Health In Southern Africa Research Articles

Development of a Decision Support System for Animal Health Management Using Geo-Information Technology: A Novel Approach to Precision Livestock Management

Livestock management is challenging for resource-poor (R-P) farmers due to unavailability of quality feed, limited professional advice, and rumor-spreading about animal health condition in a herd. This research seeks to improve animal health in southern Africa by promoting sericea lespedeza (Lespedeza cuneata), a nutraceutical forage legume. An automated geospatial model for precision agriculture (PA) can identify suitable locations for its cultivation. Additionally, a novel approach of radio-frequency identifier (RFID) supported telemetry technology can track animal movement, and the analyses of data using artificial intelligence can determine sickness of small ruminants. This RFID-based system is being connected to a smartphone app (under construction) to alert farmers of potential livestock health issues in real time so they can take immediate corrective measures. An accompanying Decision Support System (DSS) site is being developed for R-P farmers to obtain all possible support on livestock production, including the designed PA and RFID-based DSS.

Cyclone Idai–related losses and the coping strategies of adolescent survivors in the Odzi community of Manicaland Province, Zimbabwe

Climate change has been identified as one of the leading threats to human health in Southern Africa. Climate change–induced natural disasters often leave behind a trail of destruction characterized by multidimensional losses such as loss of infrastructure, physical health, and psychological health. Adolescents are among the most vulnerable groups during and after a natural disaster. This article presents findings of a research whose aim was to establish cyclone Idai–related losses and postdisaster coping strategies among adolescent survivors. Based on qualitative data collected from 15 participants in the Odzi community of Manicaland Province in Zimbabwe, the article reveals that participants experienced diverse disaster-related losses, such as loss of independence and sense of control over their lives and general life satisfaction. The study notes that the impact of disaster-related losses had a toll on adolescents’ psychological, social, and physical well-being. From the study, it is established that in the aftermath of natural disasters, adolescents adopted two-pronged coping strategies, namely, personal coping strategies that include positive thinking and self-talk, and the utilization of social support such as instrumental and counseling support. This study suggests, among other recommendations, school-based training to equip adolescents with personal coping strategies.

Promises and perils of mobile health in Burkina Faso

Mobile health (mHealth) has attracted much attention in the global health community as a technological fix that can short-circuit inadequate health-system infrastructure and build access. But like many other technology-based approaches to remedy structural health inequities, mHealth interventions can be overhyped. We discusses here [email protected], an mHealth network launched in 2013 by the Centre de Recherche en Santé de Nouna (CRSN), Burkina Faso, with funding from the International Development Research Centre, Canada. Revitalising global social medicineWhat is global social medicine? This group of art of medicine essays argues for a revitalisation of the field of social medicine as a way to reaffirm a health agenda that promotes human rights and social justice. This approach requires understanding the histories of social medicine in diverse locations, the decolonisation and democratisation of knowledge flows in global health, and a more explicit acknowledgment of the historical and structural conditions that shape the burden of disease and the opportunities for health care and caregiving. Full-Text PDF Mutual aid, pandemic politics, and global social medicine in BrazilIn the face of persistent neglect and denial of the severity of COVID-19 by the administration of President Jair Bolsonaro, residents in many of Brazil's favelas have been left to organise their own responses to the pandemic. Community leaders have raised funds and volunteers are going door-to-door to distribute food, masks, and hygiene kits, using megaphones to educate residents about mask use, physical distancing, and handwashing. Local journalists are also using social media to counter fake news, and activists are converting schools into isolation wards, facilitating cash transfers, and fighting for the accurate documentation of COVID-19 deaths. Full-Text PDF Climate disasters and global social medicineHenry suffered a stroke in 2008, 3 years after Hurricane Katrina destroyed his home in New Orleans's Lower 9th Ward, a historic Black community. His diabetes had worsened in the aftermath of Katrina as he struggled to find pharmacies with insulin and other necessary supplies. His wife, Gladys, blamed the stroke on the receipt of a second denial-of-funds letter from the Road Home Program; without that assistance, they could not rebuild their home. The stroke left him paralysed. Gladys did her best to care for him, but she saw Katrina as the disaster that never ended. Full-Text PDF The social in psychiatries: depression in Myanmar, China, and JapanIn the wake of new ways of calculating disease burdens through disability-adjusted life-years, depression emerged as the world's second most common disorder after cardiovascular disease, affecting more than 264 million people worldwide. In Asia, depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases (ICD) has also become far more recognised and diagnosed over the past two decades. On the surface, this change seems to underline the universality of the neurobiological model of depression. Full-Text PDF Infant mental health in southern Africa: nurturing a fieldThe promotion of early cognitive and emotional development is a core aim of the field of infant mental health (IMH). Yet models of early development and IMH have often been developed for high-income settings, and sometimes carry under-examined assumptions about care and wellbeing. Although this discipline is well established in Euro–American contexts, questions have been raised about how to tailor it to contexts that may differ considerably from those in which these models were developed. The ways that care, attachment, and relationship are given form in everyday practices are not universally the same, raising the challenge of shaping therapeutic models and interventions so as to ask appropriate questions, design context-sensitive interventions, and meet caregivers and infants in ways that are meaningful to them while still retaining general applicability. Full-Text PDF Beyond COVID-19: scaling up and sustaining mobile health in Africa – Authors' replyWe thank Yap Boum for taking the time to respond to our Perspective.1 Full-Text PDF Beyond COVID-19: scaling up and sustaining mobile health in AfricaIn their Perspective,1 N Hélène Sawadogo and colleagues highlight the challenges of mobile health care in Africa with the [email protected] project, which provided medical support to pregnant women but ran out of funding 3 years into operation. Securing longer-term funding to sustain mobile health is a challenge in Africa.2 Social innovations such as BIMA (Ghana), AccesAfya (Kenya), Idocta (Cameroon), and Healthforce (South Africa) use telemedicine to improve access to quality health care but have not managed to scale up. Full-Text PDF

Mutual aid, pandemic politics, and global social medicine in Brazil

In the face of persistent neglect and denial of the severity of COVID-19 by the administration of President Jair Bolsonaro, residents in many of Brazil's favelas have been left to organise their own responses to the pandemic. Community leaders have raised funds and volunteers are going door-to-door to distribute food, masks, and hygiene kits, using megaphones to educate residents about mask use, physical distancing, and handwashing. Local journalists are also using social media to counter fake news, and activists are converting schools into isolation wards, facilitating cash transfers, and fighting for the accurate documentation of COVID-19 deaths. Revitalising global social medicineWhat is global social medicine? This group of art of medicine essays argues for a revitalisation of the field of social medicine as a way to reaffirm a health agenda that promotes human rights and social justice. This approach requires understanding the histories of social medicine in diverse locations, the decolonisation and democratisation of knowledge flows in global health, and a more explicit acknowledgment of the historical and structural conditions that shape the burden of disease and the opportunities for health care and caregiving. Full-Text PDF Climate disasters and global social medicineHenry suffered a stroke in 2008, 3 years after Hurricane Katrina destroyed his home in New Orleans's Lower 9th Ward, a historic Black community. His diabetes had worsened in the aftermath of Katrina as he struggled to find pharmacies with insulin and other necessary supplies. His wife, Gladys, blamed the stroke on the receipt of a second denial-of-funds letter from the Road Home Program; without that assistance, they could not rebuild their home. The stroke left him paralysed. Gladys did her best to care for him, but she saw Katrina as the disaster that never ended. Full-Text PDF Promises and perils of mobile health in Burkina FasoMobile health (mHealth) has attracted much attention in the global health community as a technological fix that can short-circuit inadequate health-system infrastructure and build access. But like many other technology-based approaches to remedy structural health inequities, mHealth interventions can be overhyped. We discusses here [email protected], an mHealth network launched in 2013 by the Centre de Recherche en Santé de Nouna (CRSN), Burkina Faso, with funding from the International Development Research Centre, Canada. Full-Text PDF The social in psychiatries: depression in Myanmar, China, and JapanIn the wake of new ways of calculating disease burdens through disability-adjusted life-years, depression emerged as the world's second most common disorder after cardiovascular disease, affecting more than 264 million people worldwide. In Asia, depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases (ICD) has also become far more recognised and diagnosed over the past two decades. On the surface, this change seems to underline the universality of the neurobiological model of depression. Full-Text PDF Infant mental health in southern Africa: nurturing a fieldThe promotion of early cognitive and emotional development is a core aim of the field of infant mental health (IMH). Yet models of early development and IMH have often been developed for high-income settings, and sometimes carry under-examined assumptions about care and wellbeing. Although this discipline is well established in Euro–American contexts, questions have been raised about how to tailor it to contexts that may differ considerably from those in which these models were developed. The ways that care, attachment, and relationship are given form in everyday practices are not universally the same, raising the challenge of shaping therapeutic models and interventions so as to ask appropriate questions, design context-sensitive interventions, and meet caregivers and infants in ways that are meaningful to them while still retaining general applicability. Full-Text PDF

Infant mental health in southern Africa: nurturing a field

The promotion of early cognitive and emotional development is a core aim of the field of infant mental health (IMH). Yet models of early development and IMH have often been developed for high-income settings, and sometimes carry under-examined assumptions about care and wellbeing. Although this discipline is well established in Euro–American contexts, questions have been raised about how to tailor it to contexts that may differ considerably from those in which these models were developed. The ways that care, attachment, and relationship are given form in everyday practices are not universally the same, raising the challenge of shaping therapeutic models and interventions so as to ask appropriate questions, design context-sensitive interventions, and meet caregivers and infants in ways that are meaningful to them while still retaining general applicability.

Maurice Aaron Kibel

Emeritus Professor Maurice Aaron Kibel passed away peacefully on 9 October after a short period of declining health. He was an icon and a pioneer in paediatrics and child health in southern Africa.

Climate change as the biggest threat to public health in southern Africa and measures to reduce its impacts.

Climate change as the biggest threat to public health in southern Africa and measures to reduce its impacts.

Making the invisible visible: a systematic review of sexual minority women's health in Southern Africa.

BackgroundOver the past two decades research on sexual and gender minority (lesbian, gay, bisexual and transgender; LGBT) health has highlighted substantial health disparities based on sexual orientation and gender identity in many parts of the world. We systematically reviewed the literature on sexual minority women’s (SMW) health in Southern Africa, with the objective of identifying existing evidence and pointing out knowledge gaps around the health of this vulnerable group in this region.MethodsA systematic review of publications in English, French, Portuguese or German, indexed in PubMed or MEDLINE between the years 2000 and 2015, following PRISMA guidelines. Additional studies were identified by searching bibliographies of identified studies. Search terms included (Lesbian OR bisexual OR “women who have sex with women”), (HIV OR depression OR “substance use” OR “substance abuse” OR “mental health” OR suicide OR anxiety OR cancer), and geographical specification. All empirical studies that used quantitative or qualitative methods, which contributed to evidence for SMW’s health in one, a few or all of the countries, were included. Theoretical and review articles were excluded. Data were extracted independently by 2 researchers using predefined data fields, which included a risk of bias/quality assessment.ResultsOf 315 hits, 9 articles were selected for review and a further 6 were identified through bibliography searches. Most studies were conducted with small sample sizes in South Africa and focused on sexual health. SMW included in the studies were racially and socio-economically heterogeneous. Studies focused predominately on young populations, and highlighted substance use and violence as key health issues for SMW in Southern Africa.ConclusionsAlthough there are large gaps in the literature, the review highlighted substantial sexual-orientation-related health disparities among women in Southern Africa. The findings have important implications for public health policy and research, highlighting the lack of population-level evidence on the one hand, and the impact of criminalizing laws around homosexuality on the other hand.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2980-6) contains supplementary material, which is available to authorized users.

The importance of family and community support for the health of HIV-affected populations in Southern Africa: what do we know and where to from here?

Informal family and community support deriving from social relations can play an important role in protecting mental and physical health in resource-scarce contexts and may help facilitate health service access and uptake. Yet, to date, there has been surprisingly little empirical research investigating the role of social support as a resource for health in HIV-affected Southern African communities, despite the known importance of social connectedness, high rates of physical and mental health conditions, and existing 'treatment gaps'. This paper brings together and discusses findings of multiple linked analyses, from the first large-scale explanatory sequential mixed methods research investigating the relationship between social support and health with caregiver populations in HIV-endemic South Africa. Overall, findings highlight the protective role of social support for caregiver mental health, the multiple perceived psychological and behavioural mechanisms possibly explaining the relationship between social support and both mental and physical health, and gender differences in the provision, effects, and availability of support. Drawing from these findings and the broader literature, four potential foci for future research in Southern Africa are identified and discussed, as are implications for research design and methodologies. These involve achieving a better understanding of the following: The pathways and processes explaining common and differential effects of social support across different population groups; the potential protective role of social support for physical health; and the role of factors such as gender and social and cultural norms in shaping the relationship between social support and health. Statement of contribution What is already known on this subject? Mental and physical health are closely related. HIV increases the risk of mental health conditions. Studies mainly from high-income countries have shown social relations and support to be protective of health. What does this study add? First mixed methods research of this dimension on social support and health in Southern Africa. Highlights importance of social support for mental health among caregivers of children in HIV-endemic South Africa. Points to biological and psychological pathways explaining the support-health relationship in this sample.

South–South medical tourism and the quest for health in Southern Africa

Intra-regional South–South medical tourism is a vastly understudied subject despite its significance in many parts of the Global South. This paper takes issue with the conventional notion of South Africa purely as a high-end “surgeon and safari” destination for medical tourists from the Global North. It argues that South–South movement to South Africa for medical treatment is far more significant, numerically and financially, than North–South movement. The general lack of access to medical diagnosis and treatment in SADC countries has led to a growing temporary movement of people across borders to seek help at South African institutions in border towns and in the major cities. These movements are both formal (institutional) and informal (individual) in nature. In some cases, patients go to South Africa for procedures that are not offered in their own countries. In others, patients are referred by doctors and hospitals to South African facilities. But the majority of the movement is motivated by lack of access to basic healthcare at home. The high demand and large informal flow of patients from countries neighbouring South Africa has prompted the South African government to try and formalise arrangements for medical travel to its public hospitals and clinics through inter-country agreements in order to recover the cost of treating non-residents. The danger, for ‘disenfranchised’ medical tourists who fall outside these agreements, is that medical xenophobia in South Africa may lead to increasing exclusion and denial of treatment. Medical tourism in this region and South–South medical tourism in general are areas that require much additional research.

Migration and health in Southern Africa: 100 years and still circulating

Migration has deep historical roots in South and Southern Africa and to this day continues to be highly prevalent and a major factor shaping South African society and health. In this paper we examine the role of migration in the spread of two diseases nearly 100 years apart: tuberculosis following the discovery of gold in 1886 and HIV in the early 1990s. Both cases demonstrate the critical role played by human migration in the transmission and subsequent dissemination of these diseases to rural areas. In both cases, migration acts to assemble in one high-risk environment thousands of young men highly susceptible to new diseases. With poor living and working conditions, these migration destinations act as hot-spots for disease transmission. Migration of workers back to rural areas then serves as a highly efficient means of disseminating these diseases to rural populations. We conclude by raising some more recent questions examining the current role of migration in Southern Africa.

Exposure to occupational health hazards among Zambian workers

Data on occupational safety and health in Southern Africa are scant. Hence the negative impact of poor working conditions is unknown and the scientific basis for interventions and policy formulation is lacking. To determine the prevalence of, and factors associated with, exposure to occupational health hazards in Zambia. We used data collected in the 2009 National Labour Force Survey. Unadjusted and adjusted odds ratios and their 95% confidence intervals were used to measure magnitudes of associations. Exposure to occupational hazards among the 64 119 respondents (response rate = 78%) included vibration from hand tools or machinery (3%), temperatures that make one perspire even when not working (4%), low temperatures whether indoors or outdoors (4%), smoke, fume, powder or dust inhalation (13%), pesticides (3%), noise so loud that voice had to be raised to talk to people (4%), chemical handling or skin contact (3%) and exposure to heavy object lifting, frequent bending of the back or rapid movement of limbs causing body pain (30%). In multivariate analysis, exposure to occupational health hazards was associated with older age, male sex, low educational level, being married/cohabiting and not being self-employed. Results from this study indicate that Zambian workers are exposed to a broad range of occupational health hazards. This could be useful for the formulation of a multi-sector approach aimed at the prevention and control of hazard exposure.

Protecting infants of HIV-positive mothers in Malawi

Child health in southern Africa is seriously threatened by the HIV epidemic: 20–30% of pregnant women are infected in most countries in this region. Prominent among threats to child health are HIV transmission and orphanhood. The avoidance or reduced duration of breastfeeding that can occur when women learn that they are HIV-positive is no less troubling than is the epidemic. New results from the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study done in Lilongwe, Malawi, reported by Denise Jamieson and colleagues in The Lancet,1 remind us that limitation of breastfeeding duration is not suitable for HIV-infected women and their infants.

A public health approach to the impact of climate change on health in southern Africa - identifying priority modifiable risks.

Anthropogenic climate change and anticipated adverse impacts on human health as outlined by the Intergovernmental Panel on Climate Change (IPCC) are taken as given. A conceptual model for thinking about the spectrum of climate-related health risks ranging from distal and infrastructural to proximal and behavioural and their relation to the burden of disease pattern typical of sub-Saharan Africa is provided. The model provides a tool for identifying modifiable risk factors with a view to future research, specifically into the performance of interventions to reduce the impact of climate change.

Responding to climate change in southern Africa - the role of research.

Projections show that the effects of climate change in Africa will not be uniform over the region. The region is extremely vulnerable to the impact of climate change because of poverty, a high pre-existing disease burden, fragmented health services and existing water and food insecurity. Despite the consensus that locally relevant information is necessary to inform policy and practice related to climate change, very few studies assessing the association between climate change and health in southern Africa have been conducted. More complete information is therefore urgently needed for the southern African region to estimate the health risks from projected future changes in climate.

Developing a national continuing professional development framework

The African Health Professions Regulatory Collaborative, a partnership between the United States Centers for Disease Control and Prevention, Emory University, the Commonwealth Secretariat, and the East, Central and Southern Africa Health Community has provided an opportunity for countries in the east, central and southern Africa region to strengthen their nursing and midwifery regulation. Some countries have chosen to develop a national continuing professional development (CPD) programme. This article explores what some of the key features of a national CPD framework might be, drawing on the elements of other national programmes both inside and outside of Africa. The variations in national programmes are outlined, as they related to definition, principles, scope, requirement and monitoring. The article concludes that there is no ‘perfect’ model of CPD; that countries can learn from each other; and that each country should develop a model that suits its particular circumstances.

The impacts of climate change on food security and health in Southern Africa

Climate change will have a great impact on Southern Africa according to the IPCC. Two closely related topics, food security and health will be affected by the changes in many ways. Difficulties in transporting food through carbon regulations in air-freight, changing conditions for growing food crops and negative impacts on fishery might occur and will very possible lead to an increase in malnutrition in the region. Changes of the climate will also have an effect on the way illnesses are transmitted and cause a number of extreme weather events which can have an extremely damaging consequence on human living. Two main efforts are being work on in terms of dealing with these concerns. At the inter-national, regional and national levels, adaptation and mitigation action is being planned and imple-mented. Activities at each level are discussed and I argue this in this paper that currently the most effi-cient way of dealing with the existing and future burdens of climate change impacts are activities at a national level, and enhanced effort has to be made to improve regional and international collaboration in addressing these issues.

'Issues of equity are also issues of rights': lessons from experiences in Southern Africa.

BackgroundHuman rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity.MethodsThe Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies – antiretroviral access, patient rights charters and civic organization for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence.ResultsCritical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels.ConclusionWhere it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights approaches appear to offer powerful tools to support social justice and health equity.

Addressing the Challenges of Underdevelopment in Environmental and Occupational Health in Southern Africa

Since 1996, the University of Michigan's Fogarty International Center training and research program in Environmental and Occupational Health (EOH) in Southern Africa has contributed to capacity development in the 14 countries of the Southern African Development Community. Methods include training citizens from the region in master's, doctoral, and short-term focused programs; assisting the development of graduate programs in EOH at institutions, developing resources for distance-based degree programs; direct support ofjunior and mid-level researchers, and organizing regional short courses and regional conferences. Substantial EOH resources now present in South Africa are leveraged to assist capacity development in the rest of the region. The program's successes appear to be due to strong regional leadership and oversight structures, a strategy of developing EOH resource centers in several countries, and close collaboration with other regional and international EOH programs.

Introduction: From Fear to Solidarity

This brief paper is the introduction to this JEMS special issue on Migration and Health in Southern Africa, drawn from papers presented at a conference organised by the Transnational Communities Programme (University of Oxford), the Southern African Migration Programme (Queen's University, Kingston, Canada) and the Faculty of Humanities, University of Cape Town, on 27–29 January 2003. Cross-border and within-country migration have generated complex and challenging difficulties for healthcare provision; not only do migrant populations often require specialist treatment for unfamiliar conditions, but the numbers involved and the distances travelled often change long-held epidemiological assumptions about the local population. In the contemporary southern African context, the spread of HIV/AIDS has often been associated with increased population mobility. This introductory paper summarises each paper in the special issue in turn, and concludes with some practical suggestions for policy measures.