Browsing by Author "Abrahams, Zulfa"

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    Changes in blood pressure, glucose levels, insulin secretion and anthropometry after long term exposure to antiretroviral therapy in South African women
    (2015-08-05) Abrahams, Zulfa; Dave, Joel A; Maartens, Gary; Levitt, Naomi S
    Abstract Background A number of metabolic abnormalities, such as dysglycaemia, insulin resistance, lipodystrophy and dyslipidaemia, are associated with the use of antiretroviral drugs. We aimed to assess the effects of long-term antiretroviral exposure on blood pressure, glycaemia, insulin secretion and anthropometric measures in black South African women. Methods A convenience sample of HIV-infected women on first-line ART for a median of 16 months at baseline, had the following evaluations twice, at baseline and after approximately 5 years: anthropometry, including skin fold thicknesses, blood pressure, oral glucose test, and insulin. Insulin sensitivity and secretion (HOMA-IR, IGI and DIo) were estimated. Results At baseline more than half the 103 women were using stavudine and efavirenz. The median interval between baseline and follow-up evaluation was 66 months. Weight, waist circumference, and waist-hip ratio increased over time, while limb skinfold thickness decreased over time. Systolic and diastolic blood pressure increased significantly and the proportion of participants with hypertension increased from 3.9 to 15.5% (p < 0.001). There were increases from baseline in plasma glucose concentrations at 30 and 120 min; insulin concentrations at 0 and 30 min; and IGI and DIo. The proportion of participants with diabetes increased from 1 to 7.5% (p = 0.070). Conclusion In black South African women with long-term exposure to ART, increases in hypertension and possibly diabetes were observed. Participants experienced an increase in central fat and a decrease in peripheral fat distribution. Early identification and management of these metabolic changes are important, especially in a region with the highest HIV-infected population in the world.
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    Developing a ball mill model that incorporates grate and overflow discharge configurations
    (2023) Mwale, Owen; Abrahams, Zulfa
    The purpose of this thesis was to investigate performance differences between the grate and overflow discharge type ball mills of the same size under similar operating conditions using platreef ore which is classified as rheologically complex. The results from this investigation were used to develop a ball mill model that incorporates discharge mechanism and variables that influence mill power draw and product size distribution. Discharge configuration effects and power draw being one of the most important factors in ball mill performance, this thesis was set out to include these in performance prediction and analysis. The pilot ball mill operated by Magotteaux installed at the Anglo Platinum plant in Rustenburg was used to collect performance and operational data for use in the modelling. Two discharge configuration types were tested. The grate at two set open areas of 9.5% and 3.4% were used as well as the overflow type. The 1.25 m diameter and 2.20 m length mill was operated at two ball-load set points and a feed rate range of 1.50 tph to 2.25 tph for each configuration. Results showed that the grate configured ball mill produced much finer product compared to the overflow when operated under similar conditions. Results further showed that the grate ball mill had relatively higher breakage and discharge rates when operated at same conditions as the overflow. It was also shown that the grate discharge ball mill will draw an average of 18% more power than the overflow ball mill of the same size under similar operating conditions. Using these results, a new ball mill model was developed. The model is based on the principle that breakage distribution of the ore is unique to its competence and specific energy. The model incorporates mill operating conditions and retains the use of the appearance function. The model further incorporates influences of design and operating variable on mill power draw to predict product size distribution. It was found that the model agrees well with the pilot ball mill performance data. The model was later sub-developed into two models each specific to the discharge configuration type, the grate and overflow. For each configuration type, the model was found to give good predictions in agreement with real data. Thus, a model that considers the unique properties of the ore and discharge configuration incorporating mill power draw was developed.
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    Developing a task-sharing psychological intervention to treat mild to moderate symptoms of perinatal depression and anxiety in South Africa: a mixed-method formative study
    (2021-03-15) Boisits, Sonet; Abrahams, Zulfa; Schneider, Marguerite; Honikman, Simone; Kaminer, Debra; Lund, Crick
    Background Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. The aim of this study is to develop a task-sharing psychological counselling intervention for routine treatment of mild to moderate symptoms of perinatal depression and anxiety in South Africa, as part of the Health Systems Strengthening in sub-Saharan Africa (ASSET) study. Methods We conducted a review of manuals from seven counselling interventions for depression and anxiety in low- and middle-income countries and two local health system training programmes to gather information on delivery format and common counselling components used across task-sharing interventions. Semi-structured interviews were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to explore perceptions and needs relating to mental health. Stakeholder engagements further informed the intervention design and appropriate service provider. A four-day pilot training with community-based health workers refined the counselling content and training material. Results The manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural activation as common counselling components across interventions using a variety of delivery formats. The interviews found that participants mostly identified symptoms of depression and anxiety in behavioural terms, and lay health workers and pregnant women demonstrated their understanding through a range of local idioms. Perceived causes of symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified a three-session counselling model as most feasible for delivery as part of existing health care practices and community health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention with community-based health workers resulted in minor adaptations of the counselling assessment method. Conclusion Input from health workers and pregnant women is a critical component of adapting existing maternal mental health protocols to the context of routine care in South Africa, providing valuable data to align therapeutic content with contextual needs. Multisector stakeholder engagements is vital to align the intervention design to health system requirements and guidelines.
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    The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings
    (BioMed Central, 2014-08-04) Abrahams, Zulfa; Dave, Joel A; Maartens, Gary; Lesosky, Maia; Levitt, Naomi S
    Abstract Background Lipohypertrophy does not appear to be an adverse ART reaction while lipoatrophy is clearly associated with the use of stavudine (d4T) and zidovudine (AZT). In low and middle income countries d4T has only recently been phased out and AZT is still widely being used. Several case definitions have been developed to diagnose lipodystrophy, but none of them are generalizable to sub-Saharan Africa where black women have less visceral adipose tissue and more subcutaneous adipose tissue than white women. We aimed to develop a simple, objective measure to define lipoatrophy and lipohypertrophy by comparing patient report to anthropometric and dual-energy X-ray absorptiometry (DXA) -derived variables. Methods DXA and anthropometric measures were obtained in a cross sectional sample of black HIV-infected South African men (n = 116) and women (n = 434) on ART. Self-reported information on fat gain or fat loss was collected using a standard questionnaire. Receiver operating characteristic (ROC) curves were used to describe the performance of anthropometric and DXA-derived variables using patient reported lipoatrophy and lipohypertrophy as the reference standard. Results Lipoatrophy and lipohypertrophy were more common in women (25% and 33% respectively) than in men (10% and 13% respectively). There were insufficient numbers of men with DXA scans for meaningful analysis. The best predictors of lipoatrophy in women were the anthropometric variables tricep (AUC = 0.725) and thigh skinfold (AUC =0.720) thicknesses; and the DXA-derived variables percentage lower limb fat (AUC = 0.705) and percentage lower limb fat/height (AUC = 0.713). The best predictors of lipohypertrophy in women were the anthropometric variable waist/hip ratio (AUC = 0.645) and the DXA-derived variable percentage trunk fat/percentage limb fat (AUC = 0.647). Conclusions We were able to develop simple, anthropometric measures for defining lipoatrophy and lipohypertrophy, using a sample of black HIV-infected South African women with DXA scans. This is of particular relevance in resource limited settings, where health professionals need simple and inexpensive methods of diagnosing patients with lipoatrophy and lipohypertrophy.
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    Did HealthKick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?
    (2015-09-23) Steyn, Nelia P; de Villiers, Anniza; Gwebushe, Nomonde; Draper, Catherine E; Hill, Jillian; de Waal, Marina; Dalais, Lucinda; Abrahams, Zulfa; Lombard, Carl; Lambert, Estelle V
    Background: Numerous studies in schools in the Western Cape Province, South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat. HealthKick (HK) was a three-year randomised controlled trial aimed at promoting healthy eating habits. Methods: Sixteen schools were selected from two low-income school districts and randomly allocated to intervention (n = 8) or control school (n = 8) status. The HK intervention comprised numerous activities to improve the school nutrition environment such as making healthier food choices available and providing nutrition education support. Dietary intake was measured by using a 24-h recall in 2009 in 500 grade 4 learners at intervention schools and 498 at control schools, and repeated in 2010 and 2011. A dietary diversity score (DDS) was calculated from nine food groups and frequency of snack food consumption was determined. A school level analysis was performed. Results: The mean baseline (2009) DDS was low in both arms 4.55 (SD = 1.29) and 4.54 (1.22) in the intervention and control arms respectively, and 49 % of learners in HK intervention schools had a DDS ≤4 (=low diversity). A small increase in DDS was observed in both arms by 2011: mean score 4.91 (1.17) and 4.83 (1.29) in the intervention and control arms respectively. The estimated DSS intervention effect over the two years was not significant [0 .04 (95 % CI: −0.37 to 0.46)]. Food groups least consumed were eggs, fruit and vegetables. The most commonly eaten snacking items in 2009 were table sugar in beverages and/or cereals (80.5 %); followed by potato crisps (53.1 %); non-carbonated beverages (42.9 %); sweets (26.7 %) and sugar-sweetened carbonated beverages (16 %). Unhealthy snack consumption in terms of frequency of snack items consumed did not improve significantly in intervention or control schools. Discussion: The results of the HK intervention were disappointing in terms of improvement in DDS and a decrease in unhealthy snacking. We attribute this to the finding that the intervention model used by the researchers may not have been the ideal one to use in a setting where many children came from low-income homes and educators have to deal with daily problems associated with poverty.Conclusions: The HK intervention did not significantly improve quality of diet of children.
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    HealthKick : evaluating the impact of a school-based intervention on the dietary adequacy of learners from low-income settings in the Western Cape Province, South Africa
    (2011) Abrahams, Zulfa; Steyn, N P; Ehrlich, R; De Villiers, A
    HealthKick is a primary school-based nutrition and physical activity intervention programme aimed at promoting the adoption of healthy lifestyle behaviour to reduce diabetes risk factors in disadvantaged communities in South Africa. HealthKick aims to promote and increase learners', teachers' and parents' consumption of healthy food and their participation in health enhancing physical activity. This dissertation sub-study forms part of the evaluation of the greater HealthKick project. The primary objective of the study was to compare the dietary adequacy of learners at intervention and control schools after 18 months of intervention. The subsidiary objective was to identify the determinants of dietary adequacy.
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    "HealthKick": Formative assessment of the health environment in low-resource primary schools in the Western Cape Province of South Africa
    (BioMed Central Ltd, 2012) de Villiers, Anniza; Steyn, Nelia; Draper, Catherine; Fourie, Jean; Barkhuizen, Gerhard; Lombard, Carl; Dalais, Lucinda; Abrahams, Zulfa; Lambert, Estelle
    BACKGROUND: This study evaluated the primary school environment in terms of being conducive to good nutrition practices, sufficient physical activity and prevention of nicotine use, with the view of planning a school-based health intervention. METHODS: A sample of 100 urban and rural disadvantaged schools was randomly selected from two education districts of the Western Cape Education Department, South Africa. A situation analysis, which comprised an interview with the school principal and completion of an observation schedule of the school environment, was done at all schools. RESULTS: Schools, on average, had 560 learners and 16 educators. Principals perceived the top health priorities for learners to be an unhealthy diet (50%) and to far lesser degree, lack of physical activity (24%) and underweight (16%). They cited lack of physical activity (33%) and non-communicable diseases (NCDs; 24%) as the main health priorities for educators, while substance abuse (66%) and tobacco use (31%) were prioritised for parents. Main barriers to health promotion programmes included lack of financial resources and too little time in the time table. The most common items sold at the school tuck shops were crisps (100%), and then sweets (96%), while vendors mainly sold sweets (92%), crisps (89%), and ice lollies (38%). Very few schools (8%) had policies governing the type of food items sold at school. Twenty-six of the 100 schools that were visited had vegetable gardens. All schools reported having physical activity and physical education in their time tables, however, not all of them offered this activity outside the class room. Extramural sport offered at schools mainly included athletics, netball, and rugby, with cricket and soccer being offered less frequently. CONCLUSION: The formative findings of this study contribute to the knowledge of key environmental and policy determinants that may play a role in the health behaviour of learners, their parents and their educators. Evidently, these show that school environments are not always conducive to healthy lifestyles. To address the identified determinants relating to learners it is necessary to intervene on the various levels of influence, i.e. parents, educators, and the support systems for the school environment including the curriculum, food available at school, resources for physical activity as well as appropriate policies in this regard.
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    HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings
    (BioMed Central Ltd, 2010) Draper, Catherine; de Villiers, Anniza; Lambert, Estelle; Fourie, Jean; Hill, Jillian; Dalais, Lucinda; Abrahams, Zulfa; Steyn, Nelia
    BACKGROUND: The burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa. This country has a complex mix of over- and under-nutrition, especially in low-income communities, and concerning levels of physical inactivity in children and youth. This paper describes HealthKick, a school-based nutrition and physical activity intervention in primary schools in these settings aimed at reducing diabetes risk factors.METHODS/DESIGN:This study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component.DISCUSSION:This study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.
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    Metabolic complications resulting from the use of antiretroviral therapy in HIV-infected patients
    (2016) Abrahams, Zulfa; Levitt, Naomi S; Maartens, Gary
    While antiretroviral therapy (ART) has extended the life expectancy of those infected with HIV, it is also associated with a number of metabolic complications, such as dysglycaemia, insulin resistance and lipodystrophy. Lipodystrophy is characterised by an increase in trunk fat (lipohypertrophy) and/or a decrease in limb fat (lipoatrophy). This thesis investigates the metabolic complications associated with ART, and develops simple anthropometric cut-points for identifying those with lipodystrophy. Data for this thesis comes from three datasets (a cross sectional study and two longitudinal studies), collected between 2007 and 2013. All datasets consisted of black HIV-infected men and women presenting to ART clinics in Cape Town. The same measurements were collected in all studies: anthropometry, self-reported lipodystrophy, dual-energy X-ray absorptiometry (DXA), blood pressure (BP), cholesterol and glucose. Longitudinal data were used to assess long-term ART exposure on BP, glycaemia, insulin secretion and anthropometric measures in women on ART. We found that weight, waist circumference, and waist-hip ratio increased, limb skinfold thickness decreased, and the proportion of participants with hypertension and diabetes increased. Longitudinal data was used to describe changes in body fat distribution over a 24 month period. We found that women gained more overall weight and more regional fat in all areas compared to men. The risk of lipoatrophy was two-fold greater in men than in women. Simple, objective measures to define lipoatrophy and lipohypertrophy by comparing patient report to anthropometric and DXA-derived variables, were developed using cross sectional data. In women, the best predictors of lipoatrophy were triceps and thigh skinfold thicknesses, and for lipohypertrophy it was waist/hip ratio. Longitudinal data was used to validate the objective measures that were developed by comparing change in limb fat and trunk fat as measured by DXA to anthropometric variables. We showed that the best predictors of lipoatrophy in women were hip and mid-thigh circumference, and mid-arm circumference in men. The thesis findings highlight the importance of early identification of these cardiometabolic risks in Africa. The development of anthropometric measures are of particular relevance in resource limited settings, where health professionals need simple and inexpensive methods for diagnosing patients with lipoatrophy and lipohypertrophy.
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    The association between nutrition and physical activity knowledge and weight status of primary school educators
    (2014) Dalais, Lucinda; Abrahams, Zulfa; Steyn, Nelia P; de Villiers, Anniza; Fourie, Jean M; Hill, Jillian; Lambert, Estelle V; Draper, Catherine E
    The purpose of this study was to investigate primary school educators' health status, knowledge, perceptions and behaviour regarding nutrition and physical activity.Thus, nutrition and physical activity knowledge, attitudes, behaviour and risk factors for the development of non-communicable diseases of 155 educators were assessed in a cross-sectional survey. Height, weight, waist circumference, blood pressure and random glucose levels were measured. Twenty percent of the sample had normal weight (body mass index (BMI, kg/m2) < 25), 27.7% were overweight (BMI> 25 to < 30) and 52.3% were obese (BMI < 30). Most of the participants were younger than 45 years (54.2%), females 78.1%, resided in urban areas (50.3%), with high blood pressure (> 140/90 mmHg: 50.3%), and were inactive (48.7%) with a high waist circumference (> 82 cm: 57.4%). Educators' nutrition and physical activity knowledge was poor. Sixty-nine percent of educators incorrectly believed that eating starchy foods causes weight gain and only 15% knew that one should eat five or more fruit and/or vegetables per day. Aspects of poor nutritional knowledge, misconceptions regarding actual body weight status, and challenges in changing health behaviours, emerged as issues which need to be addressed among educators. Educators' high risk for developing chronic non-communicable diseases (NCDs) may impact on educator absenteeism and subsequently on school functioning. The aspects of poor nutrition and physical activity knowledge along with educators' high risk for NCD development may be particularly significant not merely in relation to their personal health but also the learners they teach.
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    Validation of a brief mental health screening tool for pregnant women in a low socio-economic setting
    (2019-12-09) Abrahams, Zulfa; Schneider, Marguerite; Field, Sally; Honikman, Simone
    Abstract Background In South Africa, the prevalence of symptoms of common mental disorders (CMD), i.e. depression, anxiety and suicidal thoughts are high. This study aimed to use a cognitive interviewing technique to validate the content and structure of a 4-item screening tool, to adapt the tool accordingly, and to use receiver operating curve (ROC) analysis to determine the optimum cut-point for identifying pregnant women with symptoms of CMD. Methods We conducted a mixed method study at a Midwife Obstetric Unit in Cape Town. Women attending the clinic for their first antenatal visit during the recruitment period, whose first language was English, Afrikaans or isiXhosa, were invited to participate. A 4-item screening tool was administered in the first language of the interviewee, after which a cognitive interviewing technique was used to examine the question-response processes and considerations used by respondents as they formed answers to the screening tool questions. The Edinburgh Postnatal Depression Scale (EPDS) was used to identify women with symptoms of CMD. Results A 2-week recall period performed well. Questions about (1) being unable to stop worrying, or thinking too much, (2) feeling down, depressed or hopeless, and (3) having thoughts and plans to harm yourself, were well understood. The question that referred to feeling little interest or pleasure in doing things, was poorly understood across all languages. Using ROC analysis with the EPDS as the reference standard, and a cut-point of ≥13, we showed that a 3-item version of the screening tool was able to correctly classify 91% of the women screened. Conclusions Cognitive interviewing enabled testing and refining of the language and constructs of an ultra-brief screening tool. The shortened, 3-item tool is well understood and effective at identifying pregnant women with symptoms of CMD, across the three most commonly spoken languages and cultures in Cape Town.