Patricia N. Albers

Self-reported sun-related knowledge, attitudes and behaviours among schoolchildren attending South African primary schools.

Skin cancer and other adverse health effects result from excess solar ultraviolet radiation exposure. Sun protective practices are important interventions for skin cancer prevention, particularly when implemented early in life. Several international studies have assessed childrens sun‐related knowledge, attitudes and behaviours in school settings but never before in Southern Africa, where multiethnic populations exist.

Students’ perceived heat-health symptoms increased with warmer classroom temperatures

Temperatures in Africa are expected to increase by the end of the century. Heat-related health impacts and perceived health symptoms are potentially a problem, especially in public schools with limited resources. Students (n = 252) aged ~14–18 years from eight high schools completed an hourly heat-health symptom log over 5 days. Data loggers measured indoor classroom temperatures. A high proportion of students felt tired (97.2%), had low concentration (96.8%) and felt sleepy (94.1%) during at least one hour on any day. There were statistically significant correlations, when controlling for school cluster effect and time of day, between indoor temperatures ≥32 °C and students who felt tired and found it hard to breathe. Consistently higher indoor classroom temperatures were observed in classrooms constructed of prefabricated asbestos sheeting with corrugated iron roof and converted shipping container compared to brick classrooms. Longitudinal studies in multiple seasons and different classroom building types are needed.

Diffuse reflectance spectroscopy versus Mexameter® MX18 measurements of melanin and erythema in an African population

Melanin provides protection against excess exposure to solar ultraviolet radiation (UVR) and related adverse health effects. Diffuse reflectance spectroscopy (DRS) can be used to calculate cutaneous melanin and erythema, but this is complex and has been mostly used for light‐to‐medium pigmented skin. Handheld reflectance spectrophotometers, such as the Mexameter® MX18, can also be used. We compared DRS‐calculated melanin and erythema values with Mexameter melanin and erythema index values to understand how these techniques/measurements correlate in an African population of predominantly deeply pigmented skin. Five hundred and three participants comprised 68.5% self‐identified Black African, 9.9% Indian/Asian, 18.4% White and 2.9% Colored. The majority of Black African (45%), Indian/Asian (34%) and Colored (53%) participants self‐identified their skin as being “brown.” Measured melanin levels increased with darker self‐reported skin color. DRS‐calculated and Mexameter melanin values demonstrated a positive correlation (Spearman rho = 0.87, P < 0.001). The results from both instruments showed erythema values were strongly correlated with their own melanin values. This finding is considered spurious and may result from the complexity of separating brown and red pigment when using narrowband reflectance techniques. Further work is needed to understand melanin, erythema and color in Black skin given sun‐related health risks in vulnerable groups in Africa.

Household fuel use and child respiratory ill health in two towns in Mpumalanga, South Africa

BACKGROUND This cross-sectional study examined respiratory health outcomes and associated risk factors in children living in a part of South Africa characterised by high levels of air pollution. METHODS A questionnaire was used to collect self-reported respiratory health and risk factor data from the parents/guardians of children between the ages of 9 and 11 years attending primary schools in the study area. Six government schools were selected based on their location, class size and willingness to participate. Univariate and bivariate analyses as well as logistic regression analysis were performed on the data, using a p-value of 0.25 and biological plausibility. RESULTS The overall prevalence of respiratory ill-health symptoms was 34.1%. The prevalence of respiratory ill-health conditions was significantly elevated among children from households using non-electrical fuels v. electricity for cooking (43.9% v. 31.6%; adjusted p-value 0.005). The same was noted among those using non-electrical fuels for heating (37.8% v. 29.0%). CONCLUSION The elevated prevalence of some respiratory health outcomes among schoolchildren, especially in conjunction with domestic fossil fuel burning, is of concern. The data collected in this study may be used to complement or form a basis for future policy regarding indoor or ambient air quality in the area.

‘My child did not like using sun protection’ : practices and perceptions of child sun protection among rural black African mothers

BackgroundPhotodamage is partially mitigated by darker skin pigmentation, but immune suppression, photoaging and cataracts occur among individuals with all skin types.MethodsTo assess practices and acceptability to Black African mothers of sun protection equipment for their children living in a rural area, participants were recruited at the time of their child’s 18-month vaccinations. Mothers completed a baseline questionnaire on usual sun behaviours and sun protection practices. They were then provided with sun protection equipment and advice. A follow-up questionnaire was administered two weeks later.ResultsMothers reported that during the week prior to the baseline questionnaire, children spent on average less than 1 hour of time outdoors (most often spent in the shade). Most mothers (97%) liked the sun protection equipment. However, many (78 of 86) reported that their child did not like any of the sun protection equipment and two-thirds stated that the sun protection equipment was not easy to use.ConclusionsAmong Black Africans in rural northern South Africa, we found a mismatch between parental preferences and child acceptance for using sun protection when outdoors. A better understanding of the health risks of incidental excess sun exposure and potential benefits of sun protection is required among Black Africans.

Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing

Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2–4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed ‘realfeel’ temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of ‘stuffiness’ and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat–health impact warning categories of ‘caution’ and ‘extreme caution’.

Effect of A Sun Protection Intervention on the Immune Response to Measles Booster Vaccination in Infants in Rural South Africa

The incidence of many serious childhood infections can be reduced by vaccination. High sun exposure at the time of vaccination has been associated with a reduced antigen‐specific immune response. We hypothesized that providing sun protection advice and equipment to mothers of children who were waiting to be vaccinated would result in a more robust immunization response. We conducted a pilot study in 2015/2016 (data analyzed in 2017–2018) among 98 Black African children (~18 months of age) receiving the booster measles vaccination at two clinics in South Africa. Clinics were randomized to receive (or not) sun protection advice and equipment. We recorded demographic information on children and mothers and data on the childs usual sun exposure. At approximately 4 weeks’ postmeasles vaccination, we measured measles immunoglobulin G levels in children. All children with blood results (n = 87, 89%) across both groups had antibody titers higher than 200 mIU mL−1 which was considered the protective antibody concentration. There was no statistically significant difference in titers between groups: geometric difference in mean titers 1.13 mIU mL−1 (95% CI 0.85, 1.51; P = 0.39) and 1.38 mIU mL−1 (95% CI 0.90, 2.11, P = 0.14) for unadjusted and adjusted analyses, respectively. This study demonstrated that a sun protection intervention study could be performed in a developing‐world pediatric vaccination setting. Although the sun protection intervention around the time of vaccination was not associated with a higher antibody level, given the potential importance of such an effect, a larger study should be considered.

The influence of HIV infection on the age dependence of squamous cell carcinoma of the skin in South Africa

BACKGROUND Cancer incidence typically increases with age, but it is not known whether ethnic characteristics influence the age dependence of squamous cell carcinoma of the skin (SCC). OBJECTIVES (i) To determine the age dependence of SCC in the black African, coloured and white population groups of South Africa (SA); and (ii) to show whether any differences in the rate of change of age dependence could be influenced by diversity in behaviour and lifestyle, especially with regard to the prevalence of HIV infection, rather than by a fundamental variation in cancer biology between the populations. METHODS Linear regression analysis was applied to the logarithm of the age-specific incidence rates for SCC v. the logarithm of age between 35 and 74 years. The slopes of the regression (age exponent) were compared for each subset of gender, population group and year of diagnosis (between 2000 and 2010). RESULTS The most notable feature was the low value of the age exponent in both male and female black African compared with the white and coloured populations. This finding could be explained in part by the difference in the prevalence of HIV infection in the black African population group compared with the white and coloured population groups. CONCLUSIONS The prevalence of HIV infection in black Africans in SA tends to decrease the apparent age component in SCC compared with the white and coloured population groups. Other factors relating to lifestyle and behaviour that differ between the population groups are also likely to influence the age component in SCC.

Geographical differences in primary schoolchildren's key sun-related behaviours: an exploratory, feasibility study

South Africa receives high levels of solar ultraviolet radiation (UVR). Exposure to UVR has beneficial and harmful effects, the most common of which are vitamin D synthesis and skin cancer, respectively. Acute exposure during childhood is a known risk factor for melanoma. In South Africa where skin cancers account for a third of all histopathologically diagnosed cancers, information on behaviour patterns and protection use is needed to inform awareness campaigns. Hence, this article aimed to perform an exploratory, feasibility study on the sun-related behaviours of urban primary schoolchildren by province. In general, use of sun protection was inconsistent and 52% of children reported sunburn. Generally, children from schools in the eastern part of the country self-reported higher incidence of suntan and sunburn compared to the western half. Similarly, children in Limpopo, Eastern Cape, Mpumalanga and North-West tended to use sun protection more often compared to the remaining provinces, although hat/cap usage and clothing were comparably high in the Northern Cape and KwaZulu-Natal, respectively. Children in the Western Cape had a high incidence of sunburn and amongst the lowest use of sun protection; this province is also known to have skin cancer incidence rates as high as those in Australia. While results are not representative of all of South Africa, they provide some indication that there is much to be done to raise levels of sun-related knowledge and tailor safe sun behaviours.

In multiple situational light settings, visual observation for skin colour assessment is comparable with colorimeter measurement

Finding inexpensive and reliable techniques for assessing skin colour is important, given that it is related to several adverse human health outcomes. Visual observation is considered a subjective approach assessment and, even when made by trained assessor, concern has been raised about the need for controlled lighting in the study venue. The aim of this study is to determine whether visual skin colour assessments correlate with objective skin colour measurements in study venues with different lighting types and configurations.