South Africa's Health Promotion Levy: excise tax findings and equity potential

In 2016, the South African government proposed a 20% sugar-sweetened beverage (SSB) tax. Protracted consultations with beverage manufacturers and the sugar industry followed. This resulted in a lower sugar-based beverage tax, the Health Promotion Levy (HPL), of approximately 10% coming into effect in April 2018. We provide a synthesis of findings until April 2021. Studies show that despite the lower rate, purchases of unhealthy SSBs and sugar intake consumption from SSBs fell. There were greater reductions in SSB purchases among both lower socioeconomic groups and in subpopulations with higher SSB consumption. These subpopulations bear larger burdens from obesity and related diseases, suggesting that this policy improves health equity. The current COVID-19 pandemic has impacted food and nutritional security. Increased pandemic mortality among people with obesity, diabetes, and hypertension highlight the importance of intersectoral public health disease-prevention policies like the HPL, which should be strengthened

Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis.

OBJECTIVES: Varying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa. Therefore, this study aimed to compare blood pressure (BP) levels and investigate the extent to which socioeconomic status (SES) is associated with BP, in rural and urban South Africa women. SETTING: Rural and urban South Africa. DESIGN: Cross-sectional. PARTICIPANTS: Cross-sectional data on SES, total moderate and vigorous physical activity (MVPA), anthropometric and BP were collected on rural (n=509) and urban (n=510) young black women (18-23 years age). Pregnant and mentally or physically disabled women were excluded from the study. RESULTS: The prevalence of combined overweight and obesity (46.5% vs 38.8%) and elevated BP (27.0% vs 9.3%) was higher in urban than rural women, respectively. Results from the structural equation modelling showed significant direct positive effects of body mass index (BMI) on systolic BP (SBP) in rural, urban and pooled datasets. Negative direct effects of SES on SBP and positive total effects of SES on SBP were observed in the rural and pooled datasets, respectively. In rural young women, SES had direct positive effects on BMI and was negatively associated with MVPA in urban and pooled analyses. BMI mediated the positive total effects association between SES and SBP in pooled analyses (ß 0.46; 95% CI 0.15 to 0.76). CONCLUSIONS: Though South Africa is undergoing nutritional and epidemiological transitions, the prevalence of elevated BP still varies between rural and urban young women. The association between SES and SBP varies considerably in economically diverse populations with BMI being the most significant mediator. There is a need to tailor prevention strategies to take into account optimising BMI when designing strategies to reduce future risk of hypertension in young women.SAN is supported by the UK MRC DfID African Research Leader Scheme and by the DST-NRF Centre of Excellence in Human Development at the University of the Witwatersrand, Johannesburg. Birth to Twenty data collection was supported by the Wellcome Trust under grant (092097/Z/10/Z). The MRC/Wits- Agincourt Unit is supported by the South African Medical Research Council, and the Wellcome Trust under grants (058893/Z/99/A, 069683/Z/02/Z, 085477/Z/08/Z, 085477/B/08/Z)

Factors associated with bacterial vaginosis in sexually active women enrolled in the Microbicide Development Program 301 Study.

Introduction Bacterial vaginosis (BV) is a highly prevalent vaginal infection which poses a significant public health burden in Sub-Saharan Africa (SSA) due to its association with HIV, other STIs and several gynaecological and obstetrical complications. The aim of this study was to explore the underlying and proximate factors associated with BV and the relationships between them. Materials and Methods This study was a cross-sectional secondary analysis of the data collected during the Microbial Development Program (MDP) 301 trial. Logistic regression and structural equation modelling were used to test for the associations between BV and the explanatory variables and to test for the direct, indirect and total effects of the variables on BV. Results A total of 2 470 women were included in the analysis and of these 2 203 were aged 40 and below. The majority of them were unemployed at 72% and 51,8% were in the lowest socio-economic level. The baseline prevalence of BV was 40.5%. In the logistic regression, high socio-economic level (AOR=1.66; 95% CI 1.04-2.64) and using a condom during their last sexual encounter (AOR 0.82; 95% CI 0.69-0.97) were associated with BV infection. The STIs significantly associated with BV infection were: Herpes Simplex Virus 2 (HSV2) (AOR=1.31; 95% CI 1.10-1.56), trichomoniasis (AOR=2.68; 95% CI 1.97-3.64) and chlamydia infection (AOR 2.02; 95% CI 1.61-2.62). In the structural equation modelling (SEM) high socio-economic status had a positive direct effect on BV infection (beta=0.12, OR=1.14).Condom use during the last sex act had a negative direct effect on BV (beta=-0.043, OR=0.96). The presence of T.vaginalis, HSV2 or chlamydia infection had significant positive effects on BV infection. Conclusions Sexual behavioural factors and the presence of STIs were significantly associated with BV. The SEM analysis showed the interaction of contraceptive use and sexual behavioural factors. No interaction between the STIs and sexual behaviour could be demonstrated in this study

MBA research and the strategic challenges of practising managers in South Africa

MBA thesis - WBSManagers of South African listed companies are faced with a variety of strategic challenges that they require to find solutions for to ensure the continued existence of their operations. Fortunately, South Africa has several business schools that are capable of conducting research which should provide solutions to some of these strategic challenges. In addition, South Africa has legislated research as an integral part of masters’ degrees and this should ensure a continuous flow of new ideas that should benefit local companies. However, despite the existence of several business schools in South Africa, practising managers seem not to be getting research output from MBA graduates that is relevant to the challenges they are facing. In particular, managers contend that MBA research output has been influenced by the scientific research approach, which elevates academic rigour at the expense of practical relevance. The purpose of this research was to identify the strategic challenges faced by managers of South African listed companies in 2008 and determine the extent to which MBA research subject areas in 2008 matched the strategic challenges faced by these companies. Using a qualitative approach, content analysis was performed on 140 annual reports of JSE listed companies for 2008, and on the 2008 research reports produced by Wits Business School, University of Stellenbosch Business School, University of Cape Town’s Graduate School of Business and University of Pretoria’s Gordon Institute of Business Science. The challenges identified from the annual reports were compared to the research subject areas from the MBA students’ reports from the 4 business schools. The findings of this study were that there were mismatches in 2008 between the challenges that managers faced and the MBA research subject areas. More work need to be done to align the research output of MBA students with the needs of managers. Increased collaboration between faculty, students and managers is required to ensure that students engage in relevant and practical research for the benefit of all stakeholders

The impact of adverse childhood experiences (ACEs) on health and well-being in young adulthood: a longitudinal analysis of data from the birth to twenty plus (Bt20+) cohort

A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, 2020ACEs have gained increasing prominence in the public health arena with evidence emerging that they are highly prevalent, interrelated and associated with a range of adverse health and social outcomes. ACEs as a set of exposures was first defined by the ACE Study, a collaboration between the Centres for Disease Control and Prevention (CDC) and the Kaiser Permanente’s Health Appraisal Centre, Department of Preventive Medicine in San Diego, California. Many adverse health outcomes have been strongly associated with ACE experience, though evidence is scarce in low-and-middle income countries due to unavailability of data. This study therefore set out to: (i) determine the prevalence of ACEs in a South African population and the childhood factors that may influence the experience of ACEs; (ii) investigate the presence and extent of interrelatedness and clustering of ACEs in the young adult population; (iii) determine the association between ACEs and psychological distress as an index of mental well-being; and finally (iv) explore the differences in the prevalence of psychological distress between a rural and urban population, and investigate the role of interpersonal violence, household stress and community danger in this relationship. Methods Data for this study came from a birth cohort in Soweto, Johannesburg in South Africa. The cohort has been followed up since 1990, in what is now the Birth to Twenty Plus Study (Bt20+). Adverse childhood experiences (ACEs) were measured retrospectively at 22 years of age using a modified ACE questionnaire. The prevalence of ACEs in the sample was determined, as well as childhood factors associated with experiencing ACEs. In the next step, the presence of underlying ACE typologies was investigated using latent class analysis. Thirdly the association between ACEs and psychological distress in the presence of contemporary stress was investigated using hierarchical regression methods. Finally, the experience of psychological distress in the urban Bt20+ cohort was compared to that of a rural population sampled from the MRC/Wits-Rural Public Health and Health Transitions Unit (Agincourt), a health and socio-demographic surveillance system based in Northeast South Africa, in the province of Mpumalanga. Only females were included in this last step of the study and data on violence and household stress were also included in the analyses. The impact of ACEs on psychological distress could not be assessed in the rural sample due to unavailability of data. xxiii Results Regarding the prevalence of experiencing at least one ACE in the Bt20+ cohort, 88% reported at least one ACE. Over one third of respondents reported experiencing four or more ACEs and 15% experienced 6 or more ACEs. Of the childhood factors investigated, higher household socio economic status (SES) at 16 years of age and maternal marital status reduced the odds of ever experiencing ACEs as well as experiencing multiple ACEs. A high degree of co-occurrence was detected with many ACE exposures increasing the risk of experiencing others. Four distinct latent clusters of ACEs were identified: class one the “Low ACE” class, class two “Low abuse and neglect, medium household dysfunction”, class three “High emotional abuse and neglect, low household dysfunction” and class four “High emotional abuse and neglect, high household dysfunction”. Once again household socio-economic status at 16 years of age was an important factor influencing class membership. The proportion of participants in the Bt20+ cohort with psychological distress (PD) was 28%. Approximately 50% of those who had PD reported experiencing at least four ACEs, compared to 30% of those who had no PD, and 25% reported six or more ACEs, compared to 11% of those who did not have PD. Compared to those who experienced low levels of ACEs, participants who reported high ACE levels had nearly twelve times greater odds of experiencing high levels of adult stress. Interaction analyses showed that high levels of adult life stress increase the likelihood of PD by over 20 times compared to no stress, in the absence of ACEs. However, both low and high levels of ACEs had a significantly different effect in individuals with high adult stress compared to those with no adult stress. In the comparison analyses, the urban sample had higher levels of PD, interpersonal violence (IPV), household stress and community danger compared to the rural young women. A direct association between IPV and PD was observed in the urban young women independent of household stress, SES, community danger and demographic factors. Rural residents showed much greater sensitivity to the effect of household stress compared to the urban residents. Conclusions ACEs are highly prevalent and interrelated in this cohort of young adults. SES is an important factor in the experience of ACEs. The association between ACEs and PD is strong and the effect of ACEs needs to be considered in assessing mental well-being. The study of ACEs needs to account for the fact that they seldom occur alone. The interplay between ACEs and mental health xxiv and contemporary stress means the management of psychological distress needs to extend beyond current events and stressors. Further research is needed to assess if there is a difference in ACE experience in rural and urban environments and if this differentially impacts mental well-being.TL (2021

Additional file 5: of Stress begets stress: the association of adverse childhood experiences with psychological distress in the presence of adult life stress

Hierarchical regression results: ACEs as binary exposure. Presented here are the adjusted hierarchical regression results using ACE as a binary exposure, including the interaction analysis. (DOCX 14 kb

Determinants of obesity and associated population attributability, South Africa: empirical evidence from a national panel survey, 2008-2012

Obesity is a major risk factor for emerging non-communicable diseases (NCDS) in middle income countries including South Africa (SA). Understanding the multiple and complex determinants of obesity and their true population attributable impact is critical for informing and developing effective prevention efforts using scientific based evidence. This study identified contextualised high impact factors associated with obesity in South Africa. Analysis of three national cross sectional (repeated panel) surveys, using a multilevel logistic regression and population attributable fraction estimation allowed for identification of contextualised high impact factors associated with obesity (BMI>30 kg/m2) among adults (15years+). Obesity prevalence increased significantly from 23.5% in 2008 to 27.2% in 2012, with a significantly (p-value<0.001) higher prevalence among females (37.9% in 2012) compared to males (13.3% in 2012). Living in formal urban areas, white ethnicity, being married, not exercising and/or in higher socio-economic category were significantly associated with male obesity. Females living in formal or informal urban areas, higher crime areas, African/ White ethnicity, married, not exercising, in a higher socio-economic category and/or living in households with proportionate higher spending on food (and unhealthy food options) were significantly more likely to be obese. The identified determinants appeared to account for 75% and 43% of male and female obesity respectively. White males had the highest relative gain in obesity from 2008 to 2012. The rising prevalence of obesity in South Africa is significant and over the past 5 years the rising prevalence of Type-2 diabetes has mirrored this pattern, especially among females. Targeting young adolescent girls should be a priority. Addressing determinants of obesity will involve a multifaceted strategy and requires at individual and population levels. With rising costs in the private and public sector to combat obesity related NCDS, this analysis can inform culturally sensitive mass communications and wellness campaigns. Knowledge of social determinants is critical to develop best buys.

Stress begets stress: the association of adverse childhood experiences with psychological distress in the presence of adult life stress

Abstract Background Adverse childhood experiences (ACES) have been linked to poor health and well-being outcomes, including poor mental health such as psychological distress. Both ACEs and psychological distress pose a significant public health burden, particularly in low to middle income countries. Contemporaneous stress events in adulthood may also impact psychological distress. The aims of this study were to describe the prevalence of ACEs and psychological distress and to assess the separate and cumulative effect of ACEs on psychological distress, while accounting for the effect of adult stress. Methods In this cross-sectional study, we used retrospectively measured ACEs from a sample of 1223 young adults aged between 22 and 23 years (52% female) from the Birth to Twenty Plus Study. Psychological distress and adult life stress were measured with a six-month recall period. Hierarchical logistic regression was employed to assess the associations between the exposures and outcome. Results Nearly 90% of the sample reported at least one ACE and 28% reported psychological distress. The median number of ACEs reported was three (range 0–11). After accounting for demographic and socio-economic factors, all ACEs were individually associated with psychological distress except for parental divorce and unemployment. The individual ACEs increased the odds of PD by between 1.42 and 2.79 times. Compared to participants experiencing no ACEs, those experiencing one to five ACEs were three times more likely to report psychological distress (AOR 3.2 95% CI: 1.83–5.63), while participants who experienced six or more ACEs had nearly eight times greater odds of reporting psychological distress (AOR 7.98 95% CI: 4.28–14.91). Interaction analysis showed that in the absence of adult life stress, the effect of low ACEs compared to high ACEs on PD was not significantly different. Discussion and conclusion The prevalence of ACEs in this young adult population is high, similar to other studies in young adult populations. A significant direct association exists between ACEs and psychological distress. Adult life stress seems to be a mediator of this relationship. Interventions targeted at psychological distress should address both early life adversity and contemporary stress

Additional file 3: of Stress begets stress: the association of adverse childhood experiences with psychological distress in the presence of adult life stress

Separate and cumulative effects of ACEs on adult life stress. The table presents the regression results of ACEs on adult life stress. (DOCX 14 kb