Showing papers in "Global Health Action in 2013"

Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa

Abstract: Background : Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies. Objective : The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. Methods : We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predic...

Depression and associated factors in older adults in South Africa

Abstract: Background and objective : Late-life depression is an important public health problem because of its devastating consequences. The study aims to investigate the prevalence and associated factors of self-reported symptom-based depression in a national sample of older South Africans who participated in the Study of Global Ageing and Adult Health (SAGE wave 1) in 2008. Methods : We conducted a national population-based cross-sectional study with a probability sample of 3,840 individuals aged 50 years or above in South Africa in 2008. The questionnaire included socio-demographic characteristics, health variables, anthropometric and blood pressure measurements as well as questions on depression symptoms in the past 12 months. Multivariable regression analysis was performed to assess the association of socio-demographic factors, health variables, and depression. Results : The overall prevalence of symptom-based depression in the past 12 months was 4.0%. In multivariable analysis, functional disability, lack of ...

Inequity in India: the case of maternal and reproductive health

Abstract: Background: Millennium Development Goal (MDG) 5 is focused on reducing maternal mortality and achieving universal access to reproductive health care. India has made extensive efforts to achieve MDG 5 and in some regions much progress has been achieved. Progress has been uneven and inequitable however, and many women still lack access to maternal and reproductive health care. Objective: In this review, a framework developed by the Commission on Social Determinants of Health (CSDH) is used to categorize and explain determinants of inequity in maternal and reproductive health in India. Design: A review of peer-reviewed, published literature was conducted using the electronic databases PubMed and Popline. The search was performed using a carefully developed list of search terms designed to capture published papers from India on: 1) maternal and reproductive health, and 2) equity, including disadvantaged populations. A matrix was developed to sort the relevant information, which was extracted and categorized based on the CSDH framework. In this way, the main sources of inequity in maternal and reproductive health in India and their inter-relationships were determined. Results: Five main structural determinants emerged from the analysis as important in understanding equity in India: economic status, gender, education, social status (registered caste or tribe), and age (adolescents). These five determinants were found to be closely interrelated, a feature which was reflected in the literature. Conclusion: In India, economic status, gender, and social status are all closely interrelated when influencing use of and access to maternal and reproductive health care. Appropriate attention should be given to how these social determinants interplay in generating and sustaining inequity when designing policies and programs to reach equitable progress toward improved maternal and reproductive health. Keywords: maternal and reproductive health; millennium development goal 5; inequity; disadvantaged populations; social determinants of health; India (Published: 3 April 2013) This paper is part of the thematic cluster Global Health Beyond 2015 . More papers from this cluster can be found at http://www.globalhealthaction.net Citation: Glob Health Action 2013, 6 : 19145 - http://dx.doi.org/10.3402/gha.v6i0.19145

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring

Abstract: Objective: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. Methods: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. Findings: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. Conclusions: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians. Keywords: verbal autopsy; cause of death; vital registration; civil registration; vital statistics;World Health Organization; InterVA (Published: 13 September 2013) Citation: Glob Health Action 2013, 6 : 21518 - http://dx.doi.org/10.3402/gha.v6i0.21518

Improving the use of health data for health system strengthening.

Abstract: Background: Good quality and timely data from health information systems are the foundation of all health systems. However, too often data sit in reports, on shelves or in databases and are not sufficiently utilised in policy and program development, improvement, strategic planning and advocacy. Without specific interventions aimed at improving the use of data produced by information systems, health systems will never fully be able to meet the needs of the populations they serve. Objective: To employ a logic model to describe a pathway of how specific activities and interventions can strengthen the use of health data in decision making to ultimately strengthen the health system. Design: A logic model was developed to provide a practical strategy for developing, monitoring and evaluating interventions to strengthen the use of data in decision making. The model draws on the collective strengths and similarities of previous work and adds to those previous works by making specific recommendations about interventions and activities that are most proximate to affect the use of data in decision making. The model provides an organizing framework for how interventions and activities work to strengthen the systematic demand, synthesis, review, and use of data. Results: The logic model and guidance are presented to facilitate its widespread use and to enable improved data-informed decision making in program review and planning, advocacy, policy development. Real world examples from the literature support the feasible application of the activities outlined in the model. Conclusions: The logic model provides specific and comprehensive guidance to improve data demand and use. It can be used to design, monitor and evaluate interventions, and to improve demand for, and use of, data in decision making. As more interventions are implemented to improve use of health data, those efforts need to be evaluated. Keywords: data-informed decision making; logic model; guidance; health information systems; health systems strengthening; data use (Published: 13 February 2013) Citation: Glob Health Action 2013, 6 : 20001 - http://dx.doi.org/10.3402/gha.v6i0.20001

Climate change threats to population health and well-being: the imperative of protective solutions that will last.

Abstract: Background: The observational evidence of the impacts of climate conditions on human health is accumulating. A variety of direct, indirect, and systemically mediated health effects have been identified. Excessive daily heat exposures create direct effects, such as heat stroke (and possibly death), reduce work productivity, and interfere with daily household activities. Extreme weather events, including storms, floods, and droughts, create direct injury risks and follow-on outbreaks of infectious diseases, lack of nutrition, and mental stress. Climate change will increase these direct health effects. Indirect effects include malnutrition and under-nutrition due to failing local agriculture, spread of vector-borne diseases and other infectious diseases, and mental health and other problems caused by forced migration from affected homes and workplaces. Examples of systemically mediated impacts on population health include famine, conflicts, and the consequences of large-scale adverse economic effects due to reduced human and environmental productivity. This article highlights links between climate change and non-communicable health problems, a major concern for global health beyond 2015. Discussion: Detailed regional analysis of climate conditions clearly shows increasing temperatures in many parts of the world. Climate modelling indicates that by the year 2100 the global average temperature may have increased by 348C unless fundamental reductions in current global trends for greenhouse gas emissions are achieved. Given other unforeseeable environmental, social, demographic, and geopolitical changes that may occur in a plus-4-degree world, that scenario may comprise a largely uninhabitable world for millions of people and great social and military tensions. Conclusion: It is imperative that we identify actions and strategies that are effective in reducing these increasingly likely threats to health and well-being. The fundamental preventive strategy is, of course, climate change mitigation by significantly reducing global greenhouse gas emissions, especially long-acting carbon dioxide (CO2), and by increasing the uptake of CO2 at the earth’s surface. This involves urgent shifts in energy production from fossil fuels to renewable energy sources, energy conservation in building design and urban planning, and reduced waste of energy for transport, building heating/cooling, and agriculture. It would also involve shifts in agricultural production and food systems to reduce energy and water use particularly in meat production. There is also potential for prevention via mitigation, adaptation, or resilience building actions, but for the large populations in tropical countries, mitigation of climate change is required to achieve health protection solutions that will last.

Climate change and the potential effects on maternal and pregnancy outcomes: an assessment of the most vulnerable – the mother, fetus, and newborn child

Abstract: In 2007, the Intergovernmental Panel on Climate Change (IPCC) presented a large amount of evidence about global warming and the impact of human activities on global climate change. The Lancet Commission have identified a number of ways in which climate change can influence human health: lack of food and safe drinking water, poor sanitation, population migration, changing disease patterns and morbidity, more frequent extreme weather events, and lack of shelter. Pregnant women, the developing fetus, and young children are considered the most vulnerable members of our species and are already marginalized in many countries. Therefore, they may have increased sensitivity to the effects of climate change. Published literature in the fields of climate change, human health, tropical diseases, and direct heat exposure were assessed through the regular search engines. This article demonstrates that climate change will increase the risk of infant and maternal mortality, birth complications, and poorer reproductive health, especially in tropical, developing countries. Thus, climate change will have a substantial impact on the health and survival of the next generation among already challenged populations. There is limited knowledge regarding which regions will be most heavily affected. Research efforts are therefore required to identify the most vulnerable populations, fill knowledge gaps, and coordinate efforts to reduce negative health consequences. The effects of malnutrition, infectious diseases, environmental problems, and direct heat exposure on maternal health outcomes will lead to severe health risks for mothers and children. Increased focus on antenatal care is recommended to prevent worsening maternal health and perinatal mortality and morbidity. Interventions to reduce the negative health impacts caused by climate change are also crucial. Every effort should be made to develop and maintain good antenatal care during extreme life conditions as a result of climate change.

An analysis of the health status of the United Arab Emirates: the ‘Big 4’ public health issues

Abstract: Background: The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. Methods: A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. Results: The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. Conclusion: The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases. Keywords: globalisation of public health; non-communicable disease; United Arab Emirates (Published: 5 February 2013) Citation: Glob Health Action 2013, 6 : 20100 - http://dx.doi.org/10.3402/gha.v6i0.20100 To access the supplementary material to this article please see Supplementary files in the column to the right (under ReadingTools).

Challenges to the implementation of health sector decentralization in Tanzania : experiences from Kongwa district council

Abstract: Background: During the 1990s, the government of Tanzania introduced the decentralization by devolution (D by D) approach involving the transfer of functions, power and authority from the centre to the local government authorities (LGAs) to improve the delivery of public goods and services, including health services. Objective: This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials. Design: The study adopted a qualitative approach, and data were collected using semi-structured interviews and were analysed for themes and patterns. Results: The results showed several benefits of decentralization, including increased autonomy in local resource mobilization and utilization, an enhanced bottom-up planning approach, increased health workers’ accountability and reduction of bureaucratic procedures in decision making. The findings also revealed several challenges which hinder the effective functioning of decentralization. These include inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. Conclusion: The article concludes that the central government needs to adhere to the principles that established the local authorities and grant more autonomy to them, offer special incentives to staff working in the rural areas and create the capacity for local key actors to participate effectively in the planning process. Keywords: challenges; decentralization; health services; Tanzania (Published: 29 August 2013) Citation: Glob Health Action 2013, 6 : 20983 - http://dx.doi.org/10.3402/gha.v6i0.20983

Factors associated with attrition, mortality, and loss to follow up after antiretroviral therapy initiation: data from an HIV cohort study in India

Abstract: Studies from sub-Saharan Africa have shown high incidence of attrition due to mortality or loss to follow-up (LTFU) after initiating antiretroviral therapy (ART). India is the third largest country...

Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data.

Abstract: Background: Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Methods: Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3) carried out during 2007-2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes - Institutional delivery, antenatal care (ANC), and use of modern contraception - and selected intermediary and structural determinants of health using multiple logistic regression. Results: Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Discussion and conclusions: Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste) has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic education and infrastructural development to begin to remove the structural causes of non-use of maternal health services. Keywords: maternal health; health care utilization; inequity; antenatal care; skilled birth attendance; Gujarat (Published: 6 March 2013) Citation: Glob Health Action 2013, 6 : 19652 - http://dx.doi.org/10.3402/gha.v6i0.19652

Determinants of antiretroviral treatment adherence among HIV/AIDS patients: a multisite study

Abstract: Introduction: Adherence to antiretroviral treatment (ART) is vital in achieving virological treatment success. This study assessed the prevalence of optimal ART adherence and its determinants among HIV/AIDS patients in Vietnam. Method: A cross-sectional survey was conducted with 1,016 HIV/AIDS patients at seven hospitals and health centers providing antiretroviral treatment services in three provinces, including Hanoi, Hai Phong, and Ho Chi Minh City. Self-reported medication adherence was measured using a 30-day visual analog scale (VAS) and 7-day missed-doses questions. Results: The mean adherence VAS-score was 94.5 out of 100 (SD=8.2), ranging from 40 to 100%. The rate of suboptimal adherence was 25.9%. The rate of missed-doses was 25.2%. In multivariate analysis, increased perceived self-efficacy, use of mobile phone alarms, and reminders from family members were associated with optimal adherence; higher CD4 level, single status, and unstable employment were associated with suboptimal adherence. Conclusion: High rate of suboptimal adherence observed in this study highlights the importance of adherence support interventions during ART. The use of mobile phone reminders, involvement of relatives, and HIV self-management training programs have the potential to improve ART adherence in Vietnam. Keywords: HIV/AIDS; adherence; antiretroviral treatment; drug users; adherence aid; Vietnam (Published: 15 March 2013) Citation: Glob Health Action 2013, 6 : 19570 - http://dx.doi.org/10.3402/gha.v6i0.19570

The non-fatal disease burden caused by type 2 diabetes in South Africa, 2009

Abstract: Background : Increasing urbanisation and rising unhealthy lifestyle risk factors are contributing to a growing diabetes epidemic in South Africa. In 2000, a study estimated diabetes prevalence to be 5.5% in those aged over 30. Accurate, up-to-date information on the epidemiology and burden of disease due to diabetes and its sequelae is essential in the planning of health services for diabetes management. Objective : To calculate the non-fatal burden of disease in Years Lost due to Disability (YLD) due to diabetes and selected sequelae in South Africa in 2009. YLD measures the equivalent loss of life due to ill-health. Methods : A series of systematic literature reviews identified data on the epidemiology of diabetes and its sequelae in South Africa. The data identified were then applied to Global Burden of Disease (GBD) methodology to calculate the burden attributable to diabetes. Results : Prevalence of type 2 diabetes in South Africa in 2009 is estimated at 9.0% in people aged 30 and older, representing approximately 2 million cases of diabetes. We modelled 8,000 new cases of blindness and 2,000 new amputations annually caused by diabetes. There are 78,900 YLD attributed to diabetes, with 64% coming from diabetes alone, 24% from retinopathy, 6% from amputations, 9% from attributable stroke disability, and 7% from attributable ischemic heart disease disability. Conclusions : We estimate that the prevalence of diabetes is increasing in South Africa. Significant disability associated with diabetes is demonstrated. Some of the attributed burden can be prevented through early detection and treatment. Keywords : burden of disease; diabetes; South Africa; developing country; epidemiology (Published: 24 January 2013) Citation: Glob Health Action 2013, 6 : 19244 - http://dx.doi.org/10.3402/gha.v6i0.19244 Access the supplementary material to this article – see Supplementary files under Article Tools online.

Exploring the paradox: double burden of malnutrition in rural South Africa

Abstract: Background : This article is a review of the PhD thesis by Elizabeth Kimani-Murage that explores the double burden of malnutrition in rural South Africa. This is in the context of a worryingly rapid increase in obesity and obesity-related diseases in low- and middle-income countries (LMICs) including South Africa, and in the wake of on-going nutrition transition and lifestyle changes in these countries. Objective : To understand the profiles of malnutrition among children and adolescents in a poor, high HIV prevalent, transitional society in a middle-income country. Methods : A cross-sectional growth survey was conducted in 2007 targeting 4,000 children and adolescents aged 120 years. In addition, HIV testing was carried out on children aged 15 years and Tanner pubertal assessment among adolescents aged 920 years. Results : The study shows stunting at an early age and adolescent obesity, particularly among girls, that co-exists in the same socio-geographic population. The study also shows that HIV is an independent modifiable risk factor for poor nutritional outcomes in children and makes a significant contribution to nutritional outcomes at the individual level. Significant predictors of undernutrition at an early age, documented at individual, household, and community levels, include child’s HIV status, age and birth weight, maternal age, age of household head, and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease during adolescence, documented at individual and household levels include child’s age, sex, and pubertal development, household-level food security, socio-economic status, and household head’s highest education level. Conclusions : The combination of early stunting and adolescent obesity raises critical concerns in the wake of the rising public health importance of metabolic diseases in LMICs. This is because, both paediatric obesity and adult short stature are risk factors for metabolic syndrome and metabolic diseases in adulthood. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged and gender-sensitive. Keywords : nutrition transition; double burden of malnutrition; stunting; underweight; wasting; overweight; obesity; metabolic disease risk; HIV; low- and middle-income countries; South Africa (Published: 24 January 2013) Citation: Glob Health Action 2013, 6 : 19249 - http://dx.doi.org/10.3402/gha.v6i0.19249 Normal 0 21 false false false SV X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} This article has also been published in Supplement 1, 2013 ‘’Building new knowledge’’. Read the supplement here . This article has been commented on by Peter A. Cooper. Read this commentary here . Normal 0 21 false false false SV X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa

Abstract: Background : South Africa is experiencing a demographic and epidemiological transition with an increase in population aged 50 years and older and rising prevalence of non-communicable diseases. This, coupled with high HIV and tuberculosis prevalence, puts an already weak health service under greater strain. Objective : To measure self-reported chronic health conditions and chronic disease risk factors, including smoking and alcohol use, and to establish their association with health care use in a rural South African population aged 50 years or older. Methods : The Study on Global Ageing and Adult Health (SAGE), in collaboration with the INDEPTH Network and the World Health Organization, was implemented in the Agincourt sub-district in rural northeast South Africa where there is a long-standing health and socio-demographic surveillance system. Household-based interviews were conducted in a random sample of people aged 50 years and older. The interview included questions on self-reported health and health care use, and some physical measurements, including blood pressure and anthropometry. Results : Four hundred and twenty-five individuals aged 50 years or older participated in the study. Musculoskeletal pain was the most prevalent self-reported condition (41.7%; 95% Confidence Interval [CI] 37.0–46.6) followed by hypertension (31.2%; 95% CI 26.8–35.9) and diabetes (6.1%; 95% CI 4.1–8.9). All self-reported conditions were significantly associated with low self-reported functionality and quality of life, 57% of participants had hypertension, including 44% of those who reported normal blood pressure. A large waist circumference and current alcohol consumption were associated with high risk of hypertension in men, whereas in women, old age, high waist–hip ratio, and less than 6 years of formal education were associated with high risk of hypertension. Only 45% of all participants reported accessing health care in the last 12 months. Those who reported higher use of the health facilities also reported lower levels of functioning and quality of life. Conclusions : Self-reported chronic health conditions, especially hypertension, had a high prevalence in this population and were strongly associated with higher levels of health care use. The primary health care system in South Africa will need to provide care for people with non-communicable diseases. Keywords : health care use; older population; self-reported health; non-communicable disease; WHODAS; WHOQOL; rural; South Africa (Published: 24 January 2013) Citation : Glob Health Action 2013, 6: 19305 - http://dx.doi.org/10.3402/gha.v6i0.19305 A Corrigendum has been published for this paper. Please see http://www.globalhealthaction.net/index.php/gha/article/view/24080

Vulnerability to extreme heat and climate change: is ethnicity a factor?

Abstract: Background: With a warming climate, it is important to identify sub-populations at risk of harm during extreme heat. Several international studies have reported that individuals from ethnic minorities are at increased risk of heat-related illness, for reasons that are not often discussed. Objective: The aim of this article is to investigate the underpinning reasons as to why ethnicity may be associated with susceptibility to extreme heat, and how this may be relevant to Australia’s population. Design: Drawing upon literary sources, the authors provide commentary on this important, yet poorly understood area of heat research. Results: Social and economic disparities, living conditions, language barriers, and occupational exposure are among the many factors contributing to heat-susceptibility among minority ethnic groups in the United States. However, there is a knowledge gap about socio-cultural influences on vulnerability in other countries. Conclusion: More research needs to be undertaken to determine the effects of heat on tourists, migrants, and refugees who are confronted with a different climatic environment. Thorough epidemiological investigations of the association between ethnicity and heat-related health outcomes are required, and this could be assisted with better reporting of nationality data in health statistics. Climate change adaptation strategies in Australia and elsewhere need to be ethnically inclusive and cognisant of an upward trend in the proportion of the population who are migrants and refugees. Keywords: Australia; barriers; climate change; ethnicity; heat-susceptibility; migrants (Published: 29 July 2013) Citation: Glob Health Action 2013, 6 : 21364 - http://dx.doi.org/10.3402/gha.v6i0.21364

Self-reported prevalence of chronic non-communicable diseases and associated factors among older adults in South Africa

Abstract: Introduction: Little is known about the prevalence and predictors of chronic non-communicable diseases (NCDs) of older adults in South Africa. This study aims to investigate the self-reported prevalences of major chronic NCDs and their predictors among older South Africans. Methods: We conducted a national population-based cross-sectional survey with a sample of 3,840 individuals aged 50 years or above in South Africa in 2008. The outcome variable was the self-reported presence of chronic NCDs suffered, namely, arthritis, stroke, angina, diabetes, chronic lung disease, asthma, depression, and hypertension. The exposure variables were sociodemographic characteristics: age, gender, education, wealth status, race, marital status, and residence. Multivariate logistic regression was used to determine sociodemographic factors predictive of the presence of chronic NCDs. Results: The prevalence of chronic NCDs was 51.8%. The prevalence of multimorbidity (≥2 chronic conditions) was 22.5%. Multivariate logistic regression analysis showed that being female, being in age groups 60-79 and 70-79, being Coloured or Asian, having no schooling, having greater wealth, and residing in an urban area were associated with the presence of NCDs. Conclusion: The rising burden of chronic NCDs affecting older people places a heavy burden on the healthcare system as a result of increased demand and access to healthcare services. Concerted effort is needed to develop strategies for the prevention and management of NCDs, especially among economically disadvantaged individuals who need these services the most. Keywords: self-reported; chronic non-communicable diseases; ageing; South Africa (Published: 19 September 2013) Citation: Glob Health Action 2013, 6 : 20936 - http://dx.doi.org/10.3402/gha.v6i0.20936

Urban—rural and gender differences in tobacco and alcohol use, diet and physical activity among young black South Africans between 1998 and 2003

Abstract: Background: Non-communicable chronic diseases (NCDs) have increased in South Africa over the past 15 years. While these usually manifest during mid-to-late adulthood, the development of modifiable risk factors that contribute to NCDs are usually adopted early in life. Objective: To describe the urban—rural and gender patterns of NCD risk factors in black adolescents and young adults (15- to 24-year-olds) from two South African Demographic and Health Surveys conducted 5 years apart. Design: An observational study based on interviews and measurements from two cross-sectional national household surveys. Changes in tobacco and alcohol use, dietary intake, physical inactivity, and overweight/ obesity among 15- to 24-year-olds as well as urban—rural and gender differences were analysed using logistic regression. The ‘Surveyset’ option in Stata statistical software was used to allow for the sampling weight in the analysis. Results: Data from 3,186 and 2,066 black 15- to 24-year-old participants in 1998 and 2003, respectively, were analysed. In males, the prevalence of smoking (1998: 21.6%, 2003: 19.1%) and problem drinking (1998: 17.2%, 2003: 15.2%) were high and increased with age, but in females were much lower (smoking — 1998: 1.0%, 2003: 2.1%; problem drinking — 1998: 4.2%, 2003: 5.8%). The predominant risk factors in females were overweight/obesity (1998: 29.9%, 2003: 31.1%) and physical inactivity (2003: 46%). Urban youth, compared to their rural counterparts, were more likely to smoke (odds ratio (OR): 1.39, 95% confidence interval (CI): 1.09—1.75), have high salt intake (OR: 1.75, 95% CI: 1.12—2.78), be overweight/obese (OR: 1.39, 95% CI: 1.14—1.69), or be physically inactive (OR: 1.45, 95% CI: 1.12—1.89). However, they had lower odds of inadequate micronutrient intake (OR: 0.46, 95% CI 0.34—0.62), and there was no overall significant urban—rural difference in the odds for problem drinking but among females the odds were higher in urban compared to rural females. Conclusion: Considering that the prevalence of modifiable NCD risk factors was high in this population, and that these may persist into adulthood, innovative measures are required to prevent the uptake of unhealthy behaviours, and regular surveillance is needed. Keywords: South Africa; young adults; lifestyle risk factors; smoking; alcohol; obesity; physical activity (Published: 29 January 2013) Citation: Glob Health Action 2013, 6 : 19216 - http://dx.doi.org/10.3402/gha.v6i0.19216

Social inequalities in mental health and mortality among refugees and other immigrants to Sweden : epidemiological studies of register data

Abstract: The aim of this PhD project was to increase knowledge, using population-based registers, of how pre- and post-migration factors and social determinants of health are associated with inequalities in poor mental health and mortality among refugees and other immigrants to Sweden. Study I and II had cross-sectional designs and used logistic regression analysis to study differences in poor mental health (measured with prescribed psychotropic drugs purchased) between refugee and non-refugee immigrants. In Study I, there was a significant difference in poor mental health between female refugees and non-refugees (OR=1.27; CI=1.151.40) when adjusted for socio-economic factors. In Study II, refugees of most origins had a higher likelihood of poor mental health than non-refugees of the same origin. Study III and IV had cohort designs and used Cox regression analysis. Study III analysed mortality rates among non-labour immigrants. Male refugees had higher relative risks of mortality from cardiovascular disease (HR=1.53; CI=1.04-2.24) and external causes (HR=1.59; CI=1.01-2.50) than male non-refugees did, adjusted for socio-economic factors. Study IV included the population with a strong connection to the labour market in 1999 to analyse the relative risk of hospitalisation due to depressive disorder following unemployment. The lowest relative risk was found among employed Swedish-born men and the highest among foreign-born females who lost employment during follow-up (HR=3.47; CI=3.02-3.98). Immigrants, and particularly refugees, have poorer mental health than native Swedes. Refugee men have a higher relative mortality risk for cardiovascular disease and external causes of death than do non-refugees. The relative risk of hospitalisation due to depressive disorder following unemployment was highest among immigrant women. To promote mental health and reduce mortality among immigrants, it is important to consider pre- and post-migration factors and the general social determinants of health. Keywords: social inequalities; mental health; mortality; refugees; immigrants; register data (Published: 27 June 2013) Citation: Glob Health Action 2013, 6 : 21059 - http://dx.doi.org/10.3402/gha.v6i0.21059

'Elastic band strategy': women's lived experiences of coping with domestic violence in rural Indonesia

Abstract: Background: Experiencing domestic violence is considered a chronic and stressful life event A theoretical framework of coping strategies can be used to understand how women deal with domestic violence Traditional values strongly influenced by religious teachings that interpret men as the leaders of women play an important role in the lives of Javanese women, where women are obliged to obey their husbands Little is known about how sociocultural and psychosocial contexts influence the ways in which women cope with domestic violence Objective: Our study aimed to deepen our understanding of how rural Javanese women cope with domestic violence Our objective was to explore how the sociocultural context influences coping dynamics of women survivors of domestic violence in rural Purworejo Design: A phenomenological approach was used to transform lived experiences into textual expressions of the coping dynamics of women survivors of domestic violence Results: Experiencing chronic violence ruined the women’s personal lives because of the associated physical, mental, psychosocial, and financial impairments These chronic stressors led women to access external and internal resources to form coping strategies Both external and internal factors prompted conflicting impulses to seek support, that is, to escape versus remain in the relationship This strong tension led to a coping strategy that implied a long-term process of moving between actively opposing the violence and surrendering or tolerating the situation, resembling an elastic band that stretches in and out Conclusions: Women survivors in Purworejo face a lack of institutional support and tend to have traditional beliefs that hamper their potential to stop the abuse Although the women in this study were educated and economically independent, they still had difficulty mobilizing internal and external support to end the abuse, partly due to internalized gender norms Keywords: domestic violence; coping; lived experience; Indonesia (Published: 2 January 2013) Citation: Glob Health Action 2013, 6 : 18894 - http://dxdoiorg/103402/ghav6i018894 This paper is part of the Cluster Gender and health More papers from this cluster can be found here and here

The mismatch between the health research and development (R&D) that is needed and the R&D that is undertaken: an overview of the problem, the causes, and solutions.

Abstract: One of the most pressing global health problems is that there is a mismatch between the health research and development (R&D) that is needed and that which is undertaken. The dependence of health R&D on market incentives in the for-profit private sector and the lack of coordination by public and philanthropic funders on global R&D priorities have resulted in a global health R&D landscape that neglects certain products and populations and is characterised, more generally, by a distribution that is not ‘needs-driven’. This article provides an overview of the mismatch, its causes, and solutions.

Factors associated with job satisfaction among commune health workers: implications for human resource policies.

Abstract: Background: Job satisfaction among health workers is an important indicator in assessing the performance and efficiency of health services. Objective: This study measured job satisfaction and determined associated factors among health workers in 38 commune health stations in an urban district and a rural district of Hanoi, Vietnam. A total of 252 health workers (36 medical doctors and 216 nurses and technicians; 74% female) were interviewed. A job satisfaction measure was developed using factor analysis, from which four dimensions emerged, namely ‘benefits and prospects,’ ‘facility and equipment,’ ‘performance,’ and ‘professionals.’ Results: The results demonstrate that respondents were least satisfied with the following categories: salary and incentives (24.0%), benefit packages (25.1%), equipment (35.7%), and environment (41.8%). The average satisfaction score was moderate across four domains; it was the highest for ‘performance’ (66.6/100) and lowest for ‘facility and equipment’ (50.4/100). Tobit-censored regression models, constructed using stepwise selection, determined significant predictors of job satisfaction including age, areas of work and expertise, professional education, urban versus rural setting, and sufficient number of staff. Conclusion: The findings highlight the need to implement health policies that focus on incentives, working conditions, workloads, and personnel management at grassroots level. Keywords: job satisfaction; human resource; commune health stations; health workers; Vietnam (Published: 30 January 2013) Citation: Glob Health Action 2013, 6 : 18619 - http://dx.doi.org/10.3402/gha.v6i0.18619 This paper is part of the thematic cluster Public health in Vietnam: here's the data, where's the action? - more papers from this cluster can be found here .

Medical causes of admissions to hospital among adults in Africa: a systematic review

Abstract: Background: Despite the publication of several studies on the subject, there is significant uncertainty regarding the burden of disease among adults in sub-Saharan Africa (sSA). Objectives: To describe the breadth of available data regarding causes of admission to hospital, to systematically analyze the methodological quality of these studies, and to provide recommendations for future research. Design: We performed a systematic online and hand-based search for articles describing patterns of medical illnesses in patients admitted to hospitals in sSA between 1950 and 2010. Diseases were grouped into bodily systems using International Classification of Disease (ICD) guidelines. We compared the proportions of admissions and deaths by diagnostic category using χ 2 . Results: Thirty articles, describing 86,307 admissions and 9,695 deaths, met the inclusion criteria. The leading causes of admission were infectious and parasitic diseases (19.8%, 95% confidence interval [CI] 19.6–20.1), respiratory (16.2%, 95% CI 16.0–16.5) and circulatory (11.3%, 95% CI 11.1–11.5) illnesses. The leading causes of death were infectious and parasitic (17.1%, 95% CI 16.4–17.9), circulatory (16%, 95% CI 15.3–16.8) and digestive (16.2%, 95% CI 15.4–16.9). Circulatory diseases increased from 3.9% of all admissions in 1950–59 to 19.9% in 2000–2010 (RR 5.1, 95% CI 4.5–5.8, test for trend p<0.00005). The most prevalent methodological deficiencies, present in two-thirds of studies, were failures to use standardized case definitions and ICD guidelines for classifying illnesses. Conclusions: Cardiovascular and infectious diseases are currently the leading causes of admissions and in-hospital deaths in sSA. Methodological deficiencies have limited the usefulness of previous studies in defining national patterns of disease in adults. As African countries pass through demographic and health transition, they need to significantly invest in clinical research capacity to provide an accurate description of the disease burden among adults for public health policy. Keywords: adults; Africa; medical admissions; health; transition; ICD; cause of death (Published: 8 January 2013) Citation: Glob Health Action 2013, 6 : 19090 - http://dx.doi.org/10.3402/gha.v6i0.19090

Masculine attitudes of superiority deter men from accessing antiretroviral therapy in Dar es Salaam, Tanzania.

Abstract: Background : This article presents part of the findings from a larger study that sought to assess the role that gender relations play in influencing equity regarding access and adherence to antiretroviral therapy (ART). Review of the literature has indicated that, in Southern and Eastern Africa, fewer men than women have been accessing ART, and the former start using ART late, after HIV has already been allowed to advance. The main causes for this gender gap have not yet been fully explained. Objecti v e : To explore how masculinity norms limit men’s access to ART in Dar es Salaam. Design : This article is based on a qualitative study that involved the use of focus group discussions (FGDs). The study employed a stratified purposive sampling technique to recruit respondents. The study also employed a thematic analysis approach. Results : Overall, the study’s findings revealed that men’s hesitation to visit the care and treatment clinics signifies the superiority norm of masculinity that requires men to avoid displaying weakness. Since men are the heads of families and have higher social status, they reported feeling embarrassed at having to visit the care and treatment clinics. Specifically, male respondents indicated that going to a care and treatment clinic may raise suspicion about their status of living with HIV, which in turn may compromise their leadership position and cause family instability. Because of this tendency towards ‘hiding’, the few men who register at the public care and treatment clinics do so late, when HIV-related signs and symptoms are already far advanced. Conclusion : This study suggests that the superiority norm of masculinity affects men’s access to ART. Societal expectations of a ‘real man’ to be fearless, resilient, and emotionally stable are in direct conflict with expectations of the treatment programme that one has to demonstrate health-promoting behaviour, such as promptness in attending the care and treatment clinic, agreeing to take HIV tests, and disclosing one’s status of living with HIV to at least one’s spouse or partner. Hence, there is a need for HIV control agencies to design community-based programmes that will stimulate dialogue on the deconstruction of masculinity notions. Keywords : gender; masculinity; HIV; access; antiretro v iral therapy (ART) (Published: 22 October 2013) Citation : Glob Health Action 2013, 6 : 21812 - http://dx.doi.org/10.3402/gha.v6i0.21812

Survival probability and prognostic factors for breast cancer patients in Vietnam

Abstract: Background: Breast cancer is becoming a public health problem in Vietnam. The mortality to incidence ratio of the disease was ranked second among the most common cancers in women. This study estimates the survival probability at 1, 3, and 5 years following diagnosis and determines prognostic factors for breast cancer mortality in Vietnam. Methods: A survival analysis was conducted based on retrospective data from Hue Central Hospital and the Cancer Registry in Ho Chi Minh City. Using the Kaplan-Meier method, the survival probability of patients with breast cancer was estimated at 1, 3, and 5 years following diagnosis. The covariates among prognostic factors for survival time were studied using an extended Cox proportion hazards model, including timedependent predictors. Results: Overall survival rates at 1, 3, and 5 years following diagnosis were 0.94, 0.83 and 0.74 respectively. Marital status, education level, stage at diagnosis, and hormone therapy were prognostic factors for mortality. For the stage at diagnosis, the relation to the risk of death for breast cancer was 1.32 (95% CI, 1.22-1.41). Married women faced a risk of death nearly 1.59 times higher than unmarried women (95% CI, 1.09-2.33). Women with higher levels of education and who received hormone therapy had approximately 10% (hazard ratio [HR]: 0.92; 95% CI, 0.89-0.96) and 80% (HR: 0.22; 95% CI, 0.12-0.41) risk reduction of death respectively, compared with those classified as illiterate and those without hormone therapy. Conclusions: The 5-year survival probability of breast cancer was lower in Vietnam than in countries with similar distributions of the stage at diagnosis. Screening programs and related support policies should be developed to increase the life expectancy of women with breast cancer in Vietnam. Keywords: breast cancer; survival; prognostic factors; Vietnam (Published: 17 January 2013) Citation: Glob Health Action 2013, 6 : 18860 - http://dx.doi.org/10.3402/gha.v6i0.18860 This paper is part of the Cluster Public health in Vietnam: here's the data, where's the action? - more papers from this cluster can be found here .

Household characteristics for older adults and study background from SAGE Ghana Wave 1

Abstract: Background: Globally, the population aged 60 years and older is projected to reach 22% by 2050. In sub- Saharan Africa, this figure is projected to exceed 8%, while in Ghana, the older adult population will reach 12% by 2050. The living arrangements and household characteristics are fundamental determinants of the health and well-being of this population, data sources about which are increasingly available. Methods: The World Health Organization’s Study on global AGEing and adult health (SAGE) Wave 1 was conducted in China, Ghana, India, Russian Federation, Mexico, and South Africa between 2007 and 2010. SAGE Ghana Wave 1 was implemented in 2007/08 using face-to-face interviews in a nationally representative sample of persons aged 50-plus, along with a smaller cohort aged 18-49 years for comparison purposes. Household information included a household roster including questions about health insurance coverage for all household members, household and sociodemographic characteristics, status of the dwelling, and economic situation. Re-interviews were done in a random 10% of the sample and proxy interviews done where necessary. Verbal autopsies were conducted for deaths occurring in older adult household members in the 24 months prior to interview. Results: The total household population was 27,270 from 5,178 households. The overall household response rate was 86% and household cooperation rate was 98%. Thirty-four percent of household members were under 15 years of age while 8.3% were aged 65-plus years. Households with more than 11 members were more common in rural areas (57.2%) and in the highest income quintile (30.6%). Household members with no formal education formed 24.7% of the sample, with Northern and Upper East regions reaching more than 50%. Only 26.8% of the household members had insurance coverage. Households with hard floors ranged from 25.7% in Upper West to 97.7% in Ashanti region. Overall, 84.9% of the households had access to improved sources of drinking water, with the lowest at 29.6% in the Volta region. The overall rate of access to improved sanitation was just 14.9%. The findings show significant regional differences, with the three Northern Regions having worse education, income, and sanitation levels, compared to Southern and Central Regions of the country. Conclusion: Household characteristics and intra-household dynamics have been shown to influence health and health-seeking behaviors across a number of contexts and countries, and play a fundamental role in the well-being of older Ghanaians. SAGE Ghana is part of a multi-country study using standardized questionnaires and tested methodologies to provide household level data required to inform policy on the growing population of older adults in Ghana. With the good response rates and measures instituted to assure quality of data, this article demonstrates the high quality data and research methods of SAGE. Keywords: SAGE; Ghana; ageing; household characteristics (Published: 11 June 2013) Citation: Glob Health Action 2013, 6 : 20096 - http://dx.doi.org/10.3402/gha.v6i0.20096 This paper is part of the thematic cluster Improving health and living conditions for elderly populations - more papers from this cluster can be found here .

A rapid assessment of a community health worker pilot programme to improve the management of hypertension and diabetes in Emfuleni sub-district of Gauteng Province, South Africa

Abstract: Background : Non-communicable diseases (NCD) and infectious chronic illnesses are recognised as significant contributing factors to the burden of disease globally, specifically in South Africa, yet clinical management is often poor. The involvement of community health workers (CHWs) in TB and HIV care in South Africa, and other low- and middle-income settings, suggests that they could make an important contribution in the management of NCDs. Objectives : Using a rapid assessment, this study examines the outcomes of a pilot CHW programme to improve the management of hypertension and diabetes in Gauteng province, South Africa. Methods : A record review compared outcomes of patients receiving home visits (n56) with a control group (n168) attending the clinic, matched, as far as possible, on age, gender, and condition. Focus group discussions and semi-structured interviews with CHWs, patients, district, clinic, and NGO staff were used to obtain descriptions of the functioning of the programme and patient experiences. Results : Despite the greater age and co-morbidity among those in the pilot programme, the findings suggest that control of hypertension was improved by CHW home visits in comparison to usual clinic care. However, too few doctor visits, insufficient monitoring of patient outcomes by clinic staff, and a poor procurement process for supplies required by the CHWs hampered the programme’s activities. Conclusion : The role of CHWs in the management of hypertension should be given greater consideration, with larger studies being conducted to provide more robust evidence. Adequate training, supervision, and operational support will be required to ensure success of any CHW programme. Keywords : community health worker; chronic care; home visits; South Africa; hypertension; diabetes (Published: 24 January 2013) Citation: Glob Health Action 2013, 6 : 19228 - http://dx.doi.org/10.3402/gha.v6i0.19228

Outreach services to improve access to health care in South Africa: lessons from three community health worker programmes

Abstract: Introduction : In South Africa, there are renewed efforts to strengthen primary health care and community health worker (CHW) programmes. This article examines three South African CHW programmes, a small local non-governmental organisation (NGO), a local satellite of a national NGO, and a government-initiated service, that provide a range of services from home-based care, childcare, and health promotion to assist clients in overcoming poverty-related barriers to health care. Methods : The comparative case studies, located in Eastern Cape and Gauteng, were investigated using qualitative methods. Thematic analysis was used to identify factors that constrain and enable outreach services to improve access to care. Results : The local satellite (of a national NGO), successful in addressing multi-dimensional barriers to care, provided CHWs with continuous training focused on the social determinants of ill-health, regular contextrelated supervision, and resources such as travel and cell-phone allowances. These workers engaged with, and linked their clients to, agencies in a wide range of sectors. Relationships with participatory structures at community level stimulated coordinated responses from service providers. In contrast, an absence of these elements curtailed the ability of CHWs in the small NGO and government-initiated service to provide effective outreach services or to improve access to care. Conclusion : Significant investment in resources, training, and support can enable CHWs to address barriers to care by negotiating with poorly functioning government services and community participation structures. Keywords : primary health care; access to care; community health workers; social determinants of health; accountability; South Africa (Published: 24 January 2013) Citation: Glob Health Action 2013, 6 : 19283 - http://dx.doi.org/10.3402/gha.v6i0.19283

InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries

Abstract: Background: Reliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are scanty, even though that is the region where most of the world’s AIDS deaths occur. There is therefore a great need for reliable and valid public health tools for assessing AIDS mortality. Objective: The aim of this article is to validate the InterVA-4 verbal autopsy (VA) interpretative model within African populations where HIV sero-status is recorded on a prospective basis, and examine the distribution of cause-specific mortality among HIV-positive and HIV-negative people. Design: Data from six sites of the Alpha Network, including HIV sero-status and VA interviews, were pooled. VA data according to the 2012 WHO format were extracted, and processed using the InterVA-4 model into likely causes of death. The model was blinded to the sero-status data. Cases with known pre-mortem HIV infection status were used to determine the specificity with which InterVA-4 could attribute HIV/AIDS as a cause of death. Cause-specific mortality fractions by HIV infection status were calculated, and a person-time model was built to analyse adjusted cause-specific mortality rate ratios. Results: The InterVA-4 model identified HIV/AIDS-related deaths with a specificity of 90.1% (95% CI 88.7-91.4%). Overall sensitivity could not be calculated, because HIV-positive people die from a range of causes. In a person-time model including 1,739 deaths in 1,161,688 HIV-negative person-years observed and 2,890 deaths in 75,110 HIV-positive person-years observed, the mortality ratio HIV-positive:negative was 29.0 (95% CI 27.1-31.0), after adjustment for age, sex, and study site. Cause-specific HIV-positive:negative mortality ratios for acute respiratory infections, HIV/AIDS-related deaths, meningitis, tuberculosis, and malnutrition were higher than the all-cause ratio; all causes had HIV-positive:negative mortality ratios significantly higher than unity. Conclusions: These results were generally consistent with relatively small post-mortem and hospital-based diagnosis studies in the literature. The high specificity in cause of death attribution achieved in relation to HIV status, and large differences between specific causes by HIV status, show that InterVA-4 is an effective and valid tool for assessing HIV-related mortality. Keywords: HIV/AIDS; mortality; Africa; verbal autopsy; InterVA; Alpha Network (Published: 18 October 2013) Citation: Glob Health Action 2013, 6 : 22448 - http://dx.doi.org/10.3402/gha.v6i0.22448 SPECIAL ISSUE This paper is part of the Special Issue Measuring HIV Associated Mortality in Africa . More papers from this issue can be found here and here .

Self-rated health and associated factors among older South Africans: evidence from the study on global ageing and adult health

Abstract: Background: Population ageing has become significant in South African society, increasing the need to improve understandings of health and well-being among the aged. Objective: To describe the self-reported ratings of overall health and functioning, and to identify factors associated with self-rated health among older South Africans. Design: A national population-based cross-sectional survey, with a sample of 3,840 individuals aged 50 years and older, was completed in South Africa in 2008. Self-reported ratings of overall health and functioning were measured using a single self-reported health state covering nine health domains (used to generate the Study on Global Ageing and Adult Health (SAGE) composite health state score). Disability was measured using the World Health Organization Disability Assessment Schedule II (WHODAS-II) activities of daily living (ADLs), instrumental activities of daily living (IADLs), perceptions of well-being, and the World Health Organization Quality of Life index/metric (WHOQoL). Results: Overall, more than three quarters (76.8%) of adults rated their health as moderate or good. On balance, men reported very good or good health more often than women ( p <0.001). Older people (aged 70 years and above) reported significantly poorer health status than those aged 50-59 (adjusted odds ratio (AOR) 1.52; 95% confidence interval (CI) 1.00-2.30). Indians and Blacks were significantly more likely to report poorer health status at (AOR =4.01; 95% CI 1.27-12.70) and (AOR =0.42; 95% CI 0.18-0.98; p =0.045), respectively, compared to Whites. Respondents with primary education (AOR = 1.83; 95% CI 1.19-2.80) and less than primary education (AOR =1.94; 95% CI 1.37-2.76) were more likely to report poorer health compared to those with secondary education. In terms of wealth status, those in low wealth quintile (AOR =2.02; 95% CI 1.14-3.57) and medium wealth quintile (AOR =1.47; 95% CI 1.01-2.13) were more likely to report poorer health status than those in high wealth quintile. Overall, the mean WHODAS-II score was 20%, suggesting a low level of disability. The mean WHOQoL score for females (Mean =51.5; SD =12.2) was comparable to that of males (Mean =49.1; SD =12.6). Conclusion: The depreciation in health and daily functioning with increasing age is likely to increase demand for health care and other services as people grow older. There is a need for regular monitoring of the health status of older people to provide public health agencies with the data they need to assess, protect, and promote the health and well-being of older people. Keywords: adult health; ageing; self-reported health; disability; quality of life; SAGE; South Africa; WHODAS-II; WHOQoL; ADLs; IADLs (Published: 6 February 2013) Citation: Glob Health Action 2013, 6 : 19880 - http://dx.doi.org/10.3402/gha.v6i0.19880 This paper is part of the thematic cluster Improving health and living conditions for elderly populations - more papers from this cluster can be found here .