Browsing Research Articles (SOPH) by Issue Date
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Puoane, Thandi; Steyn, Kristela; Bradshaw, Debbie; Laubscher, Ria; Fourie, Jean; Lambert, Vicki; Mbanangwa, Nolwazi (Nature Publishing Group, 2002)[more][less]
Abstract: To ascertain the anthropometric profile and determinants of obesity in South Africans who participated in the Demographic and Health Survey in 1998. RESEARCH METHODS AND PROCEDURES: A sample of 13,089 men and women (age, _15 years) were randomly selected and then stratified by province and urban and nonurban areas. Height, weight, mid-upper arm circumference, and waist and hip circumference were measured. Body mass index (BMI) was used as an indicator of obesity, and the waist/hip ratio (WHR) was used as an indicator of abdominal obesity. Multivariate regression identified sociodemographic predictors of BMI and waist circumference in the data. RESULTS: Mean BMI values for men and women were 22.9 kg/m2 and 27.1 kg/m2, respectively. For men, 29.2% were overweight or obese (_25 kg/m2) and 9.2% had abdominal obesity (WHR _1.0), whereas 56.6% of women were overweight or obese and 42% had abdominal obesity (WHR _0.85). Underweight (BMI _18.5 kg/m2) was found in 12.2% of men and 5.6% of women. For men, 19% of the variation of BMI and 34% of the variation in waist circumference could be explained by age, level of education, population group, and area of residence. For women, these variables explained 16% of the variation of BMI and 24% of the variation in waist circumference. Obesity increased with age, and higher levels of obesity were found in urban African women. DISCUSSION: Overnutrition is prevalent among adult South Africans, particularly women. Determinants of overnutrition include age, level of education, ethnicity, and area of residence. URI: http://hdl.handle.net/10566/291 Files in this item: 1
PuoaneSurvey2002.pdf (63.15Kb) -
Puoane, Thandi; Sanders, David; Ashworth, Ann; Chopra, Mickey; Strasser, Susan; McCoy, David (Oxford University Press, 2004)[more][less]
Abstract: OBJECTIVE. To improve the clinical management of severely malnourished children in rural hospitals in South Africa. STUDY DESIGN. A pre- and post-intervention descriptive study in three stages: assessment of the clinical management of severely malnourished children, planning and implementing an action plan to improve quality of care, and monitoring and evaluating targeted activities. A participatory approach was used to involve district and hospital nutrition teams in all stages of the research. SETTING. Two rural Wrst-referral level hospitals (Mary Theresa and Sipetu) in Mount Frere District, Eastern Cape Province. MAIN MEASURES. A retrospective record review of all admissions for severe malnutrition to obtain patient characteristics and case fatality rates, a detailed review of randomly selected cases to illustrate general case management, structured observations in the paediatric wards to assess adequacy of resources for care of malnourished children, and in-depth interviews and focus group discussions with nursing and medical staff to identify barriers to improved quality of care. RESULTS. Before the study, case fatality rates were 50% and 28% in Mary Theresa and Sipetu hospitals, respectively. Information from case studies, observations, interviews, and focus group discussions revealed many inadequacies in knowledge, resources, and practices. The hospital nutrition team developed and implemented an action plan to improve the quality of care and developed tools for monitoring its implementation and evaluating its impact. In the 12-month period immediately after implementation, case fatality rates fell by ∼25% in both hospitals. CONCLUSION. Participatory research led to the formation of a hospital nutrition team, which identiWed shortcomings in the clinical management of severely malnourished children and took action to improve quality of care. These actions were associated with a reduction in case fatality rates. URI: http://hdl.handle.net/10566/294 Files in this item: 1
PuoaneHospitalManagement2004.pdf (2.647Mb) -
Kruger, Salome H; Puoane, Thandi; Senekal, Marjanne; Van Der Merwe, Theresa M (Nutrition Society, 2005)[more][less]
Abstract: OBJECTIVES: To review data on the prevalence, causes and health consequences of obesity in South Africa and propose interventions to prevent and treat obesity and related outcomes. METHODS: Data from existing literature were reviewed with an emphasis on changing eating and activity patterns, cultural factors, perceptions and beliefs, urbanisation and globalisation. Results of studies on the health consequences of obesity in South Africans are also reviewed. RESULTS: Shifts in dietary intakes and activity patterns to higher fat intakes and lower physical activity are contributing to a higher prevalence of obesity. Few overweight black women view themselves as overweight, and some associate thinness with HIV/AIDS. Glucose and lipid toxicity, associated with insulin resistance, play roles in the pathogenesis of the co-morbid diseases of obesity. Elevated free fatty acids in the black population predispose obese black patients to type 2 diabetes. CONCLUSION & RECOMMENDATIONS: Obesity prevention and treatment should be based on education, behaviour change, political support, intersectoral collaboration and community participation, local actions, wide inclusion of the population, adequately resourced programmes, infiltration of existing initiatives, evidence-based planning, and proper monitoring and evaluation. Interventions should have the following components: reasonable weight goals, healthful eating, physical activity and behavioural change. Genes and mutations affecting susceptibility to the development of co-morbidities of obesity and vulnerable periods of life for the development of obesity should be prioritised. Prevention should be managed in community services, identification of high-risk patients in primary healthcare services and treatment of co-morbid diseases in hospital services. URI: http://hdl.handle.net/10566/285 Files in this item: 1
PuoaneObesityChallenges2005.pdf (160.4Kb) -
Puoane, Thandi; Hughes, Gail; Bradley, Hazel A. (Kamla-Raj Enterprises, 2005)[more][less]
Abstract: Obesity and associated non-communicable diseases such as Type 2 diabetes, hypertension, and ischaemic heart disease were previously thought to be diseases of affluent countries, but they are becoming increasingly prevalent in developing nations. Accessibility to cheap unhealthy food, global trade and market development influence nutrition transition towards diets with high fat and sugar contents. A decrease in physical activity due to urbanisation and other environmental factors such as crime and violence are thought to lead to an increased risk of obesity. Positive beliefs about body weight among black African women, together with the idea of association of thinness with HIV/AIDS virus infection are believed to fuel the obesity epidemic amongst this population This paper describes some of the contributory factors which black South African women are faced with in making choices about healthy living. A multisectoral approach will be needed to fight the epidemic of obesity and associated diseases. URI: http://hdl.handle.net/10566/243 Files in this item: 1
PuoaneObesity2005.pdf (29.48Kb) -
Puoane, Thandi; Fourie, JM; Shapiro, M; Rosling, L; Tshaka, N C; Oelefse, A (South African Journal of Clinical Nutrition, 2005)[more][less]
Abstract: OBJECTIVES: To explore perceptions about factors associated with body weight and body image among black female community health workers (CHWs) living and working in Khayelitsha, Cape Town. DESIGN: A descriptive, cross-sectional study. Setting. Khayelitsha, a black township in Cape Town, South Africa. SUBJECTS: Forty-four black, female, Xhosa-speaking CHWs working in Khayelitsha. Outcome measures. Anthropometric measures (height, weight, and waist circumference) were taken. Body mass index (BMI) was computed as a measure to estimate total body fat. Waist circumference was used as a measure of abdominal obesity. Focus groups were employed to explore beliefs and attitudes about body size. Information from the focus group discussions was used to develop a semi-structured questionnaire for individual interviews, which were conducted to validate the data from the focus groups, and to assess knowledge on causes and risk factors associated with obesity. A body satisfaction question was also included in the questionnaire. Body image was measured using body shape drawings (pictograms). RESULTS: Of the 44 women measured, 2 had normal weight (BMI 18.5 - 24.9 kg/m2), 2 were overweight (BMI 25 - 30 kg/m2), 25 were obese (BMI 30 - 40 kg/m2) and 15 were extremely obese (BMI ≥ ( 40 kg/m2). A moderately overweight shape (BMI 27 kg/m2) was preferred; this was associated with dignity, respect, confidence, beauty, and wealth. Perceived causes of obesity were eating the wrong food, skipping breakfast and worries about debts, husbands/partners and teenage children. Negative aspects of obesity included body aches and tiredness. CONCLUSION: This study emphasises the prevalence of obesity among urban black women in South Africa, particularly among CHWs. Socio-cultural, behavioural and environmental factors seem to influence the development of obesity in this population. URI: http://hdl.handle.net/10566/256 Files in this item: 1
PuoaneBig2005.pdf (302.9Kb) -
Scott, Vera; Chopra, Mickey; Conrad, Liz; Ntuli, Antoinette (Health and Medical Publishing Group, 2005)[more][less]
Abstract: OBJECTIVES. To assess the extent of inequalities in availability and utilisation of HIV services across South Africa. DESIGN. Cross-sectional descriptive study. Setting. Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled. Outcome measures. Availability and utilisation of HIV services and management and support structures for programmes were assessed through the collection of secondary data supplemented by site visits. RESULTS. There were marked inequalities in service delivery between the three sites. Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing (100% v. 52% and 24% respectively), better uptake of this service (59 v. 9 and 5.5 clients per 1 000 adults respectively) and greater distribution of condoms (15.6 v. 8.2 condoms per adult male per year). Extra counsellors had also been employed at the urban site in contrast to the other 2 sites. The urban site also had far more intensive management support and monitoring, with 1 manager per 12 health facilities compared with 1 manager per more than 90 health facilities at the other 2 sites. CONCLUSION. The process of scaling up of HIV services seems to be accentuating inequalities. The urban site in this study was better able to utilise the extra resources. In contrast, the poorer sites have thus far been unable to scale up the response to HIV even with the availability of extra resources. Unless policy makers pay more attention to equity, efficacious interventions may prove to be of limited effectiveness. URI: http://hdl.handle.net/10566/172 Files in this item: 1
ScottHowEquitable2005.pdf (307.4Kb) -
de Swardt, Cobus; Puoane, Thandi; Chopra, Mickey; du Toit, Andries (Sage Publications, 2005)[more][less]
Abstract: This paper describes key findings of a household livelihood survey conducted in impoverished African settlements in Cape Town, one of Africa’s wealthiest cities. Poverty in these areas is strongly shaped by the history of the Eastern Cape’s adverse spatial incorporation into the South African economy. Migrants from the rural areas are highly dependent on and integrated into the increasingly monetized economy – but are simultaneously marginalized and adversely incorporated within it. Survey findings show the costs and implications of this failure of the formal economy to provide adequate livelihoods. While many eke out a living in a vital yet marginal informal economy, these strategies are thoroughly linked to and dependent on the income that can be secured through participation in the formal job market. Those who are unable to find a foothold in the urban economy are highly vulnerable and are at risk of being confined to long-term poverty traps. URI: http://hdl.handle.net/10566/296 Files in this item: 1
PuoaneUrbanPoverty2005.pdf (798.9Kb) -
Mathews, Verona (Health Systems Trust, 2005)[more][less]
Abstract: This chapter emphasises the need for a routine information system for Human Resources Management (HRM). It provides an assessment of the current information system for HRM using a case study approach. It also outlines a suggested approach for the development of a Routine Information System with an Essential Data Set for HRM. Finally, it provides an overview of proposed indicators to produce information for the management and monitoring of Human Resources for the health sector. URI: http://hdl.handle.net/10566/459 Files in this item: 1
MathewsInformation2005.pdf (105.3Kb) -
Puoane, Thandi; Hughes, Gail (South African Medical Association, 2005)[more][less]
Abstract: HIV/AIDS continues to ravage sub-Saharan Africa, and in South Africa accounts for 30% of all mortality, making it the leading cause of death. The epidemic has had other negative effects, which have not been fully realised. Among these is the fact that, paradoxically, the awareness programmes implemented to prevent major spread of HIV/AIDS have complicated the prevention of non-communicable diseases (NCDs). URI: http://hdl.handle.net/10566/283 Files in this item: 1
HIV and NCDs m_samj_v95_n4_a6.pdf (219.2Kb) -
Puoane, Thandi; Bradley, Hazel A. (MedPharm Publications, 2006)[more][less]
Abstract: BACKGROUND: Community health workers (CHWs) are lay people trained to assist with health care in their communities. This study took place at two sites in Khayelitsha, a township in the Cape Peninsula, from 2000 to 2002. OBJECTIVES: To describe the process of developing an intervention programme for primary prevention of noncommunicable diseases (NCDs) in general and cardiovascular disease in particular, targeting CHWs. METHOD: Forty-four CHWs were assigned to either an intervention or a control group. The intervention group, living in Site C, received training on lifestyle modification with emphasis on healthy eating and physical activity, while the control group, living in Site B, did not receive any training until a year later. The process was undertaken in four stages. Stage 1 involved assessment of the CHWs’ risk factors by obtaining anthropometric measurements. CHWs were interviewed and focus group discussions were held on the socio-cultural factors associated with body weight and body image, and barriers to physical activity. Stage 2 involved developing and implementing a training programme for primary prevention of NCDs among CHWs. Stage 3, conducted at Site C, involved a situational assessment of available resources in the community for promoting healthy lifestyles. The fourth and final stage involved the implementation of community interventions by the CHWs. RESULTS: A large percentage of CHWs were overweight and obese, and therefore at risk for NCDs. They had misconceptions about causes and treatment of these diseases, and also lacked knowledge on nutrition and the risk of high fat intake. Easy access to cheap unhealthy food, rather than fresh fruit and vegetables, limited their ability to make healthy food choices. The findings from stage 1 led to a community participatory intervention. CONCLUSIONS: Developing community-targeted interventions for NCDs can be achieved by involving CHWs at the initial stage and utilising a multifaceted approach. Education of community members and CHWs does not guarantee behaviour modification. Unless the environment encourages healthy living, NCDs will continue to be a burden in the poor populations of South Africa. URI: http://hdl.handle.net/10566/236 Files in this item: 1
PuoaneCommunityIntervention2006.pdf (301.1Kb) -
Hughes, Gail; Puoane, Thandi; Bradley, Hazel A. (SEMDSA (Society for Endocrinology, Metabolism and Diabetes of SA), 2006)[more][less]
Abstract: BACKGROUND: Diabetes constitutes a significant health problem in South Africa. Early detection and good management can prevent or delay complications, with national guidelines for diabetes treatment now available to facilitate this. However, problems are being encountered with their implementation and there is evidence that preventive care is still inadequate in South Africa. Community health workers (CHWs) are lay personnel employed to serve as a link between professional health care staff and the community. They visit homes and can be a powerful force for diabetes prevention and adherence to treatment regimens, given appropriate knowledge. METHOD: We conducted a study to evaluate the knowledge, beliefs and attitudes of a group of CHWs serving a poor urban area, using focus groups and personal interviews. RESULTS: The CHWs did not have the requisite knowledge, attitudes and beliefs to make a positive impact on prevention and management of diabetes. For example, they cited eating sugar as a cause of diabetes. They advised folk remedies that purportedly diluted the blood sugar. Their patients took prescribed medication irregularly. Obesity was not considered an important risk factor. Poverty, however, was recognised as an obstacle to proper treatment. CONCLUSION: Training is clearly needed to empower the CHWs with skills to work within their communities to identify risk factors for diabetes and other non-communicable diseases, with emphasis on diet and physical activity. URI: http://hdl.handle.net/10566/278 Files in this item: 1
HughesDiabetes2006.pdf (242.4Kb) -
Hughes, Gail; Hoyo, Catherine; Puoane, Thandi (South African Medical Association, 2006)[more][less]
Abstract: BACKGROUND: In South Africa, former apartheid laws encouraged rural males seeking employment to migrate to urban areas, moving weekly, monthly or annually between their rural families and urban workplaces. The combination of the migrant labour system and long family separations caused an explosion of serious health consequences, among others sexually transmitted infections (STIs) in the migrant population. OBJECTIVE: To describe some correlates of male migration patterns for the rural women left behind, especially the fear of STIs that this engendered in them and their risk-avoidance behaviour. Setting and subjects. In KwaZulu-Natal, 208 prenatal patients who were partners of oscillating male migrant workers were interviewed to determine their demographic and behavioural characteristics, and their fear of STIs. RESULTS: Thirty-six per cent of the rural women said that they were afraid of contracting STIs from their returning migrant partners. Women who saw their partners infrequently were more fearful of STI transmission, and were less able to have sexual communication. However, almost none of the women protected themselves, while only 8% used condoms, primarily for contraceptive purposes. CONCLUSIONS: These results reflect the gender-based power relationships of South African male migrants and their rural partners, the social and economic dependency of the women on their migrant partners, and the women’s social responsibility to bear children. The results point to the need to go beyond interventions that simply seek to modify behaviour without altering the forces that promote risk taking and discourage risk reduction, and the need to develop appropriate interventions to curb STIs and decrease HIV. URI: http://hdl.handle.net/10566/260 Files in this item: 1
PuoaneSTIs2006.pdf (563.5Kb) -
Puoane, Thandi; Sanders, David; Ashworth, Ann; Ngumbela, Modesta (Democratic Nursing Organisation of South Africa, 2006)[more][less]
Abstract: A qualitative study with a pre- and post-intervention component was undertaken among 66 professional nurses at 11 hospitals in the Eastern Cape to assess their perceptions and attitudes towards severely malnourished children and their mothers/caregivers. Nurses’ attitudes were compared before and after attending a 5-day training course to improve the management of malnutrition along with implementing World Health Organization (WHO) guidelines. Severe malnutrition is a major cause of death among paediatric patients in many hospitals in South Africa. A qualitative study with a pre- and post-intervention component was undertaken among 66 professional nurses at 11 hospitals in the Eastern Cape to assess their perceptions and attitudes towards severely malnourished children and their mothers/caregivers. Nurses’ attitudes were compared before and after attending a 5-day training course to improve the management of malnutrition along with implementing World Health Organization (WHO) guidelines. Focus group discussions were conducted in isiXhosa following a semi-structured discussion guide. Three themes emerged from these discussions, i.e. blame was placed on the mothers for not giving adequate care, malnourished children were valued less than those with other conditions, and resentment that nurses felt towards caregivers. underlying reasons for negative attitudes towards severely malnourished children and their caregivers were misunderstandings of the causes of severe malnutrition, misinterpretation of clinical signs,especially poor appetite and and high mortality during treatment.However, successful application of the treatment guidelines altered these perceptions and helped nurses to have a better understanding of the causes of the presenting clinical signs. These nurses have begun advocating for raised awareness and the need to include the WHO Ten Steps of treatment in the nursing curricula and in-service training. A cadre of volunteer nurse-trainers has been formed in Eastern Cape. Experience in this province has shown that in-service training changes attitudes to malnutrition and treatment practices, as well as saving lives. URI: http://hdl.handle.net/10566/297 Files in this item: 1
PuoaneTrainingNurses2006.pdf (666.8Kb) -
Chopra, Mickey; Kendall, Carl; Hill, Zelee; Schaay, Nikki; Nkonki, Lungiswa L.; Doherty, Tanya M. (Lippincott Williams & Wilkins, 2006)[more][less]
Abstract: Interviews conducted in South Africa found that awareness of antiretroviral therapy was generally poor. Antiretroviral drugs were not perceived as new, but one of many alternative therapies for HIV/AIDS. Respondents had more detailed knowledge of indications, effects and how to access alternative treatments, which is bolstered by the active promotion and legitimization of alternative treatments. Many expressed a lack of excitement about the introduction of antiretroviral therapy, and little change in their attitudes concerning the epidemic. URI: http://hdl.handle.net/10566/478 Files in this item: 1
ChopraARV2006.pdf (1.056Mb) -
Puoane, Thandi; Matwa, Princess; Hughes, Gail; Bradley, Hazel A. (Kamla-Raj Enterprises, 2006)[more][less]
Abstract: The present study was undertaken to examine socio-cultural factors that influence food intake in different groups of people residing in a black township in Cape Town. Focus group discussions and in-depth interviews were used to explore these factors in men, and women of different age groups. Discussions were recorded, transcribed and analysed according to emerging themes. The main findings of the study indicated that in addition to nourishing the body, food is a sign of warmth, acceptance and friendship. Meat consumption on a daily basis is associated with a high socioeconomic status, while consumption of vegetables only is associated with a low socioeconomic status. Eating large portions of food is associated with affordability. Food is used for celebrations, rituals, and for welcoming guests. Food is also used during social occasions when people get together and meet socially. Sweets, ice cream and cakes are consumed on happy occasions. Fatty meat is a sign of generosity; lean meat and black tea is often used during mourning periods. Eating behaviours are learned during socialization, and carried over from generation to generation. There are socially accepted norms and values surrounding people’s understanding of what food is. This information needs to be used in a more constructive way to help people choose food wisely to prevent over nutrition and associated risks. In conclusion, this paper illustrates the impact of socio-cultural factors on eating patterns in this population and emphasizes the need to take these factors into consideration in development of interventions to promote healthy eating. URI: http://hdl.handle.net/10566/253 Files in this item: 1
JHE-SI-14-12-089-093-Puoane-T-Text.pdf (145.3Kb) -
Nkonki, Lungiswa L.; Doherty, Tanya M.; Hill, Zelee; Chopra, Mickey; Schaay, Nikki; Kendall, Carl (BioMed Central, 2007)[more][less]
Abstract: Background: The objective of this study was to examine missed opportunities for participation in a prevention of mother-to-child transmission (PMTCT) programme in three sites in South Africa. A rapid anthropological assessment was used to collect in-depth data from 58 HIV-positive women who were enrolled in a larger cohort study to assess mother-to-child HIV transmission. Semistructured interviews were conducted with the women in order to gain an understanding of their experiences of antenatal care and to identify missed opportunities for participation in PMTCT. Results: 15 women actually missed their nevirapine not because of stigma and ignorance but because of health systems failures. Six were not tested for HIV during antenatal care. Two were tested but did not receive their results. Seven were tested and received their results, but did not receive nevirapine. Health Systems failure for these programme leakages ranged from nonavailability of counselors, supplies such as HIV test kits, consent forms, health staff giving the women incorrect instructions about when to take the tablet and health staff not supplying the women with the tablet to take. Conclusion: HIV testing enables access to PMTCT interventions and should therefore be strengthened. The single dose nevirapine regimen is simple to implement but the all or nothing nature of the regimen may result in many missed opportunities. A short course dual or triple drug regimen could increase the effectiveness of PMTCT programmes. URI: http://hdl.handle.net/10566/429 Files in this item: 1
NkonkiNevirapineStudy2007.pdf (184.6Kb) -
Joubert, Jane; Puoane, Thandi (South African Medical Association, 2007)[more][less]
Abstract: OBJECTIVE: To estimate the burden of disease attributable to excess body weight using the body mass index (BMI), by age and sex, in South Africa in 2000. DESIGN: World Health Organization comparative risk assessment (CRA) methodology was followed. Re-analysis of the 1998 South Africa Demographic and Health Survey data provided mean BMI estimates by age and sex. Population attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. SETTING: South Africa. SUBJECTS. Adults ≥ 30 years of age. OUTCOME MEASURES. Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, hypertensive disease, osteoarthritis, type 2 diabetes mellitus, and selected cancers. RESULTS: Overall, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke, 38% of ischaemic heart disease, 31% of kidney cancer, 24% of osteoarthritis, 17% of colon cancer, and 13% of postmenopausal breast cancer were attributable to a BMI ≥ 21 kg/m2. Excess body weight is estimated to have caused 36 504 deaths (95% uncertainty interval 31 018 - 38 637) or 7% (95% uncertainty interval 6.0 - 7.4%) of all deaths in 2000, and 462 338 DALYs (95% uncertainty interval 396 512 - 478 847) or 2.9% of all DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in females was approximately double that in males. CONCLUSIONS: This study shows the importance of recognising excess body weight as a major risk to health, particularly among females, highlighting the need to develop, implement and evaluate comprehensive interventions to achieve lasting change in the determinants and impact of excess body weight. URI: http://hdl.handle.net/10566/284 Files in this item: 1
PuoaneEstimating2007.pdf (412.1Kb) -
Bradley, Hazel A.; Puoane, Thandi (International Society on Hypertension in Blacks, 2007)[more][less]
Abstract: The project aimed to identify factors that contribute to hypertension and diabetes and to design and implement appropriate local interventions to prevent these non-communicable diseases and promote healthy lifestyles. This was a community-based participatory action research project in which researchers and community health workers (CHWs) were the main participants. The triple A approach to planning interventions was used, that is, the process of assessing the situation, analyzing the findings, and taking action based on this analysis. Both qualitative and quantitative methods were employed. Twenty-two CHWs working in site C, Khayelitsha, a deprived urban area of Cape Town, South Africa, participated in the study. Findings from the situational assessment indicated a lack of knowledge among CHWs and the community about hypertension and diabetes and the risk factors for these non-communicable diseases. Economic constraints and cultural beliefs and practices influenced the community’s food choices and participation in physical activity. On the basis of these findings, a training program was proposed that would provide CHWs with the skills to prevent hypertension and diabetes in their community. A program was developed and piloted by the project team. A health club that focuses on promoting healthy lifestyles is currently being piloted. This paper illustrates the unique involvement of CHWs in a successful participatory action research project on the prevention of hypertension and diabetes and promotion of health in a deprived urban setting. The project emphasizes the importance of involving local people in community-based initiatives to promote health and identifies that the primary role of health services is to develop appropriate skills in the local community, monitor activities, and facilitate a link with primary health services. URI: http://hdl.handle.net/10566/182 Files in this item: 1
BradleyPuoanePrevention2007.pdf (184.0Kb) -
Puoane, Thandi (MedPharm Publications, 2008)[more][less]
Abstract: OBJECTIVE: To estimate the prevalence of overweight and obesity, and identify factors associated with Body Mass Index (BMI) and waist circumference (WC) among adults residing in an urban township in South Africa. DESIGN: Cross-sectional study. SETTING: Khayelitsha, a large black township located in Cape Town. SUBJECTS: 107 males and 530 females, aged ≥ 18 years. METHODS: The prevalence of overweight/obesity (BMI ³ 25 kg/m2) and abdominal obesity (WC ≥ 94 cm for men and ≥ 80 cm for women), and their relationship with factors previously found to increase the risk of obesity, such as age, gender, marital status, educational level, employment status, immigrant status from rural to urban, and physical activity level, were assessed using logistic regression analyses. RESULTS: The prevalence of obesity (BMI ³ 30 kg/m2) was 53.4% and 18.7%, and that of abdominal obesity was 71.5% and 23.4%, among women and men respectively. However, more women (21.3%) than men (11.2%) reported walking more than 45 minutes per day. Female gender and being married were associated with a high BMI and large WC. Recent migration was associated with a smaller WC. The level of physical activity was not associated with BMI or WC. CONCLUSIONS: These findings suggest that physical activity may play less of a role in obesity control, or that more than 45 minutes of physical activity per day is required to reduce the risk of obesity, especially in women. At least among South African women, obesity control focused on nutritional interventions may be more beneficial than increasing the intensity or duration of physical activity. URI: http://hdl.handle.net/10566/233 Files in this item: 1
MalhotraPuoaneSAJCN2008.pdf (303.1Kb) -
Puoane, Thandi; Katie, Cuming; Sanders, David; Ashworth, Ann (Oxford University Press, 2008)[more][less]
Abstract: Staff at 11 rural hospitals in an under-resourced region of Eastern Cape Province, South Africa, participated in an intervention to improve the quality of care of severely malnourished children through training and support aimed at implementing the WHO case-management guidelines. Despite similar intervention inputs, some hospitals reduced their case-fatality rates by at least half, whereas others did not. The aim of this study was to investigate reasons for this disparity. Two successful and two poorly performing hospitals were purposively selected based on their case-fatality rates, which were <10% in the successful hospitals and >30% in those performing poorly. Comparative data were collected during June to October 2004 through structured observations of ward procedures, compilation of hospital data on case-loads and resources, and staff interviews and discussions related to attitudes, teamwork, training, supervision, managerial support and leadership. The four study hospitals had broadly similar resources, infrastructure and child:nurse ratios, and all had made changes to their clinical and dietary management following training. Case-management was broadly in line with WHO guidelines but the study revealed clear differences in institutional culture which influenced quality of care. Staff in the successful hospitals were more attentive and assiduous than staff in the poorly performing hospitals, especially in relation to rehydration procedures, feeding and the recording of vital signs. There was a strong emphasis on in-service training and induction of incoming staff in the successful hospitals and better supervision of junior staff and carers. Nurses had more positive attitudes towards malnourished children and their carers, and were less judgmental. Underlying factors were differences in leadership, teamwork, and managerial supervision and support. We conclude that unless there are supportive structures at managerial level, the potential benefits of efficacious interventions and related training programmes to improve health worker performance can be thwarted. URI: http://hdl.handle.net/10566/295 Files in this item: 1
PuoaneHospitals2008.pdf (102.3Kb)
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