This report card on South African children and youth shows that there has been little or no improvement in the areas of tobacco use, nutrition, physical activity and obesity over the last three years. It draws on more than 95 published, peer-reviewed studies or reports, which cumulatively show a decline in physical activity levels, with only 42% of youth having participated in sufficient vigorous physical activity to be considered health-enhancing. Less than one-third of youth surveyed participated in moderate activity and nearly 42% did little or no physical activity. There was an increase in overweight and obese children to 20% and 5% respectively. Nearly 30% of teens consumed fast food two to three times a week, while researchers found that healthy foods in rural settings cost almost twice as much as the unhealthy equivalent, further fuelling unhealthy eating habits. Almost 30% of adolescents say they have ever smoked, while 21% admit to being smokers currently (which is double that of global prevalence estimates). Most smokers start before the age of 19, with 6.8% starting under the age of 10. These trends may give rise to serious non-communicable and preventable diseases such as heart disease, diabetes, lung disease and certain cancers, which are responsible for over half of adult deaths worldwide, according to the report.
Equity in Health
In June 2010, the Lesotho health department, in partnership with the World Health Organisation and the United Nations (UN) Children's Fund, launched a programme targeting the four worst-performing Millennium Development Goals (MDGs), namely those relating to the eradication of poverty and hunger, to reducing child and maternal mortality and to combating HIV. The programme has been implemented in the four worst-performing of Lesotho's 10 districts. Interventions are focused on helping mothers, and the programme also tries to address the lack of coordination and wasted resources that have plagued aid delivery in the past. The health department aims to identify pregnant, breast-feeding and HIV-positive mothers and their infants who are in need of food rations from the World Food Programme. They will be supplied with seeds, tools and advice on how to grow vegetables and raise chickens, in the hope of making them less reliant on food assistance, and will later receive training on how to start small businesses. By 2012, the programme should have yielded enough results and best practices for government to decide whether to take over and replicate it in other districts. The UN resident coordinator in Lesotho has called for funding for the programme to become part of the national budget, otherwise it runs the risk of failing.
In this study, the authors examine the importance of national female literacy on women’s maternal health care use in sub-Saharan Africa, using data from the 2002-2003 World Health Survey. They found that, within the various countries, individual age, education, urban residence and household income were associated with lack of maternal health care. National female literacy modified the association of household income with lack of maternal health care use. The strength of the association between income and lack of maternal health care was weaker in countries with higher female literacy. The study concludes with the observation that higher national levels of female literacy may reduce income-related inequalities through a range of possible mechanisms, including women’s increased labour participation and higher status in society. National policies that are able to address female literacy and women’s status in sub-Saharan Africa may help reduce income-related inequalities in maternal health care use.
In this study, researchers investigated whether depression, psychological distress and alcohol use are associated with sexual risk behaviours in young Ugandan adults. They sampled households in two Ugandan districts, recruiting 646 men and women aged 18-30 years. Participants were assessed for depression and psychological distress, as well as alcohol use and sexual behaviour risk. Researchers found that depression was associated with a greater number of lifetime partners and, among women, with having concurrent partners. Psychological distress was associated with a greater number of lifetime partners in both men and women but was only marginally associated with having concurrent partners among women. Psychological distress was associated with inconsistent condom use among men. Alcohol use was associated with a greater number of lifetime partners and with having concurrent partners in both men and women, with particularly strong associations for both outcome measures found among women. The researchers conclude that poor mental health is associated with sexual risk behaviours in a low-income sub-Saharan African setting. They argue that HIV preventive interventions should consider including mental health and alcohol use reduction components into their intervention packages, especially in settings where depression, psychological distress and alcohol use are common.
Health research consists of multiple disciplines that conceptualise and operationalise health in different ways, making integration of knowledge difficult, according to the authors of this paper. They argue that, to help researchers and practitioners study and intervene on complex health processes, comprehensive integrative frameworks linking multiple disciplines and bodies of knowledge must be developed. To this end, they propose a conceptual framework of health that integrates multiple elements from biomedical, psychosocial, behavioural, and spiritual research, using a ‘transdisciplinary’ approach. The framework includes discipline-specific constructs and domains, outlines their interactions, and links them to a global or holistic concept of health. In this context, health is seen as an emergent individual experience, transcending objective and subjective classifications of health and disease.
According to this editorial from the Bulletin of the World Health Organisation, most of the literature on gender differences in smoking has focused on differences in traditional sex roles. These roles have translated historically into social norms, such as disapproval of female smoking, and gender-specific personal characteristics, such as greater rebelliousness among men, which is linked to higher smoking rates. However, countries can vary widely in their actual experience with the smoking epidemic. For example, smoking levels among Chinese women have always been low and even dropped during the 20th century. In the 21st century, the situation is changing, the author argues, noting that social norms that slowed the diffusion of smoking among women are diminishing in most parts of the developing world, an unintended consequence of gender empowerment and economic growth, which allow women to freely make choices and furnish them with the economic resources to pursue those choices. A clue to the changing demographics of smokers is found in the narrowing gender gap in the rates of smoking experimentation and adoption among teenagers around the world. The author call for more research on how women view triggers that could lead to smoking adoption, such as peer pressure and role models, how addiction develops in female smokers, and how they weigh the costs and benefits of smoking.
On World Health Day, 7 April 2011, the focus will be on antimicrobials. According to the World Health Organisation (WHO), the use and misuse of antimicrobials in human medicine and animal husbandry over the past 70 years have increased the number and types of micro organisms resistant to these medicines, causing deaths, greater suffering and disability, and higher health-care costs. If this phenomenon continues unchecked, WHO warns, many infectious diseases risk becoming uncontrollable and could derail progress made towards reaching the health-related United Nations Millennium Development Goals for 2015. Furthermore, the growth of global trade and travel allows resistant organisms to spread worldwide within hours. WHO calls on governments and stakeholders to implement the policies and practices needed to prevent and counter the emergence of highly resistant micro-organisms.
The author predicts significant adjustments in the global health status quo in the coming year and identifies seven forces that are converging towards what appears to be an inevitable tipping point. Some changes will be gradual, others may appear as sudden shifts. Each of these forces has the potential to make a significant difference in its own right, but as they begin to interact and influence one another, business as usual is an unlikely outcome. Within the health sector the forces include a shift in public health priorities towards maternal and child health, non-communicable diseases, urban health promotion and primary health care renewal, as well as a shift in national health programmes and global public health initiatives from delivering the downstream interventions that constitute traditional health care services towards addressing the social determinants of health. Also included is the increased focus on health system strengthening, and continued growth in domestic health funding, particularly in the middle-income countries that are experiencing economic growth. The author also points to a change in the locus of global health governance, as countries with emerging economies, like Brazil, China, India and South Africa, exert an increasing influence on global health policies and agendas, linking them increasingly to foreign policy priorities. The author predicts other major forces affecting the global health status quo will be the new global financial reality, where international assistance for health will continue to grow, but the new fiscal prudence will bring stringent accountability and demand for aid effectiveness.
The primary objective of this paper was to review progress towards adoption of contraception among married or cohabiting women in western and eastern Africa between 1991 and 2004 by examining subjective need, approval, access and use. Indicators of attitudes towards and use of contraception were derived from Demographic and Health Surveys and trends were examined for 24 countries that had conducted at least two surveys between 1986 and 2007. In western Africa, the subjective need for contraception remained unchanged; about 46% of married or cohabiting women reported a desire to stop and/or postpone childbearing for at least two years. The percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15% (equivalent to an average annual increase of 0.6 percentage points). In eastern African countries, trends were much more favourable, with contraceptive use showing an average annual increase of 1.4 percentage points (from 16% in 1986 to 33% in 2007).
This paper reports on the prevalence of latent tuberculosis infection (LTBI) and risk factors for a positive tuberculin skin test (TST) among gold miners in South African gold mines. Among 429 participants, the estimated prevalence of LTBI was 89%; 45.5% of HIV-positive participants had a zero TST response compared to respectively 13% and 13.5% in the HIV-negative and status unknown participants. In participants with TST > 0, there was no significant difference between size of response by HIV status. Factors independently associated with a TST < 10 mm were positive HIV status and not working underground. The authors conclude that the prevalence of LTBI is very high in gold miners in South Africa. HIV-infected individuals are more likely to have a negative TST, but HIV infection does not affect the size of TST response.