Social support experiences of adolescents living with perinatal HIV in rural Limpopo, South Africa.

Background: Adolescents with perinatal HIV (APHIV) experience emotional turmoil, which is worsened by real or perceived negative impacts on the adolescents' relationships, aspirations for their careers, and aspirations for their families. Objectives: To explore the experiences of APHIV with regard to social support on their mental health and general well-being in the Vhembe District of Limpopo province. Method: A mixed-methods sequential exploratory design was employed to conduct in-depth one-on-one interviews in the Vhembe District of the Limpopo province of South Africa. The interviews were conducted in selected community health centres and clinics over a period of four months (April 2019 - July 2019). This study included APHIV between the ages of 10 years and 19 years who had been initiated on antiretroviral therapy before the age of 10 years. Results: Two major themes emerged. Theme 1 - Experiences within the family - included the sub-themes experience of positive social support within the family, and lack of support in the family. Theme 2 - Experiences outside the family - included the sub-themes experiences at the clinic, experiences at community level, and experiences at school and with friends. Conclusion: Adolescents with perinatal HIV are in need of social support from their loved ones as well as the community. Expansion of household programmes and intervention through integration of services by the multidisciplinary team might assist with alleviating the social support needs which will improve their mental health and adherence to treatment.

Corrigendum: Diet and exercise knowledge and practices for diabetes care within families in Senwabarwana.

No abstract available.

Diet and exercise knowledge and practices for diabetes care within families in Senwabarwana.

BACKGROUND:  Family members (FMs) are a valuable source of support, as the bulk of daily diabetes treatment occurs at home. Family members' insufficient understanding of patient support can lead to poor diabetes outcomes. Lack of knowledge about good diet and exercise can lead to unhealthy food preparation and sedentary lifestyles, affecting patients and increasing the risk of diabetes. This study aims to fill the gap in the level of knowledge of FMs relating to appropriate care for diabetic patients under their care. This will relate specifically to diet and exercise. METHODS:  A cross-sectional survey conducted in Senwabarwana, Limpopo province, involved 200 FMs caring for diabetic patients for at least 6 months. Their experience could offer valuable insights into the competence of their care. Data were collected regarding knowledge and practice using a close-ended questionnaire, with Likert scale responses and SPSS analysis, including descriptive statistics and chi-squared tests. Knowledge was assessed on a scale ranging from poor to excellent: poor (0% - 50%), fair (51% - 60%), good (61% - 74%) and excellent ( 75%). Practice was assessed as poor (0% - 50%), fair (51% - 69%) and good (70% - 100%). RESULTS:  Thirty-one percent of participants demonstrated excellent knowledge and only 9% demonstrated good practice. Unfortunately, 53% stated that obese patients with diabetes should skip meals to lose weight. Only 3.5% and 19%, respectively, are familiar with recommendations for exercise and glucose monitoring. Barely 35.5% of FMs eat breakfast every day, while 87.5% report exercising. CONCLUSION:  Few FMs possess excellent diabetes management knowledge but still indulge in bad practices, increasing their risk of developing diabetes. Additionally, they may potentially cause health problems for patients.Contribution: Family-centred behaviour change intervention is recommended.

Scanning for Obesogenicity of Primary School Environments in Tshwane, Gauteng, South Africa.

The purpose of this study was to scan for the obesogenicity of primary school environments in Tshwane, Gauteng, South Africa. This study was carried out in ten public primary schools in the Tshwane West district of the Gauteng province. An observational design was used to collect the data. Data collection was conducted using an observational checklist guided by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The findings revealed that although a nutrition policy was available in most schools, few schools were communicating the policy. Despite all the schools having sports fields, children were not exercising. Most schools also had a school nutrition programme. Most primary schoolchildren's lunchboxes contained sweets, sugar-sweetened beverages, and snacks. A few lunchboxes contained fruits and vegetables. Primary schools in Tshwane West did not comply with most aspects of the school mapping environment, indicating that the school environments were obesogenic. It is therefore essential to scan for obesogenicity in all South African schools so that tailor-made interventions can be implemented to rectify and further prevent obesogenic school environments.

Daily living activities' performance by male diabetics with sexual dysfunction in South Africa.

BACKGROUND: Sexual dysfunction (SD) is a common complication among men living with diabetes (MLWD), which adds to stresses induced by medical condition. Effect of stress on their daily living activities has been only poorly described. AIM: This study aimed to explore the behaviour and challenges of MLWD experiencing SD in respect of daily living activities. SETTING: Five clinics in Senwabarwana in Limpopo province. METHODS: Qualitative approach and phenomenological exploratory design were adopted to collect data from 15 male participants selected from five clinics using purposive homogeneous sampling. One-on-one interviews were conducted using voice recorders, and field notes were taken of non-verbal cues. Unstructured interview guide with principal question enabled instructive probing to be conducted. Data were analysed using eight steps of Tesch's inductive, descriptive and open coding technique. RESULTS: Participants reported stressful experiences, difficulty coping with diabetes and its accompanying complication of SD that led to fear of losing their wives. They indicated that as a result of stress and difficulty in coping with the condition, they were engaged in less physical activity than before their diagnosis. CONCLUSION: Sexual dysfunction is prevalent among male diabetics and often feel stressed and worried about losing their wives. They struggle to cope with conditions to the point where they are less capable of performing tasks than they were before diagnosis. These outcomes are critical issues that should be addressed in any diabetes treatment strategy.Contribution: Support-based collaboration of healthcare providers with spouses and revision of South African diabetes management strategy to incorporate healthy coping strategies are recommended.

Lived experiences of diabetic outpatients attending clinics in rural areas of Limpopo province in South Africa.

Background: Prevalence of diabetes mellitus is increasing in South Africa (SA), with many people unknowingly living with undiagnosed diabetes. Living with a long-term illness like diabetes significantly impacts every aspect of one's life. It is essential to understand the lived experience of patients to ensure better management and intervention. Aim: To explore the lived experiences of diabetic outpatients. Setting: Clinics of Senwabarwana, in Blouberg Local Municipality of the Capricorn District Municipality in Limpopo province of SA. Method: Qualitative phenomenological exploratory descriptive study design was adopted to collect data from 17 diabetic patients. Purposive sampling was utilised to choose respondents. Data were collected through one-to-one interviews using voice recorders and field notes for nonverbal cues. Data were analysed using the eight steps of Tesch's inductive, descriptive and open coding technique. Results: Respondents detailed difficulty disclosing their diagnosis due to feelings of shame. They also experienced stress and an inability to perform duties they used to perform before diagnosis. Male respondents detailed their experiences of sexual problems and a fear of losing their wives to other men as a result. Conclusion: Patients living with diabetes are unable to perform some tasks that they were able to perform before diagnosis. This could be attributed to poor dietary choices and a lack of social support, leading to patients missing critical elements of diabetes care. Quality of life of patients who are unable to perform their daily tasks should be assessed, with appropriate interventions introduced to curb further deterioration. Male diabetes patients experience sexual dysfunction and a fear of losing their wives, which exacerbates their stress. Contribution: This study encourages the adoption of a family-centred approach, partnering with family members in the care of diabetic outpatients since most of the care takes place at home. Further studies are also recommended to design interventions which would address the experiences of patients for better outcomes.

Navigating Mental Health: Community Members' Insights into Social Support and Inclusion in Matsafeni Village in Mbombela, Mpumalanga Province-A Qualitative Study.

Mental health illnesses are increasingly prevalent worldwide, and South Africa is no exception. The research investigates the vital significance of social support in enhancing the welfare of individuals dealing with mental disorders. An essential aspect involves comprehending the interplay of emotional and practical supports provided by both families and the larger community. This study aims to explore community perceptions regarding social support and the involvement of individuals diagnosed with mental illnesses in Matsafeni Village. The research employed the qualitative method and descriptive exploratory research design, enabling the researchers to explore social support and the involvement of individuals with mental health disorders. Data were collected through unstructured, open-ended interviews, and participants were selected using a convenience sampling method. A total of only 15 participants were enrolled in this study, with variations in their educational backgrounds. Notably, only two participants had firsthand experiences with family members facing mental disorders. The study underscored the critical roles of family and community supports for individuals diagnosed with mental health disorders. The participants emphasized the necessity of mentally ill individuals receiving support from their loved ones and the broader community. Furthermore, they highlighted the importance for including individuals with mental health disorders in community activities as a means of better managing their conditions. The findings of this study can serve as a foundation for developing interventions to assist and support individuals affected by mental health disorders. Policymakers can also utilize the information to formulate strategies and best practices for promoting mental health awareness within the community.

Qualitative Study on the Voices of Adolescents Living with Perinatally Acquired HIV in Selected Clinics in the Limpopo Province of South Africa.

The disclosure of HIV status among adolescents living with perinatally acquired HIV (APHIV) has become one of the core challenges in the management of APHIV. Disclosure is a challenge that undermines positive advances and achievements in HIV management. There is limited literature on the voices of APHIV on disclosure of their status. This study aims to explore the current disclosure process and how it affects APHIV. A qualitative exploratory design was employed to conduct one-on-one in-depth interviews using a semi-structured interview guide. Purposive sampling was used to sample 21 APHIV in 16 selected health facilities in the Vhembe district of Limpopo Province, South Africa. Data were analyzed using Tesch's qualitative data method. The findings of this study reflect the gaps in the current disclosure process and guidelines while acknowledging the importance of disclosure to APHIV. A notable finding in this study is that most APHIV, especially those in early adolescence, did not want to know their HIV status due to the stigma attached to an HIV-positive diagnosis. This study suggests that proper training and support of parents and/or guardians in the disclosure process are needed, as they are the primary caregivers of APHIV. The disclosure of HIV status must be a comprehensive part of the management and care of HIV for APHIV. Furthermore, dedicated support programs should be developed and implemented to improve their lives post-disclosure.

Exploring Mental Health Awareness: A Study on Knowledge and Perceptions of Mental Health Disorders among Residents of Matsafeni Village, Mbombela, Mpumalanga Province.

The global rise in mental health disorders has significant social, economic, and physical impacts. Despite advancements in support, cultural beliefs attributing mental illnesses to spiritual causes persist, fostering discrimination and stigmatization. The study aims to explore the understanding and perceptions of mental health in Matsafeni Village, acknowledging the complexity of mental health issues. A qualitative method and a descriptive exploratory design were employed, enabling the researcher to describe, examine, and explore the knowledge and perceptions regarding mental health. Data collection was conducted through unstructured, open-ended interviews, with 15 participants selected through convenience sampling. The data were analyzed through thematic analysis. Measures of rigor were ensured through credibility, transferability, confirmability, and dependability. Participants demonstrated knowledge of mental health disorders, recognizing disruptions in thought patterns and diverse symptoms. They highlighted key signs and behaviors, emphasizing the need for spotting indicators such as untidiness. Perceptions of the causes of mental illness varied, including witchcraft and genetics. Participants unanimously advocated for seeking help from traditional healers, medical facilities, and therapies. Community members shared their views of mental health, covering their understanding, recognition of signs, personal interactions, and observations of behaviors in individuals with mental health conditions. Reported symptoms align with existing research, emphasizing the complexity of managing safety concerns in severe mental illnesses. The study highlights the need for community education to reduce stigma, considering cultural factors in mental health perceptions. Recommendations include early interventions, enhanced mental health services, and collaboration between western and traditional approaches for a holistic and culturally sensitive approach to mental health.

Prevalence of overweight and obesity amongst patients with diabetes and their non-diabetic family members in Senwabarwana, Limpopo province, South Africa.

BACKGROUND: Diabetes remains a public health concern and the second cause of mortality in South Africa. Family history of diabetes increases risk of developing diabetes. Obesity amongst patients is associated with comorbidity, whilst amongst non-diabetic family members it is associated with developing diabetes. This study aimed at determining prevalence of overweight and obesity amongst patients with diabetes and non-diabetic family members. METHODS: A quantitative, cross-sectional descriptive study was conducted on 200 patients and 200 non-diabetic family members were selected using systematic random sampling from rural clinics of Senwabarwana. Data were collected using close-ended questionnaires and anthropometric measurements. Body mass index (BMI) and waist circumference were measured and interpreted according to World Health Organization guidelines. Data were analysed using Statistical Package for Social Sciences, using both descriptive and inferential statistics. Chi-square test was used to calculate associations at 95% confidence interval where a p-value of 0.05 was considered statistically significant. RESULTS: Most patients (75.5%) had comorbidities and hypertension was most prevalent (89.0%). Over half of the patients (57.0%) and 38.0% of family members were obese. Most patients (75.0%) and 58.0% of family members had abdominal obesity. CONCLUSION: Patients with diabetes suffer from comorbidities are overweight and obese whilst evidence from various studies suggest that non-diabetic family members are at added risk of developing diabetes because of higher BMI and abdominal obesity. There is an urgent need to create a conducive environment that discourages sedentary behaviours through lifestyle modifications using the family centred approach, and involve family members in the care of patients.

Facilitators and barriers in prevention of cardiovascular disease in Limpopo, South Africa: a qualitative study conducted with primary health care managers.

BACKGROUND: In the Southern African countries, cardiovascular disease burden is increasing and the second most prevalent cause of death after infectious diseases. The sustainable primary prevention of cardiovascular disease is associated with the engagement of facilitators that support it and hindered by barriers that undermine the support of a healthy lifestyle at the community level. The purpose of the study was to investigate facilitators and barriers at the level of primary health care facilities, on prevention of cardiovascular disease in Limpopo Province of South Africa. METHODS: This study is an exploratory and descriptive qualitative design, where open-ended key informant interviews were conducted among 20 primary health care managers conveniently sampled in their respective health care facilities. Coding and analysis were done using the thematic analysis method with the assistance of Atlas ti qualitative software. RESULTS: Various facilitators for the prevention of CVD were identified in this study. One of such facilitators is the availability and adherence to CVD treatment guidelines in the district. Other facilitators included top-down health education programme; collaboration with schools, traditional and religious leaders; the use of modern technology; and a structured healthcare system. Barriers were also identified as poor infrastructural development; shortage of medical supplies and equipment; lack of health promotion activities; shortage of nurses and other health care personnel; and poor accessibility to primary health care services. CONCLUSION: This study has identified barriers and facilitators that may be harnessed to improve cardiovascular disease prevention, care, and management in a rural setting in South Africa. The facilitators should be strengthened, and barriers identified redressed. TRIAL REGISTRATION NUMBER: REC-0310111-031.

Elucidating challenges and solutions in the maternal healthcare, identified by medical doctors in northern South Africa: a qualitative study.

INTRODUCTION: as South Africa's maternal mortality ratio increased between 1990 and 2015, the country failed to reach the United Nations millennium development goal 5a. The maternal mortality ratio of Limpopo province is higher than the national average and previous studies report shortages of manpower and medical equipment in Limpopo province. The overall study aim was to elucidate views and experiences of medical doctors regarding maternal healthcare by identifying the challenges they experience and solutions they suggest. METHODS: a qualitative interview-based study was performed with ten medical doctors as participants. Manifest content analysis was used to analyze the data. RESULTS: the main findings were categorized as lack of material and human resources, feelings of experienced isolation and solution-focused expressions. The challenges identified included logistical issues, staffing issues, demographic characteristics of the patient population, poor interinstitutional communication and lack of support from the administration. The solutions included revision of resource allocation and improvement of the interinstitutional cooperation. For example, participants suggested that exchange programs between hospitals could be arranged, that the emergency medical service personnel could triage patients and that private practitioners could be contracted to work at public institutions. CONCLUSION: most identified challenges were related to a lack of resources. Based on their inside experience, the participants suggested several solutions. These firsthand accounts of the local medical doctors highlight the need for intervention and should be taken into account when it comes to improving the provincial healthcare and working toward achieving the healthcare-related sustainable development goals by 2030.

Abnormal cervical cytology amongst women infected with human immunodeficiency virus in Limpopo province, South Africa.

BACKGROUND: Cervical cancer remains the major public problem worldwide and the most common gynaecological malignancy in the developing world, particularly in sub-Saharan Africa. AIM: To determine the prevalence of abnormal cervical cytology amongst women with and without human immunodeficiency virus (HIV) and examine the association between HIV and histological grading. SETTING: The study was conducted in Limpopo province, which is the northernmost province of South Africa. The province has five district municipalities with one tertiary, five regional and thirty four district hospitals. METHODS: We retrospectively reviewed cervical cancer cases in Limpopo province (LP) of South Africa, using data collected routinely by the National Health Laboratory Services (NHLS). The data on smears submitted for cytology between 2013 and 2015 were extracted from the Central Data Warehouse (CDW) database. RESULTS: A total of 84 466 women were screened for cervical cytology smears. Their mean age was 39.8 ± 13.6 years, with range from 15 to 113 years; 77.2% were in the age group 30 years and older and 19.6% had an abnormal cervical cytology result. Overall, 46.4% of the women screened for cervical cancer were HIV infected. A significantly higher proportion of HIV-positive women had abnormal cytology than HIV-negative women (31.8% vs. 9.2%). CONCLUSION: The prevalence of abnormal cytology amongst HIV-positive women is relatively high, and the risk appears to be significantly greater in all age groups. This finding highlights the need to ascertain HIV status of all women presenting with cervical cancer.

Alcohol use among high school learners in rural areas of Limpopo province.

BACKGROUND: Alcohol use is a serious public health concern among youth in South Africa and worldwide. AIM: To determine the factors contributing to alcohol use among high school learners in the rural areas of Limpopo province. SETTING: The Greater Marble-Hall municipality, Sekhukhune district in Limpopo province. METHOD: A quantitative, cross-sectional study design was conducted on 314 learners from three high schools in a rural area in Limpopo. A stratified random sampling technique was used to select learners from 11 to 25 years of age. The drinking behaviour was classified according to predetermined Alcohol Use Disorders Identification Test (AUDIT). Data were analysed using SPSS Software v23.0. RESULTS: More than half of the respondents were consuming alcohol 169 (53.8%). Also, 173 (55.1%) of respondents had parents who consume alcohol and 204 (65%) had friends who drank alcohol. Most respondents were classified as low-risk drinkers (AUDIT score < 8) and a quarter of the respondents were classified as almost dependent on alcohol (AUDIT score > 13). Significant associations were found between learners' alcohol consumption and parents and friends who drank alcohol (p = 0.000; p = 0.000, respectively). CONCLUSION: Alcohol use was prevalent among high school learners in the area under investigation. Also, learners who had parents and friends who consume alcohol were more likely to consume alcohol. Further, learners who were classified as almost dependent on alcohol needed urgent intervention as their health-related quality of life was likely to be poor.

Alcohol use among high school learners in rural areas of Limpopo province

Background: Alcohol use is a serious public health concern among youth in South Africa and worldwide.Aim: To determine the factors contributing to alcohol use among high school learners in the rural areas of Limpopo province.Setting: The Greater Marble-Hall municipality, Sekhukhune district in Limpopo province.Method: A quantitative, cross-sectional study design was conducted on 314 learners from three high schools in a rural area in Limpopo. A stratified random sampling technique was used to select learners from 11 to 25 years of age. The drinking behaviour was classified according to predetermined Alcohol Use Disorders Identification Test (AUDIT). Data were analysed using SPSS Software v23.0.Results: More than half of the respondents were consuming alcohol 169 (53.8%). Also, 173 (55.1%) of respondents had parents who consume alcohol and 204 (65%) had friends who drank alcohol. Most respondents were classified as low-risk drinkers (AUDIT score < 8) and a quarter of the respondents were classified as almost dependent on alcohol (AUDIT score > 13). Significant associations were found between learners' alcohol consumption and parents and friends who drank alcohol (p = 0.000; p = 0.000, respectively).Conclusion: Alcohol use was prevalent among high school learners in the area under investigation. Also, learners who had parents and friends who consume alcohol were more likely to consume alcohol. Further, learners who were classified as almost dependent on alcohol needed urgent intervention as their health-related quality of life was likely to be poor

High-risk alcohol use and associated socio-demographic, health and psychosocial factors in patients with HIV infection in three primary health care clinics in South Africa.

Alcohol use may have a negative impact on the course of HIV disease and the effectiveness of its treatment. We studied patients with HIV who use alcohol and associated socio-demographic, health and psychosocial factors. Outcomes from this study may help in selecting patients from clinical practice with high-risk alcohol use and who are likely to benefit most from alcohol reduction interventions. In a cross sectional study in three primary health care clinics in Pretoria, South Africa, from January 2012 to June 2012, patients with HIV infection were interviewed and patients' medical files were reviewed to obtain data on levels of alcohol use (Alcohol Use Disorder Identification Test), patients' socio-demographic characteristics, HIV-related information, health related quality of life (WHOQoL-HIVBref), internalized AIDS stigma, symptoms of depression and adherence to antiretroviral therapy. Analyses consisted of descriptive statistics, bi- and multivariate logistic regression models. A total of 2230 patients (1483 [66.5%] female) were included. The median age was 37 years (interquartile range 31-43), 99.5% were black Africans, 1975 (88.6%) had started ART and the median time on ART was 22 months (interquartile range 9-40). No alcohol was used by 64% of patients, 8.9% were low risk drinkers, 25.1% of patients were hazardous or harmful drinkers and 2.0% had possible alcohol dependence. In multivariate analysis high-risk drinking was positively associated with male gender, never being married, tobacco use, a higher score for the 'level of independence'-domain measured with the WHOQoL-HIVBref questionnaire, and with more depressive symptoms compared to low-risk drinking. This study shows a high prevalence of hazardous or harmful drinking in patients with HIV infection (especially men) attending primary health care clinics in South Africa. Routine screening for alcohol use should be introduced in these clinics and harm reduction interventions should be evaluated, taking into account associated factors.

Contraceptive practices among women seeking termination of pregnancy in one public hospital in Eastern Cape, South Africa.

BACKGROUND: There is significantly high contraceptive knowledge in South Africa, but the uptake of contraceptives is average to low with resultant soaring of unplanned pregnancy and rising statistics of termination of pregnancy (TOP) services. This study aimed to establish the contraceptive practices among women in the South African population seeking TOP in one public hospital in Eastern Cape, South Africa. METHODS: A cross-sectional study was carried out among women seeking TOP in a women's clinic. Self-administered questionnaires were used as data collection tool, and the data collected were entered into SPSS software for analysis, using descriptive statistics to calculate frequencies and percentages while chi-square test was used to determine the associations between the socio-demography and contraceptive practices of the participants. RESULTS: Majority of the women were aged between 20 and 29 years, had secondary education, unemployed, single and resided in townships. Contraceptive uptake prior to termination of pregnancy (CTOP) among them was 44.1%, but 85.8% had good contraceptives knowledge. Their contraceptive practices are determined by partner's opinion, source and availability of contraceptives, previous CTOP, side effect of contraceptives and having children. Age group, educational level and employment status were found to be related to the contraceptive practices of the participants but were not statistically significant. CONCLUSION: To reduce unplanned pregnancies and subsequent number of women seeking CTOP, the socio-economic factors associated with contraceptive practices as well as the programmes, policies and guidelines of contraceptives need to be improved on for any improvement on the factors determining contraceptive practices.

Knowledge and practices of supervisors on the performance management and development system at rural primary health care facilities in the Limpopo Province.

BACKGROUND: The South African government has introduced Performance Management and Development System (PMDS) as a tool to monitor and manage the performances of health institutions, in order to improve service delivery within primary health care settings. The aim of the study was to determine the knowledge and practices of supervisors regarding PMDS in primary health institutions of the Limpopo Province. MATERIALS AND METHODS: A cross-sectional, descriptive, quantitative study was used. A total of 117 participants were sampled using stratified random sampling technique and a questionnaire was used to collect data. Statistical Package for Social Sciences (SPSS) version 22.0 was used to analyse both descriptive and inferential statistics. RESULTS: Generally all the respondents had an average (65.8%) understanding of the PMDS processes including the purpose and their roles as supervisors. However, a gap exists between the theoretical knowledge and the actual ability to practise PMDS which was found to be at 52%. There are areas of weakness that still need attention, such as unavailability of PMDS guidelines and lack of training of both supervisors and employees on PMDS. CONCLUSION: This study highlights the problem of lack of knowledge and skills, unavailability of PMDS policy and poor induction into PMDS. To improve the knowledge and ability to supervise PMDS, proper induction of all PMDS supervisors and periodic in-service training should be done; reference materials, the PMDS policy manuals, are to be made available in the facility and all supervisors be orientated on how to use these manuals.

Problem Gambling Among Urban and Rural Gamblers in Limpopo Province, South Africa: Associations with Hazardous and Harmful Alcohol Use and Psychological Distress.

Little is known about the mental health correlates of problem gambling in low- and-middle-income countries such as South Africa and whether these correlates vary by urbanicity. To address this gap, we examined mental health factors associated with problem gambling among gamblers in Limpopo Province, South Africa disaggregated by rural, peri-urban and urban location. A survey of gambling behaviour and mental health was conducted among 900 gamblers. Overall, 28.3 % were at high risk and 38.1 % were at moderate risk for problem gambling. For the entire sample, hazardous/harmful alcohol use was associated with almost twofold increased chance of being at moderate risk (AOR 1.83; 95 % CI 1.08, 3.11) and almost sevenfold greater odds (AOR 6.93; 95 % CI 4.03-11.93) of being at high risk for problem gambling. Psychological distress was associated with being at high risk for problem gambling only (AOR 1.18; 95 % CI 1.14-1.22). After stratifying by urbanicity, hazardous/harmful alcohol use and psychological distress remained associated with high risk gambling across all locations. We found little knowledge of a free gambling helpline and other gambling services-particularly in less urbanised environments [χ(2) (2), 900 = 40.4; p < 0.001]. These findings highlight the need to increase awareness of free helpline services among gamblers and to ensure gambling services include screening and treatment for common mental disorders.

Efficacy of a church-based lifestyle intervention programme to control high normal blood pressure and/or high normal blood glucose in church members: a randomized controlled trial in Pretoria, South Africa.

BACKGROUND: In persons 15 years and above in South Africa the prevalence of pre-diabetes and diabetes has been estimated at 9.1% and 9.6%, respectively, and the prevalence of systolic prehypertension and hypertension, 38.2% and 24.6%, respectively. Elevated blood glucose and elevated blood pressure are prototype of preventable chronic cardiovascular disease risk factors.Lifestyle interventions have been shown to control high normal blood pressure and/or high normal blood glucose. METHODS/DESIGN: This study proposes to evaluate the efficacy of a community (church)-based lifestyle intervention programme to control high normal blood pressure and/or high normal blood glucose in church members in a randomized controlled trial in Gauteng, South Africa. The objectives are to: (1) measure non-communicable diseases profile, including hypertension and diabetes, health behaviours, weight management and psychological distress of church members; (2) measure the reduction of blood glucose and blood pressure levels after the intervention; (3) prevent the development of impaired glucose tolerance; (4) compare health behaviours, weight management and psychological distress, blood glucose and blood pressure levels between intervention and control groups, and within group during 6, 12, 24 and 36 months during and post intervention. The study will use a group-randomized design, recruiting 300 church members from 12 churches. Churches will be randomly assigned to experimental and control conditions. DISCUSSION: Lifestyle interventions may prevent from the development of high blood pressure and/or diabetes. The findings will impact public health and will enable the health ministry to formulate policy related to lifestyle interventions to control blood pressure and glucose. TRIAL REGISTRATION NUMBER: PACTR201105000297151.