Antimicrobial Agents and Chemotherapy, Sep 1, 2011
Among patients with tuberculosis, rifampin plasma concentrations and sputum conversion rates have... more Among patients with tuberculosis, rifampin plasma concentrations and sputum conversion rates have been reported to be lower in Africans. Rifampin is a substrate of P-glycoprotein (coded for by the ABCB1 gene) and organic anion-transporting polypeptide 1B1 (coded for by SLCO1B1). The objectives were to identify genetic polymorphisms of drug transporters and the transcriptional regulators pregnane X receptor (PXR) and constitutive androstane receptor (CAR) with an impact on rifampin pharmacokinetics in South Africans. Fifty-seven patients with tuberculosis from Cape Town underwent pharmacokinetic sampling during treatment with rifampin, pyrazinamide, isoniazid, and ethambutol. DNA was genotyped for ABCB1, SLCO1B1, PXR, and CAR polymorphisms by using real-time PCR. NONMEM was used for data analysis. The allele frequency of the SLCO1B1 rs4149032 polymorphism was 0.70. Patients heterozygous and homozygous for this polymorphism had reductions in the bioavailability (and, thus, the area under the curve [AUC]) of rifampin of 18% and 28%, respectively. Simulations showed that increasing the daily rifampin dose by 150 mg in patients with the polymorphism would result in plasma concentrations similar to those of wild-type individuals and reduce the percentage of patients with peak plasma concentrations (C max) below 8 mg/liter from 63% to 31%. ABCB1, PXR, and CAR polymorphisms were not associated with differences in rifampin pharmacokinetics. SLCO1B1 rs4149032 was present in most patients and was associated with substantially reduced rifampin exposure. These data suggest that the standard recommended dose of rifampin should be reconsidered for South Africans.
Objective: Childhood obesity is on the rise in South Africa (SA), and child-directed marketing (C... more Objective: Childhood obesity is on the rise in South Africa (SA), and child-directed marketing (CDM) is one of the contributing factors to children's unhealthy food choices. This study assessed CDM on packaged breakfast cereals available in SA supermarkets and their nutritional quality. Design: Photographic images were examined in a descriptive quantitative study. A codebook of definitions of CDM was developed for this purpose. REDCap, an online research database, was used for data capturing, and SPSS was used for data analyses including cross-tabulations and one-way ANOVA. Setting: The current study was set in the Western Cape province of SA. Subjects: Photographic images of all packaged breakfast cereals sold in major retailers in the Western Cape province of SA in 2019 were studied. Results: CDM strategies were classified as direct (to the child) or indirect (through the parent). A total of 222 breakfast cereals were studied, of which 96•9 % had a nutritional or health claim, 95•0 % had illustrations, 75•2 % had product and consumption appeals, 10•8 % had characters, 10•8 % consisted of different appeals, 8•6 % alluded to fantasy and 7•7 % had role models. In breakfast cereals with direct CDM, the protein and fibre content was significantly lower than in breakfast cereals without direct CDM. This study found a significantly higher total carbohydrate and total sugar content in breakfast cereals with direct CDM than those without direct CDM. Conclusion: CDM was highly prevalent in breakfast cereals sold in SA. Regulations to curb the marketing of packaged foods high in nutrients of concern is recommended.
International Journal of Environmental Research and Public Health, Feb 19, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Objective: To provide an update on the compliance to the Na reduction regulation (R.214) and to h... more Objective: To provide an update on the compliance to the Na reduction regulation (R.214) and to highlight some challenges and successes experienced by South Africa in the implementation of a mandatory Na regulation. Design: The study design was observational. Nutritional information of packaged food (specified in the R.214 regulation) was collected between February 2019 and September 2020, before and after the implementation date of the final Na targets in the regulation. Six supermarket chains that accounted for more than 50 % of the grocery retailer market share in South Africa were included. The Na content (per 100 g) of products was extracted from photographs. Products were classified according to the thirteen food categories included in R.214. The percentage of targeted food categories that met the pre and post-regulation targets as well as the percentage by which Na limits were exceeded was calculated. Setting: Low-and-middle-income suburbs in Cape Town, South Africa. Participants: N/A. Results: A total number of 3278 products were analysed. After the final implementation date, none of the categories targeted by the R.214 regulation fully complied. However, nine out of the thirteen food categories targeted by R.214 were above the 70 % compliance mark. Conclusions: The compliance to R.214 in South Africa is good, although not 100 % compliant. This research also highlights the complexities regarding the monitoring and evaluation of a national regulation. Findings from the current study could aid by providing valuable information to countries in the process of implementing a Na reduction strategy.
In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) c... more In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) commonly being used in ways that are detrimental to infant and young child nutrition, health and survival. The use of internet, digital and mobile platforms has increased, including in low-income and middle-income countries, like SA and these platforms are avenues for BMS marketing. SA has national legislation (Regulation R991) to enforce the International Code of Marketing of BMS. This paper aims to provide pertinent examples of how BMS manufacturers in SA use social media to market their products thus violating national regulations. A digital (and social media) ethnography approach was used to study BMS organisations' activity on Facebook and Instagram. Purposively selected examples of social media posts observed (from 2015 to 2019) were included, and content analysed in terms of national legislation. Several examples of BMS social media marketing are presented and interpreted according to provisions of national regulations that they violate. BMS manufacturers have found ways on social media to market their products in a media space that is complex to regulate, and where it is difficult to enforce national regulations. It is necessary to engage with stakeholders, notably social media companies, to alert them to relevant regulations applicable to their platforms. Monitoring the marketing of products for infants and young children by national governments needs to include online and digital platforms especially social media.
In most low- and middle-income countries (LMICs), household out-of-pocket (OOP) health spending c... more In most low- and middle-income countries (LMICs), household out-of-pocket (OOP) health spending constitutes a major source of healthcare financing. Household surveys are commonly used to monitor OOP health spending, but are prone to recall bias and unable to capture seasonal variation, and may underestimate expenditure–particularly among households with long-term chronic health conditions. Household expenditure diaries have been developed as an alternative to overcome the limitations of surveys, and pictorial diaries have been proposed where literacy levels may render traditional diary approaches inappropriate. This study compares estimates for general household and chronic healthcare expenditure in South Africa, Tanzania and Zimbabwe derived using survey and pictorial diary approaches. We selected a random sub-sample of 900 households across urban and rural communities participating in the Prospective Urban and Rural Epidemiology study. For a range of general and health-specific ca...
Objective:This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profi... more Objective:This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profiling model (NPM) to the food supply in South Africa (SA) and compare its performance against existing NPM as an indication of suitability for use to underpin food policies targeted at discouraging consumption of products high in nutrients associated with poor health.Design:Cross-sectional analysis of the SA-packaged food supply comparing the CAM to three other NPM: SA Health and Nutrition Claims (SA HNC), Chilean Warning Octagon (CWO) 2019, and Pan-American Health Organisation (PAHO) NPM.Setting:The SA-packaged food supply based on products stocked by supermarkets in Cape Town, SA.Participants:Packaged foods and beverages (n 6474) available in 2018 were analysed.Results:Forty-nine per cent of products contained excessive amounts of nutrients of concern (considered non-compliant) according to the criteria of all four models. Only 10·9 % of products were not excessive in any nutrients of c...
International Journal of Environmental Research and Public Health, 2022
Background: South Africa has a high prevalence of heavy episodic drinking (HED). Due to the high ... more Background: South Africa has a high prevalence of heavy episodic drinking (HED). Due to the high levels of alcohol misuse and violence, public hospital intensive care units were often overrun during the COVID-19 pandemic. This research investigated alcohol intake behaviour change during differing levels of lockdown restrictions, which included bans on alcohol sales. Methods: A self-reported Facebook survey ran from July to November 2020. The questions included socio-demographics, income, alcohol intake, purchasing behaviour, and reasoning. Chi-square tests/Fisher’s exact test for categorical data, Student’s t-test for normal continuous data, and the Mann–Whitney U test for non-normal data were applied. Multiple logistic regression was run for HED versus moderate drinkers. Results: A total of 798 participants took part in the survey, of which 68.4% were female. Nearly 50% of participants fell into the HED category and the majority bought alcohol illegally during restrictions. HED res...
African Journal of Health Professions Education, 2021
Background. Naturopathy has been taught at tertiary level in South Africa (SA) for 18 years. This... more Background. Naturopathy has been taught at tertiary level in South Africa (SA) for 18 years. This research paper examines the naturopathic curriculum to determine whether it is benchmarked to international standards and meets the needs of graduates in practice. It is the first research paper that critically reviews the curriculum of a complementary alternative medicine profession taught at a higher education institution (HEI) in SA. Objective. To critically review the naturopathy curriculum taught at an SA HEI. Methods. This research used a sequential two-stage qualitative methodology. In stage one, a comparative document analysis was conducted using the curriculum recommended by the World Health Organization (WHO), the World Naturopathic Federation (WNF) and the University of the Western Cape. Stage two consisted of a graduate review of the curriculum. Eighteen graduates participated in the review by providing input on all the subjects in the curriculum via email. The responses wer...
Background In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverage... more Background In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverages (SSBs). In 2018, the country implemented an SSB tax of approximately 10%, known as the Health Promotion Levy (HPL). We aimed to assess changes in the purchases of beverages before and after the HPL announcement and implementation. Methods We used Kantar Europanel data on monthly household purchases between January, 2014, and March, 2019, among a sample of South African households (n=113 653 household-month observations) from all nine provinces to obtain per-capita sugar, calories, and volume from taxable and non-taxable beverages purchased before and after the HPL announcement and implementation. We describe survey-weighted means for each period, and regressioncontrolled predictions of outcomes and counterfactuals based on pre-HPL announcement trends, with bootstrapped 95% CIs, and stratify results by socioeconomic status. Findings Mean sugar from taxable beverage purchases fell from 16•25 g/capita per day (95% CI 15•80-16•70) to 14•26 (13•85-14•67) from the pre-HPL announcement to post-announcement period, and then to 10•63 g/capita per day (10•22-11•04) in the year after implementation. Mean volumes of taxable beverage purchases fell from 518•99 mL/capita per day (506•90-531•08) to 492•16 (481•28-503•04) from pre-announcement to post announcement, and then to 443•39 mL/capita per day (430•10-456•56) after implementation. Across these time periods, there was a small increase in the purchases of non-taxable beverages, from 283•45 mL/capita per day (273•34-293•56) preannouncement to 312•94 (296•29-329•29) post implementation. When compared with pre-announcement counterfactual trends, reductions in taxable beverage purchase outcomes were significantly larger than the unadjusted survey-weighted observed reductions. Households with lower socioeconomic status purchased larger amounts of taxable beverages in the pre-announcement period than did households with higher socioeconomic status, but demonstrated bigger reductions after the tax was implemented. Interpretation The announcement and introduction of South Africa's HPL were followed by reductions in the sugar, calories, and volume of beverage purchases.
In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) c... more In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) commonly being used in ways that are detrimental to infant and young child nutrition, health and survival. The use of internet, digital and mobile platforms has increased, including in low-income and middle-income countries, like SA and these platforms are avenues for BMS marketing. SA has national legislation (Regulation R991) to enforce the International Code of Marketing of BMS. This paper aims to provide pertinent examples of how BMS manufacturers in SA use social media to market their products thus violating national regulations. A digital (and social media) ethnography approach was used to study BMS organisations’ activity on Facebook and Instagram. Purposively selected examples of social media posts observed (from 2015 to 2019) were included, and content analysed in terms of national legislation. Several examples of BMS social media marketing are presented and interpreted according...
Background In an effort to prevent and reduce the prevalence rate of people with obesity and diab... more Background In an effort to prevent and reduce the prevalence rate of people with obesity and diabetes, South Africa implemented a sugar-content-based tax called the Health Promotion Levy in April 2018, one of the first sugar-sweetened beverage (SSB) taxes to be based on each gram of sugar (beyond 4 g/100 ml). This before-and-after study estimated changes in taxed and untaxed beverage intake 1 year after the tax, examining separately, to our knowledge for the first time, the role of reformulation distinct from behavioral changes in SSB intake. Methods and findings We collected single-day 24-hour dietary recalls from repeat cross-sectional surveys of adults aged 18–39 years in Langa, South Africa. Participants were recruited in February–March 2018 (pre-tax, n = 2,459) and February–March 2019 (post-tax, n = 2,489) using door-to-door sampling. We developed time-specific food composition tables (FCTs) for South African beverages before and after the tax, linked with the diet recalls. By ...
International Journal of Environmental Research and Public Health, 2019
Landfill and street waste pickers in South Africa are responsible for collecting substantial volu... more Landfill and street waste pickers in South Africa are responsible for collecting substantial volumes of recyclable material, saving municipalities millions and contributing to a generally healthier and cleaner environment. Yet waste pickers continue to operate on the fringes of the economy and are exposed to many risks, particularly health risks which have a direct impact on the sustainability of their livelihoods. This article, using a mixed-methods approach, explores the health risks to which waste pickers working on nine different landfills in the country are exposed. The socio-ecological framework was used to analyse and present the results. A key finding was that waste picking, by its very nature, lends itself to innumerable health risks, but that these can be lessened through concerted and collaborative efforts on the part of landfill operators, local authorities and other stakeholders. Integrating the ‘self-employed’ waste pickers into the formal waste management system shoul...
ObjectiveThe aim of the present study was to assess anthropometric status in South African childr... more ObjectiveThe aim of the present study was to assess anthropometric status in South African children and women in 2005 in order to document temporal trends in selected anthropometric parameters.DesignHeights and weights were measured in a cross-sectional study of children aged 1–9 years and women aged 16–35 years. The WHO reference values and BMI cut-off points were used to determine weight status.SettingSouth Africa, representative sample based on census data.SubjectsChildren (n2157) and women (n2403).ResultsStunting was the most common nutritional disorder affecting 21·7 % of children in 1999 and 20·7 % in 2005. The difference was not statistically significant. Underweight prevalence remained unchanged, affecting 8·1 % of children, whereas wasting affected 5·8 % of children nationally, a significant increase from 4·3 % of children in 1999. Rural children were most severely affected. According to the international BMI cut-off points for overweight and obesity, 10 % of children natio...
Background: Low serum concentrations of vitamin A and zinc are common in tuberculosis and may hav... more Background: Low serum concentrations of vitamin A and zinc are common in tuberculosis and may have an adverse effect on host cell-mediated responses. The role of adjunctive micronutrient supplementation on treatment outcomes is uncertain. Objective: The objective was to assess the efficacy of vitamin A and zinc supplementation on sputum smear and culture conversion and time to culture detection in adults with sputum smear-positive pulmonary tuberculosis. Design: Participants attending a primary care tuberculosis clinic in Cape Town, South Africa, were randomly assigned to receive micronutrients (single dose of 200,000 IU retinyl palmitate plus 15 mg Zn/d for 8 wk) or matching placebo. Sputum was collected weekly for 8 wk for auramine staining and culture on liquid media (BACTEC MGIT 960; Becton Dickinson, Sparks, MD). Performance status, chest radiographs, and anthropometric measures were assessed at baseline and again at 8 wk. Results: The participants (n = 154) were randomly assigned to the micronutrient (n = 77) or placebo (n = 77) group. Twenty participants were HIV infected (13%), and 12 participants had an unknown HIV status (8%). No differences in time to smear or culture conversion were observed between the treatment groups by Kaplan-Meier analysis (P = 0.15 and P = 0.38, respectively; log-rank test). Log-logistic regression analysis found no significant group interaction effect in time to culture detection over the 8-wk period (P = 0.32). No significant differences in weight gain (2.3 6 3.5 compared with 2.2 6 2.4 kg, P = 0.68) or radiologic resolution were observed between the treatment groups. Conclusion: Supplementation with vitamin A and zinc did not affect treatment outcomes in participants with pulmonary tuberculosis at 8 wk. This trial was registered at controlled-trials.com as ISRCTN80852505.
In sub-Saharan Africa, urbanisation and food systems change contribute to rapid dietary transitio... more In sub-Saharan Africa, urbanisation and food systems change contribute to rapid dietary transitions promoting obesity. It is unclear to what extent these changes are mediated by neighbourhood food environments or other factors. This paper correlates neighbourhood food provision with household consumption and poverty in Khayelitsha, South Africa and Ahodwo, Ghana. Georeferenced survey data of food consumption and provision were classified by obesity risk and protection. Outlets were mapped, and density and distribution correlated with risk classes. In Khayelitsha, 71% of households exceeded dietary obesity risk thresholds while 16% consumed protective diets. Obesogenic profiles were less (26%) and protective more prevalent (23%) in Ahodwo despite greater income poverty in Khayelitsha. Here, income-deprived households consumed significantly (p < 0.005) less obesogenic and protective diets. Small informal food outlets dominated numerically but supermarkets were key household food so...
Antimicrobial Agents and Chemotherapy, Sep 1, 2011
Among patients with tuberculosis, rifampin plasma concentrations and sputum conversion rates have... more Among patients with tuberculosis, rifampin plasma concentrations and sputum conversion rates have been reported to be lower in Africans. Rifampin is a substrate of P-glycoprotein (coded for by the ABCB1 gene) and organic anion-transporting polypeptide 1B1 (coded for by SLCO1B1). The objectives were to identify genetic polymorphisms of drug transporters and the transcriptional regulators pregnane X receptor (PXR) and constitutive androstane receptor (CAR) with an impact on rifampin pharmacokinetics in South Africans. Fifty-seven patients with tuberculosis from Cape Town underwent pharmacokinetic sampling during treatment with rifampin, pyrazinamide, isoniazid, and ethambutol. DNA was genotyped for ABCB1, SLCO1B1, PXR, and CAR polymorphisms by using real-time PCR. NONMEM was used for data analysis. The allele frequency of the SLCO1B1 rs4149032 polymorphism was 0.70. Patients heterozygous and homozygous for this polymorphism had reductions in the bioavailability (and, thus, the area under the curve [AUC]) of rifampin of 18% and 28%, respectively. Simulations showed that increasing the daily rifampin dose by 150 mg in patients with the polymorphism would result in plasma concentrations similar to those of wild-type individuals and reduce the percentage of patients with peak plasma concentrations (C max) below 8 mg/liter from 63% to 31%. ABCB1, PXR, and CAR polymorphisms were not associated with differences in rifampin pharmacokinetics. SLCO1B1 rs4149032 was present in most patients and was associated with substantially reduced rifampin exposure. These data suggest that the standard recommended dose of rifampin should be reconsidered for South Africans.
Objective: Childhood obesity is on the rise in South Africa (SA), and child-directed marketing (C... more Objective: Childhood obesity is on the rise in South Africa (SA), and child-directed marketing (CDM) is one of the contributing factors to children's unhealthy food choices. This study assessed CDM on packaged breakfast cereals available in SA supermarkets and their nutritional quality. Design: Photographic images were examined in a descriptive quantitative study. A codebook of definitions of CDM was developed for this purpose. REDCap, an online research database, was used for data capturing, and SPSS was used for data analyses including cross-tabulations and one-way ANOVA. Setting: The current study was set in the Western Cape province of SA. Subjects: Photographic images of all packaged breakfast cereals sold in major retailers in the Western Cape province of SA in 2019 were studied. Results: CDM strategies were classified as direct (to the child) or indirect (through the parent). A total of 222 breakfast cereals were studied, of which 96•9 % had a nutritional or health claim, 95•0 % had illustrations, 75•2 % had product and consumption appeals, 10•8 % had characters, 10•8 % consisted of different appeals, 8•6 % alluded to fantasy and 7•7 % had role models. In breakfast cereals with direct CDM, the protein and fibre content was significantly lower than in breakfast cereals without direct CDM. This study found a significantly higher total carbohydrate and total sugar content in breakfast cereals with direct CDM than those without direct CDM. Conclusion: CDM was highly prevalent in breakfast cereals sold in SA. Regulations to curb the marketing of packaged foods high in nutrients of concern is recommended.
International Journal of Environmental Research and Public Health, Feb 19, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Objective: To provide an update on the compliance to the Na reduction regulation (R.214) and to h... more Objective: To provide an update on the compliance to the Na reduction regulation (R.214) and to highlight some challenges and successes experienced by South Africa in the implementation of a mandatory Na regulation. Design: The study design was observational. Nutritional information of packaged food (specified in the R.214 regulation) was collected between February 2019 and September 2020, before and after the implementation date of the final Na targets in the regulation. Six supermarket chains that accounted for more than 50 % of the grocery retailer market share in South Africa were included. The Na content (per 100 g) of products was extracted from photographs. Products were classified according to the thirteen food categories included in R.214. The percentage of targeted food categories that met the pre and post-regulation targets as well as the percentage by which Na limits were exceeded was calculated. Setting: Low-and-middle-income suburbs in Cape Town, South Africa. Participants: N/A. Results: A total number of 3278 products were analysed. After the final implementation date, none of the categories targeted by the R.214 regulation fully complied. However, nine out of the thirteen food categories targeted by R.214 were above the 70 % compliance mark. Conclusions: The compliance to R.214 in South Africa is good, although not 100 % compliant. This research also highlights the complexities regarding the monitoring and evaluation of a national regulation. Findings from the current study could aid by providing valuable information to countries in the process of implementing a Na reduction strategy.
In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) c... more In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) commonly being used in ways that are detrimental to infant and young child nutrition, health and survival. The use of internet, digital and mobile platforms has increased, including in low-income and middle-income countries, like SA and these platforms are avenues for BMS marketing. SA has national legislation (Regulation R991) to enforce the International Code of Marketing of BMS. This paper aims to provide pertinent examples of how BMS manufacturers in SA use social media to market their products thus violating national regulations. A digital (and social media) ethnography approach was used to study BMS organisations' activity on Facebook and Instagram. Purposively selected examples of social media posts observed (from 2015 to 2019) were included, and content analysed in terms of national legislation. Several examples of BMS social media marketing are presented and interpreted according to provisions of national regulations that they violate. BMS manufacturers have found ways on social media to market their products in a media space that is complex to regulate, and where it is difficult to enforce national regulations. It is necessary to engage with stakeholders, notably social media companies, to alert them to relevant regulations applicable to their platforms. Monitoring the marketing of products for infants and young children by national governments needs to include online and digital platforms especially social media.
In most low- and middle-income countries (LMICs), household out-of-pocket (OOP) health spending c... more In most low- and middle-income countries (LMICs), household out-of-pocket (OOP) health spending constitutes a major source of healthcare financing. Household surveys are commonly used to monitor OOP health spending, but are prone to recall bias and unable to capture seasonal variation, and may underestimate expenditure–particularly among households with long-term chronic health conditions. Household expenditure diaries have been developed as an alternative to overcome the limitations of surveys, and pictorial diaries have been proposed where literacy levels may render traditional diary approaches inappropriate. This study compares estimates for general household and chronic healthcare expenditure in South Africa, Tanzania and Zimbabwe derived using survey and pictorial diary approaches. We selected a random sub-sample of 900 households across urban and rural communities participating in the Prospective Urban and Rural Epidemiology study. For a range of general and health-specific ca...
Objective:This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profi... more Objective:This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profiling model (NPM) to the food supply in South Africa (SA) and compare its performance against existing NPM as an indication of suitability for use to underpin food policies targeted at discouraging consumption of products high in nutrients associated with poor health.Design:Cross-sectional analysis of the SA-packaged food supply comparing the CAM to three other NPM: SA Health and Nutrition Claims (SA HNC), Chilean Warning Octagon (CWO) 2019, and Pan-American Health Organisation (PAHO) NPM.Setting:The SA-packaged food supply based on products stocked by supermarkets in Cape Town, SA.Participants:Packaged foods and beverages (n 6474) available in 2018 were analysed.Results:Forty-nine per cent of products contained excessive amounts of nutrients of concern (considered non-compliant) according to the criteria of all four models. Only 10·9 % of products were not excessive in any nutrients of c...
International Journal of Environmental Research and Public Health, 2022
Background: South Africa has a high prevalence of heavy episodic drinking (HED). Due to the high ... more Background: South Africa has a high prevalence of heavy episodic drinking (HED). Due to the high levels of alcohol misuse and violence, public hospital intensive care units were often overrun during the COVID-19 pandemic. This research investigated alcohol intake behaviour change during differing levels of lockdown restrictions, which included bans on alcohol sales. Methods: A self-reported Facebook survey ran from July to November 2020. The questions included socio-demographics, income, alcohol intake, purchasing behaviour, and reasoning. Chi-square tests/Fisher’s exact test for categorical data, Student’s t-test for normal continuous data, and the Mann–Whitney U test for non-normal data were applied. Multiple logistic regression was run for HED versus moderate drinkers. Results: A total of 798 participants took part in the survey, of which 68.4% were female. Nearly 50% of participants fell into the HED category and the majority bought alcohol illegally during restrictions. HED res...
African Journal of Health Professions Education, 2021
Background. Naturopathy has been taught at tertiary level in South Africa (SA) for 18 years. This... more Background. Naturopathy has been taught at tertiary level in South Africa (SA) for 18 years. This research paper examines the naturopathic curriculum to determine whether it is benchmarked to international standards and meets the needs of graduates in practice. It is the first research paper that critically reviews the curriculum of a complementary alternative medicine profession taught at a higher education institution (HEI) in SA. Objective. To critically review the naturopathy curriculum taught at an SA HEI. Methods. This research used a sequential two-stage qualitative methodology. In stage one, a comparative document analysis was conducted using the curriculum recommended by the World Health Organization (WHO), the World Naturopathic Federation (WNF) and the University of the Western Cape. Stage two consisted of a graduate review of the curriculum. Eighteen graduates participated in the review by providing input on all the subjects in the curriculum via email. The responses wer...
Background In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverage... more Background In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverages (SSBs). In 2018, the country implemented an SSB tax of approximately 10%, known as the Health Promotion Levy (HPL). We aimed to assess changes in the purchases of beverages before and after the HPL announcement and implementation. Methods We used Kantar Europanel data on monthly household purchases between January, 2014, and March, 2019, among a sample of South African households (n=113 653 household-month observations) from all nine provinces to obtain per-capita sugar, calories, and volume from taxable and non-taxable beverages purchased before and after the HPL announcement and implementation. We describe survey-weighted means for each period, and regressioncontrolled predictions of outcomes and counterfactuals based on pre-HPL announcement trends, with bootstrapped 95% CIs, and stratify results by socioeconomic status. Findings Mean sugar from taxable beverage purchases fell from 16•25 g/capita per day (95% CI 15•80-16•70) to 14•26 (13•85-14•67) from the pre-HPL announcement to post-announcement period, and then to 10•63 g/capita per day (10•22-11•04) in the year after implementation. Mean volumes of taxable beverage purchases fell from 518•99 mL/capita per day (506•90-531•08) to 492•16 (481•28-503•04) from pre-announcement to post announcement, and then to 443•39 mL/capita per day (430•10-456•56) after implementation. Across these time periods, there was a small increase in the purchases of non-taxable beverages, from 283•45 mL/capita per day (273•34-293•56) preannouncement to 312•94 (296•29-329•29) post implementation. When compared with pre-announcement counterfactual trends, reductions in taxable beverage purchase outcomes were significantly larger than the unadjusted survey-weighted observed reductions. Households with lower socioeconomic status purchased larger amounts of taxable beverages in the pre-announcement period than did households with higher socioeconomic status, but demonstrated bigger reductions after the tax was implemented. Interpretation The announcement and introduction of South Africa's HPL were followed by reductions in the sugar, calories, and volume of beverage purchases.
In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) c... more In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) commonly being used in ways that are detrimental to infant and young child nutrition, health and survival. The use of internet, digital and mobile platforms has increased, including in low-income and middle-income countries, like SA and these platforms are avenues for BMS marketing. SA has national legislation (Regulation R991) to enforce the International Code of Marketing of BMS. This paper aims to provide pertinent examples of how BMS manufacturers in SA use social media to market their products thus violating national regulations. A digital (and social media) ethnography approach was used to study BMS organisations’ activity on Facebook and Instagram. Purposively selected examples of social media posts observed (from 2015 to 2019) were included, and content analysed in terms of national legislation. Several examples of BMS social media marketing are presented and interpreted according...
Background In an effort to prevent and reduce the prevalence rate of people with obesity and diab... more Background In an effort to prevent and reduce the prevalence rate of people with obesity and diabetes, South Africa implemented a sugar-content-based tax called the Health Promotion Levy in April 2018, one of the first sugar-sweetened beverage (SSB) taxes to be based on each gram of sugar (beyond 4 g/100 ml). This before-and-after study estimated changes in taxed and untaxed beverage intake 1 year after the tax, examining separately, to our knowledge for the first time, the role of reformulation distinct from behavioral changes in SSB intake. Methods and findings We collected single-day 24-hour dietary recalls from repeat cross-sectional surveys of adults aged 18–39 years in Langa, South Africa. Participants were recruited in February–March 2018 (pre-tax, n = 2,459) and February–March 2019 (post-tax, n = 2,489) using door-to-door sampling. We developed time-specific food composition tables (FCTs) for South African beverages before and after the tax, linked with the diet recalls. By ...
International Journal of Environmental Research and Public Health, 2019
Landfill and street waste pickers in South Africa are responsible for collecting substantial volu... more Landfill and street waste pickers in South Africa are responsible for collecting substantial volumes of recyclable material, saving municipalities millions and contributing to a generally healthier and cleaner environment. Yet waste pickers continue to operate on the fringes of the economy and are exposed to many risks, particularly health risks which have a direct impact on the sustainability of their livelihoods. This article, using a mixed-methods approach, explores the health risks to which waste pickers working on nine different landfills in the country are exposed. The socio-ecological framework was used to analyse and present the results. A key finding was that waste picking, by its very nature, lends itself to innumerable health risks, but that these can be lessened through concerted and collaborative efforts on the part of landfill operators, local authorities and other stakeholders. Integrating the ‘self-employed’ waste pickers into the formal waste management system shoul...
ObjectiveThe aim of the present study was to assess anthropometric status in South African childr... more ObjectiveThe aim of the present study was to assess anthropometric status in South African children and women in 2005 in order to document temporal trends in selected anthropometric parameters.DesignHeights and weights were measured in a cross-sectional study of children aged 1–9 years and women aged 16–35 years. The WHO reference values and BMI cut-off points were used to determine weight status.SettingSouth Africa, representative sample based on census data.SubjectsChildren (n2157) and women (n2403).ResultsStunting was the most common nutritional disorder affecting 21·7 % of children in 1999 and 20·7 % in 2005. The difference was not statistically significant. Underweight prevalence remained unchanged, affecting 8·1 % of children, whereas wasting affected 5·8 % of children nationally, a significant increase from 4·3 % of children in 1999. Rural children were most severely affected. According to the international BMI cut-off points for overweight and obesity, 10 % of children natio...
Background: Low serum concentrations of vitamin A and zinc are common in tuberculosis and may hav... more Background: Low serum concentrations of vitamin A and zinc are common in tuberculosis and may have an adverse effect on host cell-mediated responses. The role of adjunctive micronutrient supplementation on treatment outcomes is uncertain. Objective: The objective was to assess the efficacy of vitamin A and zinc supplementation on sputum smear and culture conversion and time to culture detection in adults with sputum smear-positive pulmonary tuberculosis. Design: Participants attending a primary care tuberculosis clinic in Cape Town, South Africa, were randomly assigned to receive micronutrients (single dose of 200,000 IU retinyl palmitate plus 15 mg Zn/d for 8 wk) or matching placebo. Sputum was collected weekly for 8 wk for auramine staining and culture on liquid media (BACTEC MGIT 960; Becton Dickinson, Sparks, MD). Performance status, chest radiographs, and anthropometric measures were assessed at baseline and again at 8 wk. Results: The participants (n = 154) were randomly assigned to the micronutrient (n = 77) or placebo (n = 77) group. Twenty participants were HIV infected (13%), and 12 participants had an unknown HIV status (8%). No differences in time to smear or culture conversion were observed between the treatment groups by Kaplan-Meier analysis (P = 0.15 and P = 0.38, respectively; log-rank test). Log-logistic regression analysis found no significant group interaction effect in time to culture detection over the 8-wk period (P = 0.32). No significant differences in weight gain (2.3 6 3.5 compared with 2.2 6 2.4 kg, P = 0.68) or radiologic resolution were observed between the treatment groups. Conclusion: Supplementation with vitamin A and zinc did not affect treatment outcomes in participants with pulmonary tuberculosis at 8 wk. This trial was registered at controlled-trials.com as ISRCTN80852505.
In sub-Saharan Africa, urbanisation and food systems change contribute to rapid dietary transitio... more In sub-Saharan Africa, urbanisation and food systems change contribute to rapid dietary transitions promoting obesity. It is unclear to what extent these changes are mediated by neighbourhood food environments or other factors. This paper correlates neighbourhood food provision with household consumption and poverty in Khayelitsha, South Africa and Ahodwo, Ghana. Georeferenced survey data of food consumption and provision were classified by obesity risk and protection. Outlets were mapped, and density and distribution correlated with risk classes. In Khayelitsha, 71% of households exceeded dietary obesity risk thresholds while 16% consumed protective diets. Obesogenic profiles were less (26%) and protective more prevalent (23%) in Ahodwo despite greater income poverty in Khayelitsha. Here, income-deprived households consumed significantly (p < 0.005) less obesogenic and protective diets. Small informal food outlets dominated numerically but supermarkets were key household food so...
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Papers by Rina Swart