The Wellbeing of Healthcare Workers during COVID-19 Era in Public Primary Health Facilities in Johannesburg, South Africa.

As the world grappled with the COVID-19 pandemic, healthcare workers (HCWs) continued to provide uninterrupted health care service delivery; therefore, this disproportionately affected their wellbeing. Our study explored the wellbeing of HCWs during the COVID-19 era in public health facilities in the City of Johannesburg, Gauteng province, South Africa. A qualitative study was conducted among twenty (20) HCWs through face-to-face in-depth interviews (IDIs) in the form of semi-structured interviews, audiotapes, and transcribed verbatim, and thematically analyzed with NVivo version 10. The findings showed that over half of HCWs (aged between 27 and 60 years) tested positive for COVID-19. Also, one third of HCWs' family members tested positive while some died due to COVID-19 infection. Informed by the workers' wellbeing framework, four themes emerged with fourteen sub-themes. Firstly, unsafe work environment was characterized by human resource related challenges such as increased workload; staff shortage; insufficient resources, e.g., personal protective equipment (PPE); poor policies in terms of compensation/allowance for being infected with COVID-19; poor health services; and death of colleagues. Secondly, poor health outcomes were described as strained emotional (psychosocial distress) and physical (respiratory related conditions) wellbeing. Thirdly, home and community environments were negatively impacted by interrupted relationships with family and friends, and experiences of deaths of loved ones. Finally, HCWs engaged personal wellbeing strategies through self-motivation; staying positive; family support; and participating in resilience-promoting extra mural activities to cope during the pandemic. In conclusion, the wellbeing of HCWs was aggravated during the COVID-19 era and led to low morale and compromised healthcare quality. This study advocates for promotion of greater resilience, and psychological and physical safety of HCWs through evidence-based, multilevel-multicomponent interventions at the workplace, home, and community environments in addition to strengthening public health policies and response to future pandemics.

Comparison of Malnutrition Indicators and Associated Socio-Demographic Factors among Children in Rural and Urban Public Primary Schools in South Africa.

Most children in South Africa attending public schools are predisposed to malnutrition due to poor infrastructure and social inequality. This is despite the implementation of the National School Nutrition Programme to address barriers to learning associated with hunger and malnutrition and the National Development Plan to reduce child malnutrition through provision of social grants. In view of this, we compared malnutrition indicators and associated socio-demographic factors among children in rural Mpumalanga and urban Gauteng in South African public primary schools selected using a multistage cluster random sampling. A validated researcher-administered questionnaire was used to collect socio-demographic data of caregivers, along with primary school children data collected on age, sex, learning grade, and anthropometric measures. Malnutrition indicators, which are stunting (low height-for-age z-scores), underweight (low weight-for-age z-scores), thinness (low body-mass-index-for-age z-scores), and overweight/obesity (high body mass index) were computed using WHO Anthro Plus 1.0.4 and data were analyzed using Stata 18. A total of 903 children (rural = 390 and urban = 513) with a mean age of 10 ± 2 years in the foundation phase (learning grades one to three) and the intermediate learning phase (learning grades four to seven) participated with their caregivers (mean age: 39 ± 8 years). Significant levels of poor socio-demographic status were observed among caregivers living in the rural setting compared to in the urban setting. Overall, thinness (18%), stunting (12%), underweight (10%), and overweight/obesity (24%) were observed among school children. Children in the rural schools had a significantly higher prevalence of stunting (20% vs. 3%; p < 0.0001), underweight (17% vs. 2%; p < 0.0001) and thinness (28% vs. 7%; p < 0.001) than their urban counterparts. In the urban, the odds of stunting, underweight and thinness were less among school children, while overweight/obesity was twice as likely in the urban setting. The multivariate final model showed lower odds of underweight [adjusted odds ratio (AOR) = 0.16; 95% confidence interval (CI): 0.06-0.42] and stunting [AOR = 0.33; 95% CI: 0.13-0.87] in the urban compared to the rural schools. The association of stunting with sex [AOR =0.53; 95% CI: 0.30-0.94] and the intermediate learning phase [AOR = 7.87; 95% CI: 4.48-13.82] was observed in the rural setting, while thinness was associated with living in households with an income of USD 52.51 to USD 262.60/month [AOR = 2.89; 95% CI: 1.01-8.24] and receiving the child social grant [AOR = 2.49; 0.90-6.86] in the urban setting. Overweight/obesity was associated with living in a household with an income of USD 52.51 to USD 262.60/month [AOR = 1.80; 95% CI: 1.02-3.10]. The findings suggest nutritional intervention approaches that are accustomed to the context of settings to effectively tackle malnutrition.

A Longitudinal Investigation on the Effects of Sodium and Potassium Intake on the Development of Hypertension and Abdominal Obesity from Childhood to Young Adulthood amongst Ellisras Rural Population, South Africa.

BACKGROUND: Hypertension (HT) and obesity have both been on the rise in children. Each is associated with an increase in cardiovascular disease risk, and both track into adulthood. OBJECTIVES: This study aimed to identify the association of sodium intake (Na), potassium (K) intake, and sodium-to-potassium (Na/K) ratio with the development of HT and abdominal obesity amongst the Ellisras rural population over time. METHODS: In this longitudinal study, data on dietary intake of Na and K were collected using a 24 h recall questionnaire from a total of 325 participants tracked from 1999 (5-12 years), 2001 (7-14 years), and 2015 (18-30 years). The averages of Na and K intake were analysed using local food tables and the South African Food Composition Database System (SAFOODS). In addition, blood pressure (BP) and anthropometric measurements (waist circumference (WC) and height) were also examined. Parametric (independent t-test) and Chi-square/Fishers exact tests were conducted to determine the difference between the years for numerical data and categorical variables. A generalised estimating equation (GEE) was used to assess the association of Na intake, K intake and their ratio on BP, WC, and waist-to-height ratio (WHtR). RESULTS: Our results indicate a significant positive association between K intake and WHtR, and even though the model was adjusted for age and sex, there was still an association with WHtR. The Na/K ratio was associated with both BP measurements and abdominal obesity, respectively. Furthermore, Na/K was shown to be associated with an increased risk of developing HT and abdominal obesity. CONCLUSIONS: In our study, we observed that an increase in the Na/K ratio is a predictor of HT and abdominal obesity over time compared to Na and K alone. However, more studies are required to further prove this.

Self-Management of Diabetes and Associated Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A Facility-Based Study.

The burden of diabetes continues to increase in South Africa and a significant number of diabetes patients present at public primary healthcare facilities with uncontrolled glucose. We conducted a facility-based cross-sectional study to determine the diabetes self-management practices and associated factors among out-patients in Tshwane, South Africa. An adapted validated questionnaire was used to collect data on sociodemography, diabetes knowledge, and summaries of diabetes self-management activities measured in the previous seven days, and over the last eight weeks. Data were analysed using STATA 17. A final sample of 402 diabetes out-patients was obtained (mean age: 43 ± 12 years) and over half of them were living in poor households. The mean total diabetes self-management of score was 41.5 ± 8.2, with a range of 21 to 71. Almost two thirds of patients had average self-management of diabetes, and 55% had average diabetes knowledge. Twenty-two percent of patients had uncontrolled glucose, hypertension (24%) was the common comorbidity, and diabetic neuropathy (22%) was the most common complication. Sex [male: AOR = 0.55, 95% CI: 0.34-0.90], race [Coloured: AOR = 2.84, 95% CI: 1.69-4.77 and White: AOR = 3.84, 95% CI: 1.46-10.1], marital status [divorced: AOR = 3.41, 95% CI: 1.13-10.29], social support [average: AOR = 2.51, 95% CI: 1.05-6.00 and good: AOR = 4.49, 95% CI: 1.61-7.57], body mass index [obesity: AOR = 0.31, 95% CI: 0.10-0.95], diabetes knowledge [average: AOR = 0.58, 95% CI: 0.33-0.10 and good: AOR = 1.86, 95% CI: 0.71-4.91], and uncontrolled glucose [AOR = 2.97, 95% CI: 1.47-5.98] were factors independently predictive of diabetes self-management. This study emphasizes that the self-management of diabetes was mostly on average among patients and was associated with the aforementioned factors. Innovative approaches are perhaps needed to make diabetes education more effective. Face-to-face sessions delivered generally during clinic visits should be better tailored to the individual circumstances of diabetes patients. Considerations should be given to the options of leveraging information technology to ensure the continuity of diabetes education beyond clinic visits. Additional effort is also needed to meet the self-care needs of all patients.

Increased endothelial biomarkers are associated with HIV antiretroviral therapy and C-reactive protein among a African rural population in Limpopo Province, South Africa.

In Sub-Saharan Africa (SSA) endothelial dysfunction (ED) and chronic inflammation in the HIV-positive adults population who are on highly active antiretroviral therapy (HAART) are not fully explored. We determined the effect of HAART on chronic inflammation and ED among HAART-exposed adults in a rural setting. Weight and height were measured to quantify the body mass index (BMI). Lipid and Glucose levels were determined. C-reactive protein (CRP), L-selectin, soluble intercellular adhesion molecule (sICAM-1), and soluble vascular cell adhesion molecule (sVCAM-1) in serum samples were tested. The majority of the HAART-exposed group were on treatment for <5 years. Soluble intercellular adhesion molecules, sVCAM-1, L-selectin and CRP were elevated in the HIV-infected groups as compared to the control group. The multivariate analysis showed that HIV infection (HAART-naïve) associated with increased sICAM-1 (ß = 0.350; 95% CI: 0.035-0.664, p = 0.029) and L-selectin (ß = 0.236; 95% CI: 0.038-0.434, p = 0.019) but not sVCAM-1 (ß = 0.009; 95% CI: 0.252-0.270, p = 0.468). The HAART-exposed group is associated with sVCAM-1 (ß = 0.250; 95% CI: 0.015-0.486, p = 0.037) but not with sICAM-1- (ß = 0.253; 95% CI: -0.083-0.590, p = 0.14) and L-selectin (ß = 0.119; 95% CI: -0.016-0.253, p = 0.084). sVCAM-1 was associated with decreased alcohol consumption (ß = -0.245; 95% CI: -0.469-0.021, p = 0.032) while L-selectin was associated with decreased total cholesterol (ß = -0.061; 95% CI: -0.124-0.002, p = 0.05) and increased CRP (ß = 0.015; 95% CI: 0.009-0.022, p < 0.001). Increased endothelial biomarkers were associated with HIV disease and HAART in a rural black adult population of African descent after controlling for CVD risk factors. Inflammation (as measured with CRP) may play an important role in endothelial activation. Further studies are needed to explore the association between endothelial dysfunction and inflammation especially among the HIV-positive population on HAART in similar settings.

Evidence of Concurrent Stunting and Obesity among Children under 2 Years from Socio-Economically Disadvantaged Backgrounds in the Era of the Integrated Nutrition Programme in South Africa.

In view of persistent stunting and increasing rates of obesity coexisting among children in the era of the Integrated Nutrition Programme, a cross-sectional study was conducted to determined concurrent stunting and obesity (CSO) and related factors using a random sample of child-mother pairs (n = 400) in Mbombela, South Africa. Sociodemographic data was collected using a validated questionnaire, and stunting (≥2SD) and obesity (>3SD) were assessed through respective length-for-age (LAZ) and body mass index (BAZ) z-scores. Using SPSS 26.0, the mean age of children was 8 (4; 11) months, and poor sociodemographic status was observed, in terms of maternal singlehood (73%), no education or attaining primary education only (21%), being unemployed (79%), living in households with a monthly income below R10,000 (≈$617), and poor sanitation (84%). The z-test for a single proportion showed a significant difference between the prevalence of CSO (41%) and non-CSO (69%). Testing for the two hypotheses using the Chi-square test showed no significant difference of CSO between boys (40%) and girls (41%), while CSO was significantly different and high among children aged 6-11 months (55%), compared to those aged 0-5 months (35%) and ≥12 months (30%). Further analysis using hierarchical logistic regression showed significant associations of CSO with employment (AOR = 0.34; 95%CI: 0.14-0.78), maternal education status (AOR = 0.39; 95%CI: 0.14-1.09) and water access (AOR = 2.47; 95%CI: 1.32; 4.63). Evidence-based and multilevel intervention programs aiming to prevent CSO and addressing stunting, while improving weight status in children with social disadvantages, are necessary.

Exploring Occupational Health and Safety Standards Compliance in the South African Mining Industry, Limpopo Province, Using Principal Component Analysis.

The health and safety of the miners in the South African mining industry are guided by the regulations and standards applied to promote a healthy work environment. The miners must comply with these regulations/standards to protect themselves from potential occupational health and safety risks, accidents, and fatalities. The status of compliance to safety regulations and standards in the mining industry of Limpopo Province has received little attention from scholars. This study explores the practices related to occupational health and safety standards compliance in the mining industry. A total of 277 miners were randomly selected from 1300 respondents in the mining industry. Data were collected using a 31-item survey questionnaire, administered to miners to explore occupational health and safety standards compliance from December 2019 to May 2020. Principal Component Analysis (PCA) extracted key attributes of occupational health and safety standards compliance in the mining industry and uncovered relationships between different dimensions. The study revealed that seven factors could measure occupational health and safety standards practices. It was observed that Factor 1 (occupational health practice related to regulations) is correlated with Factor 2 (measures to reduce risk of injuries/accidents). Additionally, Factor 2 (measures to minimise the risk of injuries/accidents) is correlated with Factor 4 (impact of the environment and production). There is a correlation between non-compliance with the safety regulations and the occurrence of injuries and accidents.

Assessing the Association of Sodium, Potassium Intake and Sodium/Potassium Ratio on Blood Pressure and Central Adiposity Measurements amongst Ellisras Undernourished, Rural Children Aged 5-13 Years: South Africa.

BACKGROUND: Numerous studies have shown how diet, such as sodium (Na) and potassium (K) intake, is an important risk factor for non-communicable diseases (NCDs). This study aimed to assess the relationship between sodium intake, potassium intake; and sodium/potassium ratio with blood pressure (BP) and abdominal obesity amongst Ellisras rural children. METHOD: In this cross-sectional study, data on dietary intake of sodium and potassium were collected using a 24-h recall questionnaire from a total of 765 participants, aged 5-13 years. Blood pressure and anthropometric measurements were also collected. Generalised linear models and Pearson correlation were conducted to assess the association of sodium intake, potassium intake; and their ratio with BP, waist circumference (WC), and waist-to-height ratio (WHtR). RESULTS: In both age groups, less than 14.9% of males and 19.8% of females consumed above the recommended adequate intake (AI) of sodium. In addition, both age groups had more than 90% of males and females who consumed below the recommended AI of potassium. Moreover, the sodium/potassium ratio was above the WHO recommended level in more than 30% of males and females. The study found a significant, weak positive correlation of sodium intake with systolic BP (SBP), diastolic BP (DBP), and with WHtR. A significant, weak positive correlation was also found between sodium/potassium ratio and WHtR. In addition, a significant association was found between potassium intake and systolic BP. CONCLUSION: Although our study found a notable low average intake of sodium and potassium as compared to the recommended values. There was positive correlation found between sodium intake and BP. Furthermore, a positive correlation of sodium intake and sodium/potassium ratio with WHtR was also found.