Rd Govender

Age, Gender and Suicidal Ideation Following Voluntary HIV Counseling and Testing

The aim of this study was to determine the prevalence of suicidal ideation in patients who were tested for HIV-infection and whether along with their HIV status, age and gender influenced their risk for suicidal ideation. The sample consisted of 189 patients who attended a voluntary HIV counseling and testing clinic (VCT) at a general state hospital in Durban, South Africa. Their mean age at baseline was 34.2 years, with an age range of between 16–79 years. Seropositivity, age and gender were significantly associated with suicidal ideation. The majority of these patients were in the younger age group, and young males had a 1.8 times higher risk for suicidal ideation than females. Although risk factors for seropositive-related suicidal ideation can be complex and multi-factorial, this study identified a young age and male gender as important high risk factors in the sample studied. It is recommended that all, but especially young male HIV-infected patients seen at a VCT clinic be screened for suicidal ideation and that early intervention to prevent subsequent suicides or suicidal attempts be included in pre- and post-test HIV counseling.

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic.

OBJECTIVE Suicidal behaviour and HIV/AIDS are significant public health concerns. The aim of this study was to investigate suicidal ideation in patients who were referred to a voluntary HIV counselling and testing (VCT) clinic and who were found to be seropositive. This in order to improve suicide prevention and intervention strategies amongst such patients. METHOD The sample studied consisted of volunteer adult patients referred over a three-month period to a HIVVCT clinic based at a university-affiliated general state hospital. Patients completed a questionnaire on sociodemographic data. Suicidal ideation was measured using the Beck Hopelessness Scale and the Beck Depression Inventory (BDI), at two time points (within 72 hours after notification and again at a 6 week follow-up). All patients received extensive pre-and post-test counselling. RESULTS HIV-test results were available for 189 (99.5%) of the original sample of 190 patients studied, with 157 (83.1%) testing positive. More females tested positive as did unemployed and single/divorced patients. The mean age for HIV-positive patients was 33.49 (SD = 9.449), and for HIV-negative patients it was 37.94 (SD = 15.238). Age was a significant factor in that for each year increase in age, the risk of testing HIV-positive decreased by 4.1%. Lower education and traditional beliefs were also significantly associated with testing HIV-positive. At 72 hours suicidal ideation was present in 17.1% (95% confidence interval 12.16% to 23.45%), and at 6 weeks in 24.1% (95% confidence interval 17.26% to 32.39%) of the seropositive patients. Their average BDI scores were 15.20 and 14.23 respectively at the two time points. CONCLUSION Suicidal ideation was present in a significant number of the seropositive cohort studied and increased over a six week period among these patients. The average BDI scores at both time points imply a clinical depression. The findings also suggest an association between positive HIV-test results and certain socio-demographic variables that can act as indicators for suicidal ideation in HIV-infected persons, although this requires further research. Although the relationship between suicidal ideation and HIV-infection is complex, it is an important consideration when assessing patient suicide vulnerability at HIV VCT clinics and when implementing suicide prevention and management strategies.

The barriers and challenges to Health Promotion in Africa

Health promotion is the process of enabling people to increase control over and to improve their health so as to reach a state of complete physical, mental and social well being. The World Health Organisation which was created in 1948, where some 190 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world a level of health that will permit them to lead a socially and economically productive life. Unfortunately Africa is riddled with corruption, debt, conflicts, wars, rape, child soldiers, HIV/AIDS, land mines, unemployment and the list is endless; which are formidable barriers and challenges to health promotion. (SA Fam Pract 2005;47(10): 39-42)

Overweight and obesity amongst Black women in Durban, KwaZulu-Natal: A ‘disease’ of perception in an area of high HIV prevalence

Abstract Background Overweight and obesity is an emerging health problem, particularly amongst urban Black women living in areas of high HIV prevalence. Understanding factors affecting this pandemic is essential to enable effective weight loss programmes to be implemented. This study explored urban Black womens perception of their body image against a backdrop of pre-existing non-communicable diseases (NCDs). Method In this cross-sectional exploratory study 328 urban Black women were sampled systematically. Anthropometric measurements were conducted and women were interviewed using the Stunkard body image silhouettes as a tool to determine perception. Results Most of the subjects (61%) were in the 40–59 years age group. Mean body mass index (BMI) was 37 (± 9.41 kg/m2) with over 90% being overweight or obese. Diabetes mellitus was the most common NCD, with a prevalence of 72%. Amongst the diabetic patients 7% were overweight and 64% obese. Perceived body image compared to derived BMI showed that women underestimated their body image across all weight categories. Over 40% indicated a normal to overweight preferred body image, with 99% of respondents associating the underweight silhouettes with disease and HIV infection. Conclusion Urban Black women with underlying NCDs and living in an area of high HIV prevalence perceive themselves to be thinner than their actual BMI, which may be a barrier to weight loss management. This misperception may be used as a proxy risk marker for weight gain in urban Black women.

Elevated Risk of Suicidal Ideation in HIV-Positive Persons

Globally, suicide and HIV/AIDS remain two of the greatest healthcare issues, particularly in low- and middle-income countries. Several studies have observed a relationship between suicidal behaviour and HIV/AIDS. Materials and Methods. The main objective of this research was to determine the prevalence of elevated risk of suicidal ideation in HIV-positive persons immediately following voluntary HIV counselling and testing (VCT). The study sample consisted of adult volunteers attending the VCT clinic at a university-affiliated, general state hospital. Participants completed a sociodemographic questionnaire, Becks Hopeless Scale, and Becks Depression Inventory. Results. A significantly elevated risk of suicidal ideation was found in 83.1% of the patients who tested seropositive. Despite a wide age range in the cohort studied, the majority of patients with suicidal ideation were males in the younger age group (age < 30 years), consistent with the age-related spread of the disease and an increase in suicidal behaviour in younger people. Relevant associated variables are discussed. Conclusion. The results serve as important markers that could alert healthcare professionals to underlying suicide risks in HIV-positive patients. It is recommended that screening for elevated risk of suicidal ideation and prevention of suicidal behaviour should form a routine aspect of comprehensive patient care at VCT clinics.

Knowledge, attitudes and practices of healthcare workers about healthcare waste management at a district hospital in KwaZulu-Natal

Background: Health care generates a large amount of healthcare waste (HCW), which is complex to manage because of its variety and potential to create health and safety hazards if improperly handled. It is essential that healthcare workers have appropriate knowledge of and adhere to proper disposal methods for each category of HCW. Aim: The aim of this study was to assess the knowledge, attitudes and practices of staff working at a district hospital about HCW management, and measure associations between these variables. Setting: The setting for this study was a district hospital in KwaZulu-Natal province. Methods: This was an observational descriptive study among 241 professional and non-professional staff. Data were collected using a questionnaire and analysed using the Statistical Package for the Social Sciences. Results: Knowledge of HCW management was generally inadequate, with 42.7% of the participants scoring ‘poor’ overall. Just over half of the participants reported a good attitude towards the appropriate disposal of HCW but only 53.9% demonstrated good HCW management practices. There was a significant (p < 0.05) relationship between knowledge and practice and between attitudes and practices (p < 0.05). Conclusion: Appropriate training and supervision in HCW management as well as relevant and ongoing in-service training is needed to ensure appropriate knowledge, attitudes and safe practice among all members of staff. As poor practices have been reported on a number of occasions from different hospitals in South Africa, relevant training must also be introduced or improved at undergraduate level.

Poor control and management of type 2 diabetes mellitus at an under-resourced South African Hospital: is it a case of clinical inertia?

Evidence shows that even with the implementation of evidence-based medicine, the attainment of optimal glycaemic control is difficult and challenging for both patients and healthcare providers. This study was a one-year retrospective chart review with data collected during the period October 2010 to December 2010 of patients with Type 2 diabetes mellitus (T2DM) who attended the outpatients’ department at the Port Shepstone Regional Hospital (PSRH), South Africa (SA). The total study population was 360 patients with 51% Black African, 32% Indian, 16% White and 1% Coloured. Of the 111 patients’ charts only 78 had two consecutive HbA1c levels recorded. Of the 78/111 patients, only 10 patients had the target HbA1c level of < 7% at visit 1. By visit two, 15.4% (n = 12) had achieved the target HbA1c level. Over the one-year chart review only 3/111 (2.7%) maintained their HbA1c level of < 7% and 5/111 patients whose treatment was revised according to the 2009 SEMDSA guidelines reached HbA1c < 7% by visit 2 whilst 4/111 patients, whose treatment schedule was not modified according to the 2009 SEMDSA guidelines, also reached HbA1c < 7% at visit 2. However, this one-year chart review showed that glycaemia was poorly managed at this hospital, which may be explained by clinical inertia.

More than scales and tape measures needed to address obesity in South Africa

Obesity is an emerging public health problem worldwide increasing from 857 million in 1980 to 2.1 billion by 2013. A study was done on a sample of 100 obese and overweight patients with a body mass index (BMI) above 25 kg/m2. The patients were asked to complete a questionnaire, which included socio-demographic data and perceptions regarding their weight. The patients were between the ages of 18 and 76 years old with 82% being female patients. The mean BMI for males was 41.7 kg/m2 (SD = 7.38112) and females 39.9 kg/m2 (SD = 7.90504). The results of this study confirm that 17% of overweight and obese patients saw themselves as having a normal weight and 97% felt that they were not unattractive. Of the sample, 96% affirmed that being obese was a health risk. The commonest reason cited for their obesity is by choice (70%). Although obese patients knew that obesity is a health risk, they have a positive image of obesity. The dramatic trend towards increasing obesity suggest that healthcare providers need to understand how people from different cultures view obesity. This will help them to promote key messages about the health risks associated with excess weight in a culturally sensitive way.

Self-reported knowledge and use of emergency contraception among women presenting for termination of pregnancy

Background: Emergency contraception (EC) is widely accepted as a safe method of preventing conception following unprotected coitus. Use of EC has been promoted in South Africa, yet uptake among women appears to remain low. Aim: The aim of this study was to access knowledge and use of EC among women presenting for termination of pregnancy at a district hospital in KwaZulu-Natal. Methods: This was a hospital-based cross-sectional study. Data were collected from women attending a termination of pregnancy (ToP) service at a district hospital using a questionnaire and analysed descriptively. Results: A total of 218 women participated, of whom 25% were under 20 years of age and 87% were single. Reported knowledge of EC was good with 70% of participants indicating that they knew about EC. However, knowledge around EC was not complete, with less than 50% knowing the time interval between intercourse and EC action and some believing that EC acted by inducing an abortion. Reported usage of EC was only 40%. Conclusion: This study revealed that there is much more to be done to enhance knowledge and use of EC in this context. Reasons for the discrepancy between knowledge and usage need further exploration.