Sunitha Srinivas

Antiretroviral Treatment and Follow-up of HIV-Infected Patients by Health Care Providers in South African Public Primary Health Care

&NA; Antiretroviral therapy (ART) for HIV became available in the South African public health sector in 2004. Medical treatment in public primary health care (PHC) clinics is dependent on nurses and auxiliary staff. The aim of this descriptive study was to describe practice patterns and perceptions of health care providers (HCPs) regarding treatment of HIV‐infected patients on ART, drug adherence, and patient education in a public PHC setting in the Eastern Cape, South Africa. Personal interviews, using a structured questionnaire, were conducted with all HCPs (N = 43) working with the ART program at 7 PHC clinics. Insufficient training was expressed as a major concern. Medication adherence was believed to be the most important aspect of care to discuss with HIV‐infected patients. HCPs perceived that patients had few side effects. HCPs faced challenges with heavy workloads, lack of sufficient human resources and training, and time constraints.

Healthcare providers’ experiences with adverse drug reactions and adherence challenges in antiretroviral therapy of HIV patients in the Eastern Cape Province, South Africa

PurposeTo gain insight into the experiences and handling of adverse drug reactions (ADRs) by the staffs of public primary healthcare (PHC) clinics in Eastern Cape Province, South Africa, as well as their perceptions of related adherence challenges in the treatment and follow-up of human immunodeficiency virus (HIV)-positive patients.MethodsHealthcare providers working at the PHC level in the public sector in the study area were approached and asked to participate in focus group discussions (FGDs). Seven FGDs were conducted with 32 healthcare providers (9 nurses, 23 auxiliary staff). Questions introduced by the moderator of each FGD were freely discussed by the participants. Discussions were audio-recorded and subjected to thematic content analysis.ResultsSeveral challenges in the treatment and follow-up of patients on ART were identified. These include: (1) lack of training of healthcare providers in PHC clinics to confidently identify, manage and treat the ADRs HIV-positive patients receiving ART; (2) patients’ difficulty in communicating information on ADRS; (3) insufficient pharmacovigilance; (4) role of poverty.ConclusionBoth nurses and auxiliary staff expressed lack of knowledge and confidence regarding ADRs in HIV patients and management of this. More emphasis is warranted on training the healthcare providers to identify ADRs and provide adequate advice for continued treatment of patients experiencing potential drug related problems.

Design, implementation and preliminary evaluation of an introductory service-learning elective for pharmacy students

Health promotion is an effective strategy to address the increasing global burden of non-communicable diseases. A paradigm shift in pharmacy practice requires pharmacists to be more proactive in dealing with community health issues. In order to prepare pharmacy students for their changing role, a service-learning elective incorporating health promotion, was designed and implemented. This was to provide students the opportunity to achieve the critical cross-field outcomes to which Rhodes University aspires; and to empower the community with knowledge for the prevention and management of priority chronic health conditions in South Africa. Under supervision, groups of final year pharmacy students researched these health conditions and designed interactive health promotion activities. These were presented at the 2007 Sasol National Festival of Science and Technology (SciFest). A cross-section of children and adults visited the exhibit. Feedback indicated that this interaction between students and the communit...

Knowledge, attitudes and perception on dietary salt reduction of two communities in Grahamstown, South Africa

Introduction: Dietary salt reduction has been identified as a cost effective way of addressing the global burden of non-communicable diseases (NCDs), particularly cardiovascular diseases. The World Health Organization has recommended three main strategies for achieving population-wide salt reduction in all member states: food reformulation, policies and consumer awareness campaigns. In 2013, the South African Ministry of Health announced the mandatory salt reduction legislation for the food manufacturing sector. These were set to come into effect on 30 June 2016. This decision was influenced by the need to reduce the incidence of NCDs and the fact that processed food is the source of 54% of the salt consumed in the South African diet. However, with discretionary salt also being a significant contributor, there is need for consumer awareness campaigns. The aim of this study was to assess the knowledge, attitudes and practices of guardians and cooks at two non-governmental organisations based in Grahamstown, South Africa, towards dietary salt reduction. Method: Data was collected through observation and explorative, voice-recorded semi-structured interviews and transcribed data was analysed using NVivo®. Results: At both centres, salt shakers were not placed on the tables during mealtimes. Only 14% the participants perceived their personal salt intake to be a little. No participants were aware of the recommended daily salt intake limit or the relationship between salt and sodium. Only five out of the 19 participants had previously received information on dietary salt reduction from sources such as healthcare professionals and the media. Conclusion: The results from the first phase of this study highlighted gaps in the participants’ knowledge, attitudes and practices towards dietary salt reduction. The aim of the second phase of the research is to design and implement a context specific and culturally appropriate educational intervention on dietary salt reduction.

Evaluation of a service-learning elective as an approach to enhancing the pharmacist’s role in health promotion in South Africa

Background. A service-learning (SL) elective offered to final-year pharmacy students was introduced in 2007. The elective demonstrated a holistic approach to creating opportunities for future pharmacists to understand the current needs and future challenges of the burden of disease in developing countries such as South Africa and to foresee their key roles in health promotion. Methods. The 2007 Sasol National Festival of Science and Technology (SciFest) was chosen as the ideal platform to implement this elective. Evaluation of the elective was carried out in association with the Academic Development Centre using a web-based software tool known as the ADC evaluation assistant (ADCEA). The ADCEA consisted of a ‘question bank’ from which the course facilitators selected nine ranked closed questions as well as two open-ended questions. Results. SciFest participation, in the course of the service-learning elective, was acknowledged by students to have prepared them as responsible citizens to undertake health promotion in the public sector healthcare system. Conclusion. Students’ experiences of the learning opportunities provided in the SciFest elective highlight the strengths of this SL programme. The SL elective provided a unique and relevant opportunity to address the health promotion needs of the South African community and potentially enhance human capacity to deliver health promotion in South Africa.

Facilitating and limiting factors of workplace health promotion at Rhodes University, South Africa

BACKGROUND Workplace health promotion programs, when well designed and implemented are beneficial to both employees and their employers. OBJECTIVE To investigate the factors that affect workplace health promotion initiatives intended for support staff at Rhodes University. To explore ways in which future initiatives that aim to reduce the prevalence of non-communicable diseases in the workplace may be improved. METHODS A qualitative study, using semi-structured interviews and focus group discussions with key stakeholders and support staff. All interviews and focus group discussions were voice recorded and then transcribed verbatim. Transcripts were uploaded into NVivo® 10 for coding and thematic analysis. RESULTS Key stakeholders reported that health promotion initiatives have been attempted and were advertised, however the turnout was poor. The support staff in turn, stated that past initiatives were not tailored to their health needs and they lacked context-specificity and cultural sensitivity. They also suggested improvements for future initiatives such as convenient venues and using films and short plays as a means of delivering health information. CONCLUSIONS Based on inputs from key stakeholders and support staff, there are several factors that affect the success of health promotion initiatives in the workplace. Employees, who are the recipients of the planned initiatives, need to be involved in all stages of the planning and implementation.

Assessment of Risk Factors for the Cardiovascular Diseases in People Visiting a Tertiary Care Hospital for Routine Medical Check-Up

Background: Cardiovascular diseases have become the single leading cause of death and disease burden globally in low and middle-income countries such as India. The relatively early onset age of cardiovascular diseases in India in comparison to Western countries also implies that most productive ages of the patient’s life are lost fighting the disease. Deaths associated with cardiovascular events remains constant in many countries due to new therapeutic approaches for prevention and treatment of cardiovascular diseases. This condition is widely attributable to unhealthy outcomes in its association with risk factors such as age, obesity, dyslipidemia, smoking, low socioeconomic state and sedentary lifestyle which play a significant role in the progression of cardiovascular diseases. Methods and Results: Prospective observational study conducted in a tertiary care hospital in Bangalore over 6 months. Subjects between 30-89 years of age visiting in and out-patient department of St. Philomena’s Hospital, Bangalore were enrolled in the study. Subjects with diabetes mellitus, hypothyroidism and who were on anti-hyper lipidemic agents were excluded. 92 subjects (44 male and 48 female) were included in the study, among whom 48 (52.2%) were in the age group of 50-69 years. Abnormal total cholesterol and Low Density Lipoproteins were found more in male subjects and abnormal High Density Lipoproteins and triglycerides were found predominantly high in female subjects. Approximately 62% of study participant were obese and overweight, only 34 out of 92 participants were doing physical activity, nearly 91.3% were belonged to lower socioeconomic class and among male participants 32 of them were current smoker. The result indicated that as the age increases, the risk of CVD raises. Conclusion: Our study showed that the common risk factors among our subjects without comorbidity were age, obesity and over-weight, dyslipidemia, physical inactivity, low socioeconomic status and smoking.

Appraising risk of development of cardiovascular disease in patients with type 2 diabetes mellitus

Background: Research shows a strong relationship between type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). Most commonly, diabetic participants experience increased morbidity and mortality due to CVD complications. This study aims to determine the proportion of CVD prevalence and to evaluate the risk factors for developing CVD among T2DM participants and to evaluate the CVD risk factor for the next 10 years using Joint British Societies recommendations on the the Prevention of Cardiovascular Disease (JBS3) scale. Materials and Methods: In this hospital-based observational study, data including serum creatinine, blood urea, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very LDL, echocardiography, and ECHO readings were collected from a random sample of 106 participants, both diabetic and nondiabetic. The risk of developing CVD in participants with DM in the next 10 years was evaluated using the JBS3 risk calculator through analysis of collected data. Results: Among 106 participants, there were 72 participants with DM, and the majority of these participants had comorbidities, including hypertension and other CVDs. According to the data collected from DM participants, it was observed that 77.77% had elevated serum creatinine value, 27.77% had elevated blood urea level, 61.11% had abnormal HDL value, 65.27% had elevated LDL value, and 26.38% had elevated VLDL value. Total triglycerides level was also observed to be high in 54.16% of the DM participants. Moreover, the results indicated that CVD was present in 77.78% of type 2 diabetic patients, which was comparatively higher than in nondiabetic participants of whom 32.35% had CVD. Conclusion: Based on the data collected and results obtained from the JBS3 risk calculator, it was found that the participants with DM were at higher risk of developing CVD.

Balanced nutrition and hand hygiene for children in South Africa

Globally, ∼5.9 million children under the age of 5 years died in 2015, with the challenges of child mortality and morbidity being common in developing countries. Many of these deaths are preventable and poor nutritional and hygienic practices contribute greatly to these rates. The spread of infectious disease through unhygienic practices, such as inadequate hand hygiene, remains high due to lack of education regarding hygienic infection control practices at home and in the workplace. The aim of this research was to design and implement a participatory health promotion intervention for caregivers at the Rhodes Day Care Centre (RDCC) that highlighted these important public health issues. We conducted a pre-intervention group feedback discussion with caregivers at the RDCC to identify current practices and to establish the current baseline knowledge of the caregivers. Health workshops with caregivers was facilitated by the researcher, and health information leaflets (HILs) were designed for and used during these workshops. Caregivers at RDCC exhibited fair baseline knowledge on the importance of providing nourishing meals to the infants, including the need for exclusive breastfeeding, and the importance of hand hygiene in preventing the spread of disease. This basic knowledge was positively built upon in the two health promotion intervention workshops. This initiative, held at RDCC, was able to catalyse the development of health knowledge that could have a substantial impact on the understanding of health literacy of the caregivers and on the promotion of adequate child health in the community.

Gender and leadership for health literacy to combat the epidemic rise of noncommunicable diseases

ABSTRACT Until recently, the noncommunicable diseases (NCDs) epidemic has been considered only a significant burden to men in high-income countries. However, latest figures indicate that half of all NCD-related deaths affect women, especially in low- and middle-income countries (LMICs), with global responses to the NCD epidemic overlooking the significance of women and girls in their approaches and programs. This case study highlights the burden of disease challenging South Africa that disproportionately affects women in the country and suggests that the country, along with other LMICs internationally, requires a shift in the gender-based leadership of health literacy and self-empowerment.