1,720,993 research outputs found
Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort
No full textObjective: in low- and middle-income countries (LMICs), advanced-stage diagnosis of breast cancer (BC) is common, and this contributes to poor survival. Understanding the determinants of the stage at diagnosis will aid in designing interventions to downstage disease and improve survival from BC in LMICs.Methods: within the South African Breast Cancers and HIV Outcomes (SABCHO) cohort, we examined factors affecting the stage at diagnosis of histologically confirmed invasive breast cancer at five tertiary hospitals in South Africa (SA). The stage was assessed clinically. To examine the associations of the modifiable health system, socio-economic/household and non-modifiable individual factors, hierarchical multivariable logistic regression with odds of late-stage at diagnosis (stage III-IV), was used.Results: the majority (59%) of the included 3497 women were diagnosed with late-stage BC disease. The effect of health system-level factors on late-stage BC diagnosis was consistent and significant even when adjusted for both socio-economic- and individual-level factors. Women diagnosed in a tertiary hospital that predominantly serves a rural population were 3 times (OR = 2.89 (95% CI: 1.40–5.97) as likely to be associated with late-stage BC diagnosis when compared to those diagnosed at a hospital that predominantly serves an urban population. Taking more than 3 months from identifying the BC problem to the first health system entry (OR = 1.66 (95% CI: 1.38–2.00)), and having luminal B (OR = 1.49 (95% CI: 1.19–1.87)) or HER2-enriched (OR = 1.64 (95% CI: 1.16–2.32)) molecular subtype as compared to luminal A, were associated with a late-stage diagnosis. Whilst having a higher socio-economic level (a wealth index of 5) reduced the probability of late-stage BC at diagnosis, (OR = 0.64 (95% CI: 0.47–0.85)).Conclusion: advanced-stage diagnosis of BC among women in SA who access health services through the public health system was associated with both modifiable health system-level factors and non-modifiable individual-level factors. These may be considered as elements in interventions to reduce the time to diagnosis of breast cancer in women
Exploring the national prevalence of mental health risk, multimorbidity and the associations thereof: a repeated cross-sectional panel study
No full textObjective and methods: South Africans were affected by the COVID-19 pandemic and resultant economic hardships. As a result, mental health within this region may have worsened. Therefore, using large scale nationally representative data, we repeated the cross-sectional panel study to investigate mental health risk post COVID-19 to explore mental health and multimorbidity and to examine the relationship between adverse childhood experiences (ACEs) and comorbid health conditions in South African adults (aged 18 years and older).Results: post-pandemic, 26.2, 17.0, and 14.8% of the South African respondents reported being probably depressed, anxious and had suffered high exposure to early life adversity, respectively. Nationally, the prevalence of mental health across the country remained alarmingly high when compared to Panel 1. The prevalence of multimorbidity (2 or more chronic morbidities) among the South African population was reported at 13.9%, and those with 2 or more morbidities were found to have increased odds of early adversity, irrespective of differing socio-demographics. Furthermore, early adversity was also associated with multimorbidity partly via mental health.Conclusion: this repeated cross-sectional national study reiterated that the prevalence of mental health across South African adults aged 18 years and older is widespread. Mental health remains worryingly high post-pandemic where more than a quarter of respondents are probably depressed, nearly one in every five respondents are anxious, and 14.8% reported high exposure ACEs. Public health interventions need to be upscaled with efforts to reduce the incidence of early adversity that may have the ability to lower adverse health outcomes and mental ill-health in adulthood
Multimorbidity and overall survival among women with breast cancer: results from the South African Breast Cancer and HIV Outcomes Study
No full textBackground: breast cancer survival in South Africa is low, but when diagnosed with breast cancer, many women in South Africa also have other chronic conditions. We investigated the impact of multimorbidity (≥ 2 other chronic conditions) on overall survival among women with breast cancer in South Africa.Methods: between 1 July 2015 and 31 December 2019, we enrolled women newly diagnosed with breast cancer at six public hospitals participating in the South African Breast Cancer and HIV Outcomes (SABCHO) Study. We examined seven chronic conditions (obesity, hypertension, diabetes, HIV, cerebrovascular diseases (CVD), asthma/chronic obstructive pulmonary disease, and tuberculosis), and we compared socio-demographic, clinical, and treatment factors between patients with and without each condition, and with and without multimorbidity. We investigated the association of multimorbidity with overall survival using multivariable Cox proportional hazard models.Results: of 3,261 women included in the analysis, 45% had multimorbidity; obesity (53%), hypertension (41%), HIV (22%), and diabetes (13%) were the most common individual conditions. Women with multimorbidity had poorer overall survival at 3 years than women without multimorbidity in both the full cohort (60.8% vs. 64.3%, p = 0.036) and stage groups: stages I–II, 80.7% vs. 86.3% (p = 0.005), and stage III, 53.0% vs. 59.4% (p = 0.024). In an adjusted model, women with diabetes (hazard ratio (HR) = 1.20, 95% confidence interval (CI) = 1.03–1.41), CVD (HR = 1.43, 95% CI = 1.17–1.76), HIV (HR = 1.21, 95% CI = 1.06–1.38), obesity + HIV (HR = 1.24 95% CI = 1.04–1.48), and multimorbidity (HR = 1.26, 95% CI = 1.13–1.40) had poorer overall survival than women without these conditions.Conclusions: irrespective of the stage, multimorbidity at breast cancer diagnosis was an important prognostic factor for survival in our SABCHO cohort. The high prevalence of multimorbidity in our cohort calls for more comprehensive care to improve outcomes for South African women with breast cancer
Consensus study on factors influencing the academic entrepreneur in a middle-income country’s university enterprise.
No full textPurposeThis study aims to ascertain the personal characteristics of a group of successful academic entrepreneurs in a South African university enterprise and the prevalent barriers and enablers to their entrepreneurial endeavour.Design/methodology/approachThe authors used a Delphi process to identify and rank the characteristics, enablers, barriers and behaviours of entrepreneurial academics, with a Nominal Group Technique applied to establish challenges they encounter managing their enterprise and to propose solutions.FindingsPerseverance, resilience and innovation are critical personal characteristics, while collaborative networks, efficient research infrastructure and established research competence are essential for success. The university’s support for entrepreneurship is a significant enabler, with unnecessary bureaucracy and poor access to project and general enterprise funding an impediment. Successful academic entrepreneurs have strong leadership, and effective management and communication skills.Research limitations/implicationsThe main limitation is the small study participant group drawn from a single university enterprise, which complicates generalisability. The study supported the use of Krueger’s (2009) entrepreneurial intentions model for low- and middle-income country (LMIC) academic entrepreneur investigation but proposed the inclusion of mitigators to entrepreneurial activation to recognise contextual deficiencies and challenges.Practical implicationsSkills-deficient LMIC universities should extensively and directly support their entrepreneurial academics to overcome their contextual deficiencies and challenging environment.Originality/valueThis study contributes to addressing the paucity of academic entrepreneur research in LMIC contexts by identifying LMIC-specific factors that inhibit the entrepreneur’s movement from entrepreneurial intention to entrepreneurial action
Self-reported hypertension prevalence, risk factors, and knowledge among South Africans aged 24 to 40 years old
No full textAlthough hypertension is a significant public health burden in South Africa (SA), less is known about its prevalence, risk factors, and possible preventative strategies among young adults. We assessed the prevalence, possible risk factors, and knowledge associated with self-reported hypertension among young adults from SA. A cross-sectional online survey was conducted among 1000 young South African adults (24–40 years; 51.0% women). We administered a socio-demographic questionnaire and collected information on measures of socio-economic status (SES) (e.g. asset wealth index), self-reported medical history, and lifestyle risk factors. Furthermore, a modified version of the hypertension evaluation of lifestyle and management questionnaire was used to assess participants’ hypertension knowledge. The overall prevalence of self-reported hypertension was 24.0%, with significant differences between women and men (27.5% and 20.4% respectively, p = 0.033). Only 16.8% of the respondents had good hypertension knowledge. There was a positive association between good knowledge of hypertension and being hypertensive (OR = 1.43 CI:1.23–3.12), monthly blood pressure check-ups (OR = 2.03 CI:1.78–3.23), knowing the side effects of uncontrolled blood pressure (OR = 1.28 CI:1.07–1.89) and having a biological mother with hypertension (OR = 1.79 CI:1.53–2.21). Being employed full-time (OR = 0.74 CI:0.69–0.80), having a higher SES (wealth index 4 (OR = 0.70 CI:0.59–0.97) and 5 (OR = 0.65 CI:0.48–0.81)), exercising 6 to 7 days per week (OR = 0.83 CI:0.71–0.94), and not consuming alcohol at all (OR = 0.73 CI:0.67–0.89), were all found to be protective against hypertension. The high hypertension prevalence, lack of hypertension knowledge, and reported risk factors among this group highlight the need for early robust preventative strategies to mitigate hypertension risk among this population
Social vulnerability and its association with food insecurity in the South African population: findings from a National Survey
No full textSocial vulnerability refers to the attributes of society that make people and places susceptible to natural disasters, adverse health outcomes, and social inequalities. Using a social vulnerability index (SVI), we investigated social vulnerability prevalence and its relationship with food insecurity in South Africa (SA). In this nationally representative cross-sectional survey, we calculated SVI scores from 3402 respondents (median age, 35 (26–46) years) using an SVI developed by the United States (US) Centers for Disease Control and prevention (CDC) adapted for a South African context. We measured food insecurity using a modified Community Childhood Hunger Identification Project. Findings classified 20.6% and 20.4% of adults as socially vulnerable and food insecure, respectively. The risk of food insecurity was almost threefold higher in the social vulnerability group (OR 2.76, 95% CI 2.76–2.77, p < 0.001) compared to their counterparts. The SVI could be a useful tool to guide government and policymakers in the facilitation of social relief initiatives for those most vulnerable
Food insecurity and coping strategies associate with higher risk of anxiety and depression among South African households with children
No full textAbstract
Objective:
To investigate food insecurity and related coping strategies, and their associations with the risk of anxiety and depression, among South African households with children.
Design:
Nationally representative cross-sectional study. Tools for assessing food insecurity, coping strategies, risk of anxiety and depression were assessed from the Community Childhood Hunger Identification Project, Coping Strategies Index, Generalised Anxiety Disorder-7 and Patient Health Questionnaire-9, respectively. We used ordered logistic regression to test associations of food insecurity and coping strategies with the risk of anxiety and depression. Moderating effects of each coping strategy were tested in the associations of food insecurity with anxiety and depression.
Setting:
South Africa, post COVID-19 restrictions, May–June 2022.
Participants:
1,774 adults, weighted to 20,955,234 households.
Results:
Food insecurity prevalence was 23·7 % among households with children. All coping strategies were used to some extent, but relying on less preferred and less expensive foods was the most used strategy (85·5 % of food-insecure households). Moving to a higher level of food insecurity was associated with >1·6 greater odds of being in a higher risk of anxiety and depression. Sending a household member to beg for food was the strongest associated factor (OR = 1·7, P < 0·001). All coping strategies partly moderated (lessened) the associations of food insecurity with a higher risk of anxiety and depression.
Conclusions:
Food insecurity among households with children was high following the COVID-19 pandemic. Collaborative efforts between government, private sector and civil society to eradicate food insecurity should prioritise poorer households with children, as these populations are the most vulnerable
Public attitudes towards responsibilities and actions to curb obesity in South Africa: Second South African Human Development Pulse Survey
No full textBackground: the obesity epidemic is a major global public health concern. Despite high food insecurity, South Africa is one of the most obesity-burdened nations in Africa. Additionally, non-communicable diseases (NCDs) are increasing in this region, with obesity presenting as a key modifiable risk factor contributing to this burden.Methodology: this extensive, nationally representative study assessed the prevalence of overweight and obesity confirmed by healthcare professionals among South African adults (aged 18 years and older). Various socioeconomic and demographic correlates were explored while investigating public attitudes, support for action, and nutritional knowledge related to obesity.Results: in the total sample, 3.2% reported being told by a healthcare professional that they were overweight or obese, with females at a higher rate (3.5%). Regarding responsibility for addressing overweight/obesity, more respondents with low dietary recommendation knowledge (DRK) felt that none of the suggestions made were responsible (by +12.5%) compared with those with higher knowledge. Overweight/obese individuals cited ‘gyms and leisure centres’, ‘healthcare professionals’, and all categories listed as responsible. Both males and females favoured ‘gyms and leisure centres’ (19.1% vs.19.7%) and ‘healthcare professionals’ (17.7% vs 17.1%), with urban respondents showing slightly more support for most suggestions than rural respondents (by ≥ 0.4%). When asked about actions to reduce overweight/obesity, those with low knowledge expressed neutral views to all actions (≥ 38.9%) but opposed ‘banning adverts for high-fat foods’ (41.4%), unlike those with moderate or high DRK.Conclusion: lower public support was found for implementing or increasing taxes to reduce obesity-related burdens. There is a need for evidence-based interventions that include nutrition education targeting vulnerable groups, such as those who are overweight or obese
Socioeconomic position, perceived weight, lifestyle risk, and multimorbidity in young adults aged 18 to 35 years: a Multi-country Study
No full textBackground: Multimorbidity-risk is established early in life, therefore reducing modifiable risk factors such as overweight or obesity may, in part, tackle the burden of multimorbidity in later life. Methods: We made use of a cross-sectional online survey that included young adults (18-35yrs old) from three countries – Kenya, South Africa, and the United Kingdom (n = 3000). Information pertaining to socio-demographic, health, lifestyle, and perceived weight was collected. Additionally, the sum of affirmed morbidities was used to determine a morbidity score. Likewise, a lifestyle risk score was calculated based on information obtained from questions surrounding four unhealthy lifestyle behaviours, namely current smoking, alcohol consumption, physical inactivity, and overweight/obese weight status as a confirmed clinic condition. We further explored differences in socioeconomic position, and the prevalence of perceived weight, multimorbidity, and lifestyle risk factors between the three countries. We also determined the odds ratio of multimorbidity with perceived weight as a main predictor variable. We furthermore performed a generalised structural equation model to determine whether the association between socioeconomic position and multimorbidity was mediated via perceived weight and/or lifestyle risk. Results: Socioeconomic position, weight perceptions, lifestyle risk, and multimorbidity varied significantly across the different economic countries. Higher morbidity (by > 11.9%) and lifestyle risk (by > 20.7%) scores were observed in those who reported an overweight weight perception when compared to those with an underweight or normal weight perception. In pooled analyses, the odds ratio in developing 2 or more morbidities increased multiple times in those who perceived themselves as overweight (all models: OR ≥ 2.241 [95% CI ≥ 1.693; ≥ 2.966] p < 0.001), showing a larger odds ratio with high significance in those who reported 3 or more morbidities (all models: OR ≥ 3.656 [95% CI ≥ 2.528; ≥ 5.286] p < 0.001). Furthermore, this study showed that an overweight weight perception partially mediated (p ≤ 0.001) the association between socioeconomic position and multimorbidity. Conclusions: This study confirmed poorer health outcomes in those who perceived themselves as overweight. The findings from this study further emphasise the importance of targeted intervention strategies directed at raising weight-related awareness and potentiating risk factors, specifically in those who reside in lower economic developed countries.</p
Adolescent social media use and mental health in sub-Saharan Africa: a scoping review protocol of current research
No full textIntroduction There is growing public concern and emphasis on the potential negative implications of social media on adolescent mental health and the implementation of social media restrictions, despite limited and mixed evidence that predominantly originates from the Global North. In sub-Saharan Africa (SSA), where adolescent populations are rapidly expanding and adopting technology, research on social media and mental health is limited. This scoping review aims to map and describe the available evidence on social media use and mental health among adolescents in SSA.Methods and analysis This study employs the scoping review methodology from the Joanna Briggs Institute, following a five-stage process: (1) determining the research question, (2) creating a search strategy, (3) defining inclusion criteria, (4) extracting data, (5) conducting analysis, presentation, and (6) consultations. The search strategy will be applied to databases such as PsycINFO, PubMed (Medline and OVID), Web of Science, LILACS, Scopus, Google Scholar, ProQuest Dissertations and PsycINFO Extra, covering both empirical and grey literature. Articles will be independently assessed for eligibility with data extraction and charting performed using a standardised form. Visualisation tools, such as a heatmap for the prevalence of studies in SSA and a network diagram depicting relationships, will be used.Ethics and dissemination Ethics approval was not required for this review. Dissemination will occur through a peer-reviewed journal article, academic presentations and online news media in the form of a commentary which will be publicly available
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