Catherine E. Draper

Mental health policy in South Africa: development process and content

INTRODUCTION Mental health is increasingly acknowledged as a crucial public health issue in South Africa (SA). However, it is not given the priority it deserves on policy agendas in this and many other low- and middle-income countries. The aim of this analysis is to describe the content of mental health policy and the process of its development in SA. METHODS Quantitative data regarding SAs mental health system were gathered using the World Health Organization (WHO) Assessment Instrument for Mental Health Systems. The WHO Checklist for Mental Health Policy and Plans was completed for SAs 1997 mental health policy guidelines. Semi-structured interviews provided understanding of processes, underlying issues and interactions between key stakeholders in mental health policy development. RESULTS There is uncertainty at provincial level regarding whether the 1997 policy guidelines should be considered national policy. At national level the guidelines are not recognized as policy, and a new policy is currently being developed. Although the guidelines were developed through wide consultation and had approval through national policy development processes, difficulties were encountered with dissemination and implementation at provincial level. The principles of these policy guidelines conform to international recommendations for mental health care and services but lack clear objectives. DISCUSSION The process of mental health policy implementation has been hindered by the low priority given to mental health, varying levels of seniority of provincial mental health coordinators, limited staff for policy and planning, varying technical capacity at provincial and national levels, and reluctance by some provincial authorities to accept responsibility for driving implementation. CONCLUSION These findings highlight the importance of national leadership in the development of new mental health policy, communication between national and provincial levels, the need for provincial structures to take responsibility for implementation, and capacity building to enable policy makers and planners to develop, monitor and implement policy.

What is medicine and what is a doctor? Medical students’ perceptions and expectations of their academic and professional career

Background: Research was conducted at the University of Cape Town in South Africa where a new medical curriculum was introduced in 2002. This curriculum is largely problem-based and primary health care (PHC) driven. Aim: To qualitatively explore medical students’ perceptions of medicine and doctors and their expectations of studying medicine and practising as a doctor. Methods: A questionnaire was administered to all first-year students (n = 193) that assessed their perceptions of doctors, and their expectations of studying medicine and practising as a doctor. Interviews and focus groups were conducted with purposively selected first-, second-, third- and fourth-year students. Results: Medical students at the University of Cape Town were found to have generally positive perceptions of medicine and doctors, and depicted the medical profession as one that is very significant because of its influence within society, to the point of being perceived as almost noble. Some of the more challenging and difficult aspects of a career in medicine were mentioned, but these seem to be minor compared to the positive aspects. Some students regarded the medical profession as having a biomedical and curative emphasis, although there seemed to be a strong move towards a more holistic view. However, students expected their degree to concentrate on the biomedical aspects of medicine, and therefore did not expect particular components of their degree, such as the psychosocial component. Conclusions: Unmet expectations regarding their curriculum seem to be a very significant issue for students. It is therefore important for educators who deliver the curriculum to be aware of and to understand medical students’ perceptions and expectations of medicine and doctors, in order to detect and deal with conflict between these perceptions and expectations and what may be an educational institutions ‘hidden curriculum’. Practice points Students have generally positive perceptions of medicine and doctors, and some depict the medical profession as significant and influential. Some of the challenging and difficult aspects of the medical profession were mentioned, but these seemed to be overshadowed by the significance of the profession and its associated status and wealth. Students’ views of the medical profession seem to be moving away from a biomedical and curative view and towards a holistic view of medicine. However, students still expect their medical degree to be mostly biomedical and scientific in content, and did not expect the psychosocial component of their curriculum. Students did not expect the PHC approach to be part of their medical degree or part of their medical career.

Nurses’ lifestyle behaviours, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study

BackgroundNurses have an increased risk for non-communicable diseases (NCDs), along with a high prevalence of obesity, poor eating habits and insufficient physical activity. The aim of this study was to determine the health concerns, health priorities and barriers to living a healthy lifestyle among nurses and hospital management staff from public hospitals in the Western Cape Metropole, South Africa.MethodsParticipants were purposively sampled (n = 103), and included management personnel (n = 9), night shift (n = 57) and day-shift nurses (n = 36). Twelve focus groups (FGDs) were conducted with nursing staff to obtain insight into nurses’ health concerns, lifestyle behaviours and worksite health promotion programmes (WHPPs). Seven key informant interviews (KII) were conducted with management personnel, to gain their perspective on health promotion in the worksite. Thematic analysis was used to analyse the data with the assistance of Atlas.ti Qualitative Data Analysis Software.ResultsNight shift nurses frequently identified weight gain and living with NCDs such as hypertension as their main health concerns. Being overweight was perceived to have a negative impact on work performance. All nurses identified backache and exposure to tuberculosis (TB) as occupation-related health concerns, and both management and nurses frequently reported a stressful working environment. Nurses frequently mentioned lack of time to prepare healthy meals due to long working hours and being overtired from work. The hospital environment was perceived to have a negative influence on the nurses’ lifestyle behaviours, including food service that offered predominantly unhealthy foods. The most commonly delivered WHPPs included independent counselling services, an online employee wellness programme offered by the Department of Health and wellness days in which clinical measures, such as blood glucose were measured. Nurses identified a preference for WHPPs that provided access to fitness facilities or support groups.ConclusionsPublic hospitals are a stressful work environment and shift work places an additional strain on nurses. The risk of NCDs and exposure to infectious disease remains a concern in this working population. Our findings highlight the need for WHPPs that support nurses in managing stress and transforming the work environment to facilitate healthy lifestyles.

Impact of a community-based programme for motor development on gross motor skills and cognitive function in preschool children from disadvantaged settings

The aims of the studies were to assess the impact of the Little Champs programme for motor development on (1) the gross motor skills, and (2) cognitive function of children in the programme. In study 1, 118 children from one Early Childhood Development Centre (ECDC) were tested using the Test of Gross Motor Development-2, and in study 2, 83 children were tested from six ECDCs using the Herbst Early Childhood Development Criteria test. The results showed that children exposed to eight months of Little Champs had significantly better overall scores for locomotor (p < 0.005) and object control (p < 0.01) skills compared to the control group. There was a statistically significant improvement in the cognitive scores of children who participated regularly in the programme (p < 0.0001). These findings suggest that even limited exposure to a low intensity programme for motor development can positively impact gross motor skills and cognitive function in disadvantaged preschoolers.

HealthKick: Formative assessment of the health environment in low-resource primary schools in the Western Cape Province of South Africa

BackgroundThis study evaluated the primary school environment in terms of being conducive to good nutrition practices, sufficient physical activity and prevention of nicotine use, with the view of planning a school-based health intervention.MethodsA sample of 100 urban and rural disadvantaged schools was randomly selected from two education districts of the Western Cape Education Department, South Africa. A situation analysis, which comprised an interview with the school principal and completion of an observation schedule of the school environment, was done at all schools.ResultsSchools, on average, had 560 learners and 16 educators. Principals perceived the top health priorities for learners to be an unhealthy diet (50%) and to far lesser degree, lack of physical activity (24%) and underweight (16%). They cited lack of physical activity (33%) and non-communicable diseases (NCDs; 24%) as the main health priorities for educators, while substance abuse (66%) and tobacco use (31%) were prioritised for parents. Main barriers to health promotion programmes included lack of financial resources and too little time in the time table. The most common items sold at the school tuck shops were crisps (100%), and then sweets (96%), while vendors mainly sold sweets (92%), crisps (89%), and ice lollies (38%). Very few schools (8%) had policies governing the type of food items sold at school. Twenty-six of the 100 schools that were visited had vegetable gardens. All schools reported having physical activity and physical education in their time tables, however, not all of them offered this activity outside the class room. Extramural sport offered at schools mainly included athletics, netball, and rugby, with cricket and soccer being offered less frequently.ConclusionThe formative findings of this study contribute to the knowledge of key environmental and policy determinants that may play a role in the health behaviour of learners, their parents and their educators. Evidently, these show that school environments are not always conducive to healthy lifestyles. To address the identified determinants relating to learners it is necessary to intervene on the various levels of influence, i.e. parents, educators, and the support systems for the school environment including the curriculum, food available at school, resources for physical activity as well as appropriate policies in this regard.

Spinal cord injuries in South African Rugby Union (1980-2007)

OBJECTIVES AND DESIGN To address an apparent increase in the number of rugby-related spinal cord injuries (SCIs) in South Africa, a retrospective case-series study was conducted on injuries that occurred between 1980 and 2007. We aimed to identify preventable causes to reduce the overall rate of SCIs in South African rugby. METHODS We identified 264 rugby-related SCIs. A structured questionnaire was used, and it was possible to obtain information on a total of 183 players, including 30 who had died. RESULTS SCIs increased in number in the 1980s and in 2006. Forwards sustained 76% of all SCIs, and club players 60%. Players aged 17 had the highest number of SCIs. In only 50% of cases were medical personnel present at the time of injury, and 49% of injured players waited longer than 6 hours for acute management. Of players with an SCI, 61% had a catastrophic outcome after 12 months, including 8% who died during that time; 65% received no financial compensation; and only 29% of players had medical aid or health insurance. CONCLUSION A register of all rugby-related SCIs in South Africa is essential to monitor the magnitude of the problem, identify potential risk factors, and formulate appropriate preventive interventions. The lack of reliable denominator data limits calculation of incident rates. Players from previously disadvantaged communities in particular suffered the consequences of limited public health care resources and no financial compensation.

What's in the lunchbox? Dietary behaviour of learners from disadvantaged schools in the Western Cape, South Africa.

OBJECTIVE To identify and describe factors associated with food shop (known as tuck shop in South Africa) and lunchbox behaviours of primary-school learners in South Africa. DESIGN Analysis of data collected in 2008 from a cross-sectional survey. SETTING Sixteen primary schools in the Western Cape, South Africa. SUBJECTS A total of 717 grade 4 learners aged 10-12 years. RESULTS A 24 h recall established that 69 % of learners carried a lunchbox to school and 49 % had consumed at least one item purchased from the school food shop/vendor. Most lunchboxes contained white bread with processed meat, whereas the most frequent food shop/vendor purchase comprised chips/crisps. Learners who carried a lunchbox to school had significantly lower BMI percentiles (P = 0·002) and BMI-for-age (P = 0·034), compared with their counterparts. Moreover, they were younger, had higher standard-of-living and dietary diversity scores, consumed more meals per day, had greater self-efficacy and came from predominantly urban schools, compared with those who did not carry a lunchbox to school. Learners who ate food shop/vendor purchases had a lower standard-of-living score and higher dietary diversity and meal scores. Only 2 % of learners were underweight, whereas 19 % were stunted and 21 % were overweight/obese (BMI ≥ 25 kg/m2). CONCLUSIONS Children who carried a lunchbox to school appeared to have greater dietary diversity, consumed more regular meals, had a higher standard of living and greater nutritional self-efficacy compared with those who did not carry a lunchbox to school.

Preventing spinal cord injuries in rugby union

Other countries should follow New Zealands lead

The relationship between gross motor skills and school readiness in early childhood: making the case in South Africa

Early childhood development (ECD) has gained substantial recognition in South Africa (SA) as a key issue to be addressed, but inequities and deficits remain evident, despite progressive policy and widespread effort by a range of role players in the non-governmental sector. ECD in SA requires far more attention if these are to be rectified, and school readiness is a particular area of concern. Previous research indicates that gross motor skills may positively impact on school readiness outcomes in disadvantaged SA children. This paper outlines school readiness deficits in disadvantaged SA children and presents an argument for using gross motor skill interventions to address these. This argument can hopefully form the basis for future gross motor skill interventions aimed at improving school readiness among disadvantaged children in a range of settings. Insight gained from the situation in SA may serve to assist those in other countries facing similar challenges with ECD.

Impact of social norms and social support on diet, physical activity and sedentary behaviour of adolescents: a scoping review

The prevalence of non-communicable diseases (NCDs) in adulthood is rapidly increasing, and it is essential that risk factors for NCDs be addressed in adolescence, both for the health of individuals during adolescence and for their health in later life. These risk factors include diet, physical activity and sedentary behaviour. No literature has been published that comprehensively summarizes the impact of social norms and social support on these behaviours among adolescents. Therefore, a scoping review was conducted to determine the extent of recent (since 2000) literature available on this topic. A comprehensive search strategy was used to search PubMed and EMBASE for eligible reviews. Review papers (narrative reviews, systematic and non-systematic reviews) published in English in peer-reviewed journals from 2000 to February 2013 were included in the overview. Two of the authors screened the titles and abstracts of the search results independently. Thirty reviews were included in the scoping review. This scoping review has shown sufficient evidence for parental influences, and especially the positive impact of an authoritative parenting style, on healthy behaviours of adolescents, although the evidence is somewhat more compelling for diet than for physical activity and sedentary behaviour. More research is needed to investigate parental and family influences on physical activity and sedentary behaviour. And the effect of peer influences on diet, physical activity and sedentary behaviour of adolescents requires further investigation. The evidence presented affirms the consideration of social norms and social support in the development of interventions to address these behaviours in adolescents. The evidence regarding parenting style provides some concrete guidance for such interventions.