Public Health In South Africa Research Articles

Integrated knowledge-translation in occupational therapists working with high-risk infants in South Africa: An explorative qualitative inquiry

BACKGROUND: This qualitative study explored the knowledge to practice gaps of occupational therapists who have a vital role in neurodevelopmental supportive care for high-risk infants METHODS: Via purposive sampling, 17 therapists working in public health in South Africa were recruited to participate in virtual focus groups. Data were thematically analysed using a hybrid approach FINDINGS: Five themes emerged, which included (i) occupational therapy and neonatal care in the public health sector, (ii) knowledge acquisition and knowledge synthesis, (iii) knowledge translation and utilisation, (iv) contextual barriers and adaptation and (v) the ideal occupational therapist in the ideal neonatal setting. Facilitators, inhibitors, referrals, and interest in occupational therapy neonatal care were also highlighted CONCLUSIONS: Knowledge to practice gaps in occupational therapy include insufficient training, a decreased interest in neonatal care, staff shortages, multi-disciplinary team rotations and a reduced understanding of the professional role and scope of occupational therapy. Resources, training, and policy development appear to be necessary to inform a standard of care Implication for practice The role of the occupational therapist in supporting high risk infants is generally limited and remains somewhat unknown in current South African contexts. It is essential to identify knowledge-to-practice gaps for occupational therapists supporting high-risk infants in the public health sector for successful implementation of neurodevelopmental supportive care. By the exploration of practitioner opinions and insight through appreciating the role of the occupational therapist in managing high risk infants, contextually specific and relevant knowledge translation interventions may be developed and implemented which have implications for evidence-based practice and more successful outcomes in the high-risk infant.

Efficacy of Plasmoquine for the Treatment of Plasmodium Vivax and Plasmodium Falciparum

This study is a response to the challenge of malaria infections, which remain a major public health in South Africa. Reports of malarial outbreaks in the country have been predominant in KwaZulu-Natal, Mpumalanga, and Limpopo provinces. Currently, combination therapy referred to artemisinin-based combination treatments (ACTs) has been recommended both by the World Health Organization and the National Department of Health of South Africa. However, due to widespread reports of artemisinin resistance, other alternative treatment options were explored. The aim of the study was thus to establish the efficacy of plasmoquine as an alternative treatment option among malaria patients in Johannesburg, the economic capital of South Africa, found in the Gauteng Province. The study adopted a quantitative approach, and a purposive retrospective investigation was adopted. Patient data from 2018-2022 was analyzed to determine the incidence of malaria in the study location and the efficacy of treatment with plasmoquine. The results of this study, therefore, indicate that P. falciparum is still the main cause of malaria in the study area. A total of 322 patient files were included in the study, with P. falciparum determined to be the main cause of infection over the four-year data assessed. Furthermore, plasmoquine was determined to be effective in treating malaria among 298 of the study population, with only 24 (7.5%) experiencing the development of vomiting after the treatment course. The findings of the study offer government makes policymakers the opportunity to develop policies that enhance the re-introduction of plasmoquine to combat malaria in South Africa. Keywords: Artemisinin-based combination treatments; Artemisinin resistance, Malaria; Plasmoquine.

Hepatitis B Virus Research in South Africa.

Despite being vaccine-preventable, hepatitis B virus (HBV) infection remains the seventh leading cause of mortality in the world. In South Africa (SA), over 1.9 million people are chronically infected with HBV, and 70% of all Black chronic carriers are infected with HBV subgenotype A1. The virus remains a significant burden on public health in SA despite the introduction of an infant immunization program implemented in 1995 and the availability of effective treatment for chronic HBV infection. In addition, the high prevalence of HIV infection amplifies HBV replication, predisposes patients to chronicity, and complicates management of the infection. HBV research has made significant progress leading to better understanding of HBV epidemiology and management challenges in the SA context. This has led to recent revision of the national HBV infection management guidelines. Research on developing new vaccines and therapies is underway and progress has been made with designing potentially curative gene therapies against HBV. This review summarizes research carried out in SA on HBV molecular biology, epidemiology, treatment, and vaccination strategies.

COVID-19 onset reduced the sex ratio at birth in South Africa.

The sex ratio at birth (defined as male/(male+female) live births) is anticipated to approximate 0.510 with a slight male excess. This ratio has been observed to decrease transiently around 3-5 months following sudden unexpected stressful events. We hypothesised that stress engendered by the onset of the COVID-19 pandemic may have caused such a decrease in South Africa 3-5 months after March 2020 since in this month, South Africa reported its first COVID-19 case, death and nationwide lockdown restrictions were instituted. We used publicly available, recorded monthly live birth data from Statistics South Africa. The most recent month for which data was available publicly was December 2020. We analysed live births for a 100-month period from September 2012 to December 2020, taking seasonality into account. Chi-squared tests were applied. Over this 100-month period, there were 8,151,364 live births. The lowest recorded monthly sex ratio at birth of 0.499 was in June 2020, 3 months after March 2020. This June was the only month during this period where the sex ratio inverted i.e., fewer male live births occurred. The predicted June 2020 ratio was 0.504. The observed June 2020 decrease was statistically significant p=0.045. The sex ratio at birth decreased and inverted in South Africa in June 2020, for the first time, during the most recent 100-month period. This decline occurred 3 months after the March 2020 onset of COVID-19 in South Africa. As June 2020 is within the critical window when population stressors are known to impact the sex ratio at birth, these findings suggest that the onset of the COVID-19 pandemic engendered population stress with notable effects on pregnancy and public health in South Africa. These findings have implications for future pandemic preparedness and social policy.

A qualitative study of patients and healthcare workers\u2019 experiences and perceptions to inform a better understanding of gaps in care for pre-discharged tuberculosis patients in Cape Town, South Africa

BackgroundMany people diagnosed with Mycobacterium tuberculosis (TB) in tertiary and district hospitals in South Africa do not arrive at their primary care clinic for continued care after they are discharged from the hospital. This loss to follow up is a major, ongoing problem for public health in South Africa, and contributes to drug-resistant TB strains. The objective of this paper was to explore patients’ experiences and perceptions of diagnosis and treatment before their discharge from hospital. We use a framework known as patient-centred care to illustrate how these patient narratives point to lapses in these principles within the hospital system, and to show how such lapses may contribute to loss to follow up and inconsistent TB care.MethodsWe employed a qualitative study using semi-structured interviews to investigate patient and healthcare workers’ experiences and perceptions of TB care in two Western Cape hospitals. We purposefully sampled 17 patients, 10 healthcare workers, and two key informant policy makers, all of whom had relevant experiences and insights. Data collection was done between October 2015 and February 2017. Data were analysed using Miles and Huberman’s qualitative analysis framework.ResultsHospitals did not achieve patient-centred care. Newly diagnosed patients were provided with inadequate TB education, diseased-focused approaches were favoured over patient-focused approaches, and there was limited engagement with patients to understand their needs and feelings during the critical period between diagnosis and discharge. Consequently, some patients felt anxious prior to their discharge from hospital. Coupled with their overwhelming socio-economic barriers and complex family situations, some patients felt hopeless and powerless as they prepared for discharge. Finally, there was a lack of patient-provider partnership due to problems including healthcare workers’ time constraints and heavy workloads, which detracted from a focus on patients’ needs and feelings.ConclusionsImproving the three intersecting elements of patient-centred care (health education, engaging with patients’ needs and feelings, and shared decision-making) has the potential to positively influence patients’ continuity of care for TB in South Africa. It would be helpful to also proactively address how patients plan to stay connected to care, on treatment, and supported, in light of their family situation or socio-economic circumstances. Detailed and unique pre-discharge counselling for each patient may be valuable in this regard.

South Africa field epidemiology training program: developing and building applied epidemiology capacity, 2007\u20132016

In 2007, South Africa (SA) launched a field epidemiology training program (SAFETP) to enhance its capacity to prevent, detect, and respond to public health threats through training in field epidemiology. The SAFETP began as a collaboration between the SA National Department of Health (NDOH), National Institute for Communicable Diseases (NICD), and the University of Pretoria (UP), with technical and financial support from the U.S. Centers for Disease Control and Prevention (CDC). In 2010, the CDC in collaboration with the NICD, established a Global Disease Detection (GDD) Center in SA, and the SAFETP became a core activity of the GDD center. Similar to other FETPs globally, the SAFETP is a 2-year, competency-based, applied epidemiology training program, following an apprenticeship model of ‘learn by doing’. SAFETP residents spend approximately 25% of the training in classroom-based didactic learning activities, and 75% in field activities to attain core competencies in epidemiology, biostatistics, outbreak investigation, scientific communication, surveillance evaluation, teaching others, and public health leadership. Residents earn a Master’s in Public Health (MPH) degree from UP upon successfully completing a planned research study that serves as a mini-dissertation.Since 2007, SAFETP has enrolled an average of 10 residents each year and, in 2017, enrolled its 11th cohort. During the first 10 years of the program, 98 residents have been enrolled, 89% completed the 2-year program, and of these, 76 (87%) earned an MPH degree. Of those completing the program, 88% are employed in the public health sector, and work at NICD, NDOH, Provincial Health Departments, foreign health institutions, or non-governmental organizations. In the first 10 years of the program, the combined outputs of trainees included over 130 outbreak investigations, more than 150 abstracts presented at national and international scientific conferences, more than 80 surveillance system evaluations, and more than 45 manuscripts published in peer-reviewed scientific journals. The SAFETP is having an impact in building epidemiology capacity for public health in South Africa. Developing methods to directly link and measure the impact of the program is planned for the future.

Applying behavioural science to issues of public health in South Africa: The case for social norms intervention


 
 
 In the effort to address behavioural risk factors – which contribute significantly to the global burden of disease – there is a growing movement in public health towards the use of interventions informed by behavioural science. These interventions have the benefit of being amenable to testing in randomised controlled trials, are cost-effective and, when scaled up, can have significant public health benefits. A subset of these interventions attempts to change behaviour by shifting social norms perception (what I think everyone else does and thinks). We surveyed the work on social norms intervention and considered its applicability to issues of public health in South Africa. Social norms interventions have widespread and significant potential to address issues of public health in South Africa; policymakers should look to these interventions as cost-effective tools to address key issues. More broadly, we advocate for an expansion of the use of behavioural science in developing public policy in South Africa.
 
 
 
 
 Significance: 
 
 
 
 The application of behavioural science to issues of public health will contribute to evidence-based policy efforts in South Africa.
 
 
 

Mapping South African public Health research

Background. Since 1994, South Africa (SA) has faced up to the challenge of building a strong economy, to which public health provides an important underpinning. Objectives. To map the scientific research in public health in SA after the end of apartheid and to present the links between the different financing/funding systems. Methods. Bibliographic analyses utilising the Web of Science of papers published during the period 1975 - 2014, analyses of journals, most cited articles, authors, publication years, organisations, funding agencies, countries and keywords, and mapping of the relations between countries involved in public health research and of the Web of Science Categories using VOSviewer. Results. I accessed 2 246 articles published between 1975 and 2014, the majority of which were published after 2007. The main countries of research were the USA, SA, Switzerland and the UK, representing the main network collaborations. The relevant keywords were HIV, woman, child, program/programme, rural, tuberculosis, district and sex. Conclusions. Public health research in SA reached a high level 16 years after the end of apartheid. The chief field that emerged was the spread of HIV, including mother-to-child transmission, and the policies applied to all districts of SA, through a network of institutions between the USA and SA.

Mapping South African public health research (1975 - 2014)

Background. Since 1994, South Africa (SA) has faced up to the challenge of building a strong economy, to which public health provides an important underpinning. Objectives. To map the scientific research in public health in SA after the end of apartheid and to present the links between the different financing/funding systems. Methods. Bibliographic analyses utilising the Web of Science of papers published during the period 1975 - 2014, analyses of journals, most cited articles, authors, publication years, organisations, funding agencies, countries and keywords, and mapping of the relations between countries involved in public health research and of the Web of Science Categories using VOSviewer. Results. I accessed 2 246 articles published between 1975 and 2014, the majority of which were published after 2007. The main countries of research were the USA, SA, Switzerland and the UK, representing the main network collaborations. The relevant keywords were HIV, woman, child, program/programme, rural, tuberculosis, district and sex. Conclusions. Public health research in SA reached a high level 16 years after the end of apartheid. The chief field that emerged was the spread of HIV, including mother-to-child transmission, and the policies applied to all districts of SA, through a network of institutions between the USA and SA.

Potential Climate Change Impacts on Environmental Health Services: Perspectives from a Developing Country

Climate change can be seen as a threat to sustainable development by undermining global poverty alleviation efforts and seriously impacting on successfully achieving the outcomes as envisaged by the Millennium Development Goals. There also exists severe implications for food security, clean water, environmental health and human settlements as the potential impacts of climate change bears much significance especially for the sustainable development of developing countries, such as South Africa. Therefore the role of the Environmental Health sector which is a key component in the protection of public health in South Africa, needs re-addressing as regards the potential impacts of climate change on Environmental Health Services. These potential impacts necessitates forward thinking on what adaptation measures should be considered by this sector, staffed primarily by Environmental Health Practitioners (EHPs), and how can these then be implemented proactively – given that in the South African context, EHPs have a Government regulated scope of practice that covers fourteen key job functions. Therefore, this article for each key job function, considers potential impacts of climate change followed by a discussion of possible solutions and challenges. However, despite adequate awareness on climate change and its impacts, it is evident that there are many challenges, inclusive of immense financial, technical and human resource constraints, still ahead. Therefore, a systematic approach by EHPs to assess, prevent and control climate change impacts and other interacting public health issues is vital and will be crucial to protect the health of affected populations in the future.

Reflections on Public Health in South Africa, 1993–2002

News of the completion of the new Wits School of Public Health (WSPH) building reminded me of the dream that so many of us had when the School was founded just over a decade ago. At the time I wrote: ‘The year 2001 will be remembered as the year in which the Wits School of Public Health was established. This event marks a defining moment in the development of Public Health at Wits. The establishment of the school has over a short period of a few months brought a new dimension to the way in which we function. No longer can Public Health be regarded as the Cinderella of health sciences at Wits . . . the School has demonstrated its academic worthiness.’ The new building serves to reinforce this notion. The establishment of the School did not happen without opposition from within the Faculty of Health Sciences and the university. Similarly, finding a building suitable for the rapidly expanding School of Public Health did not happen without a struggle. Initial efforts led to the university architects drawing up plans for a multi-story School of Public Health building near the entrance of the Medical School. However, the university did not see its way clear to supporting such an undertaking and the plans were shelved. Efforts to acquire premises on Oxford Road, which members of staff inspected and liked, were similarly not supported by the university. It is for this reason, amongst others, that it is such a tremendous privilege to see the new building finally a reality indeed a dream come true. (Published: 24 January 2013) Citation: Glob Health Action 2013, 6 : 20094 - http://dx.doi.org/10.3402/gha.v6i0.20094

Public health in South Africa 1975–89: reflections on a momentous past

It is an honour for me to reflect on a momentous period in the evolution of South Africa’s Public Health. In 1979, Wits University appointed its first full-time Chair of Community Health to a post, which had been approved four years earlier. The delay in filling the post was a product of bureaucratic challenge and uncertainty around the job description of the incumbent. The bureaucratic challenge centred on the post being a tri-partite appointment, with the successful candidate answerable to the National Department of Health, the Provincial Department of Hospital Services, and the University of the Witwatersrand. A further complication was that most public health activities took place under the auspices of the Johannesburg Municipality which was not a part of the tri-partite arrangement but which had a strong presence on the selection committee. (Published: 24 January 2013) Citation: Glob Health Action 2013, 6 : 20095 - http://dx.doi.org/10.3402/gha.v6i0.20095

Sexually transmitted infection and public health in South Africa: Educational campaigns for prevention, 1935–1948 and 1999–2008

This contribution compares two educational campaigns for prevention of sexually transmitted infections (STIs) in South Africa: against syphilis in the decade before penicillin became widely available after World War II, and against HIV since 1999. The syphilis campaign was led by the South African Red Cross. The HIV/AIDS campaign is in the hands of loveLife, a well-financed health non-governmental organization. Widely separated in time, they nevertheless share basic characteristics that help to explain their limited effectiveness. Much public education for STI prevention assumes that accurate medical information, if delivered effectively, will promote necessary behaviour change to reduce risk of infection irrespective of the class, culture or education level of the target groups. Approaches based on that premise largely failed against syphilis in South Africa and have so far failed again against HIV/AIDS. The paper contends that the health propaganda generated in both campaigns took insufficient account of the socio-economic circumstances and beliefs that frequently constrain changes in behaviour even when self-preservation is at stake. As mass campaigns, they were unable to respond to regional and local differences that affected reception of their messages. Recipients of public funding and support, they each aligned themselves with prevailing political discourses in ways that also impacted on effectiveness. Despite these and other preventive efforts, syphilis in the 1940s, like HIV in the years since 1994, continued undiminished to take a heavy toll of people's lives and health.

Content Analysis of Local Newspaper Coverage of the Microbicide Trials in South Africa

Based on a content analysis using framing theory, this article examines how the microbicide trials for HIV/AIDS prevention were portrayed in local newspapers in South Africa. Twenty-nine newspaper articles on microbicide research in South Africa appeared between 2004 and 2007 in 8 major South African newspapers; 13 had extended discussions of the microbicide trials while the remainder only mentioned them in passing. Six major topics were identified in these articles: participants; consequences of microbicide use; quality of the research design; research ethics; the stopping process (i.e. the way in which the microbicide trials were halted); and "villains" and "heroes." These topics were then inductively related to three emergent categories, named by the researchers as the: malicious microbicide trial, which characterizes the trials in highly negative, and disapproving ways; the marvelous microbicide trial, which frames the trials in highly positive and approving ways; and finally the multifaceted microbicide trial, which attempts to shed light on the complexities of the issues, rather than portraying them in one-sided terms. The report concludes with a discussion of the implications of the different media portrayals for public health in South Africa.

Estimating the burden of disease attributable to urban outdoor air pollution in South Africa in 2000.

To quantify the mortality burden attributed to urban outdoor air pollution in South Africa in 2000. The study followed comparative risk assessment (CRA) methodology developed by the World Heath Organization (WHO). In most urban areas, annual mean concentrations of particulate matter (PM) with diameters less than 10 microm (PM10) from monitoring network data and PM with diameters less than 2.5 microm (PM2.5) derived using a ratio method were weighted according to population size. PM(10) and PM(2.5) data from air-quality assessment studies in areas not covered by the network were also included. Population-attributable fractions calculated using risk coefficients presented in the WHO study were weighted by the proportion of the total population (33%) in urban environments, and applied to revised estimates of deaths and years of life lost (YLLs) for South Africa in 2000. South Africa. Children under 5 years and adults 30 years and older. Mortality and YLLs from lung cancer and cardiopulmonary disease in adults (30 years and older), and from acute respiratory infections (ARIs) in children aged 0 - 4 years. Outdoor air pollution in urban areas in South Africa was estimated to cause 3.7% of the national mortality from cardiopulmonary disease and 5.1% of mortality attributable to cancers of the trachea, bronchus and lung in adults aged 30 years and older, and 1.1% of mortality from ARIs in children under 5 years of age. This amounts to 4,637 or 0.9% (95% uncertainty interval 0.3 - 1.5%) of all deaths and about 42,000 YLLs, or 0.4% (95% uncertainty interval 0.1 - 0.7%) of all YLLs in persons in South Africa in 2000. Urban air pollution has under-recognised public health impacts in South Africa. Fossil fuel combustion emissions and traffic-related air pollution remain key targets for public health in South Africa.

Strengthening public health in South Africa: building a stronger evidence base for improving the health of the nation.

Strengthening public health in South Africa: building a stronger evidence base for improving the health of the nation.

Post-traumatic stress disorder as a public health concern in South Africa

This article briefly surveys the extent to which traumatic events are a feature of life all over Africa and provides a comprehensive review of research that documents the pervasiveness of traumatic events in South Africa and the prevalence of PTSD symptoms. The material reviewed includes statistics on crime, violence and accidents, research from clinical settings, and surveys. Several provide evidence for the causal link between traumatic events and the development of PTSD. These studies show that PTSD has been and continues to be a significant problem for public health in South Africa, affecting individuals in all sectors of society and as much a concern with respect to children as to adults. Keywords: Africa, epidemiology, post-traumatic stress disorder, public health, South Africa, trauma Journal of Psychology in Africa 2005, 15(2): 125–134

The embodiment of inequality: AIDS as a social condition and the historical experience in South Africa

The embodiment of inequality: AIDS as a social condition and the historical experience in South Africa

Gary Maartens–committed to improving public health in South Africa

Gary Maartens graduated in medicine from the University of Cape Town (UCT) in 1980. He then spent a year as a pre-registration house officer at the Warneford Hospital, Leamington Spa, UK. He returned to the hospitals of Cape Town, and from 1982—1989 he held the positions of medical officer and registrar. In 1990 he completed an infectious disease fellowship at the Department of Infection and Tropical Medicine, East Birmingham Hospital, UK. From 1991–1997, he was a consultant physician and lecturer in the Department of Medicine at UCT and the Groote Schuur Hospital.

‘Poor Whiteism’, White Maternal Mortality, and the Promotion of Public Health in South Africa: The Department of Public Health's Endorsement of Contraceptive Services, 1930–1938

‘Poor Whiteism’, White Maternal Mortality, and the Promotion of Public Health in South Africa: The Department of Public Health's Endorsement of Contraceptive Services, 1930–1938