UL helps ease non-communicable disease burden in rural Limpopo
The university shares the knowledge on healthy lifestyles
Non-communicable diseases (NCD) are the major health burden in industrialised countries and are increasing rapidly in developing countries owing to demographic transitions and changing lifestyles.
Research has shown that NCDS have their roots in unhealthy lifestyles or adverse physical and social environments. Risk factors such as inadequate nutrition over a prolonged period, smoking, physical inactivity, excessive use of alcohol, and psycho-social stress are among the major lifestyle issues.
While there is firm knowledge on what should be done for the prevention of these diseases, the key question at present is how it should be done. How can our existing knowledge of NCDS be best applied for effective prevention in real-life situations?
The University of Limpopo (UL) has two projects – the Ellisras Longitudinal Study (ELS) in Waterberg district municipality and DIMAMO Population Health Research Centre (PHRC) in Dikgale, Mamabolo and Mothiba villages – under the Capricorn district. Both projects were initiated in 1996.
The two projects have carefully planned community programmes which are an important component of the strategy to help prevent and reduce the occurrence of NCDS. These projects were established to investigate the gap between known knowledge about what needs to be done and the everyday situation of most of the people in rural areas.
Ellisras longitudinal study
This study aimed to identify risk factors for NCDS among the same individuals over time, from 1996 to date (ie, from childhood into adulthood).
The NCDS profile has been suggested to be changing rapidly among rural South Africans. High salt intake is a major contributor to hypertension, which is a major risk factor for cardiovascular diseases. South African legislation limiting salt levels in manufactured foods is an example of what a progressive government can do to improve health at a population level. However, salt reduction policies are currently fragmented and there are no action policies particularly at Waterberg municipality level even though they are embedded within national action plans.
Sharing knowledge
The ELS team decided to educate the Lephalale community about the dangers posed by high salt intake given the increasing high prevalence of hypertension and obesity over time.
This was done through the ELS conference, which was held twice – from November 27-28 2017 and from December 3-5 2019. The ELS team is planning a third conference in November 2021.
The conference provides a unique inclusive platform for discussion by ordinary members of the Ellisras community, expert scholars, students and experienced professionals from all over the world, offering a truly special international networking experience. It is a comprehensive and interactive programme in which participants can cultivate their cross-cultural and communication skills while shining a light on different topics related to poverty and cardiovascular diseases.
Changing behaviour
The ELS team’s salt watch campaign is aimed at changing consumer behaviour among the Lephalale community.
This can be achieved by identifying key behavioural change goals and messages that could then be integrated into broader Waterberg district municipality health communication strategies like the food-based dietary guidelines, as a framework to address salt reduction based on a whole-of-diet approach at a population level.
The Waterberg district municipality will be encouraged to join hands with the ELS team in spreading the message around reducing salt intake.
DIMAMO PHRC
This project is in Dikgale, Mamabolo and Mothiba villages under the Capricorn district and aims at investigating the major risk factors of NCDS in order to develop interventions to reduce and prevent occurrences of NCDS.
Several publications have tried to summarise the results of the major community-based preventive interventions in these rural areas.
Risk factors for NCDS such as smoking, alcohol consumption, low physical inactivity, hypertension and obesity were prevalent among adults in Dikgale HDSS but was predominant among younger participants.
The findings suggest a need to develop an integrated community chronic care model and implement other intervention programmes in order to reduce predisposing factors contributing to the epidemic of NCDS.
Barriers of chronic disease management
Nurses and chronic disease patients mentioned similar barriers to chronic disease management which, among others, are a lack of knowledge on chronic diseases, shortage of medication and shortage of nurses in the clinics. The result was that patients were often forced to wait for long periods before being assisted at the clinics.
Health-care workers are also poorly trained on the management of chronic diseases. Lack of supervision by district and provincial health managers, together with poor dissemination of guidelines, has been found to be a contributing factor to the lack of knowledge in nurses working at the clinics within the study area.
Both patients and nurses mentioned the need to involve community health workers and traditional healers and integrate their services in order to early detect and manage chronic diseases in the community.
Concerted action is needed to strengthen the delivery of medications at the clinics, improve the chronic disease knowledge for both nurses and patients by conducting in-service training or workshops, increase the involvement of community health workers and establish a link (through formal referral system) with traditional healers.
Strengthening intervention programmes
The UL is continuously working to strengthen the integrated community-based intervention programmes that will form comprehensive packages in which different kinds of feasible activities are combined to produce a synergistic effect.
Thus, strictly speaking, the effect of the components cannot be singled out. Some of the main components of these interventions include health education and media campaigns which play a prominent role in DIMAMO PHRC. The most simplified form of these campaigns used by DIMAMO PHRC is the involvement of community advisory teams (CATS) which comprise local leaders or members of the community nominated by the traditional council to form part of the project.
Health service interventions do not have as much visibility as the major media campaigns, but the systematic involvement of the CATS, in the long run, will be one of the most effective intervention tools.
This may be particularly true where the CATS encourage community members to reduce risk factors for NCDS such as smoking, alcohol consumption and low physical inactivity in order to control and prevent hypertension and obesity.
In conclusion, the strength of DIMAMO PHRC is the involvement and collaboration with various sectors of the community such as non-governmental organisations, drop-in centres and old-age homes.
The DIMAMO PHRC also demonstrated the potential of involving lay opinion leaders, a concept that has been successfully applied on many occasions in developing countries. A major role of the community-based project is to demonstrate and stimulate a national NCD prevention policy.
The strength of initiatives is collaboration of community groups
NCDS have their roots in unhealthy lifestyles in communities
Siweya HJ – Executive Dean: Faculty of Science and Agriculture
Monyeki KD – Professor: Department of Physiology and Environment Health; Ellisras Longitudinal Study Maimela E –
Director: DIMAMO PHRC; Department of Public Health