Home-based care vital for maternal and child health to counter ‘toxic poverty’

August 12, 2013 in Uncategorized

Community health workers can help improve the well-being of poor and vulnerable mothers and children, writes Mark Tomlinson in this guest post:

In 2011, 6.91 million children under five years of age died globally. While this is a significant reduction from the 11.97 million children under five dying in 1990, most of these deaths continue to occur from preventable causes and almost all in low- and middle-income countries.

In 2005 South Africa was one of only four countries in the world where the under-five mortality rate was higher than the baseline rate established by the Millennium Development Goals initiative in 1990.   This was primarily related to the HIV epidemic, with more than half of child deaths attributed to HIV/AIDS, but about 30% of under-five deaths in South Africa are newborns dying in the first 28 days of life (20,000 deaths each year).  Since 2005, as a result the scaling up of effective programmes to prevent mother-to-child transmission (PMTCT) of HIV and to some extent the roll out of antiretroviral therapy, South Africa has been making considerable progress towards reducing under-five mortality.

While the death of children is the most commonly used metric to illustrate the dire state health systems in many poor countries, more than 200 million children under the age of five (who survive) fail to reach their developmental potential. This has been linked to multiple risks such as poverty, poor nutrition, a lack of educational opportunities, maternal depression and under-stimulating home environments.  Jack Shonkoff and colleagues from Harvard University have used the term ‘toxic stress’ to describe a form of stress that occurs when a child’s stress response system is activated for a prolonged period of time, together with an absence of a supportive caregiving relationship that can buffer the stress.

If this early toxic stress is not reduced it can lead to irreversible changes in brain function and structure.  We are talking here of environments where children are exposed to chronic levels of violence, alcohol abuse, drug use, and unresponsive care.  But we are also talking about environments where children are beaten by caregivers and where their attempts at exploration and play are thwarted.  In the same vein, chronic poverty in the absence of nurturing environments and relationships might be termed ‘toxic poverty’.

To ensure that South Africa improves the health of its entire population and achieves a more equitable distribution of resources, we need effective community-based programmes that focus on pregnancy and the first two years of life – what is now called the first 1000 days of development.  The South African government is currently in the process of re-engineering the primary health care system. One component of this is teams of community health workers (CHWs), professional nurses and other medical professionals who will deliver interventions at the community level.

Over the last five years, my colleagues and I have implemented a randomised controlled trial sto examine the impact of community health workers conducting home visiting in order to improve maternal, infant and child health in Cape Town.  Our project is a partnership between the Department of Psychology at Stellenbosch University, University of California, Los Angeles and a local NGO Philani.

Philani has been operating in Cape Town since the late 1980’s and was initially designed to focus on improving child nutrition.  Philani identifies potential neighbourhood community health workers on the basis of them being women who live in the same neighbourhoods as the mothers and children that they will be serving, as well being mothers whose children are thriving, that is, mothers who are positive role models in the neighbourhoods.

They are called Mentor Mothers and they provide social support to their peers, making home visits to monitor the baby’s progress, providing alcohol, HIV/TB information and skills, as well as making referrals for clinic care on an ongoing basis. Mothers whose children thrive typically have good social skills, an ability to develop caring social relationships, and a sense of pragmatism.

The Philani + mentor-mother intervention is currently underway in Khayelitsha and Mfuleni in Cape Town.  The initial study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in the USA, and the follow up of children at 3 years old is being funded by a local South African funder Ilifa Labantwana.

Early results indicate that mothers receiving the intervention report a significantly higher number of tasks reflecting well-being than mothers who did not, were more likely to be free of maternal birth complications, and HIV+ mothers were more likely to take anti-retrovirals during delivery.

Infants whose mothers received visits from Philani Mentor Mothers and that were experiencing depressed mood during pregnancy have improved growth and cognitive development when they are 18 months old than infants who did not receive Mentor Mother visits.  These findings are important as we know from previous interventions to improve nutrition outcomes of infants and children, that early improvements in child growth suggest later cognitive, educational, social, and economic benefits.

Preventive and curative services offered by community health workers can contribute to ensuring that we avoid this loss of developmental potential in our children and adults. These community based programmes can supplement overwhelmed health-care systems that do not meet South Africa’s health needs, and certainly cannot meet the needs of the range of diseases confronting many other poor countries throughout Africa and globally.

Professor Mark Tomlinson is based in the Department of Psychology at Stellenbosch University.

Medical scheme blues

August 5, 2013 in Uncategorized

When it comes to medical schemes, I wear three different hats.

Firstly, I belong to our Media24 inhouse scheme, which is administered by Discovery, secondly, I am a trustee and board member of said Nasmed scheme, and thirdly I work as a medical journalist.

This puts me in a unique position, in that I get to see medical scheme issues from all three viewpoints. When I am thinking as a medical scheme member, my thinking is as follows:

I pay lots of money every month for this cover, and when I need medical attention, I want the scheme to cough up. I have been paying for 12 years now, I have never been hospitalised in my life, so if something horrible were to happen to me tomorrow, I want to know that I am covered. Up until now I have always found the scheme efficient and helpful and prompt to pay, but I have belonged to other schemes before, which were a nightmare. Every excuse was found not to settle medical bills, claims were “lost” (oddly enough only the big ones, but the little ones sent in the same envelope were paid swiftly) and getting through to them was more difficult than moving the Union Buildings a metre to the left. I feel for scheme members who are still experiencing this sort of service.

As a trustee I represent other members on the Board of Trustees, and my role is to speak up and raise issues which affect fellow members on the scheme. As a board member I also have some insight into the finances of the scheme. The only income of the scheme is membership fees and the expenditure is administration and medical costs. Medical schemes as such are non-profit organisations. The only money to be made is on the administration. As a board member, high-cost claims make my throat constrict, because I know a few of those could cripple many schemes.

As a journalist, I am frequently writing about medical schemes – from the perspective of the members (mostly the disgruntled ones – the happy ones don’t contact us) and the medical schemes themselves.

So, in short, I want my medical scheme to pay for everything I claim, yet I want it to remain solvent, and if it doesn’t, I will write an article about it. Whoever said life was simple?

Tell us about your experiences with your medical scheme.

Susan Erasmus
Health24 Deputy Editor

Substance abuse and depression jeopardise health of HIV/Aids patients

August 2, 2013 in Uncategorized

Substance abuse among HIV/Aids patients who also suffer from psychiatric disorders leads to poor adherence to anti-retrovirals (ARVs), HIV disease progression, lower CD4 counts and opportunistic infections. Dr Rehana Kader writes more about this in this guest post.

This is one of the main findings of my recent doctoral study, in which I conducted the first large systematic investigation of alcohol and or drug abuse, ARV adherence and psychiatric disorders among patients receiving treatment from HIV clinics in Cape Town.

The study found that 37% of the patients attending HIV clinics, abuse alcohol as assessed by the Alcohol Use Disorders Identification Test, while 13%, used drugs. More males abused alcohol and or drugs than females. They also reported poor adherence to ARVs and also had lower CD4 counts than females. Unemployed HIV/AIDS patients were significantly more likely to abuse alcohol and drugs.

More patients who abuse alcohol and or drugs were diagnosed with Tuberculosis (TB) than those who did not. Furthermore, alcohol abuse was found to be a direct predictor of TB. This is of great concern as South Africa has a high prevalence of HIV and TB. Research has shown that alcohol use also worsens TB infection, leading to higher rates of patients defaulting on treatment and possible drug-resistant forms of TB.

Please see attached the full opinion editorial, kindly let me know if you would like more information and I will gladly assist.

Dr Rehana Kader is a clinical psychologist. This article is based on her recent doctorate in Psychiatry at Stellenbosch University

South Africa’s Durex Lovers

July 22, 2013 in Health

Durex South Africa is pleased to announce that the local couple representing South Africa in the Durex Experiment was selected and sent to Venice to begin in the experiment.

Cape Town based Kirsty Carpenter and fiancé Michael Honeyman, were jetted off to Venice this past week to participate in the Durex Lovers’ Academy along with 25 other couples from around the world.

While in the City of Love the Durex Lovers enjoyed an exclusive romantic experience on a private island dedicated to ‘sex that moves’ them. Here they had the advice and expertise of psychologist Susan Quilliam, author of The Joy of Sex, and scientist Brendan Walker who worked to help lovers discover how each of the experiments would affect them.

Ahead of the rest of the globe, the Durex Lovers discovered the impact of foreplay, the pleasure of increased sensation, and where fun gameplay could take them.

To follow in their footsteps and be part of Durex’s first global experiment, download the Durexperiment APP now available for IOS and Android.

Before they left for Venice, we asked Kirsty and Michael a bit about their involvement in the Durex Experiment:

1. What made you want to enter to become the local Durex Lovers?

Kirsty: I received the press release at work (Kirsty is a journalist at Women’s Health) I thought it sounded cool and different – I wanted to know more! As a sex writer – I always want to find out new things as it enables me to help other people through my own work.

Mike: Kirsty told me about it that night and I thought it would be a great way to find out more about us as a couple. I liked the element of the psychologist’s involvement as it adds a layer of depth to the experience.

2. What makes you the ultimate Durex Lovers?

We don’t see sex as just sex. It’s both emotional and physical and this fits the Durex brand philosophy well. We are open and communicative about how we feel, which sets us apart and although we’ve been together for long, we still feel that we can learn new things about each other.

3. Do you consider yourselves among the 54% of people who are not satisfied with their sex lives or with the 46% who are?

Definitely the 46% who are satisfied! There is always room for improvement though – we are satisfied but of course we could improve the experience even more.

4. What are you most excited about being a part of this campaign?

We are really interested to see the results. We’ve never been part of an experiment before and we are excited to be a part of something so different and that could end up helping so many other people. We are really looking forward to meeting both Susan and Brendan too, and also other people from other countries! It will be fascinating to see how they feel about this experience and how we differ country to country. This is important – it’s not just a sexual experiment – it’s a scientific thing, just because its not cancer research it doesn’t mean it’s not important, because sexual satisfaction is important to a stress free life, which is important for overall health and well-being.

5. How do you think South Africa is going to compare with the other participating countries?

It’s obviously way too early to tell but we are expecting the more ‘western’ countries to be more similar… We might see a whole bunch of myths and generalisations about the sexual habits of different couples bust! It’s very exciting!

6. Do you use Durex products ordinarily?

We have as well as other brands…

7. If so, what is/are your favourite Durex product/s?

The feather-light condoms and the ribbed ones – definitely!

8. What do you think makes for a satisfying sex life?

An emotional connection and open communication! It’s not just about the orgasm… it’s about being able to connect and have fun. Being open to new things and experimenting, and talking about what you like or would like to try so that you can really know what works for you.

Disabled people in need of proper support after sexual assault

July 18, 2013 in Health

Emerging research has found that disabled people are at risk of sexual abuse for a number of reasons, writes Dr Sumaya Mall in this guest blog post.

South Africa is facing an epidemic of sexual violence. In 2013, the gang rape and murder of Bredasdorp teenager Anene Booysen made headlines. Despite identifying Jonathan Davids as one of her killers, the National Prosecuting Authority has dropped all charges against Davids. Booysen was thought not to be cognitive due to being administered morphine after the brutal gang rape. Her communication abilities were understandably impaired after her attack and thus her claim of Davids’ role in her rape and murder was not taken seriously.

The gang rape of a teenage girl with intellectual disability in Soweto made headlines in 2012. Her perpetrators videoed the incident on a cell phone and taunted her while she cried for help. They even tossed 25 cents at her, a final act of humiliation. Later it emerged that she had been a victim of sexual harassment previously. When her mother approached the police, they had dismissed the case saying as she could not talk she could not give coherent, credible testimony.

In 2011, a Cape Town school bus driver allegedly raped a 6-year-old girl with intellectual disability after dropping her off at school. The child was unable to report what had happened to her due to communication difficulties. Her mother noticed signs that she had undergone sexual assault while bathing her that evening. A few weeks ago in Khayelitsha a teenage girl with epilepsy and intellectual disability was raped by two men known to her family. She was later found with blood all over her pants, crying and unable to communicate what had happened to her. A medical examination verified signs of sexual assault. A community impatient about the country’s general lack of justice beat the two men accused of the crime senseless before handing them over to the police. The crime incited further violence. This is unsurprising considering the already violent context and the continual risk of violence for community members.

Emerging research conducted all over the world has found that disabled people are at risk of sexual abuse for a number of reasons. Firstly perpetrators believe that disabled people cannot always report what has happened to them (if their disability has resulted in communication difficulties) nor can they always identify the perpetrator. A teenage girl with visual impairment in India was raped and murdered a few weeks ago. Her home did not have a flushing toilet. It is thought she was attacked while visiting the outside toilet at night when she was probably an easy target for perpetrators she could not see.

My recent PhD research explored some of these issues for deaf and hard of hearing adolescents in South Africa who struggle to communicate without a sign language interpreter. In my research I found that educators and parents often feel the desire to protect their deaf children from sexual abuse. This sometimes results in social isolation and limited sexuality education. Young deaf people themselves fear sexual abuse. They are at heightened risk of sexual abuse as they cannot hear an attacker who may follow them and they cannot cry out for help. My PhD further showed that assistance in communication for young deaf people has positive results, particularly in the areas of drug rehabilitation or HIV prevention.

One of the most important findings in this regard is the training of deaf people to deliver Voluntary Counselling and testing services for HIV/AIDS. These counsellors are well trained to deal with social issues such as financial or domestic violence. They are also fluent in sign language and understand the importance of delivering counselling sessions in this medium of instruction. There are other means of assisting disabled people to report sexual assault. For example, Cape Mental Health, a Non-Profit Organisation based in Observatory, Cape Town developed the Sexual Abuse Victim Empowerment (SAVE) Programme. SAVE provides a number of services including assessment of intellectually disabled survivors’ of sexual assault and their ability to testify in court. SAVE also trains public prosecutors and defence attorneys in their interviewing skills when they are questioning an intellectually disabled complainant. Presently, the Justice Department refers more than 100 cases per annum to SAVE  for psychometric assessment, court preparation, case planning and support through the court process.

The police and justice system are short sighted if they believe that a complainant who cannot testify due to a pre-existing communication disability or as a result of the attack, as was the case with Anene Booysens. There are in fact resources available to help complainants testify in court so that justice can be served.

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