South African Medical Journal (SAMJ)
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Tobacco control research in South Africa from 1978 to 2022: A scoping review
Get PDFBackground. South Africa (SA) is one of the leading countries in tobacco control research in the African region.
Objective. To summarise this research over a 44-year period (1978 - 2022), and to identify research gaps.
Methods. This is a scoping review of published primary research on tobacco control in SA. Three databases were searched – PubMed, Scopus and Web of Science. A spreadsheet to capture specified details of the articles was designed by the researchers. We captured year of publication, names of authors and their affiliation(s), name of journal, title of article, key areas of tobacco control covered by the article, type of study and the funding institution.
Results. We identified 6 743 initial records. A total of 223 articles were included in the final analysis. The number of published primary research articles by year ranged from 1 in 1978 to 22 in 2022. Most studies (46.2%; n=103) focused on prevalence, while cost of e-cigarette use and industry interference received the least attention (0.4%; n=1 each). A total of 79% of the studies used cross-sectional survey design, followed by randomised controlled trials (3.6%; n=8), time series studies (3.1%; n=7) and longitudinal and qualitative studies (2.2%; n=5 each), while costs and benefits analysis (0.4%; n=1) was used much less. Most were published in the South African Medical Journal, and three of the top international tobacco control journals: Tobacco Control, Nicotine and Tobacco Research and Tobacco Induced Diseases. Almost half of the first authors of these publications are based in three institutions: the University of Cape Town (17.0%), the South African Medical Research Council (SAMRC) (16.1%) and the University of Pretoria (13.5%). SAMRC was found to be the leading funder of tobacco control research/publications in SA.
Conclusion. There has been a steady increase of tobacco control research in SA over the past 44 years, with a sharp increase within the last decade. Most studies used cross-sectional designs and focused on prevalence. More mixed-methods studies are needed to better understand the issue of tobacco in the SA context. More studies are also needed that focus on the impact of policies, nicotine addiction and industry interference. The continued funding of tobacco control research in SA will advance knowledge and inform tobacco control policies in the country
Unilateral superior vena cava syndrome: An uncommon complication of a commonly used procedure
Get PDFSuperior vena cava (SVC) syndrome constellates symptoms of plethora and facial and upper thoracic swelling with distension of neck veins, and the consequences of this condition range from mild discomfort to upper airway obstruction. The aetiology has a strong linkage with malignancy, and is always to be excluded. SVC syndrome is commonly a bilateral presentation, and unilateral SVC syndrome is rare, with very few non-malignant causes reported. Here, we demonstrate a unilateral occurrence with an uncommon cause
Time for healthcare bodies to show they are no longer apartheid-era relics and say ‘never again’ to genocide
Get PDFPrevalence of and factors associated with HIV testing among adolescent girls and young women in South Africa: Evidence from the South Africa Demographic and Health Survey 2016
Get PDFBackground. Adolescent girls and young women (AGYW) remain vulnerable to HIV, with a higher incidence rate than their male counterparts.
Objectives. To determine the prevalence of and factors associated with HIV testing among AGYW in South Africa (SA).
Methods. A cross-sectional design was used to analyse the South Africa Demographic and Health Survey 2016. Only sexually active AGYW aged 15 - 24 years residing in SA at the time of the survey were included. Descriptive statistics were used to analyse baseline sociodemographic characteristics. Univariate and multivariate logistic regression models were used to determine factors associated with HIV testing. Statistical significance was set at p<0.05, and all analyses were adjusted using survey weights to account for unequal selection probabilities.
Results. The overall prevalence of HIV testing among sexually active AGYW was 85.2% (95% confidence interval (CI) 83.0 - 87.1). The AGYW who had a history of pregnancy (adjusted odds ratio (aOR) 4.47; 95% CI 2.90 - 6.89), were employed (aOR 3.29; 95% CI 1.75 - 6.21), belonged to a middle wealth index (aOR 1.80; 95% CI 1.04 - 3.10), had knowledge about mother-to-child transmission of HIV (aOR 3.29; 95% CI 2.26 - 4.79), had visited a health facility during the past 12 months (aOR 2.93; 95% CI 2.09 - 4.10), or had secondary/tertiary education (aOR 2.04; 95% CI 1.04 - 3.99) had higher odds of HIV testing.
Conclusion. The study identified an unmet need for HIV testing among sexually active AGYW in SA, especially adolescent girls aged 15 - 19 years. Increasing knowledge about HIV testing, adolescent-friendly services and other offsite strategies are therefore important for this particular key population.
Differential management and associations of dyslipidaemia and hypertension by glycaemic status in urban South Africans
Get PDFBackground. Dyslipidaemia and hypertension care have not been reported in large samples of community-based participants with known diabetes (KD) nor compared with individuals at high risk for diabetes.Objectives. To describe the management and associations of dyslipidaemia and hypertension in adults with KD, newly diagnosed diabetes (NDD) and normoglycaemia.
Methods. This urban population-based cross-sectional study comprised participants with KD, NDD and normoglycaemia. Participants at high risk for diabetes but without KD underwent oral glucose tolerance tests; those who were subsequently classified as NDD or normoglycaemic were included in this study. Data collection comprised administered questionnaires, clinical measurements and biochemical analyses. Multivariable logistic regressions determined the associations with hypertension and dyslipidaemia management in separate models.
Results. Among 618 participants (82% women), aged median 58 years, there were 339 participants with KD, 70 with NDD and 209 with normoglycaemia. Prevalence of hypertension (BP ≥140/90 mmHg or on treatment) and dyslipidaemia (raised low-density lipoprotein cholesterol >3 mmol/L or on treatment) was highest in KD (89% and 83%) compared with NDD (64% and 74%) and normoglycaemia (66% for both) (p<0.001). Detected or known hypertension was highest in KD (97.4%), followed by NDD (88.9%) and normoglycaemia (80.3%). Among participants with known or detected hypertension, those with KD were most likely to be treated (90.2%) compared with NDD (77.5%) and normoglycaemia (74.5.%). Hypertension control among participants on treatment was highest in KD (69.5%) compared with NDD (51.6%) and normoglycaemia (61.0%). Participants with KD had significantly higher rates of previously detected dyslipidaemia (85.1%) compared with NDD (36.5%) and normoglycaemia (35.5%). KD participants were also more likely to be treated for their previously detected dyslipidaemia (85.4%) and to be controlled when on treatment (56.3%) compared with their counterparts (NDD: 63.2% and 33.3%, normoglycaemia: 61.2% and 43.3%, respectively). Diabetes control was poor; only 20% of those with KD had HbA1c <7%. In the regression models, compared with normoglycaemia, KD was associated with hypertension detection (odds ratio (OR) 6.91, 95% confidence interval (CI) 2.25 - 21.22) and control (OR 2.05, 95% CI 1.04 - 4.02). KD compared with normoglycaemia was associated with dyslipidaemia detection (OR 10.29, 95% CI 5.21 - 20.32) and treatment (OR 3.94, 95% CI 1.68 - 9.27). Sociodemographic and cardiovascular disease risk factors were generally not associated with hypertension or dyslipidaemia management.
Conclusion. Albeit that diabetes control was poor and required better management, dyslipidaemia and hypertension prevalence were higher and better managed in KD than NDD and normoglycaemia. Different approaches are required to improve glucose control in KD, better identify NDD and monitor and prevent diabetes in high-risk individuals. Also important would be to improve care of hypertension and dyslipidaemia in those without KD
An investigation of factors associated with antenatal care attendance in Gauteng in 2015
Get PDFBackground. Many studies have shown that South African women tend to initiate antenatal care late in their pregnancies. This presents challenges in the provision of quality healthcare to both mother and child. There are several studies on the social and cultural reasons for late booking. However, understanding the factors in a woman’s choice to initiate antenatal care is important in informing healthcare strategies and policies.
Methods. This study was an analytical cross-sectional study of household and general health factors associated with attendance of antenatal care by pregnant women in Tshwane in 2015. It was a secondary data analysis from complete data sampling households registered on AitaHealthTM. Univariate and multivariate logistic regression was used to assess which factors are associated with antenatal care attendance.
Results. The age of the head of the household was a significant factor in the attendance of antenatal care. The odds of attending antenatal care were 3.3, 2.1 and 1.8 times higher in households where the head of the household was 30 - 39 years of age, 20 - 29 or 40-49 years of age, respectively, than when between 10-19 years of age. Factors that increased the odds of attending antenatal care were living in households that had electricity and piped water, and running a business from home. Residing in a permanent dwelling and being food secure increased the odds of antenatal care attendance.
Conclusion. The identified health and household factors should inform policies and programmes geared towards improving services around antenatal care provision
Knowledge of pregnant women regarding prevention of mother-to-child transmission of HIV infection in Gert Sibande District, Mpumalanga Province, South Africa: A qualitative study
Get PDFBackground. Prevention of mother-to-child transmission (PMTCT) of HIV helps in closing the gaps for new HIV infections, thereby contributing to achieving the global targets of an AIDS-free generation.
Objective. To explore knowledge regarding PMTCT among pregnant women in Gert Sibande District, Mpumalanga Province, South Africa (SA).
Methods. The study was performed in two clinics in Chief Albert Luthuli Municipality, Gert Sibande District. It was a qualitative and descriptive exploratory study involving in-depth, one-on-one interviews with pregnant women regarding their PMTCT knowledge and perspectives.
Results. The study findings showed that pregnant women from the two clinics have a good knowledge of PMTCT. However, they were not aware that caesarean section can minimise mother-to-child transmission (MTCT) of HIV infection.
Conclusion. PMTCT is important in establishing an HIV-free generation. The study revealed that women had a good understanding of MTCT; nevertheless, additional education is necessary, particularly regarding birthing procedures that minimise the risk of MTCT
