C C Jinabhai

Sex differences in under and over nutrition among school-going Black teenagers in South Africa: an uneven nutrition trajectory

Objectives  To investigate the nutritional status of Black South African teenagers by sex and compare it with nutritional profiles of teenagers from other countries.

Reasons for inconsistent condom use by rural South African high school students.

Aim: To describe the condom use practices of high school students, compare the beliefs of students who used condoms with those who did not, investigate gender differences in condom use and identify factors that prevent condom use.

Changing patterns of under- and over-nutrition in South African children-future risks of non-communicable diseases.

Abstract Under- and over-nutrition in children in KwaZulu-Natal, South Africa was investigated comparing data collected from primary school children in a rural district (643 children aged 8–11 years in 1994) with secondary data from the National Schools Study (16,179 children, 4–11 years in 1994), the Vitamin A Consultative Group Study (408 children, 2–5 years in 1994) and the Income Dynamics Study (1,593 children, 2–11 years in 1998). Stunting and wasting (WHO/NCHS guidelines) and overweight and obesity (International Obesity Task Force guidelines) were retrospectively analysed from these studies and compared in the children aged 4–5 and 8–11 years. There was moderate stunting in 10–25%, wasting in 1–6%, 5–24% were overweight and 1–10% obese. Girls in the National Schools Study (p<0.005) and in the primary datasets (p=0.02) had a significantly higher prevalence of overweight than boys; girls (1.4%) were also more obese than boys (0.9%) in the Schools Study (p=0.002), and the boys significantly more stunted (p<0.005) and wasted (p<0.005). An increasing prevalence of overweight and obesity was seen in both the 4–5- and 8–11-year age-groups. The finding that moderate stunting co-exists with overweight and obesity suggests that patterns of under- and over-nutrition in South African children are changing and might indicate the early stages of a complex nutritional transition. Action is required to prevent the future risk of non-communicable diseases.

An epidemiological perspective of substance use among high school pupils in rural KwaZulu-Natal.

OBJECTIVES To investigate prevalence and the factors influencing substance use among rural high school pupils in KwaZulu-Natal in order to develop and implement intervention programmes. DESIGN Cross-sectional study. SETTING Twenty-eight high schools in southern KwaZulu-Natal. SUBJECTS One thousand three hundred and eighteen grade 10 pupils. OUTCOME MEASURES An anonymous self-reporting questionnaire was used to investigate the use of alcohol, tobacco (cigarettes), cannabis and solvents. RESULTS Of the male scholars, 52.9% (95% confidence interval (CI): 45.4-60.3) reported ever using alcohol, 16.9% (CI: 11.5-24.0) reported using cannabis, and 13.1% (CI: 7.2-22.5) had smoked more than one cigarette daily. Among male pupils 45.5% (CI: 38.6-52.6) had inhaled benzine and 34.6% (CI: 28.0-41.8), thinners; 7.4% (CI: 3.4-15.2) had used cocaine and 4.1% (CI: 1.0-10.6), crack. Female pupils reported significantly less use of alcohol (25.5%, CI: 17.6-35.3), cannabis (2.3%, CI: 1.3-4.1), cigarettes (more than one daily) (2.0%, CI: 1.0-4.1), and inhalation of benzine (18.8%, CI: 13.8-25.2) and thinners (10.8%, CI: 7.2-16). Logistical regression indicated that the odds of smoking cigarettes increased significantly (p < 0.0005) with use of the other substances. CONCLUSION The results of this study confirm the prevalence of multi-substance use among pupils at the majority of rural high schools in this district and the need for targeted interventions to reduce/prevent this.

Risky sexual behaviours of high-school pupils in an era of HIV and AIDS

OBJECTIVE To identify risky sexual behaviours and demographic factors that place high-school pupils at risk of HIV and AIDS. METHODS A cross-sectional study was undertaken to explore factors influencing the sexual behaviour of high-school pupils (mean age 15.4 years; SD 1.11). Structured self-reported questionnaires were completed by all grade 10 pupils (N = 805) at all the Wentworth, Durban, public high schools. RESULTS Significant gender differences in sexual practices were reported, such as males being more likely to engage in sexual activity than females (OR 4.92; p < 0.001). More males (24.8%) initiated sex before age 12, compared with more females (30%) who initiated sex between 16 to 20 years of age (p < 0.001). Significantly more males preferred older partners than females (p = 0.002), more females were forced to have sex than males (p = 0.009), and more males used alcohol on the last occasion of sex than females (p = 0.04). Religious affiliation and parental supervision were found to have a significant effect on sexual activity among pupils. CONCLUSIONS High-school pupils are at high risk of HIV and AIDS, yet they continue to engage in risky sexual behaviours. Preventive efforts therefore need to be aggressively up-scaled and redirected towards specific risky practices, taking gender differences into account. Contextual factors such as religious norms and parental supervision also require greater attention. Risky sexual behaviours are reflective of a broader crisis in society.

Investigating the mental abilities of rural Zulu primary school children in South Africa.

Introduction. Maximising the full potential of health and educational interventions in South African schools requires assessment of the current level of mental abilities of the school children as measured by cognitive and scholastic tests and the identification of any barriers to improved performance. Objectives. This study reports on the application and interpretation of a selected battery of mental ability tests among Zulu school children and the methodological and analytical issues that need to be addressed. Design The test scores of 806 primary school children from a rural community are presented, based on four tests: Ravens Coloured Progressive Matrices (CPM), an Auditory Verbal Learning Test (AVLT), the Symbol Digit Modalities Test (SDMT) and Youngs Group Mathematics Test (GMT). Results. Significant gender differences were found in the test scores, and the mean scores of Zulu children in this study were lower than those reported in other studies. The results of this selected test battery provide data for the further development of appropriate test instruments for South African conditions. Conclusion. These results can contribute towards the development of a test battery for South African children that can be used to assess and improve their school performance.

The association between HIV testing and sexual behaviour amongst rural Zulu high school students in Kwazulu-Natal, South Africa

This cross-sectional study investigated the prevalence of HIV testing amongst South African high school students, their perceptions about HIV testing, and the influence of HIV testing on their sexual behaviour. Grade 10 students at 28 high schools completed a questionnaire based on the I-Change Model. Of 1,192 students, 57 (4.8%) had been tested for HIV. More tested students knew a person with HIV/AIDS (p<0.005), knew other people who had been tested (p<0.005), perceived support from family (p<0.005) and friends (p=0.003), and reported self-efficacy and further intentions to be tested (p<0.005). HIV counselling and testing can promote prevention messages to reduce the prevalence of HIV infection amongst HIVseronegative people, and decrease transmission amongst those HIV-seropositive. Early diagnosis and care can improve outcomes for HIV/AIDS. Encouraging HIV testing among school students may contribute to a reduction in HIV incidence and persuade students to reduce risky sexual behaviour.

Critical risk factors driving the tuberculosis epidemic in KwaZulu-Natal, South Africa

Tuberculosis (TB) is a global public health concern and the epidemic in southern Africa has not stabilised. In South Africa, since 1994, there have been significant political reforms including tran...

Role and contribution of private healthcare sector doctors in the management of HIV-infected patients in the eThekwini Metropolitan area of KwaZulu-Natal

Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. These doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. This study investigated the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients and their training needs. A cross sectional descriptive study of private general practitioners and specialists was undertaken in the eThekwini Metro of KwaZulu-Natal. Structured self-report questionnaires were sent to 931 private healthcare sector doctors. Of the 331 (35.6%) responses received, three doctors did not complete the questionnaire, 235 (71.6%) doctors managed HIV and AIDS patients, but 93 (28.4%) doctors did not; of these, 48 (51.61%) had not encountered HIV and AIDS patients, 25 (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst ...

Appropriateness of patient attendance at specialist clinics in public hospitals in eThekwini municipality.

An important inefficiency in the public hospital sector is the treatment of patients at levels of care inappropriate to their health problem – specifically, the treatment of patients at hospital level when they could be managed effectively at a lower level of care. 3 The costs of treating a patient increase as the level of care increases from primary care (clinic) level to district, regional and tertiary hospital level. 4 As much as onethird of total hospital costs could be saved by treating primary care patients at a clinic rather than at hospital level. 3 Although a number of studies have investigated the inappropriateness of inpatient stays in hospitals, 4-8 few have looked at inappropriate