Preparedness to implement national enteral nutritional therapy practice guidelines: An observational study of primary health care institutions in South Africa.

BACKGROUND:  Despite the long-term consequences of malnutrition in hospitalised patients, nutritional practice guidelines for adults, particularly in the recovery phase are rarely implemented in community based primary health care settings. AIM:  This study aimed at assessing the current practice to establish preparedness for effective implementation of the 2016 South African Enteral Nutrition Practice Guidelines for Adults. SETTING:  This study was conducted in a district hospital in KwaZulu-Natal, a community health centre, two primary health care (PHC) clinics and one household. METHODS:  Non-participant observations were conducted to observe 10 purposefully selected health care professionals involved in nutritional therapy provision to adults, a patient on home enteral nutrition (HEN) and a family caregiver. Content analysis helped identify predominant themes that emerged in the study. RESULTS:  Observation results showed that the national enteral nutritional (EN) therapy practice guidelines were not available in all health care institutions. Health care professionals were not aware of them and the care users confirmed that they attended HEN related follow-up care at institutions that prescribed and inserted their feeding tubes. Two major themes that emerged in this study include positive factors and negative factors that influence implementation of the guideline. CONCLUSION:  The study identified factors that can have significant influence on the implementation of the national enteral nutritional therapy practice guidelines, a necessary step for changing clinical practice and thus clinical outcomes of patients. The EN/HEN training and the provision of necessary resources are needed to improve the situation. More research on the strategies for the dissemination of guidelines is essential to improve awareness and thus adoption and implementation.

Community disaster exposure and first onset of depression: A panel analysis of nationally representative South African data, 2008-2017.

Sub-Saharan Africa faces unprecedented disasters, with climate change expected to exacerbate the frequency and severity of unpredictable and stressful catastrophic events. Unlike developed nations, reconstruction in developing nations is hindered by resource constraints, with certain communities potentially experiencing multiple and enduring effects of disasters. Despite the potential danger of such cumulative community disaster exposure on mental health (e.g. depression), large-scale population-level evidence for the region is limited. We investigated the association between exposure to cumulative disaster and the first onset of depression in a nationally representative survey in South Africa. We used panel data from the South African National Income Dynamics Study (SA-NIDS) from 2008-2017, consisting of 17,255 adult study participants who were depression free at baseline. Risk of first depression onset between individuals exposed and unexposed to community disaster was measured, accounting for multiple disaster exposure over time by fitting generalized estimating equation (GEE) regression models. Data on the geographic location of disasters were obtained from the South African government gazette, and mapped with the government delineated SA-NIDS households' locations. Of the sampled individuals, 2,986 were exposed to disaster during the study duration (17.3%). Increased cumulative community disaster was significantly associated with the likelihood of depression onset (adjusted relative risk [aRR] = 1.20, p<0.01, 95% CI: 1.09-1.33), even after controlling for socio-demographic factors. In sub-group analyses, greater likelihood of depression onset was found among females [but not in men] (aRR = 1.23, p<0.01, 95% CI: 1.09-1.38), Black African [but not in other population group] (aRR = 1.21, p<0.01, 95% CI: 1.09-1.36), lower education attainment group [but not in tertiary and above educational attainment group] (aRR = 1.20, p<0.01, 95% CI: 1.08-1.33), and lower income attainment group [but not in the top income quartile group] (aRR = 1.24, p<0.01, 95% CI: 1.11-1.38), due to cumulative community disaster. Although cumulative community disaster exposure was significantly associated with the first onset of depression, its negative impact may be more pronounced among individuals considered chronically socially vulnerable (i.e. the groups above) in South Africa. Given that many individuals in South Africa rely on social, food parcel relief, and health services from government/public sector, timely access to community-based supportive intervention is needed for disaster survivors, prioritizing socially vulnerable groups to help mitigate problems associated with mental health challenges.

Condom use: a less travelled route among minibus taxi drivers and their taxi queens in KwaZulu-Natal, South Africa.

BACKGROUND: Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher burden of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships. OBJECTIVES: The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in Kwa- Zulu-Natal, South Africa. METHODS: Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal. RESULT: Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors. CONCLUSION: Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup.

Spatial clustering of food insecurity and its association with depression: a geospatial analysis of nationally representative South African data, 2008-2015.

While food insecurity is a persistent public health challenge, its long-term association with depression at a national level is unknown. We investigated the spatial heterogeneity of food insecurity and its association with depression in South Africa (SA), using nationally-representative panel data from the South African National Income Dynamics Study (years 2008-2015). Geographical clusters ("hotpots") of food insecurity were identified using Kulldorff spatial scan statistic in SaTScan. Regression models were fitted to assess association between residing in food insecure hotspot communities and depression. Surprisingly, we found food insecurity hotspots (p < 0.001) in high-suitability agricultural crop and livestock production areas with reliable rainfall and fertile soils. At baseline (N = 15,630), we found greater likelihood of depression in individuals residing in food insecure hotspot communities [adjusted relative risk (aRR) = 1.13, 95% CI:1.01-1.27] using a generalized linear regression model. When the panel analysis was limited to 8,801 participants who were depression free at baseline, residing in a food insecure hotspot community was significantly associated with higher subsequent incidence of depression (aRR = 1.11, 95% CI:1.01-1.22) using a generalized estimating equation regression model. The association persisted even after controlling for multiple socioeconomic factors and household food insecurity. We identified spatial heterogeneity of food insecurity at a national scale in SA, with a demonstrated greater risk of incident depression in hotspots. More importantly, our finding points to the "Food Security Paradox", food insecurity in areas with high food-producing potential. There is a need for place-based policy interventions that target communities vulnerable to food insecurity, to reduce the burden of depression.

Influence of Neonatal Resuscitation Training on Practice of Community Health Extension Workers in Managing Asphyxiated Newborns in Rural Nigeria: A Qualitative Study.

Birth asphyxia is a global health burden, and effective neonatal resuscitation could reduce the burden of deaths. Providing a suitable newborn resuscitation care will depend on the availability of an effective skilled health worker, who is competent in neonatal resuscitation. The study explores and assesses the effect of neonatal resuscitation training and retention of knowledge and skills in the management of asphyxiated newborns in rural Nigeria. This study used a narrative analysis technique to analyze data from a semistructured, individual interview. Data were analyzed using ATLAS.ti 8 qualitative software and applying the principle of thematic analysis. There was a considerable retention of knowledge and ability to practice the procedure even though some equipment was not available. Proficiency in neonatal resuscitation is an essential intervention for the survival of newborns and infants. Therefore, execution of neonatal resuscitation training program in rural communities can further improve knowledge and skills of community birth attendants in Nigeria.

Evidence on nutritional therapy practice guidelines and implementation in adult critically ill patients: A systematic scoping review.

BACKGROUND: The rapid increase in disease-related malnutrition makes it almost impossible for healthcare practitioners and policymakers to keep up with its negative consequences. Consequently, healthcare organisations and decision-makers have called for accelerated and double-duty actions to manage the double burden of malnutrition. Guidelines standardise nutritional practices, improve nutritional status and reduce hospitalisation duration and save costs. OBJECTIVES: A systematic scoping review of the nutritional therapy practice guidelines and implementation in critically ill adults was undertaken to identify the breadth of literature on the topic, summarise findings and identify gaps. METHODS: A comprehensive search strategy was designed and implemented to identify eligible studies from eight databases, websites of organisations, government departments and academic platforms. Reference lists of included studies were also searched for relevant studies. We assessed the quality of included studies, completed a descriptive numerical summary and analysed them. RESULTS: In total, 1555 titles and 101 abstracts were screened, 65 underwent full text review and 19 were retained for data extraction. Studies scored average to high on quality assessment, and a summary of characteristics of included studies is presented. Nutritional therapy practice guidelines are considered a proactive strategy for enhanced, uniform and individualised nutritional practices and factors that influence implementation were identified. CONCLUSIONS: A gap exists between research recommendations and actual practice despite the growing interest in implementation of nutritional therapy guidelines in critical care. There is a need for more research to evaluate the practicality of available guidelines.

Evidence on nutritional therapy practice guidelines and implementation in adult critically ill patients: a scoping review protocol.

BACKGROUND: Nutritional therapy practice guidelines are designed to improve nutritional practices and thus the delivery of nutritional therapy in critically ill patients. However, they are not implemented despite the strong recommendation of nutritional therapy in the management of critical illness. The aim of this study is to map evidence on nutritional therapy guidelines and their implementation in critically ill adult patients. METHODS: Two independent reviewers will conduct a search of published scholarly and gray literature on the implementation of nutritional therapy guidelines in critically ill adults using Arksey and O'Malley's scoping review framework. The search of studies will be conducted from databases such as PubMed, Google Scholar and EBSCOhost databases, Cumulative Index for Nursing and Allied Health Literature, MEDLINE, PsychINFO, PsychARTICLES, Health Source: Consumer Edition, Health Source: Nursing/Academic Edition, PreMEDLINE, Joanna Briggs Institute, and Cochrane Databases for Systematic Reviews. We will follow a predetermined criterion to map literature and additional articles will be searched from the reference lists of included studies. The Mixed Method Appraisal Tool (MMAT) will be used for quality assessment of the included studies. Quality assessment of included studies determines the overall quality of the resultant review. DISCUSSION: We hope to find studies on the implementation of nutritional therapy practice guidelines in adult critically ill patients and its impact on nutritional practices, patient outcomes, and health care costs. The results of this review will be disseminated through presentations in research seminars, conferences, and congresses and will also be available electronically and in print. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017058864.

Developing and Pilot Testing an Integrated Technology-Moderated Institutional Health Promotion Model Using Operational Research Approach.

The study aimed to develop and pilot test an Integrated Technology-Moderated Institutional Health Promotion Model for university staff in Nigeria. An operational research approach using mixed concurrent design was adopted to develop the model, and pretest-posttest method was used to evaluate the utilization and effectiveness of the developed model. The participants in the study were university staff. Health-promoting lifestyle behavior and health status were measured via the adapted Health-Promoting Lifestyle Profile II instrument. The emerging model (an Integrated Technology-Moderated Institutional Health Promotion Model, which is an Android phone app named Tertiary Staff Health Promotion App) was deployed. Data were collected before and 12 weeks after the app deployment. The quantitative and qualitative data findings were combined to develop an integrated technology-moderated institutional health promotion model as a means to enhance health-promoting lifestyle behavior and health status of staff. The result of the pilot testing of the model showed that the model enhances health-promoting lifestyle behaviors and improves the health status of staff. Nurses, especially in community/public health nursing practice, can provide innovative interventions to drive and enhance health-promoting lifestyle behavior and improve health status of workers and other population groups through effective use of information and communication technology.

Stakeholders' experiences in implementation of rapid changes to the South African prevention of mother-to-child transmission programme.

BACKGROUND:  South Africa's prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) programme has undergone rapid changes in the last two decades. Initially, the provision of single antiretroviral therapy was based on eligibility criteria in the year 2001, which later changed to combination therapy. This was aimed at preventing mother-to-child transmission of HIV. Since 2015, all pregnant women were eligible for antiretroviral treatment regardless of their CD4 count. Although significant strides were made to reduce mother-to-child transmission of HIV, increased efforts are required to meet UNAIDS targets, World Health Organization (WHO) elimination framework goals and sustainable development goals to eliminate new HIV infections in children and ending the HIV epidemic by 2030. AIM:  The aim of the study was to explore healthcare workers' experiences and patient perceptions of the implementation of rapid changes to the PMTCT programme in four public healthcare facilities. SETTING:  The study was conducted in the four public healthcare facilities within the two highly HIV-burdened districts of iLembe and eThekwini in KwaZulu-Natal province, South Africa. METHODS:  This study used a qualitative, exploratory, descriptive study design using interviews and focus group discussions. Participants were selected using purposive sampling. Following verbatim transcription of the data, thematic data analysis was used through data reduction and data display and the emergence of four themes. RESULTS:  A total of 61 stakeholders were interviewed. Four major themes emerged: (1) impact of poor health system design, (2) impact of poor communication of changes, (3) contextual factors affecting innovation in healthcare and (4) skill deficit in change management and forward planning. CONCLUSION:  A healthcare system more responsive to the experiences of healthcare workers and pregnant women is required to effectively implement changes in priority programmes.

Evaluation of health status and its predictor among university staff in Nigeria.

BACKGROUND: Hypertension, diabetes mellitus and obesity share some characteristics in relation to diagnosis, management, and prevention. Overweight, obesity and waist-hip ratio (WHR) are associated with increased risk for development of diabetes and hypertension. Surveillance and regular screening exercises are essential in control and prevention of overweight, obesity, diabetes and hypertension. There is limited literature that reported on these health status parameters among university staff in low- and middle-income countries such as Nigeria. It is currently unclear whether Nigerian have a high or low proportion of metabolic risk factors. Therefore, the study aims to examine health status parameters and their predictors among university staff in Nigeria. METHODS: The study used a cross-sectional descriptive design. Data were collected from 280 university staff in Nigeria. A self-administered questionnaire with sections for sociodemographic data and physical assessment was used to gather information from the participants. Data were analysed using the Statistical Package for Social Science (IBM-SPSS version 25). Univariable and multivariable logistic regression was conducted to explore the association between predictors and health status parameters of the participants. RESULT: The response rate was 87.5%. University staff had mean systolic blood pressure of 132.04 mmHg ± 19.20 mmHg, diastolic blood pressure of 78.11 mmHg ± 10.81 mmHg, body mass index of 27.74 ± 5.22, waist-hip ratio of 0.88 ± 0.68 and random blood sugar of 98.65 ± 21.30 mg/dL. Predictors of high blood pressure were age (adjusted odds ratio [aOR] = 1.10, CI 95%: [1.05-1.14]) and gender (aOR = 0.5, CI 95%: [0.8-0.9]) and predictors of body mass index were gender (aOR = 2.3, CI 95%: [1.3-4.2]) and religion (aOR = 0.3, CI 95%: [0.2-0.7]). Gender and age had statistically significant association with waist-hip ratio and random blood sugar respectively. CONCLUSION: The prevalence rates of high blood pressure and random blood sugar; overweight, obesity and risk WHR are on the increase compared to previous studies. Lifestyle modification, organized and explicit health campaigns coupled with regular screening and surveillance will contribute to the prevention and control of noncommunicable diseases.

The role of community volunteers in PMTCT programme: Lessons from selected sites in Zambia to strengthen health education on infant feeding and follow-up of HIV-positive mother-infant pair.

BACKGROUND: A global debate surrounding health care delivery at the lowest level of the community has aroused interest among researchers. In settings where skilled health workforce is scarce, the community relies on volunteers to provide care. AIM: To explore the role of community-based volunteers (CBVs) and their perspectives on human immunodeficiency virus (HIV) and infant feeding to gain insights into the implementation of prevention of mother-to-child transmission (PMTCT) interventions at community level. SETTING: The study was conducted in Lusaka using Ngombe and Chelstone health facilities to recruit participants. Fieldwork took place from January 2014 to September 2014. METHODS: An exploratory descriptive qualitative study employing focus group discussions was conducted with CBVs. Convenient sampling was used to recruit 10 participants from each site. All transcribed interviews were imported into the Nvivo 10 for open coding and analysis. RESULTS: Although the role of community volunteers was to support and teach mothers on infant feeding in relation to HIV, the known cultural norms and practices had a bearing on how they tailored their information on breastfeeding to mothers. However, their link of the community to the health facilities cannot be overemphasised in these settings. CONCLUSION: The role of community volunteers in PMTCT interventions can be strengthened by improving their training through use of appropriate educational materials and support of required resources. Lessons from these sites can inform future research to design communitybased interventions and develop health education materials that are sensitive to cultural norms and practices in this and similar settings.

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review.

BACKGROUND: Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV. AIM: To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy. METHODS: Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included 'Sub-Saharan African countries', 'implementation strategies', 'interventions to bridge implementation gap', 'prevention of mother-to-child transmission of HIV' and 'closing implementation gap'. RESULTS: Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1) health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance); (2) health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision); as well as (3) community-level strategies (community health workers, technology use - mHealth, family-centred approaches, male involvement, culturally appropriate interventions). CONCLUSION: There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency.

Evidence on health-promoting lifestyle practices and information and communication technologies: scoping review protocol.

INTRODUCTION: Information and communication technologies (ICTs) play a key role in improving health and maintaining health promoting behaviours. ICTs are therefore one potential solution for promoting healthy lifestyles. In addition, they can assist in the reduction and control of the menace of both communicable and non-communicable diseases. This study will map evidence of interventions that demonstrate the effect of ICTs on health-promoting lifestyle practices that can prevent and control diseases. It is anticipated that this study will help identify areas where there is need for primary research. METHODS AND ANALYSIS: The following electronic databases will be searched: PsycArticle (EBSCO), PsycINFO (EBSCO), Science direct, PubMed, Medline (EBSCO) and Google Scholar. The study will be conducted in two stages: the first stage will map out the studies descriptively while the second stage will map the additional inclusion criteria of quality assessment. Two independent reviewers will undertake the data extraction. Relevant outcomes of the studies will be analysed thematically using NVIvo computer software. The authors will code all evidence independently. Thereafter the authors will critically cross-examine the relationship of the research questions to the emerging themes from the selected articles. The authors hope to find a large number of studies on health-promoting lifestyles that encompass six-subscales of health-promoting activities (nutrition, stress management, interpersonal relation, self-actualisation, health responsibility, physical activity) and ICT. DISSEMINATION: This study will be presented in conferences related to health promotion and health-promoting lifestyles. It will also be disseminated in print and electronically. TRIAL REGISTRATION NUMBER: CRD42016042568.

Analyzing Empathic-Supportive Care Given to Children Living With HIV in Nigeria.

Vulnerable children living with HIV often face challenges that require supportive care. Our study explored an analysis of empathic-supportive care given to such children. A qualitative research method was adopted with focus group discussions and individual interviews with children, caregivers, nurses, and stakeholders. The findings highlighted that giving a listening ear to the children encouraged them to share their feelings, thereby cushioning the effect of reduced self-worth, withdrawal, and discrimination, and enhancing their general well-being. However, a few of the participants discussed nonacceptance, inadequate food support, and rejection as hampering care. We concluded that giving empathic-compassionate care to children infected with HIV would help them cooperate with the care and cope with the challenges of HIV. It is therefore recommended that caregivers, nurses, and significant others provide holistic care with empathy in care settings.

Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study.

BACKGROUND: Exclusive breastfeeding has the potential to reduce infant and under-five mortality, but research shows the practice is not widespread in resource-poor settings of sub-Saharan Africa. We explored factors influencing the decision to exclusively breastfeed among HIV-positive mothers accessing interventions for prevention of mother-to-child transmission of HIV in selected sites of Zambia. METHODS: This exploratory qualitative study was embedded in research conducted on: HIV and infant feeding; choices and decision-outcomes in the context of prevention of mother-to-child transmission among HIV-positive mothers in Zambia. Thirty HIV-positive mothers and six key informants were recruited from two health facilities providing mother-to-child HIV transmission prevention services. A semi-structured guide was used to conduct interviews, which were digitally recorded and simultaneously transcribed. Data coding and analysis was done with the support of QRS Nvivo 10 version software. RESULTS: Despite the known benefits of exclusive breastfeeding, gaps in understanding and potential for behaviour change remained. We found that information promoting exclusive breastfeeding may have been understood by mothers as instructions from the health care workers indicating how to feed their HIV-exposed babies rather than as an option for the mothers' own informed-decision. This understanding influenced a mother's perceptions of breast milk safety while on antiretroviral medicine, of the formula feeding option, and of the baby crying after breastfeeding. The meanings mothers attached to exclusive breastfeeding thus influenced their understanding of breast milk insufficiency, abrupt weaning and mixed feeding in the context of preventing mother-to-child transmission of HIV. CONCLUSION: In order to enhance feeding practices for HIV-exposed infants, our study suggests a broader health campaign supporting all mothers to exclusively breastfeed.

Exploring family-centered care for children living with HIV and AIDS in Nigeria.

AIM: To explored the role of family-centered care in supporting children living with HIV and AIDS in Nigeria. METHODS: A qualitative research design was adopted for this study with a grounded theory approach. Children aged between 11 and 14 years living with HIV and AIDS, their caregivers, and nurse practitioners working in the HIV clinic were engaged in separate focus group discussions in two hospitals in Nigeria. RESULTS: The findings showed that the value African families place on children plays a significant role in identifying their care needs and providing their basic necessities; hence, people around the sick child tend to make him feel better, as attested by nurse practitioners and caregiver participants. Nurse practitioner participants cited unified families as providing care support and love to the children and the support needed to alleviate their sicknesses. Children participants confirmed that family members/relatives were always at their disposal to provide supportive care in terms of administrating antiretroviral medication as well as other psychological care; although a few participants indicated that disruption in family structures in resource-poor settings, isolation and withdrawal, and deprivation of care due to poverty threatened the care rendered to the children. CONCLUSION: The study highlighted the value attached to children in the African context as helping family members to identify the care needs of children living with HIV and AIDS; thereby providing succor to alleviate their sicknesses and enhance their quality of life.

Hypertension in rural communities in Delta State, Nigeria: Prevalence, risk factors and barriers to health care.

INTRODUCTION: Hypertension is a global health challenge and its prevalence is increasing rapidly amongst adults in many African countries. Some studies on the prevalence and risk factors of hypertension have been conducted in Nigeria, but none within Delta State. We assessed the prevalence of hypertension and associated risk factors amongst adults in three villages in the Ibusa community in Delta State, Nigeria. METHOD: Homesteads were randomly selected and all consenting adults (≥ 18 years of age) were recruited for this cross-sectional study (134 individuals: 48 men, 86 women). Sociodemographic data and anthropometric measurements (weight, height and abdominal circumference) were recorded. Diagnosis of hypertension was based on blood pressure ≥ 140/90 mmHg. RESULT: Hypertension prevalence in this rural community was 44%. Results from one village (Ogboli: 82%) and ethnic group (Ibo: 50%) were significantly higher than in others in the same variable category. Multivariate logistic regression analysis suggested increasing age, increasing body mass index and high salt intake as prominent risk factors for hypertension. Lack of funds and equipment shortage in clinics were most often reported as barriers to healthcare. CONCLUSION: A nutritional education programme to promote low-cholesterol and low-salt diets is recommended to specifically target people in higher-risk areas and of higher-risk ethnicity. Local barriers to accessing health care need to be addressed.

Symptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa.

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p < .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

Fulbright Scholar opportunities for global health and women's health care in HIV/AIDS in sub-Saharan Africa.

This article addresses global health opportunities related to HIV/AIDS and women's health care in sub-Saharan Africa through Fulbright Scholar and Fulbright Student Awards. Although many universities offer a gateway to the J. William Fulbright awards, some disciplines and areas of specialization, including nursing and women's health, have had fewer scholars or students as recipients of these awards. Resource-limited countries, including the countries of sub-Saharan Africa, offer rich opportunities for cross-cultural exchange and advancement of global health. Amidst the context of the shortage of health care workers, the increasing prevalence of HIV/AIDS and other infectious and chronic diseases in sub-Saharan Africa, and the challenges of public health, this article addresses an example of partnerships in global nursing that can be developed through the Fulbright programs.

Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa.

BACKGROUND: A supportive social environment is critical for those with HIV/AIDS. In KwaZulu-Natal, in South Africa, antiretroviral therapy is available to some HIV-positive individuals. Antiretroviral adherence is an important issue for limiting HIV infection. Adherence to therapy may be linked to social support, particularly amidst the stigma prevalent in HIV. OBJECTIVE: The purpose of this study was to examine characteristics related to social support and antiretroviral medication adherence. DESIGN: This cross-sectional, descriptive study explored the nature of the relationships among social support and other selected variables, including sociodemographic variables, quality of life, and adherence. SETTINGS: After ethical review board approval, the sample of HIV-infected individuals who received care in outpatient clinics were recruited and completed the self-report instruments. PARTICIPANTS: The sample included English and/or isiZulu-speaking (n=149) individuals over the age of 18 years receiving treatment for HIV/AIDS. A total of 149 patients with a diagnosis of HIV/AIDS agreed to participate and completed questionnaires after completing informed consent procedures. The study participants were recruited at four outpatient settings in Durban, KwaZulu-Natal province of South Africa. METHODS: A descriptive, exploratory, cross-sectional design was utilized to explore the research questions: What are the characteristics of social support and the relationship to antiretroviral adherence in KwaZulu-Natal, South Africa? Descriptive statistics and regression analyses were used to answer the research questions. RESULTS: Data analyses indicated that social support scores on the Medical Outcomes Study Social Support Survey were moderate (M=64.4; S.D.=14.7) among the study participants. The number of close friends and family were significantly correlated with a greater sense of social support. Despite this, the lowest scores on the quality-of-life measure using the Medical Outcomes Study Short Form 36 item survey were reported on the Social Functioning Scale. CONCLUSIONS: In summary, the study findings suggest that a supportive social network is essential for those living with HIV/AIDS. However, social functioning and quality of life amidst the stigma of living with HIV in South Africa may be a concern and require further investigation.