Blood pressure profile of primary school children in Eastern Cape province, South Africa: prevalence and risk factors.

BACKGROUND: The problem of cardiovascular diseases and lack of adequate information about the blood pressure profiles among children in South Africa has enormous consequences for public health and the general well-being of communities. AIM: The aim of this study is to determine the blood pressure profiles and associated risk factors of primary school children in South Africa. METHODS: A cross sectional study was conducted among 876 children aged 9 to 14 years from 18 randomly selected schools in the Eastern Cape province of South Africa. Standardised blood pressure measuring instruments were used and an average of three readings was considered. Blood pressure status was classified according to the percentiles of systolic blood pressure (SBP). RESULTS: The overall prevalence of hypertension was 5.2% and pre-hypertension was 18.5% while normal blood pressure was 76.3%. The multilevel binary logistic regression's crude and adjusted analysis revealed that increase in age was significantly associated with elevated BP in children ([crude OR = 1.17 [1.05 - 1.29] and [adjusted OR = 1.12 [1.01 - 1.25]). In addition, increase in BMI was significantly associated with elevated BP in children ([crude OR = 1.08 [1.04 - 1.12] and [adjusted OR = 1.06 [1.02 - 1.11]). There was no statistically significant association between elevated BP and gender for both the univariate and multivariate models. There was also no statistical significant risk for elevated BP associated with place of residence. CONCLUSIONS: In this sampled population the established proportion of primary school children with elevated BP is of great concern. In addition, older children and those with high BMI (that is, overweight/obesity) were associated with elevated BP. Interventions towards promoting healthy lifestyles among school learners is a necessity if we are to prevent cardiovascular diseases.

Nutrient profile and energy cost of food sold by informal food vendors to learners in primary and secondary schools in the Eastern Cape, South Africa.

OBJECTIVE: To assess type, nutrient profile and cost of food items sold by informal vendors to learners; and to determine nutrient content of corn-based processed snacks frequently sold. DESIGN: Cross-sectional survey. SETTING: Quintile 1 to 3 schools (n 36) randomly selected from six education districts; Eastern Cape, South Africa. PARTICIPANTS: Informal food vendors (n 92) selling inside or immediately outside the school premises. RESULTS: Food items sold at most schools were corn-based processed snacks (94 % of schools), sweets (89 %), lollipops (72 %) and biscuits (62 %). Based on the South African Nutrient Profiling model, none of these foods were profiled as healthy. Foods less commonly sold were fruits (28 % of schools) and animal-source foods; these foods were profiled as healthy. Mean (sd) energy cost (per 418 kJ (100 kcal)) was highest for animal-source foods (R2·95 (1·16)) and lowest for bread and vetkoek (R0·76 (0·21)), snacks (R0·76 (0·30)) and confectionery products (R0·70 (0·28)). The nutrient profiling score was inversely related to the energy cost of the food item (r = -0·562, P = 0·010). Compared with brand-name corn-based processed snacks, non-branded snacks had lower energy (2177 v. 2061 kJ; P = 0·031) content per 100 g. None of the brand-name samples contained sucrose; six of the nine non-branded samples contained sucrose, ranging from 4·4 to 6·2 g/100 g. CONCLUSIONS: Foods mostly sold were unhealthy options, with the healthier food items being more expensive sources of energy.

Reasons for Discontinuation of Implanon among Users in Buffalo City Metropolitan Municipality, South Africa: A Cross-Sectional Study.

Early discontinuation of implanon, a long-acting, reversible contraceptive among reproductive age women in South Africa is a serious public health concern. The aim of this study was to examine the reasons for discontinuation of implanon among its previous users. This descriptive cross-sectional study involved 188 consecutively selected participants in two large family planning clinics in Buffalo Metropolitan Municipality, East London, South Africa. Descriptive statistics was conducted using SPSS version 22.0. The mean duration of use was 11.2±7.1 months. Side effects such as heavy bleeding, severe headache and painful arm were the main reasons for discontinuation of implanon (71.3%). Some participants discontinued implanon because they were receiving other medical treatments: 24 participants on the anti-retroviral drugs, one on antipsychotic and antituberculosis drugs, respectively, necessitating removal. Few participants reported wrong positioning (3.2%) and desire for more pregnancies (4.3%) as reasons for discontinuation. The side effects of implanon were the reason for early discontinuation of implanon among women who still needed contraception. Pre-insertion counselling should empower women towards making informed decision on discontinuation and transition to other options.

Physical activity and sedentary behaviour of primary school learners in the Eastern Cape province of South Africa.

BACKGROUND: This study was designed to assess physical activity (PA) levels and sedentary behaviour amongst primary school learners in the Eastern Cape province of South Africa. METHODS: A cross-sectional study was adopted to assess the patterns and levels of PA and sedentary behaviour using the Physical Activity Questionnaire for Older Children (PAQ-C). The sample consisted of primary school learners, both boys and girls, aged 9-14 years. The learners were randomly selected from rural, urban and peri-urban areas in the Eastern Cape province of South Africa. RESULTS: Using a complete case analysis, 870 randomly selected participants (boys = 351 and girls = 519) aged 9-14 years were retained. Overall, the sample had a low mean PAQ-C score of 2.33 ± 0.43. The mean of PA in boys was significantly higher (p = 0.003) in comparison with the girls. The 13- to 14-age group had significantly higher PA levels (p = 0.014). Learners from urban areas (n = 136; 77.3%) engaged more in sedentary behaviour compared to those from rural areas (n = 252; 54.9%). CONCLUSION: The findings demonstrated low levels of PA and high engagement of sedentary behaviour across the combined gender groups, which have negative implications on health, growth and development of children. The study, therefore, recommends relevant stakeholders to implement interventions aimed at promoting an increase in PA and a reduction in sedentary behaviours for primary school learners in the Eastern Cape province of South Africa.

Relationship between body composition and physical fitness of primary school learners from a predominantly rural province in South Africa.

BACKGROUND: There is a lack of literature regarding the relationship that exists between body composition and physical fitness amongst primary school learners in South Africa. For the sake of public health purposes, it is important to investigate how body composition relates to physical fitness amongst primary school learners in the Eastern Cape province of South Africa. AIM: The aim of this study was to examine the relationship between body composition and physical fitness amongst South African primary school children. SETTING: The study was conducted on a cohort of primary school learners in the Eastern Cape province, which is a predominantly rural province in South Africa. METHODS: A school-based cross-sectional survey was conducted amongst 870 primary schoolchildren aged 9-14 years. Body composition and physical fitness measurements were measured and recorded using standardised measurement scales. RESULTS: Of the 870 participants, 40.34% (n = 351) were boys and 59.66% (n = 519) were girls. The mean age of the participants was 11.04 ± 1.50 years. Boys had a significantly (p = 0.002) higher mean age (11.24 ±1.51 years) as compared to girls (10.91 ± 1.48 years). The results of the non-parametric Spearman's rho correlation coefficients revealed several significant and negative relationships between physical fitness and body composition measurements, which were stronger in girls than in boys. CONCLUSION: The findings call for public health authorities and other relevant policymakers to initiate the development and implementation of policies and interventions targeted at encouraging physical activity participation and healthy lifestyle amongst primary school learners in South Africa, especially amongst girls.Contribution: The study findings supports a relatively rich literature which suggests that girls are more flexible than boys and that negative relationships between body composition measurements and physical fitness characteristics exists, which are stronger in girls than in boys.

Exploring the views of academic staff on HIV/AIDS integration into the curricula: a case study of the University of Fort Hare.

As a clarion call by Higher Education HIV/AIDS programme (HEAIDS) to South African universities, entrenching, integration and infusing the teaching and learning of HIV/AIDS in the curriculum of universities prove to be a sustainable solution to changing risky behaviour and attitudes of university students towards HIV/AIDS. The majority of students in South African universities lack general awareness and education in HIV/AIDS. This raises the need to produce graduates who are knowledgeable and have a positive attitude regarding HIV/AIDS. A pilot study on HIV/AIDS curriculum integration at the University of Fort Hare involved academic staff was done. A qualitative case study approach was used to describe the process and effectiveness of the curriculum integration process. The data collection was through evaluation forms, reports and a focus group interview. Data were analysed using content analysis. Guskey's model for professional development was followed to understand the process and effect of curriculum integration. Initially, the academic staff anticipated that the HIV/AIDS curriculum integration process would result in credit overload for students, time constraints and increased workload. Later, most academic staff affirmed the benefits of being involved in the project such as improving teaching and facilitation styles and research.

Dietary Practices and Adolescent Obesity in Secondary School Learners at Disadvantaged Schools in South Africa: Urban-Rural and Gender Differences.

South Africa has a high prevalence of obesity in black female adolescents and a paucity of knowledge regarding contributing dietary practices. The aim of this study was to assess the dietary practices and weight status of male and female adolescents at secondary schools in the Eastern Cape province in urban and rural areas. Sixteen schools and grade 8-12 learners (N = 1360) were randomly selected from three health districts comprising poor disadvantaged communities. A short unquantified food frequency questionnaire was used to collect data on learners' usual eating practices with regards to weekly meal pattern, breakfast consumption, foods taken to school, takeaways, and snacks eaten while watching television (TV). Body mass index measurements were determined for each learner. Prevalence of combined overweight and obesity differed significantly between genders, 9.9% in males versus 36.1% in females (p < 0.001). Significant gender differences were noted regarding eating practices. Females had a higher frequency of eating sugary snacks (p < 0.001) and a lower frequency of eating breakfast (p < 0.01) than males. Females ate significantly more fried fish (p < 0.05), pizza (p < 0.05) fat cakes (fried dough balls) (p < 0.05), hotdogs (p < 0.01), candy (p < 0.001), cake (p < 0.01), and crisps (p < 0.001). Compared to urban areas, the frequency of eating breakfast (p < 0.01) and sugary snacks (p < 0.05) was significantly higher in rural areas. Significantly more learners in urban areas consumed boerewors (beef sausage) rolls (p = 0.027), hamburgers (p = 0.004), and soft drinks (p = 0.019), while more learners in the rural areas consumed cordial (p = 0.001). In conclusion, a high prevalence of combined overweight and obesity was found in black female adolescents and a high prevalence of poor dietary practices was observed, with significant gender and urban-rural differences.

The Food and Nutrition Environment at Secondary Schools in the Eastern Cape, South Africa as Reported by Learners.

Overweight and obesity are growing concerns in adolescents, particularly in females in South Africa. The aim of this study was to evaluate the food and nutrition environment in terms of government policy programs, nutrition education provided, and foods sold at secondary schools in the Eastern Cape province. Sixteen schools and grade 8-12 learners (N = 1360) were randomly selected from three health districts comprising poor disadvantaged communities. Based on age and sex specific body mass index (BMI) cut-off values, 13.3% of males and 5.5% of females were underweight, while 9.9% of males and 36.1% of females were overweight or obese. The main food items purchased at school were unhealthy energy-dense items such as fried flour dough balls, chocolates, candies, and crisps/chips. Nutrition knowledge scores based on the South African food-based dietary guidelines (FBDGs) were poor for 52% to 23.4% learners in Grades 8 to 12, respectively. Female learners generally had significantly higher nutrition knowledge scores compared to their male counterparts (p = 0.016). Questions poorly answered by more than 60% of learners, included the number of fruit and vegetable portions required daily, food to eat when overweight, foods containing fiber, and importance of legumes. It was noted that the majority of teachers who taught nutrition had no formal nutrition training and their responses to knowledge questions were poor indicating that they were not familiar with the FBDGs, which are part of the curriculum. Nutrition assessment as part of the Integrated School Health Program was done on few learners. Overall however, despite some challenges the government national school meal program provided meals daily to 96% of learners. In general, the school food and nutrition environment was not conducive for promoting healthy eating.

The relationship between body composition and blood pressure among primary school children in Eastern Cape province, South Africa.

BACKGROUND: In South Africa, especially in the Eastern Cape province, despite reported high prevalence of underweight and obesity, little is known regarding the relationship of body composition (BC) with blood pressure (BP) in primary school children. Understanding the relationship between BC and BP in these children is important because it is associated with adverse effects on health and social repercussion in both adolescence and adulthood. AIM: The aim of this study was to examine the relationship between BC and BP among South African primary school children. SETTING: This study was conducted on a cohort of primary school learners in the Eastern Cape Province of South Africa. METHODS: A school-based cross-sectional survey was conducted among 876 school children aged 9-14 years, using multistage sampling techniques. Body mass and stature were measured using a calibrated scale. Anthropometric measurements including weight, height, waist circumference, triceps, gluteal and subscapular were also collected. Body mass index, percentage body fat and waist-to-hip ratio were calculated. RESULTS: Of the 876 participants, 356 (40.6%) were boys and 520 (59.0%) were girls. The Spearman's rho correlation coefficients revealed positive significant correlations between systolic BP with age (r = 0.171; p 0.0001), stature (r = 0.205; p 0.0001), weight (r = 0.277; p 0.0001), body mass index (r = 0.243; p 0.0001), waist circumference (r = 0.259; p 0.0001), gluteal (r = 0.214; p 0.0001), triceps (r = 0.203; p 0.0001), subscapular (r = 0.167; p 0.0001), body fat percentage (r = 0.206; p 0.0001), fat mass (r = 0.257; p 0.0001) and fat-free mass (r = 0.238; p 0.0001). There was no statistically significant correlation between waist-to-hip ratio and systolic BP (r = 0.064; p = 0.059). In terms of diastolic BP, there existed no significant correlations with age (r = 0.026; p = 0.443) and waist-to-hip ratio (r = 0.002; p = 0.947). Collectively, the prevalence of hypertension was 76.4% in the normal group compared with those who were pre-hypertensive (18.4%) and hypertensive (5.3%). Girls showed a higher prevalence of pre-hypertension than boys (19.6% compared with 16.6%, respectively). CONCLUSION: There is a relationship between most of the BC variables and BP in children. The screening of BP as part of physical examinations of school children is necessary for early prevention and intervention programmes for hypertension.

Prevalence, awareness, control and determinants of hypertension among primary health care professional nurses in Eastern Cape, South Africa.

BACKGROUND:  Nurses in primary health care settings are key stakeholders in the diagnosis and management of hypertensive patients. Unfortunately, the working conditions of nurses predispose them to stress, long hours of work, shift duties and unhealthy diets, which are drivers of hypertension. Yet nurses are often overlooked in health screening exercises, primarily because they are assumed to be informed and 'healthy'. AIM:  This study examined the prevalence, awareness, control and determinants of hypertension among professional primary health care nurses in the Eastern Cape Province of South Africa. SETTING:  This was a cross-sectional survey of 203 professional nurses working at 41 primary health care facilities of the Eastern Cape Province. METHODS:  A modified WHO STEPwise questionnaire was used for data collection during face-to-face interviews. The information obtained included demographic information, behavioural lifestyles, anthropometric and blood pressure (BP) measurements. Hypertension is defined as an average of two BP ≥ 140/90 mmHg or self-reported history of antihypertensive medication use. RESULTS:  The prevalence of hypertension was 52%. Of this, 41% were unaware of their hypertension status. Of those who were aware and on treatment, only 38.1% had a controlled blood pressure. After adjusting for confounders (for physical activity, dietary practices, parity, income and alcohol use), only age and duration of practice were independent predictors of hypertension among the study population. CONCLUSION:  There is a high prevalence of hypertension among the study participants. There is an unexpected low rate of awareness and suboptimal control of blood pressure among the participants. Age is the significant predictor of hypertension among professional nurses in Eastern Cape Province, South Africa. There is an urgent need for the implementation of an effective workplace health programme for nurses in the province.

Social epidemiology of hypertension in Buffalo City Metropolitan Municipality (BCMM): cross-sectional study of determinants of prevalence, awareness, treatment and control among South African adults.

OBJECTIVES: This study examined hypertension prevalence, awareness, treatment and control and their determinants among adults attending health facilities in Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape. DESIGN: A cross-sectional analytical study. SETTINGS: The three largest outpatient clinics in BCMM. PARTICIPANTS: Ambulatory adults (aged 18 years and over) attending the study settings during the study period (n=998). PRIMARY OUTCOME MEASURE: The prevalence of hypertension (systolic blood pressure (BP) of ≥140 mm Hg and/or a diastolic BP of ≥90 mm Hg or current medication for hypertension), the awareness of it (prior diagnosis of it) and its treatment and control (Eighth Joint National Committee Criteria of BP <140/90/90 mm Hg). SECONDARY OUTCOME MEASURE: Associated factors of hypertension, hypertension unawareness and uncontrolled hypertension. RESULTS: Of the 998 participants included, the prevalence of hypertension was 49.2%. Hypertension unawareness was reported by 152 participants (23.1%) with significant gender difference (p=0.005). Male sex, age <45 years, higher level of education, single status, current employment, higher monthly income, current smoking, alcohol usage, absence of diabetes and non-obese were significantly associated (p<0.05) with hypertension unawareness.Of the participants who were aware of having hypertension (n=339), nearly all (91.7%, n=311) were on antihypertensive medication and only 121 participants (38.9%) achieved the BP treatment target. In the multivariate logistic regression model analysis, ageing (95% CI 1.9 to 4.4), being married (95% CI 1.0 to 2.0), male sex (95% CI 1.2 to 2.3), concomitant diabetes (95% CI 1.9 to 3.9), lower monthly income (95% CI 1.2 to 2.2), being unemployed (95% CI 1.0 to 1.9) and central obesity (95% CI 1.5 to 2.8) were the significant and independent determinants of prevalent hypertension. CONCLUSION: The prevalence and awareness of hypertension was high in the study population. In addition, the suboptimal control of BP among treated individuals, as well as the significant cardiovascular risk factors, warrant the attention of health authorities of BCMM and the country.

A model for mentoring newly-appointed nurse educators in nursing education institutions in South Africa.

BACKGROUND: South Africa transformed higher education through the enactment of the Higher Education Act (No. 101 of 1997). The researcher identified the need to develop a model for the mentoring of newly-appointed nurse educators in nursing education institutions in South Africa.  OBJECTIVES: To develop and describe the model for mentoring newly-appointed nurse educators in nursing education institutions in South Africa.  METHOD: A qualitative and theory-generating design was used (following empirical findings regarding needs analysis) in order to develop the model. The conceptualisation of the framework focused on the context, content, process and the theoretical domains that influenced the model. Ideas from different theories were borrowed from and integrated with the literature and deductive and inductive strategies were applied.  RESULTS: The structure of the model is multidimensional and complex in nature (macro, mesoand micro) based on the philosophy of reflective practice, competency-based practice andcritical learning theories. The assumptions are in relation to stakeholders, context, mentoring, outcome, process and dynamic. The stakeholders are the mentor and mentee within an interactive participatory relationship. The mentoring takes place within the process with a sequence of activities such as relationship building, development, engagement, reflective process and assessment. Capacity building and empowerment are outcomes of mentoring driven by motivation.  CONCLUSION: The implication for nurse managers is that the model can be used to develop mentoring programmes for newly-appointed nurse educators.