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1دورية أكاديمية
المؤلفون: Kufre J. Okop, Kiya Kedir, Stephen Kasenda, Jean Berchmans Niyibizi, Effie Chipeta, Hailemichael Getachew, Kerstin Sell, Estelle Victoria Lambert, Thandi Puoane, Stephen Rulisa, Christopher Bunn, Abby C. King, Charlotte Bavuma, Rawleigh Howe, Amelia C. Crampin, Naomi S. Levitt
المصدر: BMC Public Health, Vol 23, Iss 1, Pp 1-19 (2023)
مصطلحات موضوعية: Citizen Science, Community-based, Co-design, Cardiovascular disease, Prevention strategies, Advocacy, Public aspects of medicine, RA1-1270
الوصف: Abstract Background Cardiovascular diseases (CVD) were responsible for 20.5 million annual deaths globally in 2021, with a disproportionally high burden in sub-Saharan Africa (SSA). There is growing evidence of the use of citizen science and co-design approaches in developing interventions in different fields, but less so in the context of CVD prevention interventions in SSA. This paper reports on the collaborative multi-country project that employed citizen science and a co-design approach to (i) explore CVD risk perceptions, (ii) develop tailored prevention strategies, and (iii) support advocacy in different low-income settings in SSA. Methods This is a participatory citizen science study with a co-design component. Data was collected from 205 participants aged 18 to 75 years in rural and urban communities in Malawi, Ethiopia and Rwanda, and urban South Africa. Fifty-one trained citizen scientists used a mobile app-based (EpiCollect) semi-structured survey questionnaire to collect data on CVD risk perceptions from participants purposively selected from two communities per country. Data collected per community included 100–150 photographs and 150–240 voice recordings on CVD risk perceptions, communication and health-seeking intentions. Thematic and comparative analysis were undertaken with the citizen scientists and the results were used to support citizen scientists-led stakeholder advocacy workshops. Findings are presented using bubble graphs based on weighted proportions of key risk factors indicated. Results Nearly three in every five of the participants interviewed reported having a relative with CVD. The main perceived causes of CVD in all communities were substance use, food-related factors, and litter, followed by physical inactivity, emotional factors, poverty, crime, and violence. The perceived positive factors for cardiovascular health were nutrition, physical activity, green space, and clean/peaceful communities. Multi-level stakeholders (45–84 persons/country) including key decision makers participated in advocacy workshops and supported the identification and prioritization of community-specific CVD prevention strategies and implementation actions. Citizen science-informed CVD risk screening and referral to care interventions were piloted in six communities in three countries with about 4795 adults screened and those at risk referred for care. Health sector stakeholders indicated their support for utilising a citizen-engaged approach in national NCDs prevention programmes. The citizen scientists were excited by the opportunity to lead research and advocacy. Conclusion The collaborative engagement, participatory learning, and co-designing activities enhanced active engagement between citizen scientists, researchers, and stakeholders. This, in turn, provided context-specific insights on CVD prevention in the different SSA settings.
وصف الملف: electronic resource
Relation: https://doaj.org/toc/1471-2458
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2دورية أكاديمية
المؤلفون: Melanie D. Whittington, Kathy Goggin, Lungiswa Tsolekile, Thandi Puoane, Andrew T. Fox, Ken Resnicow, Kandace K. Fleming, Joshua M. Smyth, Frank T. Materia, Emily A. Hurley, Mara Z. Vitolins, Estelle V. Lambert, Naomi S. Levitt, Delwyn Catley
المصدر: Global Health Action, Vol 16, Iss 1 (2023)
مصطلحات موضوعية: economic analysis, hba1c, lifestyle interventions, low- and middle-income countries, probabilistic sensitivity analysis, Public aspects of medicine, RA1-1270
الوصف: Background Lifestyle Africa is an adapted version of the Diabetes Prevention Program designed for delivery by community health workers to socioeconomically disadvantaged populations in low- and middle-income countries (LMICs). Results from the Lifestyle Africa trial conducted in an under-resourced community in South Africa indicated that the programme had a significant effect on reducing haemoglobin A1c (HbA1c). Objective To estimate the cost of implementation and the cost-effectiveness (in cost per point reduction in HbA1c) of the Lifestyle Africa programme to inform decision-makers of the resources required and the value of this intervention. Methods Interviews were held with project administrators to identify the activities and resources required to implement the intervention. A direct-measure micro-costing approach was used to determine the number of units and unit cost for each resource. The incremental cost per one point improvement in HbA1c was calculated. Results The intervention equated to 71 United States dollars (USD) in implementation costs per participant and a 0.26 improvement in HbA1c per participant. Conclusions Lifestyle Africa reduced HbA1c for relatively little cost and holds promise for addressing chronic disease in LMIC. Decision-makers should consider the comparative clinical effectiveness and cost-effectiveness of this intervention when making resource allocation decisions. Trial Registration Trial registration is at ClinicalTrials.gov (NCT03342274).
وصف الملف: electronic resource
Relation: https://doaj.org/toc/1654-9880
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3دورية أكاديمية
المؤلفون: Katherine Murphy, Jamie Berk, Lorrein Muhwava-Mbabala, Sharmilah Booley, Janetta Harbron, Lisa Ware, Shane Norris, Christina Zarowsky, Estelle V. Lambert, Naomi S. Levitt
المصدر: BMC Public Health, Vol 23, Iss 1, Pp 1-19 (2023)
مصطلحات موضوعية: Intervention development study, Behaviour Change Wheel, COM-B model, Women with gestational diabetes, Diet and physical activity intervention, Public aspects of medicine, RA1-1270
الوصف: Abstract Background In South Africa, the prevalence of gestational diabetes (GDM) is growing, concomitant with the dramatically increasing prevalence of overweight/obesity among women. There is an urgent need to develop tailored interventions to support women with GDM to mitigate pregnancy risks and to prevent progression to type 2 diabetes post-partum. The IINDIAGO study aims to develop and evaluate an intervention for disadvantaged GDM women attending three large, public-sector hospitals for antenatal care in Cape Town and Soweto, SA. This paper offers a detailed description of the development of a theory-based behaviour change intervention, prior to its preliminary testing for feasibility and efficacy in the health system. Methods The Behaviour Change Wheel (BCW) and the COM-B model of behaviour change were used to guide the development of the IINDIAGO intervention. This framework provides a systematic, step-by-step process, starting with a behavioural analysis of the problem and making a diagnosis of what needs to change, and then linking this to intervention functions and behaviour change techniques to bring about the desired result. Findings from primary formative research with women with GDM and healthcare providers were a key source of information for this process. Results Key objectives of our planned intervention were 1) to address women’s evident need for information and psychosocial support by positioning peer counsellors and a diabetes nurse in the GDM antenatal clinic, and 2) to offer accessible and convenient post-partum screening and counselling for sustained behaviour change among women with GDM by integrating follow-up into the routine immunisation programme at the Well Baby clinic. The peer counsellors and the diabetes nurse were trained in patient-centred, motivational counselling methods. Conclusions This paper offers a rich description and analysis of designing a complex intervention tailored to the challenging contexts of urban South Africa. The BCW was a valuable tool to use in designing our intervention and tailoring its content and format to our target population and local setting. It provided a robust and transparent theoretical foundation on which to develop our intervention, assisted us in making the hypothesised pathways for behaviour change explicit and enabled us to describe the intervention in standardised, precisely defined terms. Using such tools can contribute to improving rigour in the design of behavioural change interventions. Trial registration First registered on 20/04/2018, Pan African Clinical Trials Registry (PACTR): PACTR201805003336174.
وصف الملف: electronic resource
Relation: https://doaj.org/toc/1471-2458
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4دورية أكاديمية
المؤلفون: Larske M. Soepnel, Veronique Nicolaou, Christine Slater, Glory Chidumwa, Naomi S. Levitt, Kerstin Klipstein-Grobusch, Shane A. Norris
المصدر: Annals of Human Biology, Vol 48, Iss 2, Pp 81-92 (2021)
مصطلحات موضوعية: gestational hyperglycaemia, childhood obesity, childhood adiposity, south africa, maternal bmi, Biology (General), QH301-705.5, Human anatomy, QM1-695, Physiology, QP1-981
الوصف: Background Understanding the association between maternal metabolic conditions in pregnancy and the risk of childhood overweight, a growing concern in sub-Saharan Africa (SSA), helps to identify opportunities for childhood obesity prevention. Aim To assess the association between hyperglycaemia first detected in pregnancy (HFDP) (gestational diabetes mellitus [GDM] and diabetes in pregnancy [DIP]) and child obesity and adiposity in pre-school-aged children in South Africa, independently of maternal BMI. Subjects and methods Measurement of anthropometry and fat mass index (FMI) by the deuterium dilution method was done for 102 3–6-year-old children born to mothers with HFDP and 102 HFDP-unexposed children. Hierarchical regression analysis and generalised structural equation modelling (GSEM) were performed. Results The prevalence of overweight/obesity was 10.5% and 11.1% in children exposed to GDM and DIP, respectively, and 3.9% in the HFDP-unexposed group. Log-transformed FMI was significantly higher in the DIP-exposed group (β = 0.166, 95% CI = 0.014–0.217 p= .026), but not when adjusting for maternal pregnancy BMI (β = 0.226, 95% CI = 0.003–0.015, p = .004). GSEM showed significant total effects of maternal BMI and birth weight on FMI/BMI. Conclusions Maternal pregnancy BMI seems to play a greater role in the development of childhood adiposity than maternal hyperglycaemia, requiring further research and identifying maternal BMI as a relevant prevention target in our setting.
وصف الملف: electronic resource
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5دورية أكاديمية
المؤلفون: Kufre Joseph Okop, Kathy Murphy, Estelle Victoria Lambert, Kiya Kedir, Hailemichael Getachew, Rawleigh Howe, Jean Berchmans Niyibizi, Selemani Ntawuyirushintege, Charlotte Bavuma, Stephen Rulisa, Stephen Kasenda, Effie Chipeta, Christopher Bunn, Amelia C. Crampin, Gertrude Chapotera, Abby C. King, Ann Banchoff, Sandra J. Winter, Naomi S. Levitt
المصدر: Research Involvement and Engagement, Vol 7, Iss 1, Pp 1-14 (2021)
مصطلحات موضوعية: Community-driven, Citizen science, Cardiovascular disease, Risk perception, Community engagement, Participatory learning, Medicine, Medicine (General), R5-920
الوصف: Abstract Background In sub-Saharan Africa (SSA), which experiences a disproportionately high cardiovascular disease (CVD) burden, population-based screening and prevention measures are hampered by low levels of knowledge about CVD and associated risk factors, and inaccurate perceptions of severity of risk. Methods This protocol describes the planned processes for implementing community-driven participatory research, using a citizen science method to explore CVD risk perceptions and to develop community-specific advocacy and prevention strategies in the rural and urban SSA settings. Multi-disciplinary research teams in four selected African countries will engage with and train community members living in rural and urban communities as citizen scientists to facilitate conceptualization, co-designing of research, data gathering, and co-creation of knowledge that can lead to a shared agenda to support collaborative participation in community-engaged science. The emphasis is on robust community engagement, using mobile technology to support data gathering, participatory learning, and co-creation of knowledge and disease prevention advocacy. Discussion Contextual processes applied and lessons learned in specific settings will support redefining or disassembling boundaries in participatory science to foster effective implementation of sustainable prevention intervention programmes in Low- and Middle-income countries.
وصف الملف: electronic resource
Relation: https://doaj.org/toc/2056-7529
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6دورية أكاديمية
المؤلفون: Veronique Nicolaou, Larske Soepnel, Kenneth Huddle, Kerstin Klipstein-Grobusch, Naomi S. Levitt, Shane A. Norris
المصدر: PLoS ONE, Vol 17, Iss 2 (2022)
الوصف: Background Hyperglycaemia first detected during pregnancy(HFDP) has far-reaching maternal consequences beyond the pregnancy. Our study evaluated the cardiometabolic outcomes in women with prior HFDP versus women without HFDP 3–6 years post-partum in urban South Africa. Design and methods A prospective cohort study was performed of 103 black African women with prior HFDP and 101 without HFDP, 3–6 years post-partum at Chris Hani Baragwanath Academic Hospital, Soweto. Index pregnancy data was obtained from medical records. Post-partum, participants were re-evaluated for anthropometric measurements, body composition utilizing dual energy X-ray absorptiometry(DXA) and biochemical analysis (two-hour 75gm OGTT fasting insulin, lipids, creatinine levels and glucose levels). Cardiovascular risk was assessed by Framingham risk score(FRS). Carotid intima media thickness(cIMT) was used as a surrogate marker for subclinical atherosclerosis. Factors associated with progression to cardiometabolic outcomes were assessed using multivariable logistic and linear regression models. Results Forty-six(45.1%) HFDP women progressed to diabetes compared to 5(4.9%) in non HFDP group(pConclusion Women with a history of HFDP have a higher risk of cardiometabolic conditions within 6 years post-partum in an urban sub-Saharan African setting.
وصف الملف: electronic resource
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7دورية أكاديمية
المؤلفون: Mahmoud Werfalli, Peter J. Raubenheimer, Mark Engel, Alfred Musekiwa, Kirsten Bobrow, Nasheeta Peer, Cecilia Hoegfeldt, Sebastiana Kalula, Andre Pascal Kengne, Naomi S. Levitt
المصدر: Systematic Reviews, Vol 9, Iss 1, Pp 1-19 (2020)
مصطلحات موضوعية: Medicine
الوصف: Abstract Objective Community-based peer and community health worker-led diabetes self-management programs (COMP-DSMP) can benefit diabetes care, but the supporting evidence has been inadequately assessed. This systematic review explores the nature of COMP-DSMP in low- and middle-income countries’ (LMIC) primary care settings and evaluates implementation strategies and diabetes-related health outcomes. Methods We searched the Cochrane Library, PubMed-MEDLINE, SCOPUS, CINAHL PsycINFO Database, International Clinical Trials Registry Platform, Clinicaltrials.gov , Pan African Clinical Trials Registry (PACTR), and HINARI (Health InterNetwork Access to Research Initiative) for studies that evaluated a COMP-DSMP in adults with either type 1 or type 2 diabetes in World Bank-defined LMIC from January 2000 to December 2019. Randomised and non-randomised controlled trials with at least 3 months follow-up and reporting on a behavioural, a primary psychological, and/or a clinical outcome were included. Implementation strategies were analysed using the standardised implementation framework by Proctor et al. Heterogeneity in study designs, outcomes, the scale of measurements, and measurement times precluded meta-analysis; thus, a narrative description of studies is provided. Results Of the 702 records identified, eleven studies with 6090 participants were included. COMP-DSMPs were inconsistently associated with improvements in clinical, behavioural, and psychological outcomes. Many of the included studies were evaluated as being of low quality, most had a substantial risk of bias, and there was a significant heterogeneity of the intervention characteristics (for example, peer definition, selection, recruitment, training and type, dose, and duration of delivered intervention), such that generalisation was not possible. Conclusions The level of evidence of this systematic review was considered low according to the GRADE criteria. The existing evidence however does show some improvements in outcomes. We recommend ongoing, but well-designed studies using a framework such as the MRC framework for the development and evaluation of complex interventions to inform the evidence base on the contribution of COMP-DSMP in LMIC.
وصف الملف: electronic resource
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8دورية أكاديمية
المؤلفون: Nina Abrahams, Lucy Gilson, Naomi S. Levitt, Joel A. Dave
المصدر: BMC Endocrine Disorders, Vol 19, Iss 1, Pp 1-11 (2019)
مصطلحات موضوعية: Non-communicable disease, Inpatient, empowerment, Self-management, Diabetes, South Africa, Qualitative methods, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
الوصف: Abstract Background The burden of non-communicable diseases is growing rapidly in low- and middle-income countries. Research suggests that health interventions that aim to improve patient self-management and empower patients to care actively for their disease will improve health outcomes over the long-term. There is, however, a gap in the literature about the potential role of the inpatient setting in supporting chronic care. This is particularly important in low-and-middle income countries where hospitals may be a rare prolonged point of contact between patient and health provider. The aim of this small scale, exploratory study was to understand what factors within the inpatient setting may affect patients’ feelings of empowerment in relation to their chronic disease care and provides recommendations for future inpatient-based interventions to support self-management of disease. Methods This study was based in a public, academic hospital in South Africa. Eighteen qualitative, semi-structured interviews were conducted with multiple participants with experience of diabetes care: inpatients and health professionals such as nurses, endocrinologists, and dieticians. Findings were analysed using a broad, exploratory, thematic approach, guided by self-management and chronic care literature. Results Interviews with both patients and providers suggest that patients living in low socio-economic contexts are likely to struggle to access appropriate healthcare information and services, and may often have financial and emotional priorities that take precedence over their chronic illness. Younger people may also be more dependent on their family and community, giving them less ability to take control of their disease care and lifestyle. In addition, hospital care remains bound by an acute care model; and the inpatient setting of focus is characterised by perceived staff shortages and ineffective communication that undermine the implementation of patient empowerment-focused interventions. Conclusions Patient and provider contexts are likely to make supporting patient engagement in long-term chronic care difficult in lower income settings. However, knowledge of these factors can be harnessed to improve chronic care interventions in South Africa and other similar countries.
وصف الملف: electronic resource
Relation: https://doaj.org/toc/1472-6823
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9دورية أكاديمية
المؤلفون: Smart Z. Mabweazara, L.L. Leach, Clemens Ley, Sunday O. Onagbiye, Joel A. Dave, Naomi S. Levitt, Estelle V. Lambert
المصدر: Health SA Gesondheid: Journal of Interdisciplinary Health Sciences, Vol 26, Iss 0 (2021)
مصطلحات موضوعية: Public aspects of medicine, RA1-1270
الوصف: No abstract available.
وصف الملف: electronic resource
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10دورية أكاديمية
المؤلفون: Tawanda Chivese, Magret C. Haynes, Hetta van Zyl, Una Kyriacos, Naomi S. Levitt, Shane A. Norris
المصدر: PLoS ONE, Vol 16, Iss 10 (2021)
الوصف: Introduction Little is known about the influence of hyperglycemia first detected in pregnancy (HFDP) on weight outcomes in exposed offspring in Africa. We investigated the influence of maternal blood glucose concentrations during pregnancy on offspring weight outcomes at birth and preschool age, in offspring exposed to HFDP, in South Africa. Research design and methods Women diagnosed with HFDP had data routinely collected during the pregnancy and at delivery, at a referral hospital, and the offspring followed up at preschool age. Maternal fasting, oral glucose tolerance test 1 and 2-hour blood glucose were measured at diagnosis of HFDP and 2-hour postprandial blood glucose during the third trimester. Offspring were classified as either those exposed to diabetes first recognized in pregnancy (DIP) or gestational diabetes (GDM). At birth, neonates were classified into macrosomia, low birth weight (LBW), large for gestational age (LGA), appropriate (AGA) and small for gestational age (SGA)groups. At preschool age, offspring had height and weight measured and Z-scores for weight, height and BMI calculated. Results Four hundred and forty-three neonates were included in the study at birth, with 165 exposed to DIP and 278 exposed to GDM. At birth, the prevalence of LGA, macrosomia and LBW were 29.6%, 12.2% and 7.5%, respectively, with a higher prevalence of LGA and macrosomia in neonates exposed to DIP. At pre-school age, the combined prevalence of overweight and obesity was 26.5%. Maternal third trimester 2-hour postprandial blood glucose was significantly associated with z-scores for weight at birth and preschool age, and both SGA and LGA at birth. Conclusion In offspring exposed to HFDP, there is a high prevalence of LGA and macrosomia at birth, and overweight and obesity at preschool age, with higher prevalence in those exposed to DIP, compared to GDM. Maternal blood glucose control during the pregnancy influences offspring weight at birth and preschool age.
وصف الملف: electronic resource
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