Factors influencing men's decisions to utilize sexual reproductive health services in KwaZulu Natal, South Africa.

Sexual and Reproductive Health (SRH) service utilization remains a global public health concern. The SRH problems account for major health challenges and disease burdens for men. This descriptive cross-sectional study of 421 men aims to identify factors influencing men's decisions to utilize SRH services. The interviewer-administered questionnaire obtained data from conveniently selected men who met the inclusion criteria. Frequencies and percentages were used to summarize variables associated with SRH services utilization. Univariable logistic regression was conducted before conducting a multivariable logistic regression. Of the 421 participants, 307 (72.9%) reported having utilized SRH services at least more than once. Although participants reported barriers to SRH service utilization, most men utilize services despite encountering challenges. The final multivariate logistic regression model revealed that age, education level, medical aid, and perceived good quality of services were significantly associated with SRHS utilization (p-value <0.05). Study findings indicate that older men (age 45 and above) were more likely to utilize SRH services than younger men (ages 15 to 44). Barriers to SRH service utilization must be eliminated so that men can easily use the services. Identifying factors influencing men to utilize SRH services will help policymakers and program managers address the poor utilization of SRH services by men.

Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study.

BACKGROUND: In countries such as Eswatini, where there is a high HIV prevalence and low male circumcision the World Health Organization and the Joint United Nations Programme for HIV/AIDS recommend infant and adult circumcision be implemented. The aim of this study was to assess the knowledge, attitudes and acceptability of voluntary medical male circumcision amongst males attending high school in Eswatini. METHODS: An observational cross-sectional study was conducted during February and March of 2018 amongst 407 young males (15-21 years) attending Form 4, in nine high schools in the Shiselweni region of Eswatini using a self-administered questionnaire of 42 close ended questions. Sociodemographic details, circumcision status, acceptance of voluntary medical male circumcision, knowledge and attitude scores analysed in Stata® 14 statistical software were described using frequencies, medians and ranges respectively. Bivariate and multivariate linear regression was used to assess the impact of independent variables on circumcision status and acceptance of voluntary medical male circumcision. The level of statistical significance was p < 0.05. RESULTS: Amongst the 407 high school-going males, 48.98% (n = 201) reported being circumcised. The majority of the adolescents (75.74%; n = 306) were knowledgeable about voluntary medical male circumcision. However, an even larger majority (84.90% (n = 343) had a negative attitude towards it. In the multivariate logistic regression analysis, having parented their own children (aOR: 3.55; 95%CI: 1.2-10.48), and having circumcised friends (aOR: 3.99; 95%CI: 1.81-8.84) were significantly associated with being circumcised. Neither knowledge nor attitude were associated with the acceptability of voluntary medical male circumcision. CONCLUSION: In Eswatini male high school students are knowledgeable about voluntary medical male circumcision but have a negative attitude towards it. Having parented their own children, and having circumcised friends influenced being circumcised.

Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium.

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions.

Prevalence and associated risk factors of chronic malnutrition amongst children under five in Eswatini.

BACKGROUND: About 20 million children under fi-ve in Southern Africa have chronic malnutrition. This study determines the prevalence of chronic malnutrition and associated risk factors amongst children under five. AIM: To determine the proportion of children with chronic malnutrition and investigate associated risk factors of chronic malnutrition. SETTING: The study was conducted in communities in the four regions of Eswatini. METHODS: This study is a retrospective cross-sectional study that used data from a Multiple Indicator Cluster Survey (MICS) conducted in 2014. The study involved 3261 children who are under 5 years of age. Data on nutritional status and household characteristics were used. Logistic regression was used to identify factors associated with chronic malnutrition in the univariable and multivariable models, respectively. RESULTS: Results showed that 18.1% (confidence interval [CI]: 18.5-21.5) of children under five have chronic malnutrition. The highest prevalence was 20.8% (CI: 17.4-24.7) in the Shiselweni region, followed by the Manzini region with 17.6% (CI: 14.5-21.1) and the Lubombo region with 17.2% (CI: 13.9-21.2). The lowest prevalence of chronic malnutrition at 16.7% (CI: 13.6-20.3) was the Hhohho region. The results indicated that low birth weight (odds ratio [OR] = 4.63, CI: 1.12-19.2), mothers' lack of education (OR = 1.50, CI: 1.04-2.17) and children aged 12-24 months (OR = 1.28, CI: 0.88-1.87) were significantly associated with chronic malnutrition. CONCLUSION: The findings showed that malnutrition is an important public health problem in children under five and needs a multisectoral response. Low birth weight, mothers' education and the child's age are risk factors associated with chronic malnutrition.Contribution: The results inform evidence-based programming for the prevention of chronic malnutrition in children thus assist the country to meet sustainable development goals.

Knowledge, attitudes, and practices towards drug-food interactions among patients at public hospitals in eThekwini, KwaZulu-Natal, South Africa.

Background: Drug-food interactions can lead to adverse drug reactions and therapy failure which can potentially impact patient safety and therapy outcome. Objectives: This study assessed patients' knowledge, attitudes and practices regarding drug-food interactions. Methods: A cross-sectional study was conducted among patients at three public hospitals in eThekwini, KwaZulu-Natal. Statistical analysis was performed using SPSS® version 25. The association between demographic variables and patients' knowledge, attitudes and practices were assessed. Results: Of the 342 patients, 70.5% were female, and the mean age was 42.87±0.89 years. Almost 50% of patients had secondary level education, and 64% were unemployed. About 52% of patients had high knowledge of drug-food interactions; however, only 30-50% of the patients could identify potential drug-food interactions of their drugs. More than half of the patients (51.5%) answered that they took multivitamin pills with medications and 61.7% responded they consulted healthcare professionals for drug-food interactions' information before taking new medications. Few patients (15.2%) had experienced drug-food interactions. Conclusions: Overall, patients had gaps in their knowledge and practices, and positive attitudes towards drug-food interactions. Many patients could not identify food items that can potentially interact with their drugs. It is important that education and medication counselling are provided to patients to prevent drug-food interactions, ensure optimal drug therapy and patient safety.

COVID-19 and resilience of healthcare systems in ten countries.

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26-96% declines). Total outpatient visits declined by 9-40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

Knowledge and perceptions about non-communicable diseases by people living with HIV: a descriptive cross-sectional study from Chitungwiza Central Hospital Zimbabwe.

Background: Sub-Saharan Africa has shown a rise in morbidity and mortality due to NCDs. PLHIV have shown to be more exposed to NCDs and identifying the knowledge gaps might help the management of NCDs in PLHIV. Objective: The study was conducted in order to determine knowledge and perceptions regarding NCDs in PLHIV from Chitungwiza Hospital. Methods: This was a cross-sectional survey on 324 participants from Chitungwiza Hospital. Data collection was through a designed questionnaire. Knowledge and perceptions were evaluated, and the associated risk factors were identified using the Logistic Regression Model. Results: Results showed a 65% level of knowledge and 80% positive perceptions on NCDs. Participants <40 years of age were more knowledgeable (p=0.003) and history of NCD in the family influenced positively on knowledge (p=0.001). Females showed a more positive perception (p=0.043), both increasing age and low education negatively impacted the perceptions (p<0.001) as well as the knowledge (p=0.020). Conclusion: Knowledge and perception were moderately high, but reduced with decreasing levels of education and increasing age. The study recommends educational campaigns to disseminate information about NCDs in PLHIV, targeting the least educated population groups and those older than 40 years of age.

Erratum: Factors associated with stroke survivors' inconsistent uptake of physiotherapy interventions at Turton Community Health Centre, KwaZulu-Natal.

[This corrects the article DOI: 10.4102/sajp.v76i1.1475.].

Assessment of knowledge of drug-food interactions among healthcare professionals in public sector hospitals in eThekwini, KwaZulu-Natal.

BACKGROUND: Foods and the nutrients they contain can interact with drugs and thereby interfere with their therapeutic safety and efficacy. Adequate knowledge of healthcare professionals (HCPs) about drug-food interactions can help in preventing potential drug-food interactions among patients. This study aimed to assess the knowledge of HCPs about common drug-food interactions. METHODS: A cross-sectional study was carried out among 459 HCPs from three public hospitals in eThekwini district, KwaZulu-Natal between November 2018, and January 2019. Informed consent was obtained from the HCPs, and a structured questionnaire was thereafter administered. Data were analysed using SPSS® version 25. Factors associated with knowledge of the HCPs were determined using logistic regression analysis. RESULTS: Of the 459 participants, 22.2% (n = 102) were doctors, 11.3% (n = 52) pharmacists, 63.8% (n = 293) nurses and 2.6% (n = 12) dietitians. Most of the HCPs were females 79.7% (n = 366), the mean age of the HCPs was 38.61±0.48. The knowledge score of the HCPs was 22.66±0.25 out of an overall score of 46. The HCPs poorly identified food types that interact with drugs and correct administration time of drugs relative to meals. Being a pharmacist (OR: 14.212, CI: 4.941-40.879, p<0.001), doctor (OR: 5.223, CI: 2.146-12.711, p<0.001), or a dietitian (OR: 5.476, CI: 1.103-27.191, p = 0.038) was associated with higher knowledge of drug-food interactions. CONCLUSION: The HCPs in this survey had low drug-food interaction knowledge. These findings suggest the need for additional training and educational courses for the HCPs on drug-food interactions.

Effect of perceived HIV risk on initiation of antiretroviral therapy during the universal test and treat era in South Africa.

BACKGROUND: South Africa has not achieved the 90-90-90 goals, in part due to low rates of antiretroviral therapy (ART) initiation among those aware of their HIV status. Perceived risk of HIV at the time of testing may affect likelihood of rapid ART initiation. The purpose of this study was to evaluate factors associated with perceived risk of HIV and the relationship between perceived HIV risk and rapid ART initiation during the universal test and treat era which was adapted in October 2016. METHODS: We conducted a prospective study of adults undergoing HIV testing from October 2016-February 2019 at Ithembalabantu Clinic in Durban. Eligible participants reported not previously being diagnosed with HIV. Before HIV testing, participants were asked to assess their perceived HIV risk on a four-level scale. We categorized "definitely not" and "probably not going to acquire HIV" as a low perceived risk, and "probably will" and "definitely will become HIV-infected" as a high perceived risk of HIV infection. Participants were followed for up to 14 months following HIV testing to assess ART initiation. RESULTS: Among 1519 people newly diagnosed with HIV, 55% were female and mean age was 33 years. Among those, 1382 (90.9%) had a high HIV risk perception and 137 (9.1%) reported low HIV risk perception. In the low risk group individuals were more likely to be female (58% vs 55%), unemployed (62% vs 59%), have a partner with unknown HIV status (61% vs 55%) compared to the high risk group. 83.2% of those with low HIV risk perception reported previously HIV testing compared 91.5% of those with high HIV risk perception. In the multivariate model, males were associated with a higher chances of initiating ART compared to females (adjusted hazard ratio (aHR): 1.187, CI 1.187 (1.060-1.329) and being unemployed (aHR 0.767 CI (0.650-0.905). Those with a low HIV risk perception were less likely to initiate ART 125 (91%) vs 1310 (95%) p = 0.022), and took longer to initiate on ART after HIV diagnosis (11 days' vs 4 days, p = 0.042). CONCLUSION: Factors associated with high HIV risk perception included being unemployed, single, and having a partner of unknown HIV status. People living with HIV (PLHIV) in South Africa who had a low self-perceived risk to HIV infection were less likely to initiate ART. Assessing self-perceived risk of HIV infection may help direct counselling and improve ART initiation to achieve universal 90-90-90 goal.

Availability and Use of Mobile Health Technology for Disease Diagnosis and Treatment Support by Health Workers in the Ashanti Region of Ghana: A Cross-Sectional Survey.

Mobile health (mHealth) technologies have been identified as promising strategies for improving access to healthcare delivery and patient outcomes. However, the extent of availability and use of mHealth among healthcare professionals in Ghana is not known. The study's main objective was to examine the availability and use of mHealth for disease diagnosis and treatment support by healthcare professionals in the Ashanti Region of Ghana. A cross-sectional survey was carried out among 285 healthcare professionals across 100 primary healthcare clinics in the Ashanti Region with an adopted survey tool. We obtained data on the participants' background, available health infrastructure, healthcare workforce competency, ownership of a mobile wireless device, usefulness of mHealth, ease of use of mHealth, user satisfaction, and behavioural intention to use mHealth. Descriptive statistics were conducted to characterise healthcare professionals' demographics and clinical features. Multivariate logistic regression analysis was performed to explore the influence of the demographic factors on the availability and use of mHealth for disease diagnosis and treatment support. STATA version 15 was used to complete all the statistical analyses. Out of the 285 healthcare professionals, 64.91% indicated that mHealth is available to them, while 35.08% have no access to mHealth. Of the 185 healthcare professionals who have access to mHealth, 98.4% are currently using mHealth to support healthcare delivery. Logistic regression model analysis significantly (p < 0.05) identified that factors such as the availability of mobile wireless devices, phone calls, text messages, and mobile apps are associated with HIV, TB, medication adherence, clinic appointments, and others. There is a significant association between the availability of mobile wireless devices, text messages, phone calls, mobile apps, and their use for disease diagnosis and treatment compliance from the chi-square test analysis. The findings demonstrate a low level of mHealth use for disease diagnosis and treatment support by healthcare professionals at rural clinics. We encourage policymakers to promote the implementation of mHealth in rural clinics.

A qualitative exploratory study of selected physicians' perceptions of the management of non-communicable diseases at a referral hospital in Zimbabwe.

INTRODUCTION: Non-communicable diseases (NCDs) have recently become a global public health burden and a leading cause of premature death, mainly in low- and middle-income countries (LMICs). The aim of the study was to explore physicians' perceptions on the availability and quality of clinical care for the management of NCDs. METHODS: This was a qualitative exploratory study meant to obtain expert perceptions on clinical care delivery for NCDs in one Zimbabwean central hospital setting. Data was collected from participants who consented and was analyzed using Stata version 13. A four-point Likert scale was used to categorize different levels of perceived satisfaction. FINDINGS: Twenty-three doctors participated in the study: four female doctors and nineteen males. Nineteen of the doctors were general practitioners, whilst four were specialists. The findings indicated that both categories perceived some shortfalls in clinical care for NCDs. Moreover, the perceptions of general practitioners and specialists were not significantly different. Participants perceived cancer care to be lagging far behind the other three NCDs under study. Care of cardiovascular diseases (CVDs) and diabetes showed mixed perceptions amongst participants, with positive perceptions almost equaling negative perceptions. Furthermore, hypertension was perceived to be clinically cared for better than the other NCDs under consideration. Reasons for the gaps in NCD clinical care were attributed by 33% of the participants to financial challenges; a further 27% to patient behavioral challenges; and 21% to communication challenges. CONCLUSIONS: The article concludes that care delivery for the selected NCDs under study at CCH need to be improved. Furthermore, it is crucial to diagnose NCDs before patients show clinical symptoms. This helps disease prognosis to yield better care results. The evaluation of doctors' perceptions indicates the need to improve NCD care at the institution in order to control NCD co-morbidities that may increase mortality.

Determinants of Confidence in Overall Knowledge About COVID-19 Among Healthcare Workers in South Africa: Results From an Online Survey.

Background: Adequate information and knowledge about COVID-19 has been shown to induce the confidence and positive performance among healthcare workers (HCWs). Therefore, assessing the relationship between confidence in knowledge and associated factors among HCWs is vital in the fight against COVID-19. This paper investigates factors associated with HCWs' confidence in their overall knowledge about COVID-19 in South Africa in the early stages of the epidemic. Methods: Data utilized in this paper were from an online survey conducted among HCWs using a structured questionnaire on a data free online platform. The study population were all the medical fraternity in South Africa including medical and nurse practitioners as well as other healthcare professionals. Bivariate and multivariate logistic regression models were performed to examine the factors associated with confidence in HCWs' overall knowledge about COVID-19. Results: Overall, just below half (47.4%) of respondents indicated that they had confidence in their overall knowledge about COVID-19. Increased odds of having confidence in the knowledge about COVID-19 were significantly associated with being male [aOR = 1.31 95% CI (1.03-1.65), p < 0.05], having a doctorate degree [aOR = 2.01 (1.23-3.28), p < 0.05], being satisfied with the information about COVID-19 guidelines [aOR = 6.01 (4.89-7.39), p < 0.001], having received training in 6-8 areas [aOR = 2.54 (1.89-3.43), p < 0.001] and having received training in 9-11 areas [aOR = 5.33 (3.81-7.47), p < 0.001], and having already treated COVID-19 patients [aOR = 1.43 (1.08-1.90), p < 0.001]. Those who were highly concerned with the levels of training of HCWs [aOR = 0.47 (0.24-0.92), p < 0.05] had decreased odds of having confidence in their overall knowledge about COVID-19. Conclusion: This study sheds light on the importance of capacitating HCWs with knowledge and adequate relevant training as part of infection prevention control measures during pandemics. Future training and information sharing should be sensitive to knowledge gaps by age, gender, qualifications, professional categories, and experience.

Incidence of non-communicable diseases (NCDs) in HIV patients on ART in a developing country: Case of Zimbabwe's Chitungwiza Central Hospital-A retrospective cohort study (2010-2019).

INTRODUCTION: The incidence of non-communicable diseases (NCDs) has been reported to be rising over the years leading up to 2010. In Zimbabwe, there are few studies done to examine the incidence of NCDs in people living with HIV (PLHIV) on anti-retroviral treatment (ART). OBJECTIVE: To determine the incidence of NCDs in HIV patients on ART at the Chitungwiza Central Hospital over ten years and the associated risk factors. METHODS: This was a retrospective cohort study using data from 203 patients enrolled on ART at the Chitungwiza Central Hospital between 2010 and 2019. All 500 records were considered and the selection was based on participants' consenting to the study and their strict adherence to ART without absconding. The incidence of NCDs was determined and generalized estimating equations (GEE) were used to estimate the association between NCDs and the selected risk factors. FINDINGS: Data collected at the study's baseline (2010) showed that the most prevalent NCD was hypertension, found in (18/203) 8.9% of the study participants, followed by diabetes (6.9%), then followed by cardiovascular diseases (CVD) (3.9%), and the least common NCD was cancer (1.9%). Incidences of all of these NCDs showed an increasing trend as the time of follow-up progressed. The factors found to be significantly associated with the development of NCDs were gender (p = 0.002) and follow-up time (p<0.001). Geographical location was a significant risk factor as urban patients were more likely to develop hypertension as compared to the peri-urban patients (p = 0.001). CONCLUSIONS: NCDs and HIV comorbidity is common with women more likely than males to develop NCDs as they advance in age. There is need to devise targeted intervention approach to the respective NCDs and risk factors since they affect differently in relation to the demographic details of the participants. RECOMMENDATIONS: This paper recommends a multi-stakeholder approach to the management of NCDs, with researchers, clinicians and the government and its various arms taking a leading role.

Healthcare providers' knowledge and perceptions regarding the use of modern contraceptives among adolescent girls in Umlazi Township, KwaZulu-Natal province, South Africa.

INTRODUCTION: the phenomenon of unintended adolescent pregnancy continues to be a reproductive and public health concern in sub-Saharan Africa. Healthcare providers play an important role in influencing the use of contraceptives among adolescent girls. This study assessed knowledge and perceptions of healthcare providers regarding the use of modern contraceptives among adolescent girls in Umlazi township, KwaZulu-Natal province, South Africa. METHODS: this was a descriptive study involving 35 healthcare providers covering all 10 primary healthcare clinics in Umlazi township. Data collected through a structured questionnaire were coded, entered into Epi data manager (version 4.6) and exported to STATA (version 15.0) for analysis. RESULTS: of the thirty-five healthcare providers that participated in this study, professional nurses (54.3%) and enrolled nurses (17.1%) constituted the majority. The mean age of the participants was 42.11 years, with 88.6% being females. More than a third (37.1%) of healthcare providers did not know whether or not modern contraceptives make users promiscuous, while more than half (57%) had negative attitudes towards adolescents exploring contraceptive methods. Healthcare providers viewed health systems challenges, such as poor working conditions, long queues, and contraceptives stock-outs, as deterrents towards the provision of quality sexual behaviour counselling and modern contraceptive education to users. CONCLUSION: poor health systems and negative behaviours by healthcare providers influences the delivery of family planning services in primary healthcare clinics and serve as barriers to quality family planning services provided to younger women.

Knowledge, attitudes and practices of hospital-based staff regarding physical activity at a private hospital in Johannesburg.

BACKGROUND: Physical activity has been established as an important component to incorporate into a healthy lifestyle. Hospital-based staff are also threatened by the risks of sedentary lifestyles, despite their association with a healthcare environment. The aim of this study was to determine the knowledge, attitudes and practices of private hospital-based staff regarding physical activity in Johannesburg. METHODS: A cross-sectional study was conducted. Data were collected using a self-administered questionnaire. Data were analysed with a combination of descriptive and inferential statistics. A p-value less than 0.05 was deemed statistically significant. RESULTS: A total number of 217 participants responded to the questionnaire. The majority of participants (n = 179; 82.49%) displayed excellent knowledge of physical activity, had a good attitude towards physical activity (n = 157; 72.35%) and displayed satisfactory practices (n = 137; 63.13%). Participants with the highest level of education had better mean knowledge, attitude and practice scores as opposed to those with lower levels of education. There was a statistically significant difference amongst staff categories in terms of knowledge (p = 0.004) and practice scores (p = 0.031). In addition, there was a statistically significant difference amongst different levels of education in terms of knowledge (p = 0.000), attitude (p = 0.02) and practice scores (p = 0.004). CONCLUSION: Staff members who participated in the study displayed only satisfactory physical activity practices. The hospital's employee wellness programme should establish appropriate strategies to improve staff practices of physical activity in order to promote health.

Risk factors associated with high prevalence of intimate partner violence amongst school-going young women (aged 15-24years) in Maputo, Mozambique.

BACKGROUND: In many countries, there is evidence that intimate partner violence is prevalent among young women. This study aimed to determine the prevalence and the factors associated with intimate partner violence in young women (aged 15-24 years) attending secondary schools in Maputo, Mozambique. METHOD: Using a probability proportional sampling strategy, 431 participants were recruited, and the data were collected using a self-administered questionnaire. Binary and multivariate logistic regression analyses were performed to assess the association between IPV and sociodemographic and sociocultural factors. Odds ratio (OR) and 95% confidence intervals (CI) are reported. RESULTS: Of the 413 participants, 248 (60%) (95% CI: 55.15-64.61) had experienced at least one form of IPV in their lifetime. Then, of the 293 participants who had a partner in the previous 12 months prior to the data collection, 186 (63.4%) (95% CI: 57.68-69.00) reported IPV in the 12 months prior to data collection. The psychological violence was the predominant type of violence, lifetime prevalence 230 (55.7%), and over the previous 12 months 164 (55.9%). The risk of IPV was associated with young women lacking religious commitment (AOR, 1.596, 95% CI: 1.009-2.525, p = 0.046) and if the head of the young women's household was unemployed (AOR, 1.642 95% CI: 1.044-2.584, p = 0.032). In the bivariate analysis the odds of being abused remained lower among the younger teenage women (OR, 0.458 95% CI: 0.237-0.888, p = 0.021), and higher, among young women if the partner was employed (OR, 2.247 95% CI: 1.187-4.256, p = 0.013) and among the young women believing that males are superior to females (OR, 2.298 95% CI:1.014-5.210. p = 0.046). CONCLUSION: These findings reveal a high prevalence of IPV among young women. Comprehensive programs should incorporate socioeconomic empowerment strategies to increase women's autonomy. There is a need to address religious beliefs through cultural perspectives, to improve social interactions that promote violence free relationships, gender egalitarian norms, and physical and emotional wellbeing for young women.

Electronic Health Information Systems to Improve Disease Diagnosis and Management at Point-of-Care in Low and Middle Income Countries: A Narrative Review.

The purpose of an electronic health information system (EHIS) is to support health care workers in providing health care services to an individual client and to enable data exchange among service providers. The demand to explore the use of EHIS for diagnosis and management of communicable and non-communicable diseases has increased dramatically due to the volume of patient data and the need to retain patients in care. In addition, the advent of Coronavirus disease 2019 (COVID-19) pandemic in high disease burdened low and middle income countries (LMICs) has increased the need for robust EHIS to enable efficient surveillance of the pandemic. EHIS has potential to enable efficient delivery of disease diagnostics services at point-of-care (POC) and reduce medical errors. This review provides an overview of literature on EHIS's with a focus on describing the key components of EHIS and presenting evidence on enablers and barriers to implementation of EHISs in LMICs. With guidance from the presented evidence, we proposed EHIS key stakeholders' roles and responsibilities to ensure efficient utility of EHIS for disease diagnosis and management at POC in LMICs.

Modifiable risk factors associated with non-communicable diseases among adult outpatients in Manzini, Swaziland: a cross-sectional study.

BACKGROUND: Four major non-communicable diseases (NCD), including T2DM, contributed to nearly three-quarters of all deaths worldwide in 2017. Dietary and lifestyle actors associated with NCDs are potentially modifiable. Therefore, this study was conducted to determine the dietary and lifestyle factors associated with T2DM, pre-diabetes, and hypertension among adult outpatients in Manzini, Swaziland. METHODS: A random sample of 385 subjects aged 18 years and above was selected. The data regarding demographics, socio-economic status, lifestyle behaviour, diet, and physical activities were collected. Additionally, participants' anthropometric measurements and vital signs were taken. A biochemical examination was done for fasting plasma glucose, and a 2-h oral glucose tolerance test, where necessary. The Statistical Package for Social Sciences (SPSS) version 26 was used for this data analysis, and the level of statistical significance was set at p < 0.05. RESULTS: A total of 385 (197 men and 188 women) subjects aged 18 years and older participated in the study. The overall prevalence of hypertension was 48.3%, while the prevalence of hypertension stage 1 and 2 were 29.4 and 19%, respectively. Smoking, SES and consumption of sweet drinks, salty processed foods, fruits, and vegetables were significantly associated with T2DM. However, in the multivariate analysis, only consumption of vegetables (p < 0.0001), fruits (p =0.014), sweet drinks (p = 0.042), and salty processed foods (p = 0.005) remained significantly associated with T2DM. Smoking (p = 0.002) and consumption of fruits (p < 0.0001), vegetables (p < 0.0001), and sweet drinks (p = 0.043) were independently associated with pre-diabetes, while the consumption of vegetables (p = 0.002) and salty processed foods (p = 0.003) were the factors independently associated with hypertension. CONCLUSIONS: The factors associated with T2DM, pre-diabetes, and hypertension are potentially modifiable. Therefore, interventions which target lifestyle changes at primary health care and population levels are warranted to address the growing burden of these chronic conditions in Swaziland.

Prevalence of abnormal glucose metabolism among adults attending an outpatient department at a tertiary referral hospital in Swaziland: a cross-sectional study.

BACKGROUND: The exact prevalence of type 2 diabetes mellitus (T2DM) and pre-diabetes in Swaziland remains unknown. Estimates suggest that the prevalence rate of type 2 diabetes mellitus is between 2.5 and 6.0% in Swaziland. The disparity in these estimates is due to a lack of quality data but the prevalence of diabetes is increasing in Swaziland. This study estimates the prevalence of type 2 diabetes mellitus and pre-diabetes among patients in a tertiary hospital in Manzini, Swaziland. METHODS: A cross-sectional observational survey was used to estimate the crude and age-adjusted prevalence rates of diabetes and pre-diabetes (impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)) in the Manzini regional referral hospital of Swaziland. Diabetes was defined as a fasting blood glucose (FBG) ≥ 7.0 mmol/L (126 mg/dL) and pre-diabetes was defined as an FBG of 6.1-6.9 mmol/L (110-125 mg/dL) and an FBG < 7.0 mmol/L (< 126 mg/dL), respectively for IFG and IGT. A random sample of 385 participants was used. Data analysis was done using SPSS version 26 and the level of statistical significance was set at α < 0.05. RESULTS: The crude prevalence of type 2 diabetes mellitus and pre-diabetes was 7.3% [95% CI 4.9-10.3] and 6.5% [95% CI 4.2-9.4], respectively, with clear gender differences in the prevalence of diabetes (men 1.6% vs women 5.7%, p = 0.001). On the other hand, significantly more men (3.6%) had pre-diabetes than women (2.9%) (p = 0.004). The overall age-adjusted prevalence rates of type 2 diabetes mellitus and pre-diabetes were 3.9 and 3.8%, respectively. Among the diabetic group, 3 (10.7%) had known T2DM, whereas 25 (89.3%) were newly diagnosed during the study. Advancing age, gender, raised blood pressure, abnormal body mass index, and wealth index were significant risk factors for T2DM or prediabetes. CONCLUSION: The prevalence of type 2 diabetes mellitus among adult outpatients in the Raleigh Fitkin Memorial hospital was higher than previously reported in the health facility in Manzini; suggesting the need for routine T2DM screening at outpatient departments.