Urbanisation and women's health in Khayelitsha. Part I. Demographic and socio-economic profile

Demographic and socio-economic data and information on migration patterns and urban/rural links was collected from 722 households in the formal housing area and the serviced and the unserviced site areas of Khayelitsha; 659 women and 61 men were interviewed. Thirty-eight per cent of the population were aged under 15 years and 77% under 35 years. There was a predominance of females in the 5-35-year age group. There was a mean of 4.9 persons per household, and 93.5% of sites contained 1 dwelling. Of the 659 female respondents, 7% had received no formal education, 39% had primary school education, and 54% had secondary school education. Unemployment among women was 45%. Domestic service accounted for 66.2% of formal employment. Of all women 86% were unskilled, 71.9% had been born in a 'homeland', and 69.7% had migrated to an urban area before 1985. Ties to the rural areas were strong, particularly in the 'shack' areas. 'New arrivals' to an urban area were young, mostly unemployed, and lived in the worst environmental conditions. In the unserviced 'shack' areas, 47.5% of women had migrated to an urban area in the last 5 years. There are important target areas for a study of the health effects of urbanisation and for possible interventions. This study tends to confirm the 'quadruple' oppression of women in Khayelitsha, on the basis of race, social class and gender and as new arrivals in an urban environment.     

Child health and health care utilisation. A community-based survey in Mitchell's Plain, CP

A community-based study of proxy-reported illness and health care use by children under 15 years of age in Mitchell's Plain, CP, is reported. The most commonly reported acute illness was respiratory infection and the most commonly reported chronic illness was asthma. There are estimated to be 1.82 consultations/child/year for acute illness. Fifty per cent of first-contact acute care was provided by private general practitioners. The public sector provided the remainder, and also care for the more severe acute illness and treated chronic illness. Medical aid was an important determinant of access to after-hours care. There is a need for an extended after-hours public sector service and similar studies elsewhere would be beneficial.     

Assessment of health services on relevant primary health care principles in internally displaced people of pakistan based on sphere standards and indicators

SPHERE based assessment of internally displaced persons camp was done to assess health services on relevant primary health care principles using a cross-sectional survey in Jalozai Camp, Pakistan. Most of the households (74%, n=87) had access to health education addressing issues to protect and promote their health which was provided at household level (83%, n=72), community level (44%, n=38) and health centre level (13%, n=11). All the health facilities were culturally and socially acceptable in terms of language, separate waiting rooms, presence of female health providers and language translators. A referral system was in place which provided free transport in (67%, n=2) health facilities to tertiary care hospitals. Health services provided were culturally and socially acceptable and efforts on health education were also appreciable, except that no health education or intervention was done on HIV AIDS. Referral should be made to referral facilities within the districts instead of directly to tertiary care hospitals.     

Sexual and reproductive health service needs of university/college students: updates from a survey in Shanghai, China

AIM: To promote the provision of reproductive health services to young people by exploring the attitudes and perceptions of university students in Shanghai, China, toward reproductive health. METHODS: From July 2004 to May 2006, 5 243 students from 14 universities in Shanghai took part in our survey. Topics covered the demands of reproductive health-care services, attitudes towards and experience with sex, exposure to pornographic material, and knowledge on sexual health and sexually transmitted infections (STIs)/AIDS. RESULTS: Of the 5 067 students who provided valid answer sheets, 50.05% were female and 49.95% were male, 14.86% were medical students, and 85.14% had non-medical backgrounds. A total of 38.4% of respondents had received reproductive health education previously. The majority of students supported school-based reproductive health education, and also acquired information about sex predominantly from books, schoolmates, and the Internet. Premarital sexual behavior was opposed by 17.7% of survey participants, and 37.5% could identify all the three types of STIs listed in the questionnaire. Although 83.7% knew how HIV is transmitted, only 55.7% knew when to use a condom and 57.8% knew that the use of condoms could reduce the risk of HIV infection. CONCLUSION: The reproductive health service is lagging behind current attitudes and demands of university students. Although students' attitudes towards sexual matters are liberal, their knowledge about reproductive health and STIs/AIDS is still limited. It is therefore necessary to provide effective and confidential reproductive health services to young people.     

Effect of a mother-to-child HIV prevention programme on infant feeding and caring practices in South Africa.

OBJECTIVES: To conduct a rapid assessment of the impact of the Khayelitsha Prevention of Mother-to-Child Transmission (MTCT) programme on infant care practices among programme participants and the local population. STUDY DESIGN: Cross-sectional survey and qualitative in-depth interviews. SETTING. Khayelitsha, a large formal and informal settlement of about 300,000 people on the outskirts of Cape Town. At the time of the study the HIV seroprevalence rate among antenatal women was about 15% and the MTCT programme had enrolled nearly 800 infected women. SUBJECTS: Seventy randomly selected caregivers with young children in the survey; in-depth structured interviews with 11 nutrition counsellors and 11 mothers enrolled in the programme. RESULTS: Caregivers have good knowledge of the spread and prevention of HIV. A majority knew that breast-feeding can transmit HIV but 90% stated that this did not affect their feeding decisions. Over 80% had stopped exclusively breast-feeding by the time their infants were 3 months of age. All of the respondents felt that being diagnosed HIV-positive would result in serious social and domestic consequences. None of the health workers could correctly estimate the risk of spreading HIV through breast-feeding and many reported feeling confused about what they should counsel mothers. All the mothers on the programme reported exclusive formula-feeding. Some had serious problems with preparation and feeding of formula milk. Nearly all reported running out of feeds before being able to fetch new supplies. None reported any negative social effects of not breast-feeding. Most of the mothers endorsed the programme and felt that it had given them strength to face up to and plan for the consequences of their diagnosis. CONCLUSION: This rapid appraisal of the infant feeding and care component of the MTCT programme has raised a number of important challenges which health managers and policymakers need to address. Similar assessments in the new pilot sites will be important.     

Health services--needs of the elderly in two black urban areas of the Cape Peninsula

The availability and utilisation of essential social and health services were studied in two urban areas, Langa, an established township well within the city boundaries, and Khayelitsha, a newly established and fast-growing township on the margin of the city. They are approximately 10 km and 30 km respectively from the central business district of Cape Town. Random cluster samples were drawn of 195 residents in Langa and of 170 in Khayelitsha (age range 59-89 years). Respondents' knowledge and use of the following services were ascertained: social, shopping, transport, doctors, clinics and services centres for the aged. The questionnaire was adapted from the widely used Duke Older American Resources and Services strategy and Gurland's Comprehensive Assessment and Referral Evaluation. Most of the elderly in both areas know where to obtain health and social services and transport. Residents of Langa have been in Cape Town much longer and therefore have fewer problems in using the services when needed. The people in Khayelitsha use the social worker services much more than the Langa residents.     

Availability of environmental health services among blacks in urban and peri-urban areas of South Africa.

Fundamental to primary health care is the need to provide adequate environmental health services to the population. Such services constitute primary prevention, and, under some circumstances, may have a greater impact on health than the provision of personal health services. This study aimed to assess the availability of environmental health services among blacks living in urban and peri-urban areas of South Africa. A stratified random sample of 800 households was selected. After discussions with the Urban Foundation, it was felt that the proportion of informal dwellings obtained (20%) underestimated the true figure, which was closer to 50%. For that reason estimates are presented for a range of values (20-50% informal dwellings). For environmental health services the percentage availability was 30-45% for reticulated water in the home; 18-29% for an inside flush toilet; and 48-62% for possession of a personal refuse receptacle. Data obtained on domestic fuel use indicated that 41-61% of households had electricity. General indicators of social class showed that 62% of households had a monthly income less than R400, and that 22-30% of mothers with children under 5 years of age had an educational level of less than Standard 5. All of the measures were substantially worse among people living in informal dwellings. The data indicate that urgent attention should be given to improving the foundations of primary health care, particularly by providing and giving attention to equity, intersectoral co-ordination and community participation in the provision of essential environmental health services.     

The influence of news events on health after disaster: A longitudinal study in general practice

This study investigates the influence of local and international news events on utilization of health services resources and health complaints as presented by victims of a fireworks depot disaster. It was hypothesized that victims (N = 2,854) will show more utilization and health complaints to their general practitioner (GP) in the week after 11 local news reports of events relating to the specific index trauma and 6 unrelated disasters reported in international print news, than the week before. Health data of victims and matched controls were extracted from electronic medical records, covering 4‐years postdisaster. Especially local news events concerning the cause of the disaster were associated in both victims and controls with an increase of GP utilization and health complaints, including medically unexplained physical symptoms, chronic diseases, and psychological problems. No difference between victims and controls were found.     

Diarrhoeal diseases and oral fluid therapy in the Gelukspan health ward

This study reports the results on diarrhoeal disease and oral fluid therapy (OFT) obtained during a survey on maternal knowledge and child health in the Gelukspan health ward (GHW) in 1985-1986. We studied 210 women sampled by means of a multistage sampling procedure. Strict selection criteria ensured that the baby had been born in the GHW, that it was the first-born and the only child, and that it had been cared for by the mother from birth until the time of interviewing. All the children were between 12 and 24 months old. Information was collected by interviewing the mother and by analysing data on the home-retained 'Road to Health' cards (RTHCs) of the study children. Ninety-three per cent of the children had an RTHC and 97% of these had at least one record about reasons to visit the health service. Most visits were 'well' visits (71%), 18% were associated with respiratory tract complaints, and 12% were associated with gastro-intestinal complaints (most commonly diarrhoea). Sixty-three per cent of children with data on visits to the health services attended at least once with gastro-intestinal complaints during the first year of life. About two-thirds of the mothers knew the composition of an acceptable oral fluid solution for home therapy of diarrhoeal disease. Only 40% knew how frequently it should be given and only a quarter knew how much to give. After multivariate analysis the only independent variables that remained predictors of knowledge on OFT were maternal knowledge on signs and symptoms of dehydration (SSD) and frequency of gastro-intestinal complaints as recorded on the RTHC.(ABSTRACT TRUNCATED AT 250 WORDS)     

High prevalence of abnormal Pap smears among young women co-infected with HIV in rural South Africa - implications for cervical cancer screening policies in high HIV prevalence populations.

OBJECTIVE: To establish the relationship between HIV infection and cervical dysplasia in young women in rural South Africa. METHODS: This cross-sectional study was conducted at a primary health care clinic in Vulindlela, KwaZulu- Natal. Standardised questionnaires were used to collect sociodemographic and clinical presentation data from women attending family planning and other reproductive health services. Pap smears were done using standard methods. Pap smear data were linked to HIV serostatus. RESULTS: Four hundred and sixty-six women were included in the study. The median age was 24.3 years (range 15 - 55 years), and 80% were younger than 30 years. The HIV prevalence rate was 24.5% (95% confidence interval: 20.7 - 28.7%) and the prevalence of abnormal Pap smears was 16.9 - 6.4% ASCUS (atypical squamous cells of undetermined significance), 9.2% LGSIL (low-grade squamous intraepithelial lesions), and 1.3% HGSIL (high-grade squamous intraepithe lial lesions). The association between HIV seropositivity and abnormal Pap results was statistically significant (p < 0.05). CONCLUSION: There is a need for more data on cervical changes in HIV co-infected women and for review of guidelines on selective Pap smear screening in high HIV prevalence settings such as sub-Saharan Africa and where access to antiretroviral treatment remains limited.     

Awareness and health beliefs of women towards osteoporosis

A population-based survey was conducted to determine the awareness, knowledge of risk factors, and attitudes toward osteoporosis in middle-aged and elderly women in Singapore. Chinese women aged 45 years and above (n=1,376) living in Teban Gardens (community on the western side of Singapore) were randomly sampled. Household interviews were conducted and questions on socioeconomic status, knowledge of osteoporosis, identification of risk factors for osteoporosis, and health beliefs were assessed. There were 946 (68.8%) women who were postmenopausal and 430 (31.2%) who were not. Fifty-eight percent of the sample had heard of osteoporosis. Women who were younger, better educated, who exercised regularly, or who were single were more likely to have heard of osteoporosis. The main sources of information about osteoporosis were the mass media and friends. The identification of risk factors ranged from fair to good: 85.7% of women identified low calcium intake, 43.7% identified lack of exercise, and 30.5% identified family history of osteoporosis as risk factors for osteoporosis. Most women (79.1%) were concerned about developing osteoporosis but only 15.2% thought that osteoporosis was more serious than cancer. Community-based health education programs on osteoporosis that target a wide audience including the less well educated, could be implemented. Increasing the awareness of osteoporosis and its risk factors may be essential in efforts to decrease the incidence of this disease.     

Perinatal health in the peri-urban township of Khayelitsha, Cape Town. Part I. Mothers and their newborn infants

The satellite 'city' of Khayelitsha lies some 40 km south-east of the centre of metropolitan Cape Town. The first phase of the development, Town 1, including a large 'squatter' area, accommodates approximately 150,000 people at present. It is envisaged that ultimately the entire 3,200 ha site will house between 250,000 and 350,000 people. In order to obtain useful planning information for future community obstetric and neonatal health care services, a survey of all births within the Peninsula Maternal and Neonatal Service (PMNS) during 1986 was undertaken. Of a total of 2,113 mothers from Khayelitsha, 2,000 (94.7%) gave birth to a live singleton infant. The mean maternal age was 26.2 years, 15.1% of mothers being under 20 years of age. The mean parity was 3.03, and 18.3% of mothers were having their first baby. Only 3.1% of mothers booked early (in the first trimester); however, 91.9% were booked before delivery. The average number of prenatal visits was 3. The largest proportion of mothers (43.1%) delivered at the Heideveld midwife obstetric unit (MOU). There was an overall pre-term rate of 7.6%, while 8.8% of infants were of low birth weight (LBW) (less than 2,500 g). In addition, 51.4% of the LBW infants were born at term. The mean birth weight was 3,160 g. The largest proportion of mothers (53.6%) were residents of the 'squatter' area. No statistically significant differences in obstetric features, maternal characteristics and pregnancy outcome were discernible between the squatter, site-and-service, and core housing areas of Khayelitsha, with the exception of higher maternal weight, earlier booking and more antenatal visits in the group from the core housing area.     

Health Problems Among Latin-American and Middle-Eastern Refugees in the Netherlands: Relations With Violence Exposure and Ongoing Sociopsychological Strain

In two studies (n = 480; n = 156), the health problems (somatic, psychological, and migration-related complaints) of refugees were examined, in relation to violence, demographic, and asylum variables (ongoing sociopsychological strain). High frequencies for torture events and a substantial number of medical complaints were reported, but few cases of diagnosable Posttraumatic Stress Disorder (PTSD) were identified (Study I: 6%; Study II: 11%). Not only reported violence, but also the current social situation contributed to the experiencing of ongoing health complaints. Refugees attributed their somatic and psychological complaints to illness (48%) and to torture (29%) and psychological complaints, in particular, to worries related to the postmigration situation (40%). Paying attention only to health complaints and to past violent experiences is too limited an approach in responding to the needs of refugees.     

Symptoms of urinary and faecal incontinence among men and women 75+ in relations to health complaints and quality of life

AIMS: The aim was to investigate the prevalence of self-reported symptom of urinary, faecal, and double incontinence (UI, FI, and DI) in men and women 75+ and to identify how other health complaints and Quality of Life (QoL) relate to incontinence symptoms. METHODS: A randomised sample, stratified for age, of eligible men and women from the population were included in the study and 4,277 out of 8,500 completed a postal questionnaire (61.6% women). The questions focused on difficulties in controlling urine and faeces, other health complaints, socio-economic background, and social relations. RESULTS: Among all respondents 39% reported symptom of UI (more so among women P < 0.001), symptom of FI in 16.9% (ns between sexes), DI, i.e., a combination of UI and FI, was reported among 14.5% (ns between sexes). Incontinence increased with age, and persons reporting incontinence also had significantly more of all other health complaints compared with persons without incontinence. Those reporting DI comprised an especially vulnerable group. Health complaints associated with UI were communicative and mobility problems, other urinary complaints, dizziness, cough, and fatigue. FI was associated with diarrhoea, stomach pain, fatigue, and other pain. Risk factors for DI were diarrhoea, communication, and mobility problems. CONCLUSIONS: UI and FI were common among elderly men and women and increased with age. Furthermore, incontinence was associated with many other co-existing health complaints, and the most frail were those with DI.     

赴利比里亚维和军人接受艾滋病自愿咨询检测的意愿及影响因素的调查

目的:调查赴利比里亚维和的中国和埃塞俄比亚军人接受艾滋病自愿咨询检测(VCT)的意向和与之相关的影响因素,为进一步开展艾滋病健康教育及VCT提供依据。方法:采用匿名问卷表,调查518例23～51岁的男性中国赴利比里亚维和军人和648例25～49岁的男性埃塞俄比亚维和军人接受VCT的意向并分析相关的影响因素。结果:两国维和军人中从未听说过艾滋病的比例分别为8.1%和7.9%,两者比较P>0.05。在听说过艾滋病的调查对象中,分别有407例(85.5%)的中国维和军人和449例(75.2%)的埃塞俄比亚维和军人有接受VCT的意向,两者比较P<0.05。与两国维和军人接受VCT意向均有关联的因素为受教育的程度和艾滋病知识水平,与埃塞俄比亚维和军人接受VCT有关的因素还有自己感染艾滋病的可能性。结论:艾滋病知识知晓程度较低及受教育程度较低的维和军队接受VCT意向也较低。应有针对性地开展艾滋病知识的健康教育,提高维和军队接受VCT的自觉性及对艾滋病的警觉性,以有效地预防艾滋病。     

广州市白领女性对更年期知识和绝经激素治疗的认知现况调查

目的了解广州市白领女性对更年期知识和绝经激素治疗(MHT)的认知情况,为有针对性地开展生殖健康服务提供依据。方法采用调查问卷对广州市1 019名白领女性进行横断面研究。结果 47.60%(485/1 019)白领女性对更年期早期症状充分知晓,14.52%(148/1 019)对绝经远期危害充分知晓;43.30%(431/1 019)完全不知道MHT,45.34%(462/1 019)仅听说过但了解不多;40岁及以上白领女性更年期相关症状的发生率为73.11%(416/569),仅有6.15%(35/569)使用过MHT;77.72%(792/1 019)认为有必要或非常有必要科普更年期和MHT相关知识。结论广州市白领女性对更年期早期症状和绝经远期危害的认知度较差,MHT的使用率较低,对获得更年期和MHT相关知识有较大需求,有必要对该群体开展更年期和MHT相关知识的宣教,促进女性更年期健康。     

Socio-economic inequalities as a predictor of health in South Africa--the Yenza cross-sectional study.

OBJECTIVES: To describe the demographic, environmental and health characteristics of the rural Eastern Cape and to explore demographic and environmental predictors of health. DESIGN: Cross-sectional study. SETTING: Engcobo and Umtata in the Eastern Cape, South Africa. SUBJECTS: 12,049 people from 4608 households. OUTCOME MEASURES: (i) Children: immunisation history and being breastfed; (ii) women aged 15-45 years: use of contraception; (iii) women aged 20-25 years: total numbers of dead children; and (iv) all adults: smoking status, body mass index and blood pressure. RESULTS: 2741 houses (59.5%) were structurally adequate, 1795 (39.0%) had access to clean water, and 1174 (25.6%) had access to gas or electric energy. Of children up to 5 years of age 1436 (44.2%) were fully immunised and 2472 (76.1%) were breastfed in their first year of life. Among women aged 15-45 years, 903 (37.8%) used contraceptives, and among women aged 20-25 years, 56 (11.8%) had lost at least 1 child. Self-report of chronic illness and disability was low. Current smokers include 264 men (12.7%) and 325 women (6.0%), and 315 men (15.2%) and 1439 women (26.7%) had a body mass index > 30. Adequate housing (odds ratio (OR) 1.31, 95% confidence interval (CI): 1.12-1.53) and access to refuse disposal (OR 1.65, 95% CI: 1.36-2.00) were predictive of complete immunisation in children. Children living in houses with access to clean water (OR 0.8, 95% CI: 0.64-0.99) and a fitted toilet (OR 0.56, 95% CI: 0.38-0.83) were less likely to be breastfed in the first year of their life. Women aged 15-45 years were likely to use contraception if they were well educated (OR 2.75, 95% CI: 1.76-4.28) and lived in houses with access to refuse disposal (OR 1.46, 95% CI: 1.20-1.78). Better education was associated with a reduced likelihood of loss of a child (OR 0.11, 95% CI: 0.02-0.51) and being a smoker (OR 0.52, 95% CI: 0.38-0.73). Obesity was associated with being female (OR 1.88, 95% CI: 1.62-2.18) and living in a house with electricity (OR 1.46, 95% CI: 1.26-1.68). High blood pressure was associated with living in a house with electricity (OR 1.36, 95% CI: 1.10-1.70) and with monthly household income exceeding R2 000 (OR 1.38, 95% CI: 1.07-1.78). CONCLUSIONS: High socio-economic deprivation in the Eastern Cape is associated with health status comparable to that of poorer regions in sub-Saharan Africa. The educational level of the population, access to electricity, clean water and refuse disposal facilities are important predictors of child, maternal and adult health.     

Implementation of cervical cancer screening using visual inspection with acetic acid in rural Mozambique: successes and challenges using HIV care and treatment programme investments in Zambézia Province

Background

In order to maximize the benefits of HIV care and treatment investments in sub-Saharan Africa, programs can broaden to target other diseases amenable to screening and efficient management. We nested cervical cancer screening into family planning clinics at select sites also receiving PEPFAR support for antiretroviral therapy (ART) rollout. This was done using visual inspection with acetic acid (VIA) by maternal child health nurses. We report on achievements and obstacles in the first year of the program in rural Mozambique.

Methods

VIA was taught to clinic nurses and hospital physicians, with a regular clinical feedback loop for quality evaluation and retraining. Cryotherapy using carbon dioxide as the refrigerant was provided at clinics; loop electrosurgical excision procedure (LEEP) and surgery were provided at the provincial hospital for serious cases. No pathology services were available.

Results

Nurses screened 4651 women using VIA in Zambézia Province in year one of the program, more than double the Ministry of Health service target. VIA was judged positive for squamous intraepithelial lesions in 8% (n=380) of the women (9% if age ≥30 years (n=3154) and 7% if age <30 years (n=1497); p=0.02). Of the 380 VIA-positive women, 4% (n=16) had lesions (0.3% of 4651 total screened) requiring referral to Quelimane Provincial Hospital. Fourteen (88%) of these 16 women were seen at the hospital, but records were inadequate to judge outcomes. Of women screened, 2714 (58%) either had knowledge of their HIV status prior to VIA or were subsequently sent for HIV testing, of which 583 (21%) were HIV positive.

Conclusions

Screening and clinical services were successfully provided on a large scale for the first time ever in these rural clinics. However, health manpower shortages, equipment problems, poor paper record systems and a limited ability to follow-up patients inhibited the quality of the cervical cancer screening services. Using prior HIV investments, chronic disease screening and management for cervical cancer is feasible even in severely resource-constrained rural Africa.     

Knowledge, attitudes and beliefs about AIDS in township school students in Cape Town

Students (N = 377) from four Cape Town township high schools were surveyed to obtain information on their knowledge of and attitudes towards the acquired immunodeficiency syndrome (AIDS), and on their sexual behaviour. The study was undertaken to provide information for planning an AIDS education intervention. Three-quarters of students reported that they had had sexual intercourse. Most students had heard of AIDS, and the majority of these knew that it was infectious. More than half of the students were confused or lacked knowledge about the modes of transmission. Two-thirds of the students believed AIDS could be prevented, but knowledge of prevention strategies was superficial. Of the sexually active students only 11.4% had ever used a condom, and of all students 39.6% stated that they would use a condom in the future. Two-thirds of the students were not aware that there is no cure for AIDS. Students did not acknowledge that AIDS could affect them directly, and attributed the problem to prostitutes and 'promiscuous' people in 36.4% of responses, and to 'white' people in 23.8% of responses. Students expressed intolerance, fear and rejection of people with AIDS, and only 6.4% would accept an affected person into their class. Almost all the students wanted AIDS education at school, and most of these requested that the school nurse facilitate this education. It is concluded that appropriate AIDS prevention education is urgently required for both high school and junior school students.