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BackgroundSouth Africa's rates of psychiatric morbidity are among the highest in sub-Saharan Africa and are foregrounded by the country's long history of political violence during apartheid. Growing evidence suggests that in utero stress exposure is a potent developmental risk factor for future mental illness risk, yet the extent to which the psychiatric effects of prenatal stress impact the next generation are unknown. We evaluate the intergenerational effects of prenatal stress experienced during apartheid on psychiatric morbidity among children at ages 17-18 and also assess the moderating effects of maternal age, social support, and past household adversity.MethodsParticipants come from Birth-to-Twenty, a longitudinal birth cohort study in Soweto-Johannesburg, South Africa's largest peri-urban township which was the epicentre of violent repression and resistance during the final years of the apartheid regime. Pregnant women were prospectively enrolled in 1990 and completed questionnaires assessing social experiences, and their children's psychiatric morbidity were assessed at ages 17-18.ResultsFull data were available from 304 mother-child pairs in 2007-8. Maternal prenatal stress in 1990 was not directly associated greater psychiatric morbidity during at ages 17-18. Maternal age and past household adversity moderated the intergenerational mental health effects of prenatal stress such that children born to younger mothers and late adolescent/young adult children experiencing greater household adversity exhibited worse psychiatric morbidity at ages 17-18. Social support did not buffer against the long-term psychiatric impacts of prenatal stress.ConclusionsGreater prenatal stress from apartheid predicted adverse psychiatric outcomes among children born to younger mothers and adolescents/young adults who experienced greater concurrent stress. Our findings suggest that prenatal stress may affect adolescent mental health, have stress-sensitising effects, and represent possible intergenerational effects of trauma experienced under apartheid in this sample.

BackgroundMost of the world’s women living with human immunodeficiency virus (HIV) reside in sub-Saharan Africa. Although efforts to reduce mother-to-child transmission are underway, obtaining complete and accurate data from rural clinical sites to track progress presents a major challenge. ObjectiveTo describe the acceptability and feasibility of mobile phones as a tool for clinic-based face-to-face data collection with pregnant women living with HIV in South Africa. MethodsAs part of a larger clinic-based trial, 16 interviewers were trained to conduct mobile phone–assisted personal interviews (MPAPI). These interviewers (participant group 1) completed the same short questionnaire based on items from the Technology Acceptance Model at 3 different time points. Questions were asked before training, after training, and 3 months after deployment to clinic facilities. In addition, before the start of the primary intervention trial in which this substudy was undertaken, 12 mothers living with HIV (MLH) took part in a focus group discussion exploring the acceptability of MPAPI (participant group 2). Finally, a sample of MLH (n=512) enrolled in the primary trial were asked to assess their experience of being interviewed by MPAPI (participant group 3). ResultsAcceptability of the method was found to be high among the 16 interviewers in group 1. Perceived usefulness was reported to be slightly higher than perceived ease of use across the 3 time points. After 3 months of field use, interviewer perceptions of both perceived ease of use and perceived usefulness were found to be higher than before training. The feasibility of conducting MPAPI interviews in this setting was found to be high. Network coverage was available in all clinics and hardware, software, cost, and secure transmission to the data center presented no significant challenges over the 21-month period. For the 12 MHL participants in group 2, anxiety about the multimedia capabilities of the phone was evident. Their concern centered on the possibility that their privacy may be invaded by interviewers using the mobile phone camera to photograph them. For participants in group 3, having the interviewer sit beside vs across from the interviewee during the MPAPI interview was received positively by 94.7% of MHL. Privacy (6.3%) and confidentiality (5.3%) concerns were low for group 3 MHL. ConclusionsMobile phones were found both to be acceptable and feasible in the collection of maternal and child health data from women living with HIV in South Africa. Trial RegistrationClinicaltrials.gov NCT00972699; http://clinicaltrials.gov/ct2/show/NCT00972699 (Archived by WebCite at http://clinicaltrials.gov/ct2/show/NCT00972699)

A syndemic has been theorized as a cluster of epidemics driven by harmful social and structural conditions wherein the interactions between the constitutive epidemics drive excess morbidity and mortality. We conducted a mixed-methods study to investigate a syndemic in Soweto, South Africa, consisting of a population-based quantitative survey (N = 783) and in-depth, qualitative interviews (N = 88). We used ethnographic methods to design a locally relevant measure of stress. Here we show that multimorbidity and stress interacted with each other to reduce quality of life. The paired qualitative analysis further explored how the quality-of-life impacts of multimorbidity were conditioned by study participants' illness experiences. Together, these findings underscore the importance of recognizing the social and structural drivers of stress and how they affect the experience of chronic illness and well-being.

Social vulnerability indices (SVI) can predict communities' vulnerability and resilience to public health threats such as drought, food insecurity or infectious diseases. Parity has yet to be investigated as an indicator of social vulnerability in young women. We adapted an SVI score, previously used by the US Centre for Disease Control (CDC), and calculated SVI for young urban South African women (n = 1584; median age 21.6, IQR 3.6 years). Social vulnerability was more frequently observed in women with children and increased as parity increased. Furthermore, young women classified as socially vulnerable were 2.84 times (95% CI 2.10-3.70; p

Many observational studies and some randomized trials demonstrate how fetal growth can be influenced by environmental insults (for example, maternal infections)1 and preventive interventions (for example, multiple-micronutrient supplementation)2 that can have a long-lasting effect on health, growth, neurodevelopment and even educational attainment and income in adulthood3. In a cohort of pregnant women (n = 3,598), followed-up between 2012 and 2019 at six sites worldwide4, we studied the associations between ultrasound-derived fetal cranial growth trajectories, measured longitudinally from

Background: Contextual factors are likely to influence whether young children are able to adhere to recommended health behaviours. This study aimed to: (1) describe the social and environmental characteristics of children under five living in Soweto, South Africa; and (2) determine factors associated with screen time and outdoor play in this population. Methods: Household surveys were conducted in Soweto to collect data on children's screen time and access to outdoor space, as well as information about the household. A multilevel regression analysis was conducted for each outcome. Results: Data on 2309 children aged five or under were included in this analysis. Children used screens for an average of one and a half hours per day during the week, and nearly 2 hours per day on weekends. Almost all (92%) children had a safe space to play inside, while just over a third (34%) had a safe space to play outside. A higher socioeconomic status was associated with less time spent playing outside and more screen time. Conclusion: Interventions promoting outdoor play and restricting screen time are essential for improving health trajectories, but need to address structural barriers that exist, in order to protect the safety of children while promoting health behaviours.

BackgroundHow people perceive the coronavirus disease 2019 (COVID-19) pandemic and understand their risk can influence their health, behaviours and overall livelihood. The disease's novelty and severity have elicited a range of attitudes and perspectives countrywide, which consequently influence the public's adherence to public health prevention and treatment guidelines.AimTo investigate perceptions, experiences and knowledge on COVID-19 in a community-based cohort study.SettingAdults living in Soweto in South Africa's Gauteng province during the first six weeks of the national lockdown regulations (i.e. Alert Level 5 lockdown from end of March to beginning of May 2020).MethodsParticipants completed a series of surveys and answered open-ended questions through telephonic interviews (n = 391). We queried their perceptions of the origins of COVID-19, understandings of the disease, personal and communal risks and its relations with the existing disease burden.ResultsFindings from our sample of 391 adults show that perceptions and knowledge of COVID-19 vary across several demographic characteristics. We report moderate levels of understanding about COVID-19, prevention methods and risk, as well as exposure to major physical, psychosocial and financial stressors. Depressive symptoms, perceived infection risk and concern about COVID-19 significantly predicted COVID-19 prevention knowledge.ConclusionPublic health communication campaigns should focus on continuing to improve knowledge and reduce misinformation associated with the virus. Policymakers should consider the mental health- and non-health-related impact of the pandemic on their citizens in order to curb the pandemic in a manner that maximises well-being.

BackgroundBreast cancer is the most common cancer globally and among South African women. Women from socioeconomically disadvantaged South African communities more often present later and receive total mastectomy compared to those from more affluent communities who have more breast conserving surgery (which is less invasive but requires mandatory radiation treatment post-operatively). Standard chemotherapy and total mastectomy treatments are known to cause traumatizing side effects and emotional suffering among South African women; moreover, many women face limited communication with physicians and psychological support.ObjectiveThis article investigates the experiences of women seeking breast cancer treatment at the largest public hospital in South Africa.MethodsWe interviewed 50 Black women enrolled in the South African Breast Cancer Study to learn more about their health system experiences with detection, diagnosis, treatment, and follow-up care for breast cancer. Each interview was between 2-3 hours, addressing perceptions, experiences, and concerns associated with breast cancer and comorbidities such as HIV and hypertension.ResultsWe found most women feared diagnosis, in part, because of the experience of chemotherapy and physical mutilation related to mastectomy. The importance of social support from family, religion, and clinical staff was fundamental for women coping with their condition and adhering to treatment and medication.ConclusionsThese findings exemplify how interventions might promote early detection of breast cancer and better adherence to treatment. Addressing community perceptions of breast cancer, patient needs and desires for treatment, structural barriers to intensive therapies, and the burden of invasive treatments are imperative next steps for delivering better breast cancer care in Soweto and other resource-constrained settings.

Sensory Processing Sensitivity (SPS) is a personality trait that describes highly neurosensitive individuals who, for better and for worse, are permeable to their environmental context. Recently, these individuals have been noted for their amenability to positive intervention efforts - an observation that may have important psychosocial value. SPS is currently assessed through the 27-item Highly Sensitive Person Scale (HSPS). However, this instrument has not been adequately scrutinised in cross-cultural samples, and has generated varied factor solutions that lack consistent support. We assessed the HSPS in South African university student samples which were ethno-culturally diverse, across four academic years (n = 750). The HSPS demonstrated strong reliability across samples ([alpha] > .84). Factor analysis revealed a novel five-factor solution (Negative Affect, Neural Sensitivity, Propensity to Overwhelm, Careful Processing and Aesthetic Sensitivity). As per previous reports, latent class analysis suggested a three class solution. We validated these findings in a general population sample that was part of the longitudinal Birth to Twenty Plus cohort (n = 1400). In conclusion, we found the HSPS to be reliable in culturally diverse samples. The instrument remains a robust tool for identifying sensitive individuals and may be an important addition to psychosocial studies in low-to-middle income countries., Author(s): Andrew K. May [sup.1] , Shane A. Norris [sup.2] [sup.3] , Linda M. Richter [sup.3] , Michael M. Pitman [sup.4] Author Affiliations: (1) grid.11951.3d, 0000 0004 1937 1135, Division [...]