Prevalence and factors associated with tuberculosis treatment outcome among hazardous or harmful alcohol users in public primary health care in South Africa.

BACKGROUND: Tuberculosis (TB) remains a chronic infectious disease with high morbidity and mortality. OBJECTIVE: The aim of this study was to assess the prevalence and associated factors of tuberculosis treatment failure, death and default among hazardous or harmful alcohol users. METHOD: We conducted a prospective study with TB patients in 40 public health clinics in three districts in South Africa. All consecutively new tuberculosis and retreatment patients presenting at the 40 primary health care facilities with hazardous or harmful alcohol use were included in this study. Logistic regression was used to assess determinants of TB treatment failure, death and default. RESULTS: The findings of our study showed that 70% of TB patients were either cured or had completed their TB treatment by the end of 6 months. In multivariate analysis participants living in a shack or traditional housing (Odds Ratio=OR: 0.63, Confidence Interval=CI: 0.45-0.89), being a TB retreatment patient (OR: 1.61, CI: 1.15-2.26) and residing in the eThekwini district (OR: 1.82, CI: 1.27-2.58) were significant predictors of treatment failure, death and default. CONCLUSION: A high rate of treatment failure, death and default were found in the TB patients. Several factors were identified that can guide interventions for the prevention of treatment failure, death and default.

Problem drinking and associated factors in older adults in South Africa.

OBJECTIVE: Alcohol abuse poses special risks for increased morbidity and mortality among older adults. Little attention has focused on assessing alcohol use and associated factors among older adults in transitional societies such as South Africa. This study aimed to determine the prevalence of alcohol use and associated factors in older South Africans who participated in the Study of Global Ageing and Adults Health (SAGE) in 2008. METHOD: We conducted a national population-based cross-sectional study with a sample of 3840 aged 50 years or older in South Africa in 2008. In this study we analysed data from all 2144 participants who were over 60 years old. The questionnaire included socio-demographic characteristics, alcohol intake as well as comorbidity. Risky drinking was defined in two ways: heavy drinkers (>7 drinks/week) and binge drinkers (>3 drinks/one occasion/week). RESULTS: Four percent of participants reported heavy drinking and 3.7% binge drinking. Male gender (Odds Ratio (OR) =3.79, Confidence Interval (CI) =1.38-10.37) and white population group (OR=3.01, CI=1.31-6.89) were associated with risky drinking in multivariate analysis; as well as tobacco use (OR=5.25, CI=2.20-12.52) and not being obese (OR=0.14, CI=0.05-0.35). Hypertension, diabetes and depression were not associated. CONCLUSION: This study reveals moderate rates of risky drinking among older adults (60 years and more) in South Africa that puts them at risk of morbidity. Alcohol problems among older adults are commonly under-recognized, indicating a need for health care worker intervention.

Determinants of HIV testing among young people aged 18 - 24 years in South Africa.

BACKGROUND: Although recent estimates of the HIV/AIDS burden in South Africa show the particular vulnerability of youth to HIV, HIV testing and its determinants are largely understudied in this age group. OBJECTIVE: To investigate the prevalence and determinants of HIV testing among young people aged 18 to 24 years, as part of an evaluation of the impact of loveLife. METHODS: South Africa's national HIV prevention campaign for young people, on HIV and related risk behaviours. A cross-sectional population-based household survey was conducted using a multistage stratified cluster sampling approach. The total sample included 3123 participants, aged 18-24, 54.6% men and 45.4% women, from four provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). RESULTS: The results indicated that over half (52.2%) of the youth reported testing for HIV, with more young females (60.1%) testing for HIV compared to their male counterparts (39.9%). In the multivariate analysis, older age, being female, HIV knowledge, having ever talked to the mother or female guardian about HIV and having ever been pregnant or made someone pregnant were found to be associated with testing for HIV. CONCLUSION: There is still room for improving the low proportion of young people who test for HIV. Specific attention needs to be paid to younger males, with lack of HIV knowledge, having never talked to the mother or female guardian about HIV and having never been pregnant or made someone pregnant were less likely to be tested. Outreach at individual and community levels and public health messages targeting these youth should be implemented.

A community-based study to examine the effect of a youth HIV prevention programme in South Africa.

The aim of this study was to examine the relationships among changes in self-reported HIV and sexually transmitted infection (STI) and exposure to the loveLife youth HIV prevention programmes. A cross-sectional population-based household survey was conducted using a multistage stratified cluster sampling approach. The total sample included 3123 participants, aged 18-24, 54.6% men and 45.4% women, from four provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). Results indicate a self-reported STI past-year prevalence of 2.6%, experienced genital sores or ulcers in the past year prevalence of 3.9% and an HIV self-reported prevalence of 7.4%. In multivariable analyses it was found that knowing a person living with HIV and a person who has died from AIDS, lower education, having had two or more sexual partners in the past year, not having talked with a partner about condom use, difficulty of getting condoms and not having been male circumcised were associated with having been diagnosed with an STI in the past 12 months and/or HIV. Face-to-face and multimedia youth HIV prevention programmes had limited effect.

Adolescent pregnancy and associated factors in South African youth.

BACKGROUND: Adolescent pregnancy, occurring in girls aged 10-19 years, remains a serious health and social problem worldwide, and has been associated with numerous risk factors evident in the young people's family, peer, school, and neighbourhood contexts. OBJECTIVE: To assess the prevalence of adolescent pregnancy and associated factors in the South African context, as part of a population-based household survey that formed part of an evaluation of the impact of loveLife, South Africa's national HIV prevention campaign for young people. METHODS: A cross-sectional population-based household survey was conducted using a multi-stage stratified cluster sampling approach. The total sample included 3123 participants, aged 18-24, 54.6% men and 45.4% women, from four of nine provinces in South Africa (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). RESULTS: Among female youth 19.2% said that they had an adolescent pregnancy, while 5.8% of male youth indicated that they had impregnated a girl when they were an adolescent (12-19 years), 16.2% of the women indicated that they ever had an unwanted pregnancy and 6.7% had ever terminated a pregnancy. In multivariable analysis among women it was found that being employed or unemployed, greater poverty, having higher sexually permissive attitudes and scoring higher on the contraceptive or the condom use index was associated with adolescent pregnancy, and among men wanting the pregnancy and having a sense of the future were associated with adolescent pregnancy. CONCLUSION: Adolescent pregnancy was found to be high in this sample of South African youth. Multiple factors contributing to adolescent pregnancy have been identified which can be used in targeting young people on the prevention of adolescent pregnancy.

Early smoking initiation and associated factors among in-school male and female adolescents in seven African countries.

OBJECTIVE: This report examines the prevalence and common correlates of early smoking initiation among male and female school children across seven African countries. METHOD: The total sample included 17,725 school children aged 13 to 15 years from nationally representative samples in seven African countries. Univariate and multivariate analyses were conducted to assess the relationship between early smoking initiation, health compromising behaviours, mental distress, protective factors and socio-economic status variables. RESULTS: Overall 15.5% had experienced smoking initiation before age 14, with the percentages 20.1% among boys and 10.9% among girls. In multivariable analysis, early smoking initiation was among boys associated with ever drunk from alcohol use (OR = 4.73, p = 0.001), ever used drugs (OR = 2.36, p = 0.04) and ever had sex (OR = 1.63, p = 0.04). Among girls, it was associated with higher education (OR = 5.77, p = 0.001), ever drunk from alcohol use (OR = 4.76, p = 0.002), parental or guardian tobacco use (OR = 2.83, p = 0.001) and suicide ideation (OR = 2.05, p = 0.02). CONCLUSION: The study found a high prevalence of early smoking initiation among 13-15 year-olds in seven African countries. Various risk factors have been identified in boys and girls who initiate smoking before age 14, forming a distinct risk group in this setting. Specific interventions are needed for boys and girls in the preteen years, before smoking initiation.

Drug prescription habits in public and private health facilities in 2 provinces in South Africa.

The aim of this study was to explore drug prescription habits using WHO standard indicators in public hospitals and 36 private surgeries in 2 provinces in South Africa. A high mean number of drugs were prescribed per patient (3.2 versus 2.8) in public hospitals and by general practitioners (GPs) respectively andc generic prescribing rates were low (45.2% versus 24.5%). The rates of prescribing in public hospitals and by GPsa were 8.3% versus 23.3% for injections, 68.1% versus 31.9% for antibiotics and 92.6% versus 68.5% for drugs from the essential drugs list. Drug prescribing in both sectors needs to be regulated, especially the use of antibiotics, essential drugs and generic prescribing.

Report and policy brief from the 4th Africa Conference on Social Aspects of HIV/AIDS Research: innovations in access to prevention, treatment and care in HIV/AIDS, Kisumu, Kenya, 29 April - 3 May 2007.

About 520 delegates from all over Africa and 21 countries attended the conference. This report and policy brief summarises the key findings and suggested policy options that emerged from rapporteur reports of conference proceedings including the following themes: (1) Orphans and vulnerable children, (2) Treatment, (3) Prevention, (4) Gender and male involvement, (5) Male circumcision, (6) People living with HIV/AIDS, (7) Food and nutrition, (8) Socioeconomics, and (9) Politics/policy. Two (11.8%) of the 17 OVC projects from the three countries were classified as best practice interventions. Of the 83 abstracts that were accepted at the conference, only 7 (8.4%) were dealing with antiretroviral therapy (ART). There has been tremendous effort by various organisations to provide information about prevention of HIV/AIDS. Information received by adolescents has been effective in increasing their knowledge, but without positive sexual behaviour change. The conference noted the contribution of gender discrimination and violence to the HIV epidemic and the different risks that men and women face in relation to the epidemic. Social scientists need to study the deep cultural meanings attached to male circumcision among different ethnic groups to be able to guide the debate on the latest biomedical findings on the protective effect of circumcision against HIV. Palliative care and support is crucial for coping among people living with HIV/AIDS (PLWHA) in order to deal with medical and psychological issues. Results from several countries have helped researchers to explore alternative ways of examining poverty in the context of HIV and AIDS. Policy frameworks which are likely to succeed in combating HIV/AIDS need to be updated to cover issues of access, testing, disclosure and stigma. In general, the conference was successful in identifying innovations in access to prevention, treatment and care in HIV/AIDS.

Utilization of delivery services in the context of prevention of HIV from mother-to-child (PMTCT) in a rural community, South Africa.

The aim of this study was to investigate the utilization of delivery services in the context of PMTCT in a rural community in South Africa. Based on a cross-sectional survey, the sample included 870 pregnant women who had delivered before recruited from five PMTCT clinics and surrounding communities. Results indicated that 55.9% had delivered their last child in a health care facility and 44.1% at home (mostly without assistance from a traditional birth attendant). The odds of access to the health facility were (1) women who stayed close to the hospital (OR = 2.87), (2) those who had higher formal education (OR = 1.55), (3) higher traveling costs (affordability) to get to nearest clinic (OR = 1.77), and (4) those who were single (OR = 1.58). Childbirth experiences of the mother or mother-in-law greatly influenced the delivery choices in terms of home delivery. The majority of the pregnant women were aware of mother-to-child HIV transmission but only 9% of the pregnant women had ever been tested for HIV. HIV knowledge, HIV testing behaviour and attitudes were found to be not associated with the delivery option.

Nutrition knowledge and food choice among black students in South Africa.

OBJECTIVES: To investigate the relationship between nutrition knowledge and dietary behaviour, and to assess the perceived influences on food selection among Black students in South Africa. DESIGN: Cross sectional study. SETTING: University of the North and two semi-urban Secondary Schools. SUBJECTS: 213 second year social science university students, 104 (48.2%) male and 112 (51.9%) female, and 199 Grade 11 secondary school students, 67 male (32.7%) and 132 female (66.3%). MAIN OUTCOME MEASURES: A General Nutrition Knowledge Questionnaire and a Food Choice Questionnaire. RESULTS: Generally, students seemed to have below average nutrition knowledge levels. University students had significantly more nutrition knowledge than secondary school students. Dietary recommendations were associated with source of nutrients and diet-disease relationships, and sources of nutrients were associated with diet-disease relationships. Choosing everyday foods was not associated with dietary recommendations, source of nutrients, and diet-disease relationships. Among both university and secondary school students the three highest food choice factors included health, sensory appeal and mood. CONCLUSION: Below average nutrition knowledge levels were found. Choosing everyday food seemed to be not associated with nutrition knowledge, and food choice was not only influenced by health but also sensory appeal and mood.

Breast self-examination and cervical (Pap) smear test: attitudes and self-reported practices among South African women.

This study investigated the attitudes and practices of breast self-examination and cervical (Pap) smear test among South African women. The sample included 150 Black and 150 White women chosen by systematic random sampling from telephone directories. The Black women were within the age range of 18 to 80 years (M age 38.9 yr., SD = 4.7), and the White women were within the age range of 19 to 91 years (M age 41.8 yr., SD = 3.5). Analysis indicated that 97.1% of the White women and 44.9% of the Black women said that they know how to examine their breasts. Of those women, significantly more Black (56.1%) than White (8.9%) women examined with the recommended frequency of more than 10 times a year. Of the Black women 60.5% and 8.4% of White women had never had a cervical smear test. Logistic regression analysis indicated that attitudes were an independent predictor for these two tests.

Perceptions of interventions for child sexual abuse in an urban South African sample.

A questionnaire was used to study perceptions of interventions for child sexual abuse in a nonrepresentative urban South African population of 132 African/Black participants (61 men and 71 women) from the general public of Mankweng. Their ages ranged from 21 to 60 years (M age = 32.2 yr., SD = 10.4). Analysis indicated these participants clearly supported most of the components of nonadversarial approaches. Women were more positive about a nonadversarial approach than men; however, participants disagreed on questions about controlling the offender and whether an accused relative should move out of the home of the victim. Participants supported prosecuting offenders and longer prison sentences and did not favour leniency for first-time offenders. They further believed children, the family, and even less the offenders should receive treatment.

Tobacco use among black South African university students: attitudes, risk awareness and health locus of control.

OBJECTIVES: To provide data on African/black South African university students' tobacco use status, belief in the benefits to health of not smoking, risk awareness in terms of knowledge of the links between smoking and disease, health locus of control, value for health, subjective health status and well-being. DESIGN: Cross sectional. SETTING: University of the North. SUBJECTS: 793 Black University students from non-health courses chosen by random sampling, of these 370 (46.7%) were males and 423 (53.3%) were females in the age range of 18 to 25 years (M age 21.0 years, SD = 3.48). MAIN OUTCOME MEASURES: A measure of smoking, the Multidimensional Health Locus of Control Scale, the Health as a Value Scale, and a measure for subjective health and subjective well-being. RESULTS: The average prevalence of current tobacco use was 15% in men and 1% in women. The proportion of tobacco users who were classified as light users (1-10 per day) averaged 10% in men and 1% in women. Age and being male were significantly positively associated with status and frequency of tobacco use. Awareness of the link between smoking and lung cancer was high (93%), but awareness of the role of smoking in heart disease was very low (16%). The importance to health of not smoking was associated with smoking status (non-smoking versus smoking). Overall, 75% of the current smokers stated that they would like to reduce the amount they smoked. Poor subjective health status and low subjective well-being was associated with smoking status. No significant differences were found among non-tobacco users and tobacco users in relation to the three subscales of the Health Locus of Control (Internal, Chance, and Powerful others) and Value for health. CONCLUSION: For about 9% of the male students investigated, a high risk exists to become regular tobacco users for the next 30 years.

Tobacco smoking in Black and White South Africans.

OBJECTIVES: To provide data on black and white South Africans' tobacco use status, belief in the benefits to health of not smoking, risk awareness in terms of knowledge of the links between smoking and disease, health status, subjective health status and well-being. DESIGN: Randomised study. SETTING: Two urban communities in the Northern Province of South Africa. PARTICIPANTS: Two hundred and fifty blacks and 250 whites. The black participants were 100 (40%) men and 150 (60%) women in the age range of 18 to 80 years (mean = 38.9 years, SD=4.7), and the white participants were 111 (44.4%) men and 139 (55.6%) women in the age range of 19 to 91 years (mean = 41.8 years, SD=3.5). MAIN OUTCOME MEASURES: A measure of smoking, health benefits, risk awareness, health status, subjective health and subjective well-being. RESULTS: The average prevalence of current smoking was 11.2% in Blacks, 23.6% in whites, 31.8% in men and 6.9% in women. Age, being male, being white, and being married or living with a partner were significantly positively associated with smoking status and smoking frequency. Risk awareness of the negative effects of smoking and the belief in the importance of not smoking were both significantly negatively associated with both smoking status and smoking frequency. CONCLUSION: The prevalence of smoking tobacco, especially among males and Whites as well as the low risk awareness of smoking is a cause of concern. Stronger beliefs in the importance of not smoking, being female and lower age were identified as independent predictors among non-smokers than smokers.

Parasuicide among youth in a general hospital in South Africa.

Parasuicide cases among youth (15-24 years) referred to the clinical psychology section of a regional hospital from 1995 to 1998 were reviewed. In all 100 cases (37 males and 63 females) were identified being about 10% of the caseload. As part of the clinical psychological assessment sociodemographic, clinical characteristics, trigger factors, employed methods and suicide intentions were analysed. Most patients were students (79%) or unemployed (16%). The major method employed to attempt suicide was ingestion of harmful substances (like paraffin, pesticides or battery acid)(73%). Acute social conflicts (38%), socio-economic deprivation (17%), AIDS phobia (17%), academic failure (14%), teenage pregnancy (10%) and mental illness (5%) triggered suicide attempts. Fifty-eight percent of the attempts were categorised as demonstrative and 27% as genuine. The psychodynamics of parasuicides are discussed in case studies and with reference to other studies.

Psychosocial aspects of unwed adolescent pregnancy in Lusaka, Zambia.

PIP: Adolescent pregnancy in Zambia contributed to 22.5% of the pregnancies seen at the University Teaching Hospital in Lusaka in 1979/80. Some of the psychosocial factors in teenage pregnancy are examined among 80 teenage unmarried adolescents appearing at the prenatal clinic of the University Teaching Hospital (40) and at a low-income prenatal clinic in Lusaka (40). Participants were matched with controls on the basis of age, education, and socioeconomic status. In-depth interviews were conducted in 1987, when the girls were in their second to fifth month of pregnancy. Analysis was conducted on sex socialization, knowledge of and attitudes toward contraception, socioeconomic factors, and family coherence as preventive aspects of teenage pregnancy. The reaction to the pregnancy and management of the pregnancy were also determined. The mean age of menarche was 13.2 and 13.5 years for the participants and controls, respectively, which is somewhat lower than reports among other African populations. A formal initiation ceremony was conducted for 3% of participants and 8% of controls. Participants had 2.4 sex partners, and controls had 0.5 sex partners. Motives for getting pregnant were: economic support (85%); being in love and hoping for marriage (67%); peer pressure (54%);l and three other reasons. Both groups were similar in their knowledge of, attitudes toward, and use of contraception. 28% of the pregnant girls reported knowing about "counting days," but only 1% knew how to do this. Only 6% had knowledge of contraception. About 75% came from low-income families. The average age of formal education was 6.2 years for participants and 6.8 years for controls. 68% were in school at the time of the pregnancy; 29% dropped out of school before the end of the pregnancy. 52% of the male partners were of low socioeconomic status. 61% of pregnant girls lived with both real parents. 6% reported wanting to become pregnant. 67% of male partners had a negative reaction to the pregnancy; 16% rejected the pregnancy. 63% of mothers agreed to care for the baby while their daughters returned to school. The control group appears to have had stronger responses to avoid sexual encounters. Traditional social control has been replaced by "ignorance and secrecy." There has been a breakdown in the means of acquiring information about healthy reproduction and about birth control.^ieng