Browsing by Author "Macnab, Andrew J."
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- ItemAssociations between the severity of obstructive lower urinary tract symptoms and care-seeking behavior in rural Africa : a cross-sectional survey from Uganda(Public Library of Science, 2017) Stothers, Lynn; Macnab, Andrew J.; Bajunirwe, Francis; Mutabazi, Sharif; Berkowitz, JonathanBackground: Global estimates indicate that by 2018 2.3 billion individuals worldwide will suffer from lower urinary tract symptoms (LUTS), with 1.1 billion having LUTS related to bladder outlet obstruction (BOO). Left untreated BOO in men causes irreversible changes to the urinary tract leading to urinary retention, the need for catheterization, renal failure and even death. Estimates suggest that Africa will be one of the continents with the greatest increase in (LUTS) by 2018 however direct measures in Africa are lacking. The objectives were to: (1) measure of prevalence of LUTS/BOO in a community-based sample of men in Africa, (2) compare community-based LUTS/BOO frequency to those seeking care for LUTS in a local clinic (3) quantify bother, interference with daily living, worry and quality of life related to LUTS/BOO between community and clinic settings and (4) examine relationships between socioeconomic and demographics related to LUTS/BOO. Methods and findings: 473 men from a rural Ugandan community (238 residents living with their symptoms and 177 presenting at a clinic for care) completed the International Prostate Symptom Scale (IPSS) and a 53-item validated LUTS symptom, bother and quality of life index. Severity of symptoms was categorized based on reference ranges for mild, moderate and severe levels of the IPSS, comparing those in the community versus those seeking care for symptoms. IPSS indicated that 55.9% of men in the community versus 17.5% of those at the clinic had mild symptoms, 31.5% in the community versus 52.5% of those at the clinic had moderate symptoms and 12.6% of those in the community versus 29.9% of those at the clinic had severe symptoms (p<0.001). Men seeking care for LUTS/BOO had a lower quality of life (p<0.05), were more bothered by their urinary symptoms (p<0.05), had more interference with daily activity and worry (p<0.05) but this did not have an impact on their general sense of wellbeing. Conclusions: The burden of disease of LUTS/BOO in this rural African cohort is high and significantly higher among those seeking care due to the bother of their symptoms. One in 4 men will spend money for transport to clinic due to LUTS/BOO despite low economic resources. Educational tools for patients structured to the level of literacy are justified.
- ItemCelebrity health promotion messaging : novel opportunities to engage youth in the developmental origins of health and disease(African Sun Media, 2020) Macnab, Andrew J.; Mukisa, RonaldThis chapter is a personal view seen from disparate viewpoints of age and culture. Two proponents of health promotion, one a Ugandan youth with firsthand experience of the burden of illness among African children and the other a Canadian academic with a lifetime spent treating sick children, speak to the place and potential of celebrity in the promotion of health among youth. Since 2011, school-based health promotion programmes conceived at the Stellenbosch Institute for Advanced Study (STIAS) have been introduced into many communities in Uganda. These initiatives are seen as an example of innovative health promotion with the potential to give the next generation health knowledge and skills that will translate into an important measure of ‘health independence’ for them in their future lives. A regular component of these programmes enables schools to introduce new topics through teacher-guided in-class discussions about health; in this way, pupils were introduced to elements of the developmental origins of health and disease (DOHaD) agenda, and then asked to discuss which ‘messages’ they saw as most relevant to them, and which ‘messengers’ could deliver these messages with the greatest impact. Amongst the messengers, celebrities were identified as particularly influential; young people said they would listen to what a celebrity said about health, lifestyle and behaviour. Expanding on these discussions, pupils quoted health and lifestyle messaging that they already knew from listening to celebrity-recorded music videos. Here we describe examples, from a Ugandan perspective, of this form of celebrityendorsed health messaging contained in music videos; these are the songs young people told us they listened to and knew the promotional messages they contain. National music celebrities, whom these young people identify with, have recorded a variety of videos with content advocating specific health behaviours, endorsing physical, emotional or spiritual health and calling for individual and collective action to address challenges such as maternal deaths related to childbirth and infant mortality. Some artists even raise awareness of difficult but very important social issues such as gender inequity, sexual harassment and domestic violence through their music. Music videos resonate with youth, and celebrity recordings appeal as they combine young people’s love of music with their fascination of the aura of celebrity. We review the production concepts, content and messaging that make these celebrity music videos particularly powerful, and also suggest future directions where the engagement of celebrity messengers could offer a conduit for innovative delivery of DOHaD-related messages, and an effective way to impart knowledge and impact health behaviours among youth.
- ItemInternational Society for Developmental Origins of Health and Disease's work at the Stellenbosch Institute for Advanced Study(African Sun Media, 2020) Daar, Abdallah; Pauw, Christoff; Macnab, Andrew J.This chapter describes the core group at the Stellenbosch Institute for Advanced Study (STIAS) who have contributed to the long-term theme project, ‘Health in Transition’. It also describes what this book is about, why it is crucial, and the different strands and topics that are covered.
- ItemMapping of developmental origins of health and disease to 'Sustainable Development Goals' and implications for public health in Africa(African Sun Media, 2020) Kajee, Nabeela; Daar, Abdallah; Macnab, Andrew J.; Sobngwi, EugeneA call for new approaches and knowledge systems has emerged, to map the way forward for the ‘Sustainable Development Goals’ in Africa.6 Public health on the continent, calls for an approach to effect changes to reach the goals proposed by the World Health Organization.7 It is against this backdrop that the developmental origins of health and disease (DOHaD) are proposed as a framework of implementation for specific Sustainable Development Goals.8 The DOHaD concept identifies the origins of health and disease, and also elucidates early mechanisms for achieving these goals. Numerous Sustainable Development Goals are specifically applicable to the DOHaD concept, and DOHaD and Sustainable Development Goals have immense synergistic potential. The chapter identifies gaps in which DOHaD may offer direct, informed solutions to the hurdles encountered in Sustainable Development Goals achievement strategies, and these have direct public health implications for the continent.
- ItemPhoto-essays : a creative format for effective communication(African Sun Media, 2020) Stothers, Lynn; Mukisa, Ronald; Macnab, Andrew J.Scientists and educators regularly face the challenge of effectively, concisely and interestingly communicating their ideas and findings, and the need to engage readers unfamiliar with the concepts or issues they want to describe. In the context of advancing the developmental origins of health and disease (DOHaD) agenda, effective communication is essential, particularly when aiming to engage government agencies, inform leaders in the health care professions, and motivate organisations able to drive change in the community. Hence, it is important to consider approaches that might make key DOHaD concepts and health promotion strategies more readily accessible to any target population. In this chapter, we share our experience from a collaboration between the Peter Wall Institute for Advanced Studies (PWIAS) at the University of British Columbia, and STIAS at Stellenbosch University to explore ways to make research and global public health issues accessible and meaningful to a broad readership; we identified the genre of photo-essay as an established and valid format, and describe its origins and principles. A photo-essay effectively presents a broad range of facts and data to varied audiences because the format principally relies on the impact visual images have. When well-chosen images are combined with appropriate captions and a concise explanatory text, the resulting composition can engage and inform a wide range of readers, and in a way likely to allow even those unfamiliar with the topic to rapidly gain an overall understanding of the information and recommendations presented. Photographs are a powerful way to furnish evidence because they expand the scope of the information provided and uniquely engage individual readers. The reader cannot be made to look at the images in the presented order, nor can the time spent on each image be indicated. So, we suggest that a photo-essay offers a very individual, informative yet flexible format for sharing ‘what works and why”, and how, and under what circumstances it works in the context of DOHaD.
- ItemSchool-based initiatives to reduce malaria morbidity and promote academic achievement in children(African Sun Media, 2020) Macnab, Andrew J.In sub-Saharan Africa, the challenge of addressing illnesses related to the developmental origins of health and disease (DOHaD) is compounded by other determinants of health, most notably the impact of poverty and infectious disease. Research has identified social factors to be the root cause of inequities in health that involve both non-communicable and infectious diseases, hence the calls for remedial action to involve social and treatment strategies. There is a recognised need for school programmes to educate the next generation about DOHaD, so that young people gain a measure of ‘health independence’ through learned knowledge, acquired skills and positive behaviours with the potential to improve the future health of their offspring. However, this goal is at risk when other adverse social determinants of health exist, and especially where infectious diseases are endemic, and morbidity from infection among school children is high. In sub-Saharan Africa, for example, malaria is the principal reason a child will be absent from school. How long a child is absent is a well-accepted measure of the severity of morbidity from malaria. Such absences can be of long duration, and associated residual cognitive compromise can compound the negative impact of malaria on a child’s ability to learn. For this reason, school-based strategies to advance knowledge about DOHaD in sub-Saharan Africa will benefit where school-based programmes addressing malaria are offered in parallel. A variety of educational approaches able to advance knowledge and provide practical skills related to DOHaD lend themselves to parallel programmes. For example, programmes can follow policies to advance the United Nations (UN)’ ‘Sustainable Development Goals’, adopt global strategies to promote the education of girls and implement the World Health Organization (WHO)’s ‘Health-Promoting School’ model. Malaria morbidity exemplifies how health inequity can negatively impact a child’s ability to benefit from education. However, simple and effective school-based approaches exist that can positively impact morbidity, provide access to diagnostic and treatment services, reduce absence due to illness and increase the capacity of large numbers of children to learn. This chapter reviews global efforts to reduce the impact of malaria on children's health, improve their ability to attend school, enhance their potential for academic achievement and minimise their risk of cognitive impairment. It also describes a successful and inexpensive community participatory intervention model based on WHO-endorsed diagnostic and treatment principles, that also follows the 2017 Lancet Commission’s current recommendations on the future of health in sub- Saharan Africa to use ‘non-traditional outlets’, ‘people-centred approaches’ and ‘improved tools’ to address health challenges. This model is suitable for use in schools worldwide where malaria is endemic and can be offered in parallel with school-based strategies to engage youth in the context of the DOHaD agenda.
- ItemThe World Health Organization's 'Health-promoting School' model: a potential avenue for developmental origins of health and disease education in Africa(African Sun Media, 2020) Macnab, Andrew J.Traditional health care strategies to manage illness are based on the tenets of prevention and cure. Health promotion is an urgent matter from both a health and economic standpoint, as most non-communicable diseases cannot be cured, and the future costs of management are prohibitive. Hence, a new focus on prevention involving youth has been widely called for, including by the Cape Town Manifesto.2 This chapter reviews the challenge and opportunities of engaging youth in health promotion related to the developmental origins of health and disease (DOHaD) agenda. It explores the potential for using the World Health Organization (WHO)’s ‘Health-Promoting School’ model as part of health initiatives in Africa to promote the adoption of a DOHaD related health agenda. At a societal level, effective disease prevention must often rely on the application of new science and technological innovation, plus legislation to dictate change. However, at an individual level, alterations in health behaviours are required to contain the epidemic of DOHaD-related non-communicable diseases, which can only be achieved through learning and increased awareness driving attitudinal change. The challenge facing DOHaD related health promotion is how we, as a society, can disseminate valid information widely and frame compelling arguments to engage and motivate individuals to improve their health and change their behaviours. The nature of DOHaD also predicates that the most fertile place to invest in prevention and health improvement strategies is the next generation. The WHO estimates are that school-based health promotion has the potential to reach one billion children worldwide. Health-Promoting School programmes are a proven means of providing children with the knowledge and practical ways to improve their health and have been shown to positively impact a range of specific health issues and health behaviours. Importantly in the context of Africa, the integrated educational approach used in Health-Promoting School has proved to be applicable and beneficial even in low- and middle-income settings. Significantly in the context of prevention, children who participate in good Health-Promoting School programmes have been shown to develop improved resilience, self-esteem and self-efficacy; traits recognised to engender a greater desire and increased ability to exercise control over their lives, and characteristics all likely relevant to advancing the DOHaD agenda.