South African Adult Population Research Articles

Validation of screening instruments for common mental disorders and suicide risk in south African primary care settings

IntroductionIn South Africa, there is limited mental health infrastructure and resources. Valid screening tools are needed to facilitate identification and linkage to care. We evaluated the performance of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Primary Care Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5), and the Columbia Suicide Severity Rating Scale (C-SSRS) among adults in South Africa against a diagnostic gold standard. MethodsAdults present at healthcare facilities were screened with the PHQ-9, GAD-7, PC-PTSD-5, and the C-SSRS. Nurses used a structured diagnostic interview to identify depression, anxiety, panic disorder, PTSD and elevated suicide risk. We assessed the internal consistency, criterion validity, and the sensitivity and specificity of these tools. ResultsOf the 1885 participants, the prevalence of common mental disorders and suicide risk was 24.4 % and 14.9 %, respectively. The PHQ-9, GAD-7, and PC-PTSD-5 showed good internal consistency (0.80–0.89). All screeners demonstrated good criterion validity. For depression, a cut-off of ≥5 on the PHQ-9 yielded sensitivity of 84.24 %, while ≥10 yielded sensitivity of 48.77 %. For anxiety, the GAD-7 performed similarly. A cut-off of ≥4 on the PC-PTSD yielded sensitivity of 61.96 %. The C-SSRS yielded lower sensitivity than expected. LimitationsThe prevalence data is not generalizable to the larger South African adult population given the use of a targeted, healthcare facility-based sampling and recruitment strategy. ConclusionsThe performance of the PHQ-9, GAD-7, and PC-PTSD-5 demonstrated good internal consistency and criterion validity, though sensitivity and specificity trade-offs were enhanced with lower cut-offs. Further research into suicide risk screening is warranted.

Dolutegravir and the management of HIV/AIDS in the South African adult population

Dolutegravir and the management of HIV/AIDS in the South African adult population

The prevalence and social determinants of multimorbidity in South Africa

AbstractMultimorbidity is an increasing global public health challenge, however, most existing research focuses on high‐income countries, with limited evidence from low‐ and middle‐income countries. This paper aims to estimate the prevalence of multimorbidity in South Africa and analyse the associations between multimorbidity and social determinants of health in the adult population. Multimorbidity will be defined as the coexistence of two or more chronic diseases in an individual throughout this paper. Data from the South African National Income Dynamics Survey of 2017 was used with a total sample of 20,833. A binary logistic regression was performed to analyse the associations between multimorbidity and several social determinants of health indicators based on the Commission on Social Determinants of Health Framework. Multimorbidity was prevalent in 5.4% of the South African adult population surveyed, with 71.35% of those with multimorbidity being female. Hypertension was the most common NCD and the highest contributor to multimorbidity. Multimorbidity was found to have statistically significant associations with age, obesity, being female, being of Colored or Asian/Indian ethnicity, being in employment, and having no schooling. This study highlights the importance of analysing the associations between multimorbidity and the social determinants of health. Further research on multimorbidity is required in low‐ and middle‐income countries to understand the specific challenges not identifiable in the existing research predominately based in high‐income nations.

The Use of Information Communication Technologies in a South African Deaf Older Adult Population Living in a Residential Care Home to Communicate with Emigrant Family Members.

South Africa has experienced considerable international outward migration in the last half century, which has had a severe psychological impact on members of families affected by this phenomenon. Older parents who remain behind may experience feelings of loss and isolation. Information Communication Technologies (ICTs) are useful in maintaining relationships between family members separated by migration and increasingly allow migrant families to experience a virtual co-presence despite geographical separation. However, the process may be challenging, especially for older people with hearing difficulties. This article reports on a qualitative study exploring the perceptions of a group of older adults who have difficulty hearing and who live in a residential care home about using ICTs to communicate with family abroad. Interview data were analysed using thematic analysis. Most of the participants used either a fixed line telephone or a mobile phone. They reported challenges in communicating with family members abroad arising from their deafness, as well as difficulties using technological devices together with their hearing aids. These challenges resulted in feelings of helplessness and frustration. Although the data collection took place prior to the COVID-19 pandemic, these findings may be of particular relevance to situations such as those during the pandemic when many older adults became more reliant on technology to communicate with family members because of restrictions on direct contact. Accordingly, suggestions are made to address challenges in communication between older adults and loved ones who are geographically separated.

COVID-19 Vaccine Hesitancy in South Africa: Lessons for Future Pandemics.

Vaccine hesitancy, long considered a global health threat, poses a major barrier to effective roll-out of COVID-19 vaccination. With less than half (45%) of adult South Africans currently fully vaccinated, we identified factors affecting non-uptake of vaccination and vaccine hesitancy in order to identify key groups to be targeted when embarking upon COVID-19 vaccine promotion campaigns. A cross-sectional, anonymous online survey was undertaken among the South African adult population in September 2021. Our research identified race, interactive–critical vaccine literacy, trust in the government’s ability to roll out the COVID-19 vaccination programme, flu vaccination status and risk perception for COVID-19 infection as key factors influencing the uptake of COVID-19 vaccination. Respondents who did not trust in the government’s ability to roll out vaccination were almost 13 times more likely to be vaccine-hesitant compared to those respondents who did trust the government. Reliable, easy-to-understand information regarding the safety of COVID-19 vaccines is needed, but it is also important that vaccination promotion and communication strategies include broader trust-building measures to enhance South Africans’ trust in the government’s ability to roll out vaccination effectively and safely. This may also be the case in other countries where distrust in governments’ ability prevails.

Predictive value of different body segments to estimate height in a South African adult hospital population.

Height measurement is a vital component for assessing nutritional risk, and calculating dietary requirements in a clinical setting where indirect calorimetry is not available. In many patients, height cannot be measured accurately, and equations based on body segments are relied on to predict height. This study aimed to evaluate if specific body segments are better associated with height than others in a South African public hospital setting. A descriptive cross-sectional study was conducted in three public hospitals in Bloemfontein, South Africa, on patients, 20-50 years of age, and able to stand upright without assistance to be measured by stadiometer. Spearman correlations were assessed between stadiometer height and arm-span, demi-span, ulna length, knee height, tibia length, fibula length and foot length (measured by standardised techniques). Multiple regression analysis was performed to identify the segment that is most closely associated with stadiometer height in the study population. The sample included 141 participants (61.7% male, median age 38.8 years; IQR: 10.1 years). All measured body segment were statistically significantly correlated with stadiometer height, the strongest association being with knee height in both males (R2:0.77) and females (R2:0.86). Foot length and ulna length had the weakest correlation with stadiometer height in males and females, respectively. Multiple regression analysis identified knee height as having the best predictive value in determining stadiometer height. Overall, measurements of lower leg segments, particularly knee height, predicted measured height better than upper body segments. When choosing height-prediction equations in clinical settings in populations with a high prevalence of stunting, such as South Africa, the fact that stunting affects the growth of long bones in the lower body more than in the upper body, should be considered.

Distribution of anterior chamber angle measurements in South African young adults: an optical coherence tomography study

Assessment of anterior chamber angle (ACA) variables is important to screen, diagnose and monitor ocular anomalies. Even though data on ACA variables, such as angle-opening distance taken at 500µm (AOD500) and trabecular-iris angle (TIA), are available in the literature, limited information is available about these variables in African sub-populations. The purpose of this study is to describe the distribution of ACA measurements (AOD500 and TIA) in a South African young adult population. In this cross-sectional study, 700 young adults were recruited from a university student population using two-stage random sampling. The Optovue iVue 100 optical coherence tomographer was used to measure the ACA variables. The distribution of the AOD500 and TIA measurements was analysed using descriptive and inferential statistics. Data from only the right eyes were analysed because the ACA measurements in the two eyes showed high levels of interocular symmetry. The measurements for the nasal and temporal ACAs were asymmetrically distributed (p < 0.001). The median AOD500 measurements in the nasal and temporal angles were 539µm and 542µm, respectively. The median TIA measurements were similar (~ 36°) in the two horizontal angles. The temporal ACA measurements were slightly higher than the nasal ACA measurements. Females had higher median ACA measurements than males (p ≥ 0.029). The ACA measurements in South African young adults resemble non-Gaussian curves. The ACA measurements are different from that reported in other sub-populations worldwide and most participants had ACA measurements associated with non-occludable ACAs.

Dental caries in a South African adult population: findings from the Cape Town Vascular and Metabolic Health Study

Caries is a ubiquitous non-communicable disease worldwide. There is a paucity of literature on adult caries in Africa, with the last epidemiological caries study in South Africa conducted in 1988/1989. This article reports on the decayed, missing and filled teeth (DMFT) scores in relation to demographic characteristics for a mixed-ancestry South African population. This cross-sectional epidemiological study was part of the ongoing Cape Town Bellville South Vascular and Metabolic Health Study. Each participant signed an informed consent form prior to enrolling in the study. During a clinical examination, DMFT score and components were recorded for each participant. Data analysis was performed with the statistical Package STATA 15. A sample of 1,885 participants was included in the study. Sixty-eight percent of the population experienced high DMFT scores. Mean DMFT score increased with age from 5 (≤ 24-year-old group) to 32 (≥ 75-year-old group, P<0.001). It was higher in women than in men (28.5 vs. 18, respectively, P<0.001). The missing component contributed 83% to DMFT score, followed by decayed (14%) and filled (3%) scores. Males had a higher average number of teeth present than females (18 vs. 6.5, P<0.001). Dental caries experience was very high, with high levels of tooth loss in this community. These findings highlight limited access to preventive oral healthcare and a high rate of tooth extraction. Females presented higher levels of oral disease than males, indicating the need for preventive oral healthcare programmes in Cape Town, South Africa.

The cost-effectiveness of using pneumococcal conjugate vaccine (PCV13) versus pneumococcal polysaccharide vaccine (PPSV23), in South African adults

Streptococcus pneumoniae (pneumococcus) remains an important cause of morbidity and mortality. Pneumococcal vaccination is part of the South African pediatric public immunization program but the potential cost-effectiveness of such an intervention for adults is unknown. This study aimed to compare the cost-effectiveness of two widely used pneumococcal vaccines: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) in South African adults, 18 years and older. Four analyses were carried out in a) both the private and public health care sectors; and b) for the HIV-infected population alone and for the total mixed population (all HIV-infected and -uninfected people). A previously published global pharmacoeconomic model was adapted and populated to represent the South African adult population. The model utilized a Markov-type process to depict the lifetime clinical and economic outcomes of patients who acquire pneumococcal disease in 2015, from a societal perspective. Costs were sourced in South African rand and converted to US dollar (USD). The incremental cost divided by the incremental effectiveness (expressed as quality-adjusted life years gained) represented the incremental cost-effectiveness ratio for PCV13 compared to PPSV23. Results indicated that the use of PCV13 compared to PPSV23 is highly cost-effective in the public sector cohorts with incremental cost-effectiveness ratios of $771 (R11,106)/quality-adjusted life year and $956 (R13,773)/quality-adjusted life year for the HIV-infected and mixed populations, respectively. The private sector cohort showed similar highly cost-effective results for the mixed population (incremental cost-effectiveness ratio $626 (R9,013)/quality-adjusted life year) and the HIV-infected cohort (dominant). In sensitivity analysis, the model was sensitive to vaccine price and effectiveness. Probabilistic sensitivity analyses found predominantly cost-effective ICERs. From a societal perspective, these findings provide some guidance to policy makers for consideration and implementation of an immunization strategy for both the public and private sector and amongst different adult patient pools in South Africa.

Distribution of corneal thickness measured using optical coherence tomography in South African young adults

Background: Corneal thickness measurements have various diagnostic and therapeutic applications. Studies have reported on the distribution of corneal thickness measurements in Caucasian and Asian subpopulations with limited focus on African subpopulations. Aim: The goal of this study was to examine the distribution of corneal thickness measured using optical coherence tomography in a South African young adult population. Setting: The study was conducted at the eye clinic at the University of KwaZulu-Natal. Methods: The study used a quantitative cross-sectional research design and participants were recruited using two-stage random sampling. Seven hundred participants consisting of 50% South African blacks and 50% South African Indians aged between 17 and 30 years were included. The sample included an equal distribution of male ( n = 350) and female ( n = 350) participants. Corneal thickness was measured using the Fourier-domain Optovue iVue100 optical coherence tomographer. As the data from the right and left eyes showed high levels of interocular symmetry, data from only the right eyes were analysed using descriptive and inferential statistics. Results: The mean age of the sample was 20.42 ± 1.80 years. Corneal thickness measurements resembled Gaussian curves ( p ≥ 0.095) and the mean central corneal thickness (CCT) was 501.91 µ m. Corneal thickness at the thinnest point was 495.73 µ m and 1.23% thinner than the mean CCT measurement ( p < 0.001). Males had slightly higher corneal thickness measurements than females but these differences (0.35 µ m – 3.93 µ m) were not significant ( p ≥ 0.137). Corneal thickness varied significantly with refractive error and was lowest in emmetropes followed by myopes and then hyperopes. Conclusion: Corneal thickness measurements are normally distributed in South African young adults. The mean CCT is different from that reported in other populations and lower than the calibrated CCT measurement for Goldmann applanation tonometry. Eye care personnel should consider the characteristics of corneal thickness measurements and its implications on intraocular pressure measurements when examining South African individuals.

Assessing tobacco use in an African population: Serum and urine cotinine cut-offs from South Africa

BackgroundCotinine, a nicotine metabolite, is used to measure tobacco use and exposure, but recommended cut-offs to differentiate tobacco users from those exposed through the environment range from 3 to 58 ng/ml in serum, and 2.5 to 550 ng/ml in urine. Cut-offs may differ by ethnicity, sex and age. As data from adults in Africa are scarce, our aim was to evaluate cut-offs for serum and urine cotinine that best predict self-reported tobacco use in South African adults. MethodsTwo datasets were explored: African-PREDICT (n = 941 black and white healthy young adults, 20–30 years, serum cotinine); and WHO SAGE Wave 2 (n = 604 adults, 18–102 years, urine cotinine). Population specific cut-offs (ROC analyses) were compared with published cut-offs and self-reported tobacco use. ResultsOverall, 19% (293 of 1545) reported current tobacco use. The following cotinine cut-offs showed the highest sensitivity and specificity: serum ≥15 ng/ml in black and white men, and white women; serum ≥10 ng/ml in black women; urine ≥300 ng/ml for black, mixed ancestry, and older adults (50-plus years); urine ≥500 ng/ml for younger adults (18–49 years). Specificity was lower for urine than for serum cotinine. ConclusionOur study suggests that a serum cotinine level of ≥15 ng/ml and a urine cotinine level of ≥300 ng/ml best distinguish current tobacco users from non-users generally in the South African adult population.

Antihypertensive treatment and blood pressure trends among South African adults: A repeated cross-sectional analysis of a population panel survey.

BackgroundRecent findings suggest a decline in mean blood pressure and prevalence of uncontrolled hypertension in the South African adult population in the last decade, in contrast with the increase previously observed. This study aimed at quantifying the contribution of antihypertensive treatment to this decline.MethodsWe used data from the four waves of the National Income Dynamics Study between 2008 and 2015 and analysed changes in systolic (SBP) and diastolic blood pressure (DBP) and prevalence of uncontrolled hypertension among South African adults (15 years and above). We compared the observed changes with a counterfactual scenario in which the impact of antihypertensive treatment was estimated by censored regression and removed, with and without adjustment for BMI, waist circumference, alcohol use and smoking.ResultsDuring the study period, the prevalence of antihypertensive treatment rose from 13.1% to 17.6% among women and from 5.3% to 8.2% among men. Concurrently–despite worsening trends in major biobehavioural risk factors for elevated blood pressure–mean SBP decreased in both genders, DBP decreased among women and was stable among men. The odds of uncontrolled hypertension decreased by 4%/year among women and 1%/year among men. After removing the treatment effect, the downward trend in the odds of uncontrolled hypertension was reduced to 1%/year among women and completely offset among men. Among those 55 years and older, but not among younger subjects, treatment effects also explained most of the observed decreases in mean SBP and DBP.ConclusionsAmong South African adults, we infer that diffusion of antihypertensive treatment contributed substantially to the downward trend in the prevalence of uncontrolled hypertension observed between 2008 and 2015. The marked decrease in SBP and uncontrolled hypertension found among younger participants could not be explained by treatment nor by the changing distribution of the measured risk factors available in this study, and requires further investigation.

The iron status of a healthy South African adult population

IntroductionIron deficiency is associated with significant morbidity and mortality, can present with or without haematological changes and is a major cause of microcytic anaemia. In South Africa and Africa in general, there is a paucity of studies on the iron status of healthy adult non pregnant females and males >18years of age. The aim of the study was to determine the prevalence of iron deficiency in a healthy South African population. MethodsA total of 651 healthy adults >18years were included in the study. Blood samples were taken for the determination of iron status, haematological and inflammatory parameters. A ferritin level of <30μg/L was used to define iron deficiency and these subjects were further divided into those with and without anaemia. Diet and menstrual history in females was further investigated. ResultsOverall, the prevalence of anaemia was 12.6% and iron deficiency was found in 78% of anaemic subjects. The prevalence of iron deficiency was 39.8% in all participants and females and Black Africans had a very high prevalence of 56.6% and 50.7% respectively. Significant (p<0.05) differences were found in concentrations of ferritin, haemoglobin, iron, transferrin, transferrin saturation, MCV and MCH between the groups. ConclusionAnaemia is a minor health problem but a large proportion of subjects with iron deficiency do not present with anaemia. The prevalence of iron deficiency was high especially in females and Black African participants.

Obesity trends and risk factors in the South African adult population.

BackgroundObesity prevalence is increasing globally and contributes substantially to the burgeoning burden of non-communicable diseases. South Africa is particularly affected by this increasing trend and cross-sectional evidence suggests socioeconomic and behavioural variables as possible drivers. However, no large scale longitudinal study has attempted the direct identification of risk factors for progression towards obesity.MethodsThis study analysed data on 10,100 South African adults (18 years and over) randomly selected in 2008 and successfully recontacted in 2010 and 2012. Latent Growth Modelling was used to estimate the average rate of change in body mass index (BMI) during the study period, and to identify baseline characteristics associated with different trajectories.ResultsThe overall rate of change in BMI during the study period was +1.57 kg/m2 per decade (95 % CI: 0.93 −2.22), and it was higher among women (+ 1.82 kg/m2 per decade, 95 % CI: 1.06 −2.58) than among men (+ 1.03 kg/m2 per decade; 95 % CI: 0.14 −1.93).Female gender, younger age, larger waist circumference, white population group and higher household income per capita were baseline characteristics associated with higher rates of change.The association between tobacco use and obesity was complex. Smoking was associated with greater waist circumference at baseline but lower rates of increase in BMI during the study period. Quitting smoking was an independent predictor of BMI increase among subjects with normal weight at baseline.Among subjects with baseline BMI lower than 25 kg/m2, rates of changes were higher in rural than urban areas, and inversely related to the frequency of physical exercise.ConclusionsA strong positive trend in BMI remains in South Africa and obesity prevalence is likely to increase. Trends are not homogeneous, and high risk groups (subjects with high socioeconomic status, rural dwellers, young women) and modifiable risk factors (physical inactivity) can be targeted. Subjects quitting smoking should receive additional weight-loss support in order that the numerous health benefits of cessation are not reduced by increasing BMI. Centrally obese subjects should be targeted in campaigns.Electronic supplementary materialThe online version of this article (doi:10.1186/s40608-015-0072-2) contains supplementary material, which is available to authorized users.

Socioeconomic Status Modifies the Seasonal Effect on Blood Pressure

Seasonal variations in blood pressure have been consistently reported. However, uncertainty remains about the size of the seasonal effect in different regions, and about factors that explain the differences observed across and within populations. Using data from a national panel study, we investigated seasonal variations in blood pressure in the South African adult population, and whether these variations differed across socioeconomic strata.We estimated age-specific seasonal effects on blood pressure using a multilevel structural equation model, with repeated measurements nested within subjects. Effect modification by socioeconomic status was assessed by repeating the analyses in the subpopulations defined by levels of education, household income per capita, and type of housing.In men and women, season had a statistically significant effect on blood pressure, with higher levels in winter and lower levels in summer. For systolic blood pressure, the magnitude of the seasonal effect was 4.25/4.21 mmHg (women/men) and was higher in the older age groups. For diastolic blood pressure, the effect size was 4.00/4.01 mmHg, with no evident age trend. Seasonal effects were higher among subjects in the lowest socioeconomic classes than in the highest, with differences between 2.4 and 7.7 mmHg, depending on gender, whether systolic or diastolic blood pressure, and socioeconomic status indicator.In the South African adult population, blood pressure shows seasonal variation modified by age and socioeconomic status. These variations have epidemiological, clinical, and public health implications, including the prospect of population level intervention to reduce elevated risk of cold weather cardiovascular morbidity.

Problem drinking as a risk factor for tuberculosis: a propensity score matched analysis of a national survey

BackgroundEpidemiological and other evidence strongly supports the hypothesis that problem drinking is causally related to the incidence of active tuberculosis and the worsening of the disease course. The presence of a large number of potential confounders, however, complicates the assessment of the actual size of this causal effect, leaving room for a substantial amount of bias. This study aims to contribute to the understanding of the role of confounding in the observed association between problem drinking and tuberculosis, assessing the effect of the adjustment for a relatively large number of potential confounders on the estimated prevalence odds ratio of tuberculosis among problem drinkers vs. moderate drinkers/abstainers in a cross-sectional, nationally representative sample of the South African adult population.MethodsA propensity score approach was used to match each problem drinker in the sample with a subset of moderate drinkers/abstainers with similar characteristics in respect to a set of potential confounders. The prevalence odds ratio of tuberculosis between the matched groups was then calculated using conditional logistic regression. Sensitivity analyses were conducted to assess the robustness of the results in respect to misspecification of the model.ResultsThe prevalence odds ratio of tuberculosis between problem drinkers and moderate drinkers/abstainers was 1.97 (95% CI: 1.40 to 2.77), and the result was robust with respect to the matching procedure as well as to incorrect adjustment for potential mediators and to the possible presence of unmeasured confounders. Sub-population analysis did not provide noteworthy evidence for the presence of interaction between problem drinking and the observed confounders.ConclusionIn a cross-sectional national survey of the adult population of a middle income country with high tuberculosis burden, problem drinking was associated with a two fold increase in the odds of past TB diagnosis after controlling for a large number of socio-economic and biological confounders. Within the limitations of a cross-sectional study design with self-reported tuberculosis status, these results adds to previous evidence of a causal link between problem drinking and tuberculosis, and suggest that the observed higher prevalence of tuberculosis among problem drinkers commonly found in population studies cannot be attributed to the confounding effect of the uneven distribution of other risk factors.

Assessment of candidate ocular biomarkers of ageing in a South African adult population: Relationship with chronological age and systemic biomarkers

Certain anatomic and functional parameters of the eye change with increasing chronological age. They may, therefore, serve as potential biomarkers of ageing. We investigated associations between four such ocular parameters (lens density, retinal vessel calibre, corneal endothelial cells and retinal nerve fibre layer thickness) and two ‘cellular’ biomarkers of ageing (leukocyte telomere length and CDKN2A expression), with frailty (a clinical correlate of biological ageing) in a population of South African adults. All ocular parameters revealed an association with either telomere length or CDKN2A expression. However, lens density was most strongly correlated with age, increased CDKN2A expression, and with frailty (p=0.05 and 0.03, respectively). Narrow retinal arteriolar diameter, associated with increased chronological age, was also associated with increased CDK2NA expression (0.42 vs. 0.31, p=0.02) but not with frailty. Ocular parameters may aid in determining biological age, warranting investigation in longitudinal studies.

Accuracy assessment of a novel blood pressure measurement device in a South African adult population

The Tensoval duo control device uses a novel combination of auscultatory and oscillometric technology to measure blood pressure. We assessed the accuracy of this device in a South African adult population according to the International Protocol of the European Society of Hypertension. Ethical approval was obtained and 33 participants were recruited from Kimberley Hospital Complex (South Africa). Trained observers took sequential same arm blood pressure measurements from each participant, alternating between mercury sphygmomanometery and the device. The Tensoval duo control passed all the phases of the protocol and achieved a mean difference ± SD of -3.2 ± 7.2 and 2.0 ± 6.0 mmHg for systolic and diastolic pressures, respectively. This study confirms the accuracy and recommendation for clinical use of the Tensoval duo control device in adults. Accuracy in special patient groups is yet to be assessed, but this novel technology could be particularly valuable in those with vascular disease.

A correlational study of systemic blood pressure and intraocular pressure in a young South African adult population*

Increased blood pressure (BP) and raised intraocular pressure (IOP) are probably both common oc-currences among the South African population. If left untreated both conditions have detrimentalcomplications. Previous cross-sectional studies suggested BP was positively related to IOP. This study therefore sets out to determine in a young South African adult population the correlation between systemic BP and IOP. Systemic BP was measured using an electronic sphygmomanometer and IOP using a Goldman applanation tonometer. For all subjects, two averages were obtained fromthree measurements each of BP and IOP. Other clinical procedures such as uncompensated visual acuity (VA), pinhole and direct ophthalmoscopy were done to exclude underlying factors possiblyaffecting either BP or IOP before the commencement of the investigation. Two hundred (N = 200)subjects were included in the study and their ages ranged from 18 to 30 years with a mean of 21 ± 3.9 years. The correlation coefficients between average IOP and average systolic or diastolic BP respectively were 0.67 and 0.55. These weak positivecorrelations suggested that with an increase in BP there is a corresponding increase in IOP. Also, similar correlation between IOP and BP was found toexist amongst both males and females with systolic BP having a greater effect. This study validates theimportance of evaluating either systemic BP or IOP amongst all patients seen by primary eye-care practitioners, and that such evaluations should form part of daily routine patient examination.

The mental health impact of AIDS-related mortality in South Africa: a national study

Background:Few data exist on how the HIV/AIDS epidemic may influence population mental health. The associations were examined between knowing someone who died of HIV/AIDS and common mental disorders among South...