: An exploratory, cross-sectional research study design was employed. Developmental screening was conducted during home visits with 126 caregivers and children between 0 and 42 months of age from a low-income South African community. Children who failed the rescreen were referred for diagnostic assessment. A binomial logistic regression was used to determine the effect of developmental risks on developmental outcomes. Results: Seventy-three percent of children screened were identified with a possible developmental delay (n = 59) according to caregiver-report using the PEDS tools. The regression model was statistically significant (χ2 (3) = 34.902, p < 0.001) with exposure to multiple languages (p < 0.05; odds ratio 3.810, CI 1.2–12.4) most indicative of potential developmental delay. Older children (19–42 months) were also more at risk of developmental delay (p < 0.001) than younger children (0–18 months). Conclusions for Practice: Healthcare professionals serving these vulnerable populations should create awareness amongst caregivers about the effect of developmental risks, in particularly multiple language exposure, on development. [ABSTRACT FROM AUTHOR]

Background: Choosing a career in anaesthesiology depends on factors that are inherent to the profession as well as factors related to the individual. Awareness of these factors is necessary for recruitment based on the needs of the specialty and the expectations of the individual. Methods: A prospective, contextual, descriptive study design was conducted using convenience sampling. A self-administered questionnaire was used to describe the factors associated with choosing anaesthesiology as a career. This questionnaire was obtained from the USA and was modified for the South African context. It was used with permission from the original authors. The questionnaire was completed by anaesthetists at the University of the Witwatersrand, South Africa. The results of the questionnaire were described as categorical data and chi-squared tests were used for comparisons. A p-value < 0.05 was considered statistically significant. Results: Anaesthesiology was chosen as a career by 38.5% of participants while working as a medical officer. The main factor that influenced this choice was dealing with one patient at a time, which was chosen by more than half of the participants. Of the 130 participants, 94.6% were satisfied with their career choice and 89.2% would choose anaesthesiology as a career again. Conclusion: The three-to-five-year period after medical school is crucial for doctors to develop an interest in anaesthesiology. The main factor that influenced them to choose anaesthesiology as a career, was dealing with one patient at a time and most participants were satisfied with their career choice of anaesthesiology. This information can guide recruitment into anaesthesiology, especially among medical students. This study provides a foundation for further research to investigate these factors, as well as possible reasons for gender differences (which were not explored in this study). [ABSTRACT FROM AUTHOR]

Background: Chronic patients are required to access their chronic medicines on a regular basis, often only to refill their repeat prescriptions. Adherence to chronic medicines is challenging and has stimulated health care providers to devise differentiated service delivery models of care to decentralise chronic medicine distribution to decrease the frequency of medicine collection at health care facilities. One such option includes a last kilometre medicine delivery service. This study investigated chronic patients' preferences for a last kilometre medicine delivery service model. Methods: An exploratory non-randomised quantitative study was conducted over 4 weeks at four public sector primary health care facilities in Cape Town, South Africa. Data was collected on a structured questionnaire from chronic patients queuing to receive medication at each facility's pharmacy waiting area. Patient demographics were noted to align with preferences for chronic medicine service delivery characteristics including; mobile ordering, fee for service and location for delivery. Chi-square test and frequencies were employed to analyse data using SPSS version 23. Results: A total of 116 patients participated in this study. Most were interested in a medicine delivery service (80.2%) and were willing to use a mobile application to order their medicines (84.5%). Almost all patients (96.8%) preferred that their medicines be delivered to their home. More than three quarters of participants were willing to pay for the service (77.6%). Chi-square test showed that gender, age group, employment status, distance to the health facility and /or average waiting time at the clinic significantly influenced the preference for certain characteristics of the medicine delivery service (p < 0.05). Conclusion: Most participants were interested in a last kilometre medicine delivery service, especially those older than 45 years, waiting for more than 6 h at the facility, and staying within one kilometre radius of the clinic. More studies are needed to establish the influence of patients' employment status and the distance to health facility on interest in the medicine delivery service. [ABSTRACT FROM AUTHOR]

Background: Towards the end of the 2017 school year, a prominent beverage company in South Africa pledged to remove their sugar-sweetened beverages (SSBs) and advertisements from primary schools in order to contribute to the realization of a healthy school environment. Objectives: To assess the availability and advertising of the company's beverages in public primary schools in Gauteng province following their voluntary pledge to remove the products, and to explore perceptions of school staff regarding SSB availability in schools and processes related to the implementation of the pledge. Methods: In 2019, we conducted a representative survey of public sector primary (elementary) schools in Gauteng province, South Africa. A random sample of schools was drawn, with schools stratified by whether or not they charge fees. This was a proxy for the socioeconomic status of the locale and student body. At each school, the availability of beverages and presence of advertising or not was assessed by an observational audit tool and differences across fee status assessed by Pearson χ 2 test. Semi-structured interviews were conducted with a purposive sample of school officials. Data from the interviews were coded and thematic analysis conducted. Results: Two years following a voluntary pledge, the company's carbonated SSBs were available for sale in 54% (CI: 45–63%) of schools with tuck shops and advertised in 31% (CI: 25–39%). Qualitative interviews revealed a complex landscape of actors within schools, which, combined with indifference or resistance to the pledge, may have contributed to the continued availability of SSBs. Conclusions: Though we were unable to examine SSB availability before and after the pledge, our findings provide some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove SSBs and advertisements from schools. Mandatory regulations coupled with in-depth engagement with schools may be an avenue to pursue in the future. [ABSTRACT FROM AUTHOR]

Among men in South Africa, the prevalence of tobacco smoking is as high as 33%. Although smoking is responsible for most lung cancer in South Africa, occupational and environmental exposures contribute greatly to risk. We conducted a tobacco and lung cancer screening needs assessment and administered surveys to adults who smoked >100 cigarettes in their lifetime in Johannesburg (urban) and Kimberley (rural). We compared tobacco use, risk exposure, attitudes toward and knowledge of, and receptivity to cessation and screening, by site. Of 324 smokers, nearly 85% of current smokers had a <30 pack-year history of smoking; 58.7% had tried to stop smoking ≥1 time, and 78.9% wanted to quit. Kimberley smokers more often reported being advised by a healthcare provider to stop smoking (56.5% vs. 37.3%, p=0.001) than smokers in Johannesburg but smokers in Johannesburg were more willing to stop smoking if advised by their doctor (72.9% vs. 41.7%, p<0.001). Findings indicate that tobacco smokers in two geographic areas of South Africa are motivated to stop smoking but receive no healthcare support to do so. Developing high risk criteria for lung cancer screening and creating tobacco cessation infrastructure may reduce tobacco use and decrease lung cancer mortality in South Africa. [ABSTRACT FROM AUTHOR]

Alcohol and drug misuse (ADM) pose a significant disease burden globally. Yet, there remains a gap in understanding risk factors associated with women's ADM, particularly those in marginalised settings. We investigated risk factors associated with ADM amongst young women in urban informal settlements in South Africa. Bivariate and multivariable logistic regression analyses were conducted on a sample of 680 young women assessing associations between sociodemographic factors, mental health, relationship factors and past year ADM. Alcohol misuse was assessed using the 10 item Alcohol Use Disorders Identification Test (AUDIT) scale, with scores ≥8 defining misuse, a single item assessed past year illegal drug use. Alcohol and drug misuse were reported by 23.1% and 31.8% of the women respectively. In multivariable regression, alcohol misuse was associated with experiencing past year non-partner sexual violence, transactional sex with a main partner, past year drug use, and past week depressive symptoms, while drug misuse was associated with alcohol misuse, transactional sex with a casual partner, past year experience of physical and/or sexual IPV and having a functional limitation (disability). Results indicate ADM in informal settlements are shaped by violence and poor mental health. Interventions geared towards strengthening women's economic position and mental healthcare are recommended. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

In this study the relationship between treatment outcomes and antiretroviral treatment (ART) recipients' knowledge, attitudes and beliefs towards HIV/AIDS was analysed. The study employed the positivist paradigm, guided by the Health Belief Model in explaining the intricate relationship between disease, sick-role behaviour and the expected outcome of treatment. The target population comprised ART recipients at Mthatha, South Africa. This study made use of a purposive sample of 112 participants, inclusive of male and female adult recipients. The respondents in this study raised a number of positive and negative issues. The results of the study revealed a significant relationship between ART recipients' knowledge of HIV/AIDS treatment, their view that taking HIV drugs is a waste of time, and the recipients' results of HIV/AIDS treatment. This implies that a significant difference exists between those who have a better CD4, the same CD4, and a worse CD4, based on their knowledge about taking ARVs. The study did not establish a significant relationship between treatment outcomes and some variables of recipients' attitudes towards HIV/AIDS, which means there is no difference between the recipients based on all the attitude variables. While a significant difference exists among recipients of different treatment outcomes (CD4 counts), based on their belief that "Having HIV is a death sentence," no significant difference was found among recipients of different CD4 counts based on their beliefs, such as: whether HIV treatment prolongs life; if a traditional healer can heal HIV; if prayer can heal HIV; that HIV has serious consequences on health; and that practising preventive actions can reduce HIV transmission. [ABSTRACT FROM AUTHOR]

There is very little evidence whether recalling and answering questions about abuse or interpersonal violence has a positive or negative impact on participants of such research. This is an important ethical dilemma to ensure an appropriate risk-benefit ratio in research with young people is maintained. We assessed reported harms, benefits, and regrets of young adolescents who participated in a sensitive research project, and compared the harms and benefits in those who had and had not been victims and/or perpetrators of abuse or intimate partner violence. Participants were 3,264 adolescents aged 12 to 15 years in 41 public schools in the Western Cape, South Africa, who completed a survey about intimate partner violence, verbal, physical, and sexual abuse, as part of an HIV prevention cluster randomized controlled trial. The majority of participants reported research participation as beneficial (70.3%), while 27.7% reported harms and 14% regrets. Victims of abuse were more likely than non-victims to report benefits (71.9% vs. 67.1%; p =.02) and harms (31% vs. 20.9%; p <.01) and were less likely to report regret (13.1% vs. 16.7%; p =.02). Perpetrators of abuse were less likely than non-perpetrators to report benefits (67.4% vs. 72.8%; p =.01) and more likely to report harms (36.4% vs. 26.1%; p <.01) and regrets (17.4% vs. 13.3%; p =.01). Our findings suggested that research participation was more likely to have a positive rather than a negative emotional impact on young adolescents and that relatively few regretted participating. Victims and perpetrators of abuse were more likely to report benefits than harms, supporting the ethical appropriateness of ongoing research on abuse and violence. We recommend that further research is required to clarify and standardize terminology and instruments to quantify these kinds of evaluations, including measurement of the severity and intensity of reported benefits, harms and regrets, and the longer term impact of participation in sensitive research. [ABSTRACT FROM AUTHOR]

Objective: Access to hearing care is challenging in low- and middle-income countries, where the burden of hearing loss is greatest. This study investigated a community-based hearing screening programme using smartphone testing by community care workers (CCWs) in vulnerable populations infected or affected by HIV. Experiences of CCWs were also surveyed. Design: The study comprised two phases. Phase one employed a cross-sectional research design to describe the community-based programme. Phase two was a survey design to describe CCW's knowledge and experiences. Study Sample: Fifteen trained CCWs administered hearing screenings on 511 participants during home-based visits using a validated smartphone application (hearScreen™) during phase one. Diagnostic follow-up assessments included evaluation using the smartphone test (hearTest™), otoscopy and tympanometry. Phase two surveyed the 15 CCW screening experiences. Results: Referral rates for adults and children were 5.0% and 4.2%, respectively. 75.0% of referred participants returned for follow-up diagnostic assessments, 33.3% were diagnosed with hearing loss and referred for further intervention. All 15 CCWs agreed that communities needed hearing services and only 6.6% did not want to continue providing hearing screening. Conclusion: Trained CCWs can decentralise hearing services to vulnerable communities using smartphone screening incorporating automated testing and measures of quality control. [ABSTRACT FROM AUTHOR]

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues – particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities. Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals – 322 persons with disability and 451 comparisons (without disability) – covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling. Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa. Persons with disabilities in rural South Africa have poorer reported health outcomes. Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa. Better access to health care for persons with disabilities is needed in rural South Africa. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mine workers in South Africa face various health and safety risks, and socioeconomic challenges. OBJECTIVE: This study aimed to assess the associations between socio-demographic factors and health, safety and wellness in the South African mining industry. METHODS: Qualitative and quantitative data were collected from 64 interviews with mine management and labour representatives, 14 focus groups with mine workers, and 875 questionnaires completed by mine workers from three platinum, two gold, one coal, one diamond, and one manganese mine in South Africa. RESULTS: Health challenges included non-communicable diseases, HIV/AIDS, tuberculosis (TB), and respiratory diseases, while safety challenges included worker behaviour, stress and fatigue. Socio-demographic factors associated with disease, sick leave, fatigue, accidents and job satisfaction included age, length of service, race, nationality, education, mining sector, work status, income, housing, domestic crowding, sleep, exercise, alcohol use, and perceived quality of life. CONCLUSION: Socio-demographic factors should be taken into consideration when developing workplace health and safety programmes. [ABSTRACT FROM AUTHOR]

Background/aim: The transition from student to occupational therapy practitioner is challenging. In South Africa, this transition is undertaken in rural and underserved areas, as graduate health professionals are deployed by the government for a year of compulsory Community Service. This study set out to establish the characteristics of these practice settings, the resources available for occupational therapy services, the availability and quality of supervision, and participants' perceived ability to communicate with their patients and negotiate cultural differences. Methods: A cross‐sectional survey design was utilised and a questionnaire was sent to all occupational therapists completing Community Service in 2013 (N = 240). Data were analysed using Stata 12 and IBM SPSS Statistics 21.0. Frequencies and percentages were calculated for categorical variables and associations tested with Odds Ratios and the Pearson's Chi square test. Responses to open‐ended questions were post‐coded. Results: A 44.3% (n = 103) response rate was achieved. Practice settings often provided few resources. Although most participants had supervisors (89.6%), many did not find supervision satisfactory (65.9%). Communication difficulties featured strongly (73.9%), but the majority of participants felt they possessed basic cultural competence. Conclusion: Participants worked within complex practice settings that were frequently resource‐restricted with less than satisfactory supervision. Practice required cultural competence and an ability to work across language barriers. Undergraduate curricula need to be tailored to equip new graduates to navigate these contextual realities. Furthermore, human resourcing strategies need to be evaluated and effective supervision and support structures need to be developed. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine whether attendance at an occupational therapy-led day treatment centre for mental health care users affects the use of inpatient services in South Africa. Methods: A retrospective pre-test/post-test quasi-experimental study design was used to compare admissions and days spent in hospital during the 24 months before and after attendance at the centre, using the hospital's electronic records. Total population sampling yielded data for 44 mental health care users who made first contact with the service between July 2009 and June 2010. Data were compared using the Kruskal–Wallis test, Wilcoxon Signed Ranks test and Mann–Whitney U test. Results: There was a significant decrease in the number of admissions (z = −4.093, p = 0.00) and the number of days spent in hospital (z = −4.730, p = 0.00). Participants were admitted to psychiatric care 33 times less in the 24 months' post-intervention, indicating a medium effect (r = 0.436). They also spend 2569 days less in hospital, indicating a large effect (r = 0.504). Conclusion: The findings suggest that an occupational therapy-led day treatment centre could be effective in reducing the use of inpatient mental health services in South Africa. Attendance at an occupational therapy-led community day treatment centre decreases the number of admissions and number of days spent in hospital and is therefore beneficial to mental health care users and service providers. The study indicates that the successful implementation of a community day treatment centre for mental health care users on the grounds of a tertiary hospital by utilising existing resources is possible. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine underlying factor structure of the Critical Care Family Needs Inventory—Emergency Department across three countries to identify similarities and differences. Background: Understanding family needs assists nurses to provide family‐centred care to deliver optimal outcomes for critically ill patients and their families in Emergency Departments. Design: Retrospective secondary analyses of data collected in three cross‐sectional surveys. Methods: Convenience samples involved recruitment of family members accompanying a critically ill relative into four Emergency Departments in Australia (2), South Africa (1) and Taiwan (1). Item‐matched raw data from 374 responses to 40 items from the surveys were collated and analysed using confirmatory factor analysis methods. Reporting adhered to an adapted STROBE checklist. Results: The factor structure of the 40‐item Critical Care Family Needs Inventory—Emergency Department differed between countries. Analyses of the Australian data revealed a four‐factor solution comprised of 18 items across four categories of family need (support, communication, participation and comfort); the Taiwanese data also demonstrated a four‐factor solution comprised of 13 items (support, communication, participation and comfort); alternatively, the South African data revealed a two‐factor solution comprised of nine items (communication and participation). Fifteen items did not match across the countries. However, loading for four items common across all three countries was related to family participation (3) and communication (1). Conclusions: The findings suggest family members from different countries responded to Critical Care Family Needs Inventory—Emergency Department items in different ways. Consistent with concepts of family‐centred care, the study identified participation and communication needs that were common across the countries. The outcomes illustrate the challenge of providing appropriate care for family members during critical illness of a relative in the ED. Relevance to clinical practice: Family perceptions of important needs during critical illness in the Emergency Department differ across countries; hence, the Critical Care Family Needs Inventory—Emergency Department has limited utility. Participation and communication needs emerged as common family needs. [ABSTRACT FROM AUTHOR]

We investigated the impact of an eclectic framework for combining theoretical conceptual practice models on occupational therapists' theoretical reasoning using concurrent mixed methods with repeated measures and grounded theory designs. Study participants (n = 9) attended two workshops to review select occupational therapy theoretical conceptual practice models and learn how to use the eclectic framework. We assessed skills in eclectic combination of theoretical conceptual practice models using the Theory Application Assessment Instrument. The skills improved significantly [χ2(2, 9) = 7.09, p =.02], a finding that was corroborated by the qualitative findings indicating that the eclectic framework may potentially help improve theoretical reasoning among occupational therapists. [ABSTRACT FROM AUTHOR]

The management of forests for multiple purposes coupled with a varying socioeconomic profile of forest users can result in attitudinal differences towards forest management. This study examines the attitudes of rural people in South Africa towards the management of tribal forests. Attitude towards forest management was analysed with respect to five forest management objectives: 1, forest management for rural livelihood resilience to climate change; 2, forest management for reduction and management of forest fire risk; 3, forest management for sustainable forest-based livelihood; 4, forest management for household socioeconomic wellbeing; and 5, forest management for community-based climate change adaptation initiative. A household questionnaire survey was used to elicit information from 155 rural households using the proportionate random sampling procedure. Chi-square test was used to analyse data from the household survey. Factorial analysis was used to analyse variance in attitude towards forest management. The results showed that rural people generally have positive attitudes toward the management of tribal forests. Factor analysis isolated 2 major factors that explained 61% variance in attitude. Based on the findings we conclude that centralising forest management around the four management objectives (1, 3, 4 & 5) are likely to promote inclusive forest-based development in the study communities. [ABSTRACT FROM AUTHOR]

Background: Non-compliance with designated referral pathways has ramifications such as increased patient waiting time, overburdening of higher levels of care and increasing healthcare costs on patients and the healthcare system. The purpose of this study was to assess the determinants of self-directed referrals amongst patients attending hospitals in the eThekwini district of KwaZulu-Natal. Methods: An analytic, cross-sectional study was conducted at the Medical Outpatient Departments across five district hospitals in eThekwini using interviewer-administered questionnaires. Descriptive statistics were used to determine the proportion and the most frequent factors contributing towards patient self-referral. The likelihood of patients to self-refer was tested using chi-square (X2) and a multivariate regression model. Results: There were 315 patients interviewed with 35% (n = 109/315) having self-referred. The majority (51%; 55/107) of self-referrals were male and were of African race (74%; n = 80/107). Five institutional factors, namely: availability of medication at the pharmacy (98%); quality of care at the facility (93%); waiting time at facility (92%); services provided (90%); and attitude of healthcare workers (87%), were ranked as the main drivers of self-referral. Multivariate logistic regression established a significant positive association between patient self-referral and male gender (OR 1.73; CI 1.04–2.87, p < 0.05). Age < 39 years (OR 0.96; CI 0.94–0.99, p < 0.05); and patient awareness of a referral letter (OR 0.28; CI 0.09–0.86, p < 0.05) emerged as protective factor against self-referrals. Conclusion: Males patients tend to bypass the referral pathway whilst younger patients and patients who were aware of a referral letter were less likely to bypass the referral system. In addition to addressing the systemic challenges of waiting times, quality of care and availability of medication, a patient-oriented approach that comprises education, encouragement and increased patient awareness is an important strategy to improve referral pathway compliance. [ABSTRACT FROM AUTHOR]

Objectives We investigated whether a woman's role in household decision-making was associated with receipt of services to prevent mother-to-child HIV transmission (PMTCT). Methods We conducted a secondary analysis of the PEARL study, an evaluation of PMTCT effectiveness in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Our exposure of interest was the women's role (active vs. not active) in decision-making about her healthcare, large household purchases, children's schooling, and children's healthcare (i.e., four domains). Our primary outcomes were self-reported engagement at three steps in PMTCT: maternal antiretroviral use, infant antiretroviral prophylaxis, and infant HIV testing. Associations found to be significant in univariable logistic regression were included in separate multivariable models. Results From 2008 to 2009, 613 HIV-infected women were surveyed and provided information about their decision-making roles. Of these, 272 (44.4%) women reported antiretroviral use; 281 (45.9%) reported infant antiretroviral prophylaxis; and 194 (31.7%) reported infant HIV testing. Women who reported an active role were more likely to utilize infant HIV testing services, across all four measured domains of decision-making (adjusted odds ratios [AORs] 2.00-2.89 all p < .05). However, associations between decision-making and antiretroviral use—for both mother and infant—were generally not significant. An exception was active decision-making in a woman's own healthcare and reported maternal antiretroviral use (AOR 1.69, p < 0.05). Conclusions for Practice Associations between decision-making and PMTCT engagement were inconsistent and may be related to specific characteristics of individual health-seeking behaviors. Interventions seeking to improve PMTCT uptake should consider the type of health-seeking behavior to better optimize health services. [ABSTRACT FROM AUTHOR]

Background: Stability of measures in quantitative social science research is crucial to understand. There is very little evidence on the stability of violence against women and girls measures in the global South. Objective: To assess the test-retest stability of violence against women and girls measures, amongst young (18–30) people in South Africa. Methods: Data were collected from 124 women and 112 men at zero weeks (time 1) and two weeks (time 2), who resided in urban informal settlements in South Africa. Prevalence of each construct was assessed using chi-square contingency tables. Stability of self-report over time was assessed using Cohen's Kappa. Bivariate logistic regression assessed factors associated with changing responses between time 1 and time 2. Results: At group level prevalence of all measures showed no significant differences. Stability of self-report: kappas for past year physical IPV were both k0.20, for ever physical IPV (women k0.58; men k0.50). Sexual IPV in past 12m (women k0.44; men k0.18), and for ever sexual IPV (women k0.56; men k0.46). Kappas for men's perpetration of non-partner sexual violence was k0.29 for past 12m and k0.38 ever. In bivariate regression, completion of secondary education was associated with a reduced odds of changing responses over the time-period for sexual IPV ever women (OR0.16, 0.02–1.04), sexual IPV past 12 months men (OR 0.09, 0.01–0.56), past 12 month non-partner sexual violence men (OR0.19, 0.02–1.41) and lifetime non-partner sexual violence (OR0.23, 0.04–1.19). Being male, compared to being female, was associated with an increased likelihood of changing responses for past 12 month sexual IPV (OR2.10, 1.08–4.09). Conclusions: Prevalence estimates of violence against women measures are stable at group level, but stability of self-reported measures remains a concern. Individual statistical analyses must be treated with caution. Future studies are required to develop further understandings of stability of measures over time. [ABSTRACT FROM AUTHOR]

Medical male circumcision (MMC) is a proven method of HIV risk reduction for men in southern Africa. MMC promotion campaigns and scale-up programmes are widely implemented throughout the Republic of South Africa. However, the impact of promoting MMC on women’s awareness, beliefs, and behaviours has been understudied. We conducted a self-administered anonymous survey of 279 women receiving health services in an impoverished township located in Cape Town, South Africa. Results showed that two in three women were unaware that male circumcision partially protects men from contracting HIV. Women who were aware of MMC for HIV prevention also endorsed beliefs that male circumcision reduces the need for men to worry about HIV and reduces the need for men to use condoms. Male circumcision awareness was also related to reduced perceptions of HIV risk among women. Multivariable models showed that women’s MMC awareness, circumcision risk compensation beliefs, and risk perceptions were associated with decreased condom use and higher HIV risk index scores defined as number of condomless vaginal intercourse X number of sex partners. These results suggest a need for MMC education efforts tailored for women living in communities with high-HIV prevalence where men are targeted for MMC. [ABSTRACT FROM AUTHOR]

Objectives: A cross-sectional study was undertaken at Lancers Road Clinic, Durban, South Africa to determine body composition, haemoglobin, serum albumin and serum high sensitivity C-reactive protein (hs-CRP) levels in asymptomatic ART-naive HIV positive adults. Methods: All eligible adults attending the clinic were sampled. Body composition was assessed using deuterium dilution. Descriptive statistics, Wilcoxon rank-sum test, chi-square test, Fisher’s exact test and Spearman’s rank correlation coefficient were used for data analysis. Results: A total of 84 participants (CD4 count: 542.5 ± 145 cell/mm3) enrolled. The mean body mass index (BMI) was 29.5 (± 6.4) kg/m2 and the mean fat mass percentage was 44.9 (± 18.7). The prevalence of overweight (26.2%, 22/84) and obesity (46.4%, 39/84) was high. Mean haemoglobin (Hb) levels were 12.0 ± 1.6 g/dl. Mild, moderate and severe anaemia was present in 21.4% (18/84), 20.2% (17/84) and 1.2% (1/84) of patients, respectively. Mean albumin levels (36.2 ± 3.8 g/l) were on the borderline low range of normal with mildly depleted albumin levels being present in a third (32.1%, 27/84) of patients. The mean hs-CRP levels (5.5 ± 7.2 mg/l) were high. Conclusion: In this cohort of patients, wasting was not associated with HIV as the prevalence of overweight/obesity was high and followed the population trend in SA. This seemingly well, asymptomatic population of people living with HIV was at an increased risk of morbidity, progression and death due to the compounding factors of overweight/obesity, hypoalbuminemia, raised hs-CRP levels and anaemia. [ABSTRACT FROM AUTHOR]

The ability to reflect meaningfully may help practitioners or students to maintain competence and keep abreast with the latest trends in their practice. Practitioners who are more self-aware or self-discovered are more effective and competent in practice. However, unless educators are trained to practise reflection and to facilitate activities that promote the development of reflective learners, the role of the educator in promoting reflective learning by students will be limited. The purpose of this study was to explore and to describe the role of educators in the facilitation of reflective learning by students. A quantitative, explorative, descriptive study was conducted at nine nursing education institutions in South Africa. A total of 121 nurse educators (n = 121) was selected through a multi-staged probability sampling method. Data were collected using a structured questionnaire. The findings revealed that educators recognise the value of reflective practice but did not necessarily strive to develop their own reflective practices. Although reflective learning was not a formal learning approach in most programmes, the educators included reflection in the teaching and learning activities they facilitated. Educators need formal training to facilitate reflective learning activities to create a reflective learning environment that is conducive to reflection. Reflective learning should also be a formal teaching and learning approach in nursing curricula as reflective practices promote students' critical and creative thinking. [ABSTRACT FROM AUTHOR]

Background. Transforming growth factor-β (TGF-β) may inhibit the development of atherosclerosis. We evaluated serum levels of TGF-β isoforms concurrently with serum levels of endotoxin and various inflammatory markers. In addition, we determined if any association exists between polymorphisms in the TGF-β1 gene and atherosclerosis in South African CKD patients. Methods. We studied 120 CKD patients and 40 healthy controls. Serum TGF-β1, TGF-β2, TGF-β3, endotoxin, and inflammatory markers were measured. Functional polymorphisms in the TGF-β1 genes were genotyped using a polymerase chain reaction-sequence specific primer method and carotid intima media thickness (CIMT) was assessed by B-mode ultrasonography. Results. TGF-β isoforms levels were significantly lower in the patients with atherosclerosis compared to patients without atherosclerosis (p<0.001). Overall, TGF-β isoforms had inverse relationships with CIMT. TGF-β1 and TGF-β2 levels were significantly lower in patients with carotid plaque compared to those without carotid plaque [TGF-β1: 31.9 (17.2 – 42.2) versus 45.9 (35.4 – 58.1) ng/ml, p=0.016; and TGF-β2: 1.46 (1.30 – 1.57) versus 1.70 (1.50 – 1.87) ng/ml, p=0.013]. In multiple logistic regression, age, TGF-β2, and TGF-β3 were the only independent predictors of subclinical atherosclerosis in CKD patients [age: odds ratio (OR), 1.054; 95% confidence interval (CI): 1.003 – 1.109, p=0.039; TGF-β2: OR, 0.996; 95% CI: 0.994–0.999, p=0.018; TGF-β3: OR, 0.992; 95% CI: 0.985–0.999, p=0.029). TGF-β1 genotypes did not influence serum levels of TGF-β1 and no association was found between the TGF-β1 gene polymorphisms and atherosclerosis risk. Conclusion. TGF-β isoforms seem to offer protection against the development of atherosclerosis among South African CKD patients. [ABSTRACT FROM AUTHOR]

South Africa's public healthcare system responses seldom engage with migration. Our exploratory study investigates migration profiles and experiences of primary healthcare (PHC) users. A cross-sectional survey involving non-probability sampling was conducted with 229 PHC users at six purposively selected PHC clinics in three districts of SA. The survey captured socio-demographic information, migration histories, and PHC experiences. Chi square and Fischer's exact tests were used to compare categorical variables, whilst Mann-Whitney U tests compared continuous variables between groups. Most PHC users were migrants (22% internal South African; 45% cross-border) who generally move for reasons other than healthcare seeking. Length of time accessing services at a specific clinic was shown to be key in describing experiences of PHC use. Understanding population movement is central to PHC strengthening in SA and requires improved understanding of mobility dynamics in regard to not just nationality, but also internal mobility and length of stay. [ABSTRACT FROM AUTHOR]

There is growing concern about alcohol problems in low- and middle-income countries. More research is required, particularly among the younger generation. The aim of this study was to investigate the prevalence of alcohol disorders and associated socioeconomic characteristics among young men and women living in the Eastern Cape Province, South Africa. This was a cross-sectional population-based study of 977 participants (52% male and 48% female) aged 18-40, the majority of whom lived in low-income areas. Data collection was carried out in 2012 by trained fieldworkers. The Mini International Neuropsychiatric Interview ( DSM- IV) was used to investigate the prevalence of alcohol dependence (increased tolerance to alcohol, failed attempt to cut down, risk of physical and mental effects) and alcohol abuse (harmful use, consistent intoxication, risk behaviour, physically hazardous, social problems). A high 12-month prevalence of alcohol dependence was found (26.5% in total; 39.0% among men and 19.1% among women) as well as of alcohol abuse (9% in total; 19.0% among men and 6.0% among women). Few socioeconomic differences emerged among the men, except older men ( OR 1.94, CI 1.11-3.42) and those supported by social grants ( OR 2.28, CI 1.06-4.93), who presented higher odd ratios for alcohol dependence than the reference groups. Among the women, more differences emerged: women who were widowed/single ( OR 2.35, CI 1.20-4.62), had no education ( OR 3.41, CI 1.04-11.21), had a low income ( OR 3.26, CI 1.55-6.80) and had no social support from friends when ill presented higher odd ratios ( OR 1.73, CI 1.07-2.80). In the adjusted model, marital status and low income remained statistically significant. With regard to alcohol abuse, fewer socioeconomic differences emerged. Interventions need to address the early onset of alcohol misuse in order to meet both current needs and long-standing mental and physical illness. [ABSTRACT FROM AUTHOR]

Speech-language therapists (SLTs) have direct contact with a wide variety of individuals who require augmentative and alternative communication (AAC) and they are therefore considered to have a primary role in the assessment, selection, and implementation of AAC symbols, techniques, aids, and strategies. Limited information is available with regard to SLTs’ practices in the field of AAC, and there is a particular paucity of information about developing country contexts such as South Africa. The aim of this study was to determine how South African SLTs perceive their current AAC practices. Specifically, the study aimed to investigate SLTs’ assessment and intervention practices, their choice and use of graphic symbols, and display layouts for aided AAC systems. An online survey was developed, using the Qualtrics Research Suite™ online survey software. The survey included open-ended questions (analyzed using thematic analysis) and closed questions (analyzed using descriptive statistics). The responses indicated that SLTs in South Africa currently use a limited variety of assessment and intervention approaches. The data suggest that current practices are informed by previous experience with various technologies and AAC systems and that the primary caseloads of SLTs do not appear to inform specific approaches to assessment and AAC implementation. [ABSTRACT FROM PUBLISHER]

Introduction: The burden of HIV is increasing among adults aged over 50, who generally experience increased risk of cormorbid illnesses and poorer financial protection. We compared patterns of health utilisation and expenditure among HIV-positive and HIV-negative adults over 50.Methods: Data were drawn from the Study on global AGEing and adult health in South Africa with analysis focusing on individual and household-level data of 147 HIV-positive and 2725 HIV-negative respondents.Results: HIV-positive respondents reported lower utilisation of private health-care facilities (11.8%) than HIV-negative respondents (25.0%) (p = .03) and generally had more negative attitudes towards health system responsiveness than HIV-negative counterparts. Less than 10% of HIV-positive and HIV-negative respondents experienced catastrophic health expenditure (CHE). Women (OR 1.8;p < .001) and respondents from rural settings (OR 2.9;p < .01) had higher odds of CHE than men or respondents in urban settings. Over half the respondents in both groups indicated that they had received free health care.Conclusions: These findings suggest that although HIV-positive and HIV-negative older adults in South Africa are protected to some extent from CHE, inequalities still exist in access to and quality of care available at health-care services – which can inform South Africa’s development of a national health insurance scheme. [ABSTRACT FROM AUTHOR]

Background: High-risk human papillomavirus (hr-HPV) infections and low-grade squamous intraepithelial lesions occur frequently in young women. The available vaccines cover up to seven hr-HPV genotypes (HPV16, HPV18, HPV31, HPV33, HPV45, HPV52 and HPV58) and two low-risk HPV types (HPV6 and HPV11). The objective of this study was to describe the hr-HPV genotypes present among HIV-uninfected and HIV-infected young women in rural high schools. Methods: Cervicovaginal lavages were obtained from sexually active young women recruited from high schools in KwaZulu-Natal (n = 1223). HPV testing was done by the polymerase chain reaction using GP5+/GP6 + primers and enzyme immunoassay. HIV testing was done using rapid test kits. Results: Of the 1223 cervicovaginal lavages, 301 (25%) were positive for hr-HPV. The HPV prevalence was higher in HIV infected (32.20%, 95% CI: 0.27–0.38) than in HIV-uninfected women (22.50%, 95% CI: 0.21–0.26), (p =.001). Similarly, multiple infections were slightly more common in HIV infected (59.32%) than in HIV-uninfected women (53.51%), (p =.37). The nine predominant genotypes in descending order were HPV types 16 (n = 99, 22.10%), 51 (n = 58, 12.91%), 18 (n = 56, 12.50%), 35 (n = 50, 11.10%), 33 (n = 47, 10.82%), 56 (n = 42, 9.31%), 45 (n = 34, 7.60%), 52 (n = 32, 7.14%) and 59 (n = 31, 6.91%). HPV 35, 51, 56 and 59 (40.62%), which are not covered by any vaccine, were among the most prevalent in the schools of KwaZulu-Natal. Conclusion: Four of the most predominant high-risk HPV types in this region are not covered by the new nine-valent HPV vaccine. [ABSTRACT FROM AUTHOR]

South Africa's refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Symptom Checklist-25. The proportion of those who responded 'often true' to not having enough food and eating less was 23.1 and 54.3 %, respectively. The proportion of individuals with a significant level of anxiety and depressive symptomatology was 49.4 and 54.6 %, respectively. The adjusted logistic regression indicated that not eating enough was significantly associated with anxiety (aOR = 4.52, 95 % CI: 2.09-9.80) and depression (aOR = 4.51, 95 % CI: 2.01-10.09). Similarly, eating less was significantly associated with anxiety (aOR = 2.88, 95 % CI: 1.56-5.31) and depression (aOR = 2.88, 95 % CI: 1.54-5.39). The high prevalence of food insecurity, and its relationship to mental illness, highlight the importance of addressing basic needs among this population. [ABSTRACT FROM AUTHOR]

Background: Alongside the global population ageing phenomenon, there has been a rise in the number of individuals who suffer from multiple chronic conditions. Taking the case of South Africa, this study aims, first, to investigate the association between multi-morbidity and disability among older adults; and second, to examine whether hypertension (both diagnosed and undiagnosed) mediates this relationship. Lastly, we consider whether the impact of the multi-morbidity on disability varies by socio-demographic characteristics. Methods: Data were drawn from Wave 1 (2007-08) of the South African Study on Global Ageing and Adult Health. Disability was measured using the 12-item World Health Organisation Disability Assessment Schedule (WHODAS) 2.0. Scores were transformed into a binary variable whereby those over the 90th percentile were classified as having a severe disability. The measure of multi-morbidity was based on a simple count of self-reported diagnosis of selected chronic conditions. Self-reports of diagnosed hypertension, in addition to blood pressure measurements at the time of interview, were used to create a three category hypertension variable: no hypertension (diagnosed or measured), diagnosed hypertension, hypertension not diagnosed but hypertensive measured blood pressure. Interactions between the number of chronic diseases with sex, ethnicity and wealth were tested. Logistic regression was used to analyze the relationships. Results: 25.4% of the final sample had one and 13.2% two or more chronic diseases. Nearly half of the respondents had a hypertensive blood pressure when measured during the interview, but had not been previously diagnosed. A further third self-reported they had been told by a health professional they had hypertension. The logistic regression showed in comparison to those with no chronic conditions, those with one or two or more had significantly higher odds of severe disability. Hypertension was insignificant and did not change the direction or size of the effect of the multi-morbidity measure substantially. The interactions between number of chronic conditions with wealth were significant at the 5% level. Conclusions: The diagnosis of multiple chronic conditions, can be used to identify those most at risk of severe disability. Limited resources should be prioritized for such individuals in terms of preventative, rehabilitative and palliative care. [ABSTRACT FROM AUTHOR]