scholarly journals Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa

Author(s):  
Deborah Louise Sinclair ◽  
Steve Sussman ◽  
Maarten De Schryver ◽  
Cedric Samyn ◽  
Sabirah Adams ◽  
...  

The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residential substance use treatment in the Western Cape province of South Africa. The brief assessment of recovery capital, overall life satisfaction scale, and an adapted version of the addiction matrix self-report measure were completed during and post-treatment. Results indicate that substitutes were employed consciously for anticipated appetitive effects, for time-spending, (re)connecting with others, and enjoyment. At follow-up, 36% of service users had substituted their primary substance(s) with another substance or behavior; 23% had relapsed and 40% had maintained abstinence. While some service users may be especially vulnerable to developing substitute behaviors, targeted prevention and intervention efforts can reduce this risk.

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ronita Mahilall ◽  
Leslie Swartz

Abstract Background South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust. Discussion Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.


2018 ◽  
Vol 25 (6) ◽  
pp. 529-534 ◽  
Author(s):  
Colleen Jayne Saunders ◽  
Robyn Adriaanse ◽  
Abigail Simons ◽  
Ashley van Niekerk

IntroductionDrowning is a neglected public health threat in low-income and middle-income countries where the greatest drowning burden is observed. There is a paucity of drowning surveillance data from low-resource settings, particularly in Africa. Understanding local epidemiological factors will enable the development of context-specific drowning prevention initiatives and the appropriate allocation of resources.AimThe primary aim of this study was to describe the epidemiology of fatal drowning in the Western Cape, South Africa.MethodThis retrospective study describes fatal drowning incidents captured in the Western Cape vital registration system between 2010 and 2016. Data were obtained from the Forensic Pathology Services of the Western Cape Government. One-way analysis of variance was performed to detect a trend in mean drowning mortality rates between 2010 and 2016. χ2 tests for independence were performed to detect differences in the distribution of variables between groups.ResultsA total of 1391 fatal drownings occurred in the Western Cape between 2010 and 2016, with an age-adjusted drowning mortality rate of 3.2 per 100 000 population. Rates were fourfold higher in men compared with women. Children, particularly young children aged 0–4 years, and young adult men between 20 and 34 years of age were identified to be at high risk of fatal drowning. Drowning occurred predominantly in large, open bodies of water with concentrations in summer and public holidays.ConclusionsThe Western Cape drowning prevention strategy should prioritise interventions to reduce drowning in children and young adult men, with a targeted focus on festive periods such as public holidays.


2016 ◽  
Vol 3 ◽  
Author(s):  
J. C. Kane ◽  
L. K. Murray ◽  
S. Sughrue ◽  
J. DeMulder ◽  
S. Skavenski van Wyk ◽  
...  

Background.Studies from low- and middle-income countries (LMIC) indicate that the use of audio computer-assisted self-interviewing (ACASI) is associated with more accurate reporting of sensitive behaviors (e.g. substance use and sexual risk behaviors) compared with interviewer-administered questionnaires. There is a lack of published information on the process of designing, developing, and implementing ACASI in LMIC. In this paper we describe our experience implementing an ACASI system for use with a population of orphans and vulnerable children in Zambia.Methods.A questionnaire of mental health, substance use, and HIV risk behaviors was converted into an ACASI system, tested in pilot and validity studies, and implemented for use in a randomized controlled trial. Successes, barriers, and challenges associated with each stage in the development and implementation of ACASI are described.Results.We were able to convert a lengthy and complex survey into an ACASI system that was feasible for use in Zambia. Lessons learned include the importance of: (1) piloting the written and electronic versions; (2) proper and extensive training for study assessors to use ACASI and for those doing voice recordings; and (3) attention to logistics such as appropriate space, internet, and power.Conclusions.We found that ACASI was feasible and acceptable in Zambia with proper planning, training, and supervision. Given mounting evidence indicating that ACASI provides more accurate self-report data and immediate data download compared with interview-administered measures, it may be an effective and economical alternative for behavioral health research studies in LMIC.


Author(s):  
Bonolo Anita Pududu ◽  
Hanna-Andrea Rother

Para-occupational “take-home” exposure risks among forestry workers and their families in low-and middle-income countries (LMICs) have not been well characterized. This is a concern because research shows an association between chronic low-dose herbicide exposure and adverse health effects. This study explored take-home herbicide residue exposure risks among forestry workers in the Western Cape, South Africa, through the community-based participatory research approach of photovoice. A key finding of the study was the absence of provisions related to take-home exposure in the national legislation and workplace policies, which largely contributed to poor adherence to risk reduction practices at worksites, in addition to workers transporting residues to their homes. This study demonstrated evidence of the key omissions regarding take-home exposure at the policy level (e.g., recommendations for employers to reduce take-home risks among employees, and training of workers and their families on take-home exposure) and take-home herbicide residue exposure among worker’s families, including children.


Author(s):  
Chloé Sieber ◽  
Martina S. Ragettli ◽  
Mark Brink ◽  
Olaniyan Toyib ◽  
Roslyn Baatjies ◽  
...  

In developing countries, noise exposure and its negative health effects have been little explored. The present study aimed to assess the noise exposure situation in adults living in informal settings in the Western Cape Province, South Africa. We conducted continuous one-week outdoor noise measurements at 134 homes in four different areas. These data were used to develop a land use regression (LUR) model to predict A-weighted day-evening-night equivalent sound level (Lden) from geographic information system (GIS) variables. Mean noise exposure during day (6:00-18:00) was 60.0 A-weighted decibels (dB(A)) (interquartile range 56.9-62.9 dB(A)), during night (22:00-6:00) 52.9 dB(A) (49.3-55.8 dB(A)) and average Lden was 63.0 dB(A) (60.1-66.5 dB(A)). Main predictors of the LUR model were related to road traffic and household density. Model performance was low (adjusted R2=0.130) suggesting that other influences than represented in the geographic predictors are relevant for noise exposure. This is one of the few studies on the noise exposure situation in low- and middle-income countries. It demonstrates that noise exposure levels are high in these settings.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Beulah Christina van Zyl ◽  
Michelle Monique Barnard ◽  
Keith Cloete ◽  
Amanda Fernandez ◽  
Matodzi Mukosi ◽  
...  

Abstract Background The reduction of inequality is a key United Nations 2030 Sustainable Development Goal (WHO, Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda, 2014; Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020). Despite marked disparities in radiological services globally, particularly between metropolitan and rural populations in low- and middle-income countries, there has been little work on imaging resources and utilization patterns in any setting (Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020; WHO, Local Production and Technology Transfer to Increase Access to Medical Devices, 2019; European Society of Radiology (ESR), Insights Imaging 6:573-7, 2015; Maboreke et al., An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity, 2020; Kabongo et al., Pan Afr Med J 22, 2015; Skedgel et al., Med Decis Making 35:94-105, 2015; Mollura et al., J Am Coll Radiol 913-9, 2014; Culp et al., J Am Coll Radiol 12:475-80, 2015; Mbewe et al., An audit of licenced Zambian diagnostic imaging equipment and personnel, 2020). To achieve equity, a better understanding of the integral components of the so called “imaging enterprise” is important. The aim was to analyse a provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province of South Africa for 2017, utilizing provincial databases. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the whole province, the metropolitan and the rural areas. Results Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km2). Rural imaging facilities by population are double the metropolitan (20 vs 11/106 people). Metropolitan imaging personnel by population (112 vs 53/106 people) and equipment unit (1.7 vs 0.7/unit) are more than double the rural. Overall population-based utilization of imaging services was 30% higher in the metropole (289 vs 214 studies/103 people), with mammography (24 vs 5 studies/103 woman > 40 years) and CT (21 vs 6/103 people) recording the highest, and plain radiography (203 vs 171/103 people) the lowest differences. Conclusion Despite attempts to achieve imaging equity through the provision of increased facilities/million people in the rural areas, differential utilization patterns persist. The achievement of equity must be seen as a process involving incremental improvements and iterative analyses that define progress towards the goal.


2020 ◽  
Author(s):  
Ronita Mahilall ◽  
Leslie Swartz

Abstract Background: South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods: Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results:Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust.Discussion:Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions:While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.


2020 ◽  
Vol 15 (4) ◽  
pp. 181-186
Author(s):  
Petal Petersen Williams ◽  
Catherine Mathews ◽  
Esmé Jordaan ◽  
Yukiko Washio ◽  
Mishka Terplan ◽  
...  

Background This paper examines the degree of agreement among simple dichotomous self-report, validated screening results, and biochemical screening results of prenatal alcohol and other drug use among pregnant women. Method Secondary analysis was conducted on a cohort of pregnant women 16 years or older, presenting for prenatal care in the greater Cape Town, South Africa. Dichotomous verbal screening is a standard of care, and pregnant patients reporting alcohol and other drug use in dichotomous verbal screenings were asked to engage in screening using the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) and urinalysis. Results Significant agreements between dichotomous and ASSIST scores were observed (K = 0.73–0.76). A higher rate of self-reported (36.9%) alcohol use was detected, relative to urine screening (19.6%) with a predictive value of 34.9; while underreporting of illicit substance use was observed (3.6% self-report vs. 8.8% urine screening) with an overall predictive value of 50.0. Conclusion Dichotomous verbal screening was considered valid after comparison with the ASSIST; however, combined use with urine screenings can be recommended especially for identifying illicit substance use in order to accurately detect alcohol and other drug use in pregnancy, so that women can be identified and referred for appropriate interventions where needed.


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