1,721,395 research outputs found
Adolescent mental health in sub-Saharan Africa: Crisis? What crisis? Solution? What solution?
No full textAddressing adolescent mental health care across sub-Saharan Africa faces numerous challenges, including underfunded public health systems, a shortage of mental health professionals, barriers to access, and pervasive stigma. Untreated adolescents often experience worsening symptoms, academic and social difficulties, physical health risks, and engage in risky behaviours. Early detection and appropriate treatment of common mental health conditions can support adolescents in developing robust social and emotional foundations and enhancing their mental well-being. Ensuring adolescents receive the mental health care required for healthy development depends on collaborative, evidence-based solutions that consider the contextual challenges of sub-Saharan Africa. Innovative community-based solutions to mental health services may significantly improve accessibility and support adolescents close to their homes and schools. For example, co-creation and peer-delivered interventions with professional supervision may enhance uptake and reduce stigma. This short article adds to the current debate arguing for working with communities and implementing community mental health services for common mental health conditions. Sensitivity to community-specific challenges and building referral networks are crucial for effective care. Investing in these strategies, alongside increasing mental health literacy, could lead to affordable and significant interventions to address adolescent mental health.Paper contextMain findings: Addressing adolescent mental health in sub-Saharan Africa requires collaborative, evidence-based solutions that consider local challenges.Added knowledge: To improve adolescent mental health care in sub-Saharan Africa, it is crucial to collaborate with communities, develop community-specific solutions, and establish referral networks.Global health impact for policy and action: Investing in adolescent mental health care and enhancing mental health literacy can lead to significant, cost-effective interventions that support healthy development
Health literacy, multimorbidity and its effect on mental health in South African adults: a repeated cross-sectional nationally representative panel study
No full textObjective and methods: Health literacy is a key determinant of physical and mental health outcomes, particularly in low- and middle-income settings like South Africa, where multimorbidity is increasingly common. Limited health literacy may hinder effective management of multiple chronic conditions and worsen mental health. Using repeated cross-sectional nationally representative data, this study examined the relationship between health literacy and multimorbidity, with a specific focus on mental health among South African adults (18 years and older).Results: Most respondents had minimal depression risk, with 21.7% showing probable depression, lower than the 25.7 and 26.2% in Panels 1 (2021) and 2 (2022) respectively. In efforts to further corroborate the odds of having mental or physical health risk with higher levels of ACE exposure, our results confirmed the increased likelihood of depression, anxiety and multimorbidity with increased odds of early adversity, irrespective of differing socio-demographics. The results further revealed that socioeconomic status directly influenced depression, which was partially mediated via health literacy. Additionally, the association between socioeconomic status and multimorbidity was fully mediated by ACE exposure and depression.Conclusion: One in five South Africans experience depressive symptoms, with notable regional differences. Childhood adversity contributes to increased mental health risk and higher multimorbidity. Health literacy was found to influence the link between socioeconomic status and depression, suggesting that lower literacy increases vulnerability. These findings therefore emphasize the need for targeted interventions to address childhood adversity, improve health literacy, and enhance mental health resources across South Africa
Association of maternal prenatal copper concentration with gestational duration and preterm birth: a multicountry meta-analysis
No full textBackground: Copper (Cu), an essential trace mineral regulating multiple actions of inflammation and oxidative stress, has been implicated in risk for preterm birth (PTB).Objectives: This study aimed to determine the association of maternal Cu concentration during pregnancy with PTB risk and gestational duration in a large multicohort study including diverse populations.Methods: Maternal plasma or serum samples of 10,449 singleton live births were obtained from 18 geographically diverse study cohorts. Maternal Cu concentrations were determined using inductively coupled plasma mass spectrometry. The associations of maternal Cu with PTB and gestational duration were analyzed using logistic and linear regressions for each cohort. The estimates were then combined using meta-analysis. Associations between maternal Cu and acute-phase reactants (APRs) and infection status were analyzed in 1239 samples from the Malawi cohort.Results: The maternal prenatal Cu concentration in our study samples followed normal distribution with mean of 1.92 μg/mL and standard deviation of 0.43 μg/mL, and Cu concentrations increased with gestational age up to 20 wk. The random-effect meta-analysis across 18 cohorts revealed that 1 μg/mL increase in maternal Cu concentration was associated with higher risk of PTB with odds ratio of 1.30 (95% confidence interval [CI]: 1.08, 1.57) and shorter gestational duration of 1.64 d (95% CI: 0.56, 2.73). In the Malawi cohort, higher maternal Cu concentration, concentrations of multiple APRs, and infections (malaria and HIV) were correlated and associated with greater risk of PTB and shorter gestational duration.Conclusions: Our study supports robust negative association between maternal Cu and gestational duration and positive association with risk for PTB. Cu concentration was strongly correlated with APRs and infection status suggesting its potential role in inflammation, a pathway implicated in the mechanisms of PTB. Therefore, maternal Cu could be used as potential marker of integrated inflammatory pathways during pregnancy and risk for PTB
Cohort Profile: Africa Wits-INDEPTH partnership for Genomic studies (AWI-Gen) in four sub-Saharan African countries
No full textKey FeaturesAfrica Wits-INDEPTH partnership for Genomic studies (AWI-Gen) was established to examine genomic, environmental and behavioural factors influencing body composition and cardiometabolic diseases and traits in African populations.Population-based longitudinal cohort, involving four sub-Saharan African countries representing rural and urban settings: West Africa [Nanoro (Burkina Faso) and Navrongo (Ghana)]; East Africa [Nairobi (Kenya)]; and South Africa (Agincourt, Dikgale/DIMAMO and Soweto).Baseline data collected from 2013 to 2017, enrolling 12 032 adults [55.1% women; mean (SD) 51.9 (8.3) years, range 37–82], with follow-up ∼5 years later and a retention rate of almost 60%. In Wave 2 an additional 579 individuals were enrolled (n = 7804; 55.9% women; 57.0 (7.9), 39–98).Main categories of data collected at two time points include sociodemographic characteristics, history of chronic diseases and lifestyle behaviours, with spirometry, cognition and frailty added in the second data collection wave. Measurements at both time points include anthropometry, blood pressure, carotid intima–media thickness and body fat distribution. Blood and urine samples are collected to measure biomarkers for diabetes, HIV, dyslipidaemia and kidney disease, and stool samples are collected in a women’s sub-sample for gut microbiome analyses. Genome-wide genotyping is available for all participants and whole genome sequences for a subset.We encourage collaboration, and data are accessible through the AWI-Gen Principal Investigator [[email protected]] in consultation with the steering committee or the H3Africa Data and Biospecimen Access Committee
A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective
No full textBackground: Pregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18-28 years, and ii) factors characterising the decision to terminate.Methods: In-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach.Results: An application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants' decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants' decisions through detrimental changes in interpersonal support and financial situation.Conclusions: Amongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women's needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support
The feasibility and acceptability of an app-based intervention aimed at improving maternal health literacy regarding infant play and development: mixed methods study
No full textBackground: allowing infants access to unstructured, unrestricted play in their home environment is imperative for increasing healthy movement behaviors and, therefore, developmental outcomes. Interventions should equip mothers to provide opportunities for infant play as early as possible. Evaluating such interventions is necessary to understand the feasibility for scale-up and implementation in specific contexts. Furthermore, the appropriateness and relevance of standardized outcome measures in different ethnic and socioeconomic contexts should be determined to ensure validity.Objective: this study aimed to (1) test the feasibility and acceptability of an intervention aimed at improving maternal health literacy regarding infant play and development and (2) determine participants' understanding of the study outcome questionnaires.Methods: this mixed methods study was nested within the Play Love and You (PLAY) study, a randomized controlled trial (PACTR202202747620052) designed to promote infant development. Mothers assigned to the PLAY study intervention arm at 6 months post partum (n=68) received telephone or in-person check-ins and assessments every 2 months and health literacy intervention content and resources (videos and infographics) delivered via a mobile app every week. Feasibility was assessed by monitoring appointment attendance (adherence) and frequency of access to the content via the app. Acceptability was explored using a questionnaire and 2 participant focus group discussions (FGDs) at the end of the study (12 months post partum). The FGDs also included questions exploring the participants' understanding of the 4 study outcome measure questionnaires administered at both 6 and 12 months.Results: in total, 68 participants were enrolled in the study at 6 months, of whom 17 (25%) attended the FGDs (n=8, 47% in FGD 1 and n=9, 53% in FGD 2). A total of 79% (49/62) of the participants completed the acceptability questionnaire. The health literacy content was found to be highly acceptable based on qualitative and quantitative data. Most acceptability questions had 98% (48/49) positive answers. Participants enjoyed learning about active infant play and developmental milestones and how to make recycled toys. Over 80% of participants (62/68, 91%) attended the 12-month exit appointment. Most of the participants (47/62, 76%) could access the intervention content over the 12 months of the PLAY study, and of those, 60% (28/47) looked at content more than once a week, and 11% (5/47) did so every day. Less than a quarter (10/47, 21%) only looked at the content sporadically. Access was impacted by technical difficulties attributed to using inconsistent external service providers.Conclusions: this study was found to be acceptable to participants and feasible in this setting. The high acceptability of the intervention content and belief that other mothers would benefit from it suggests potential for effectiveness in similar communities. However, the feasibility of app-based interventions relies on consistent and low-cost management of digital tools in low-resource settings
Describing correlates of early childhood screen time and outdoor time in Soweto, South Africa
No full textBackground: contextual factors are likely to influence whether young children are able to adhere to recommended health behaviours. This study aimed to: (1) describe the social and environmental characteristics of children under five living in Soweto, South Africa; and (2) determine factors associated with screen time and outdoor play in this population. Methods: household surveys were conducted in Soweto to collect data on children's screen time and access to outdoor space, as well as information about the household. A multilevel regression analysis was conducted for each outcome. Results: data on 2309 children aged five or under were included in this analysis. Children used screens for an average of one and a half hours per day during the week, and nearly 2 hours per day on weekends. Almost all (92%) children had a safe space to play inside, while just over a third (34%) had a safe space to play outside. A higher socioeconomic status was associated with less time spent playing outside and more screen time. Conclusion: interventions promoting outdoor play and restricting screen time are essential for improving health trajectories, but need to address structural barriers that exist, in order to protect the safety of children while promoting health behaviours.</p
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
The association of intrauterine and postnatal growth patterns and nutritional status with toddler body composition.
No full textBackgroundGrowth patterns may be indicative of underlying changes in body composition. However, few studies have assessed the association of growth and body composition in poorly resourced regions experiencing the double-burden of malnutrition exists. Thus, the aims of this study were to investigate the association of intrauterine and postnatal growth patterns with infant body composition at 2 years in a middle-income country.MethodsParticipants were from the International Atomic Energy Agency Multicentre Body Composition Reference study. Fat mass (FM), fat free mass (FFM), Fat mass index (FMI), fat free mass index (FFMI), and percentage fat mass (%FM) were measured in 113 infants (56 boys and 57 girls), from Soweto, South Africa, using deuterium dilution from 3 to 24 months. Birthweight categories were classified using the INTERGROWTH-21 standards as small (SGA), appropriate (AGA), and large-for gestational age (LGA). Stunting (> -2 SDS) was defined using the WHO child growth standards. Birthweight z-score, conditional relative weight and conditional length at 12 and 24 mo were regressed on body composition at 24 mo.ResultsThere were no sex differences in FM, FFM, FMI and FFMI between 3 and 24 mo. SGA and AGA both had significantly higher %FM than LGA at 12 mo. LGA had higher FM at 24 mo. Children with stunting had lower FM (Mean = 1.94, 95% CI; 1.63–2.31) and FFM (Mean = 5.91, 95% CI; 5.58–6.26) at 12 mo than non-stunting, while the reverse was true for FFMI (Mean = 13.3, 95% CI; 12.5–14.2) at 6 mo. Birthweight and conditionals explained over 70% of the variance in FM. CRW at both 12 and 24 mo was positively associated with FM and FMI. CRW at 12 mo was also positively associated with FMI, while CH at 24 mo was negatively associated with both FFMI and FMI in boys.ConclusionBoth LGA and SGA were associated with higher body fat suggesting that both are disadvantaged nutritional states, likely to increase the risk of obesity. Growth patterns through infancy and toddler period (1–2 years) are indicative of body fat, while growth patterns beyond infancy are less indicative of fat-free mass
Associations between skeletal muscle mass and elevated blood pressure are independent of body fat: a cross-sectional study in young adult women of African ancestry
No full textAlthough research on the relationship between lean body mass and blood pressure (BP) has been inconsistent, most studies reported that measures of lean body mass are associated with a higher risk of hypertension. We explored relationships between body composition (fat and skeletal muscle mass) and BP in 1162 young adult African women. Dual-energy X-ray absorptiometry-derived measures of whole-body, central and arm fat mass were associated with higher systolic and diastolic BP, while leg fat percentage was associated with lower systolic and diastolic BP. However, only the associations with diastolic BP remained after adjusting for appendicular skeletal muscle mass (ASM). ASM was associated with higher systolic and diastolic BP, before and after adjusting for whole-body fat percentage and visceral adipose tissue. While there was no overlap in targeted proteomics of BP and body composition, REN was lower in the elevated BP than the normal BP group and was inversely associated with diastolic BP (false rate discovery adjusted P< 0·050). Several proteins were positively associated with both visceral adipose tissue and ASM (LEP, FABP4, IL6 and GGH) and negatively associated with both visceral adipose tissue and ASM (ACAN, CELA3A, PLA2G1B and NCAM1). NOTCH3, ART3, COL1A1, DKK3, ENG, NPTXR, AMY2B and CNTN1 were associated with lower visceral adipose tissue only, and IGFBP1 was associated with lower ASM only. While the associations between body fat and BP were not independent of skeletal muscle mass, the associations between muscle mass and BP were independent of overall and central adiposity in young adult African women. Future interventions targeting muscle mass should also monitor BP in this population
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