The DREAM model's effectiveness in health promotion of AIDS patients in Africa

This study evaluates the effectiveness of a holistic model fortreating people living with AIDS in Africa; the model aims toimprove knowledge about AIDS prevention and care, increase trustin the health centre, impact behaviour, and promote a high levelof adherence to HAART. The study took place in the context ofthe DREAM (Drug Resource Enhancement against AIDS and Malnutrition)programme in Mozambique, designed by the Community of Sant'Egidioto treat HIV patients in Africa. It provides patients with freeanti-retroviral drugs, laboratory tests (including viral load),home care and nutritional support. This is a prospective studyinvolving 531 patients over a 12-month period. The patients,predominantly poor and with a low level of education, demonstrateda good level of knowledge about AIDS (more than 90% know howit is transmitted) and trust in the treatment, with a relativelysmall percentage turning to traditional healers. Overall thepatients had a low level of engaging in risky sexual behaviourand a very good level of adherence to HAART (69.5% of the 531subjects had a pill count higher than 95%). The positive resultsof the programme's educational initiatives were confirmed withthe patients' good clinical results.     

HIV/AIDS control in Africa: the importance of epidemiological and health promotion approaches

HIV infection and AIDS are disproportionately afflicting ThirdWorld countries, especially the countries of Africa, where substantialadult communities and villages are literally being annihilated.Because there is no known cure for HIV/AIDS, and because ofthe high costs of current antiviral therapy (e.g. AZT), it isa cost-effective use of health resources for the economicallypoor countries of Africa to use health promotion/ educationto intervene and control the incidence of HIV infection andAIDS. Crucial to any effective health promotion effort is athorough knowledge about the epidemiological specifics and distributionof HIV/AIDS in Africa, the known at-risk segments of the population,and the known at-risk conditions (e.g. male–female relationships,stress) and behaviours (e.g. peer and other pressures to engagein unprotected sex) for HIV infection. For health promotionto be successful it has to be unrelentingly applied to all at-riskgroups in African societies, region-specific and culturallysensitive, and it has to acquire active cooperation from allmembers of the community of African nations.     

Restructuring public health in Ontario: implications for heart health promotion

Community-based heart health promotion is viewed as an effective means of reducing cardiovascular disease risk. Although public health agencies have a central role in the implementation and dissemination of heart health programmes, their effectiveness is being challenged by major structural changes to Provincial public health systems across Canada, although the impacts of the changes have received relatively little attention in the research literature. As part of the Canadian Heart Health Initiative--Ontario Project (CHHIOP), this study used a qualitative approach to address the perceived implications of these changes to Ontario's public health system for heart health promotion. Interviews (n = 38) were conducted in eight public health units with staff most familiar with managing and/or delivering heart health activities. The results are mixed; that is, while many see the future of heart health promotion programming in Ontario as being at risk, others see recent changes as a step forward toward their institutionalization, particularly in light of recent funding decisions made by the Ministry of Health's Health Promotion Branch.     

Powerlessness, empowerment, and health: implications for health promotion programs

PURPOSE AND SCOPE. This article reviews the health and social science research relevant to both the role of powerlessness as a risk factor for disease, and the role of empowerment as a health-enhancing strategy. The research literature surveyed includes studies that address these key concepts from the fields of social epidemiology, occupational health, stress research, social psychology, community psychology, social support and networks, community competence and community organizing. Definitions are provided to operationalize these sometimes loosely-applied terms. IMPORTANT FINDINGS. Powerlessness, or lack of control over destiny, emerges as a broad-based risk factor for disease. Empowerment, though more difficult to evaluate, can also be demonstrated as an important promoter of health. MAJOR CONCLUSIONS. Given the importance and currency of these concepts of powerlessness and empowerment, a model of empowerment education is proposed for health-promotion practitioners. Measurement of empowerment raises issues for researchers on how to test the multiple personal and community changes that may result from an empowering education intervention.     

Social determinants of health: implications for environmental health promotion.

In this article, the authors draw on the disciplines of sociology and environmental and social epidemiology to further understanding of mechanisms through which social factors contribute to disparate environmental exposures and health inequalities. They propose a conceptual framework for environmental health promotion that considers dynamic social processes through which social and environmental inequalities--and associated health disparities--are produced, reproduced, and potentially transformed. Using empirical evidence from the published literature, as well as their own practical experiences in conducting community-based participatory research in Detroit and Harlem, the authors examine health promotion interventions at various levels (community-wide, regional, and national) that aim to improve population health by addressing various aspects of social processes and/or physical environments. Finally, they recommend moving beyond environmental remediation strategies toward environmental health promotion efforts that are sustainable and explicitly designed to reduce social, environmental, and health inequalities.     

Health on the Internet: implications for health promotion

The aim of this article is to discuss the implications of health on the Internet for health promotion, focusing in particular on the concept of empowerment. Empowering aspects of health on the Internet include the enabling of advanced information and knowledge retrieval, anonymity and convenience in accessing information, creation of social contacts and support independent of time and space, and challenging the expert-lay actor relationship. The disempowering aspects of health on the Internet are that it involves a shift towards the expert control and evaluation of sources of health information, that it widens the gap between 'information-rich' and 'information-poor' users, thus reproducing existing social divisions, and that the increase in medicalization and healthism results in increased anxiety and poorer health. The health promotive and empowering strategies presented in this article are directed at strengthening people's ability to evaluate different information sources in relation to their own interests and needs rather than in relation to scientific and/or professional standards.     

Understanding childrens' health behaviour: the implications for health promotion for young people

Understanding the causes and determinants of young people's health behaviour is central to the development of relevant and effective health promotion programmes. This paper traces the development of health education programmes in the past two decades, identifying the influence of a range of concepts and theories which emerged during that period. Drawing on results from a WHO Cross-National Study of children's health behaviour, the relationships between individual behaviours and a range of social and environmental influences are illustrated, together with the inter-relationship between individual behaviours as 'lifestyles'. The implications for health education programmes from the results are identified and special emphasis is given to the need to communicate effectively with young people through a range of networks and through the media, as well as through traditional school health education. The need to continue research into 'lifestyles' is also stressed.     

Household and community HIV/AIDS status and child malnutrition in sub-Saharan Africa: evidence from the demographic and health surveys

This paper examines the extent to which under five children in households or communities adversely affected by HIV/AIDS are disadvantaged, in comparison with other children in less affected households/communities. The study is based on secondary analysis of the Demographic and Health Survey (DHS) data collected during 2003-2008 from 18 countries in sub-Saharan Africa, where the DHS has included HIV test data for adults of reproductive age. We apply multilevel logistic regression models that take into account the effect of contextual community/country level HIV/AIDS factors on child malnutrition. The outcome variable of interest is child undernutrition: stunting, wasting and underweight. The results suggest that across countries in sub-Saharan Africa, children whose mothers are infected with HIV are significantly more likely to be stunted, wasted or underweight compared to their counterparts of similar demographic and socio-economic background whose mothers are not infected. However, the nutritional status of children who are paternal orphans or in households where other adults are HIV positive are not significantly different from non-orphaned children or those in households where no adult is infected with HIV. Other adult household members being HIV positive is, however, associated with higher malnutrition among younger children below the age of one. Further analysis reveals that the effect of mothers' HIV status on child nutritional status (underweight) varies significantly across communities within countries, the effect being lower in communities with generally higher levels of malnutrition. Overall, the findings have important implications for policy and programme efforts towards improved integration of HIV/AIDS and child nutrition services in affected communities and other sub-groups of the population made vulnerable by HIV/AIDS. In particular, children whose mothers are infected with HIV deserve special attention.     

Employee stress claims: increasing implications for health promotion programming

Abstract Characterized as "the Nation's fastest growing occupational disease" by the National Council on Compensation Insurance, stress has become a major issue for corporate leaders today. With the recent rise in high cost stress claims, organizations have become interested in preventing potential stress problems. This article discusses types of stress claims, individual and occupational risks, reasons given for filing claims, efforts aimed at prevention, and future outlooks. Finally, the implications for health promotion programming in providing a multi-dimensional approach to preventing the physical, psychological and economic impact of stress, are discussed.     

Obesity in South Africa: the South African demographic and health survey

OBJECTIVES: To ascertain the anthropometric profile and determinants of obesity in South Africans who participated in the Demographic and Health Survey in 1998. RESEARCH METHODS AND PROCEDURES: A sample of 13,089 men and women (age, > or =15 years) were randomly selected and then stratified by province and urban and nonurban areas. Height, weight, mid-upper arm circumference, and waist and hip circumference were measured. Body mass index (BMI) was used as an indicator of obesity, and the waist/hip ratio (WHR) was used as an indicator of abdominal obesity. Multivariate regression identified sociodemographic predictors of BMI and waist circumference in the data. RESULTS: Mean BMI values for men and women were 22.9 kg/m(2) and 27.1 kg/m(2), respectively. For men, 29.2% were overweight or obese (> or =25 kg/m(2)) and 9.2% had abdominal obesity (WHR > or =1.0), whereas 56.6% of women were overweight or obese and 42% had abdominal obesity (WHR >0.85). Underweight (BMI <18.5 kg/m(2)) was found in 12.2% of men and 5.6% of women. For men, 19% of the variation of BMI and 34% of the variation in waist circumference could be explained by age, level of education, population group, and area of residence. For women, these variables explained 16% of the variation of BMI and 24% of the variation in waist circumference. Obesity increased with age, and higher levels of obesity were found in urban African women. DISCUSSION: Overnutrition is prevalent among adult South Africans, particularly women. Determinants of overnutrition include age, level of education, ethnicity, and area of residence.