Adlai Davids

Self-reported prevalence of chronic non-communicable diseases and associated factors among older adults in South Africa

Introduction Little is known about the prevalence and predictors of chronic non-communicable diseases (NCDs) of older adults in South Africa. This study aims to investigate the self-reported prevalences of major chronic NCDs and their predictors among older South Africans. Methods We conducted a national population-based cross-sectional survey with a sample of 3,840 individuals aged 50 years or above in South Africa in 2008. The outcome variable was the self-reported presence of chronic NCDs suffered, namely, arthritis, stroke, angina, diabetes, chronic lung disease, asthma, depression, and hypertension. The exposure variables were sociodemographic characteristics: age, gender, education, wealth status, race, marital status, and residence. Multivariate logistic regression was used to determine sociodemographic factors predictive of the presence of chronic NCDs. Results The prevalence of chronic NCDs was 51.8%. The prevalence of multimorbidity (≥2 chronic conditions) was 22.5%. Multivariate logistic regression analysis showed that being female, being in age groups 60–79 and 70–79, being Coloured or Asian, having no schooling, having greater wealth, and residing in an urban area were associated with the presence of NCDs. Conclusion The rising burden of chronic NCDs affecting older people places a heavy burden on the healthcare system as a result of increased demand and access to healthcare services. Concerted effort is needed to develop strategies for the prevention and management of NCDs, especially among economically disadvantaged individuals who need these services the most.Introduction Little is known about the prevalence and predictors of chronic non-communicable diseases (NCDs) of older adults in South Africa. This study aims to investigate the self-reported prevalences of major chronic NCDs and their predictors among older South Africans. Methods We conducted a national population-based cross-sectional survey with a sample of 3,840 individuals aged 50 years or above in South Africa in 2008. The outcome variable was the self-reported presence of chronic NCDs suffered, namely, arthritis, stroke, angina, diabetes, chronic lung disease, asthma, depression, and hypertension. The exposure variables were sociodemographic characteristics: age, gender, education, wealth status, race, marital status, and residence. Multivariate logistic regression was used to determine sociodemographic factors predictive of the presence of chronic NCDs. Results The prevalence of chronic NCDs was 51.8%. The prevalence of multimorbidity (≥2 chronic conditions) was 22.5%. Multivariate logistic regression analysis showed that being female, being in age groups 60-79 and 70-79, being Coloured or Asian, having no schooling, having greater wealth, and residing in an urban area were associated with the presence of NCDs. Conclusion The rising burden of chronic NCDs affecting older people places a heavy burden on the healthcare system as a result of increased demand and access to healthcare services. Concerted effort is needed to develop strategies for the prevention and management of NCDs, especially among economically disadvantaged individuals who need these services the most.

Self-rated health and associated factors among older South Africans: evidence from the study on global ageing and adult health

Background : Population ageing has become significant in South African society, increasing the need to improve understandings of health and well-being among the aged. Objective : To describe the self-reported ratings of overall health and functioning, and to identify factors associated with self-rated health among older South Africans. Design : A national population-based cross-sectional survey, with a sample of 3,840 individuals aged 50 years and older, was completed in South Africa in 2008. Self-reported ratings of overall health and functioning were measured using a single self-reported health state covering nine health domains (used to generate the Study on Global Ageing and Adult Health (SAGE) composite health state score). Disability was measured using the World Health Organization Disability Assessment Schedule II (WHODAS-II) activities of daily living (ADLs), instrumental activities of daily living (IADLs), perceptions of well-being, and the World Health Organization Quality of Life index/metric (WHOQoL). Results : Overall, more than three quarters (76.8%) of adults rated their health as moderate or good. On balance, men reported very good or good health more often than women (p<0.001). Older people (aged 70 years and above) reported significantly poorer health status than those aged 50–59 (adjusted odds ratio (AOR) 1.52; 95% confidence interval (CI) 1.00–2.30). Indians and Blacks were significantly more likely to report poorer health status at (AOR = 4.01; 95% CI 1.27–12.70) and (AOR = 0.42; 95% CI 0.18_0.98; 30 p < 0.045), respectively, compared to Whites. Respondents with primary education (AOR = 1.83; 95% CI 1.19–2.80) and less than primary education (AOR = 1.94; 95% CI 1.37–2.76) were more likely to report poorer health compared to those with secondary education. In terms of wealth status, those in low wealth quintile (AOR = 2.02; 95% CI 1.14–3.57) and medium wealth quintile (AOR = 1.47; 95% CI 1.01–2.13) were more likely to report poorer health status than those in high wealth quintile. Overall, the mean WHODAS-II score was 20%, suggesting a low level of disability. The mean WHOQoL score for females (Mean = 51.5; SD = 12.2) was comparable to that of males (Mean = 49.1; SD = 12.6). Conclusion : The depreciation in health and daily functioning with increasing age is likely to increase demand for health care and other services as people grow older. There is a need for regular monitoring of the health status of older people to provide public health agencies with the data they need to assess, protect, and promote the health and well-being of older people.

HIV Self-Testing Could “Revolutionize Testing in South Africa, but It Has Got to Be Done Properly”: Perceptions of Key Stakeholders

South Africa bears the world’s largest burden of HIV with over 6.4 million people living with the virus. The South African government’s response to HIV has yielded remarkable results in recent years; over 13 million South Africans tested in a 2012 campaign and over 2 million people are on antiretroviral treatment. However, with an HIV & AIDS and STI National Strategic Plan aiming to get 80 percent of the population to know their HIV status by 2016, activists and public health policy makers argue that non-invasive HIV self-testing should be incorporated into the country HIV Counseling and Testing [HCT] portfolios. In-depth qualitative interviews (N = 12) with key stakeholders were conducted from June to July 2013 in South Africa. These included two government officials, four non-governmental stakeholders, two donors, three academic researchers, and one international stakeholder. All stakeholders were involved in HIV prevention and treatment and influenced HCT policy and research in South Africa and beyond. The interviews explored: interest in HIV self-testing; potential distribution channels for HIV self-tests to target groups; perception of requirements for diagnostic technologies that would be most amenable to HIV self-testing and opinions on barriers and opportunities for HIV-linkage to care after receiving positive test results. While there is currently no HIV self-testing policy in South Africa, and several barriers exist, participants in the study expressed enthusiasm and willingness for scale-up and urgent need for further research, planning, establishment of HIV Self-testing policy and programming to complement existing facility-based and community-based HIV testing systems. Introduction of HIV self-testing could have far-reaching positive effects on holistic HIV testing uptake, giving people autonomy to decide which approach they want to use for HIV testing, early diagnosis, treatment and care for HIV particularly among hard-to reach groups, including men.

Factors associated with female high-risk drinking in a rural and urban South African site

OBJECTIVE To assess and compare the extent of high-risk drinking and factors associated with high-risk drinking in the adult female population of a rural and an urban region in South Africa. DESIGN Cross-sectional household survey using multistage sampling methods. Setting. A rural wine farming area of the Western Cape and an urban site in Gauteng. Subjects. Women of reproductive age (18 - 44 years). Outcome measures. The extent of risky alcohol consumption measured using the Alcohol Use Disorders Identification Test (AUDIT) scale which categorises current drinkers into high- and low-risk drinkers. RESULTS Twenty-seven per cent (166/606) and 46% (188/412) of the women interviewed in Gauteng and the Western Cape respectively were current drinkers. In turn, 20% (33/166) of the Gauteng current drinkers and 68% (128/188) of the Western Cape current drinkers were classified as high-risk drinkers. Multivariate analysis indicated that employed people in Gauteng were less likely to be high-risk drinkers (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1 - 0.8). Living in a household that never/seldom went hungry was inversely associated with risky drinking for both sites (OR 0.3, 95% CI 0.1 - 0.9 for Gauteng and OR 0.2, 95% CI 0.3 - 1.2 for the Western Cape). Current smokers (Western Cape) (OR 7.6, 95% CI 3.1 - 18.9) and respondents with an alcohol problem in one or more family members (both sites) (OR 6.0, 95% CI 2.3 - 15.7 and OR 3.1, 95% CI 1.5 - 6.4) were more likely to be high-risk drinkers. CONCLUSIONS High-risk drinking by women is a major problem, especially in the Western Cape. Targeted interventions are needed for women with alcohol problems in the family setting, lower socio-economic status, and concurrent substance abuse.

Lay Counsellors' Experiences of Delivering HIV Counselling Services in Public Health Facilities in a Eastern Cape Province District of South Africa

The study examined experiences of lay counsellors who provide HIV counselling services to identify potential HIV counselling needs. Qualitative and quantitative interview data were collected from 74 lay counsellors from a sample of Eastern Cape Province districts health facilities (n=74). Results indicated that lay counsellors experienced medium to high job stress, but with relatively high job satisfaction. They utilized a number of techniques and concepts in the counselling process. Lay counsellors experienced role conflicts when working in a health team and perceived to receive poor support and supervision. In addition, they reported little job training and lack of career pathing. Formalization of their role in HIV prevention and on career pathing could improve effectiveness.

Barriers to accessing PMTCT services in a rural area of South Africa

Despite good intentions and commitment from providers, prevention-of-mother-to-child-transmission of HIV (PMTCT) services can be difficult for pregnant women to access, despite the provision of free health services for women and children. We examined the introduction of PMTCT services in a very poor rural area of the Eastern Cape, South Africa, to assess the contexts impact on the provision of this service. Our approach involved 13 individual in-depth interviews and 26 focus group discussions, spread over six clinics in a single district, supplemented by situational observations. Our goal was to suggest how access to PMTCT services at the clinics may be improved. Poor roads, an underdeveloped transport system and poor telecommunications typify the pervasive poverty in the study area. Families have few resources for travel and most live a long distance from a clinic. Accessing emergency transport is especially difficult and expensive. Poor infrastructure also means that many families do not have access to clean water, which complicates the use of infant formula. PMTCT services had been recently added to several clinics that provide general services to the local population, but that were already understaffed and over-pressured. Since the PMTCT services were new, some elements of the intervention and staff training were delayed, thus inhibiting full implementation. New staff had not been added to ease accumulated pressures. Thus, socio-economic context can present a formidable barrier to the provision of PMTCT services. Improvement in services to rural areas will require creative thinking, perhaps including the use of mobile services and the development of community structures, such as contributions to community health education by traditional birth attendants and local volunteer groups.

Liquor outlet density, deprivation and implications for foetal alcohol syndrome prevention in the Bergriver municipality in the Western Cape, South Africa

Foetal alcohol syndrome (FAS) is the most common preventable birth defect in the world, and some South African communities have amongst the highest reported rates. In August 2008, global positioning systems and geographic information systems (GIS) were used to collect data on legal and illegal alcohol outlets in the Bergriver municipality. A total of 112 outlets were recorded and towns with the densest distributions (outlet/km2) were Piketberg and Eendekuil. Spearman coefficients were used to estimate the relationship between alcohol outlet distributions within the study area and the South African Index of Multiple Deprivation. Although not statistically significant, the data are suggestive of an inverse relationship between legal alcohol outlets and deprivation – less deprived areas had higher density of legal alcohol outlets – while the opposite relationship applied for illegal alcohol outlets. GIS provides spatial documentation of determinants of FAS risks amenable to geographically based prevention strategies, as well as providing baseline data to evaluate the effectiveness of liquor legislation aimed at controlling access to alcohol. Results are being repurposed into health education materials that encourage community action to address the social determinants of health outcomes such as FAS.

Perceptions of sugar mommy practices in South Africa

The study sought to explore sugar mommy practices regarding their occurrence, acceptability as well as perceived reasons why older women and younger men enter into sugar mommy relationships. An exploratory qualitative study involving 135 participants from 11 diverse focus groups in terms of age, gender (females=27%) and geotype throughout the nine South African provinces was conducted. Data on the participants’ views, opinions and experiences of sugar mommy practices were collected using focus group interviews. The data were thematically analyzed. The study found that sugar mommy practices were prevalent in South Africa. The perceived reasons for acceptability were: love, survival, and correctness. Perceived reasons why older women have sexual relationships with younger men included: sexual fulfilment, domination, reduction of stress, physical attraction, procreation, lack of self-control, youthful feeling, migrancy, difficulty in finding partners of compatible age and young men being seen as not demanding. Perceived reasons why younger men have sexual relationships with older women included: material gain, reduction of stress, being enticed, rejection by women of compatible age, peer influence and belief that older women are purer. Given the increase in sugar mommy practices, which may have significant implications for the prevalence of HIV/AIDS, it is necessary to understand the underlying perceptions of these practices, in order to develop culturally relevant and socially acceptable intervention programmes.

Intimate Partner Violence and HIV Risk among Women in Primary Health Care Delivery Services in a South African Setting

The aim of the study is to investigate intimate partner violence (IPV) and HIV risk among antenatal care attendees at primary care health care facilities in a South African setting. A convenient sample of 984 pregnant women (mean age of 26.1 years, SD=6.3 years) attending 35 antenatal clinics were interviewed using a structured questionnaire. Collected data was captured and analyzed using Statistical Package for Social Services (SPSS) Version 16 computer programme. Proportions of HIV risk and IPV were assessed. Odds of IPV were estimated using logistic regression analysis. Results indicate high rates of intimate partner violence and HIV risk: 14% of the women had experienced physical partner violence in the past 12 months, 14% reported a history of having an STI in the past 12 months, 6.7% had consistently (every time) used a condom with their primary partner in the past three months, and 70.1% reported knowing that their primary partners placed them at risk for HIV transmission, 78.6% were worried that they might already have or in the future get HIV, the virus that causes AIDS. Logistic regression found that the variables not cohabitating, having two or more sexual partners in the past 12 months, having a history of a sexually transmitted infection (STI) and partner alcohol abuse were associated with intimate partner violence.

Community member perceptions of influences on teenage pregnancies

This exploratory qualitative study aimed to provide insight into the factors contributing to the high prevalence rate of teenage pregnancy in South African communities. Focus group were conducted with 193 community members (females = 44.6%; adults = 50.8%, teenagers/youth = 44.0%) and followed by thematic content analysis to interpret the data. Several overarching themes regarding the increasingly common occurrence of teenage pregnancy emerged from the data. These included: (1) the increased acceptability of teenage pregnancy to families and communities for economic and material gain; (2) the influence of social pressure; and (3) the lack of sexual knowledge and provision of sex education. Community members perceived teenage pregnancy as an increasingly common occurrence in their communities. Community members perceived teenage pregnancy to be driven by multiple factors and to require holistic interventions at the individual, family and community level.