The purpose of this study was to explore and describe the EcoHealth markers and health promotion interventions in the behaviour and practices of vegetables growers in Addis Ababa. The objectives were to assess the urban and peri-urban community members’ knowledge and practices on the existing environmental health policies/regulations/guidelines, assess the perspectives of women and youth on urban and peri-urban EcoHealth promotions and protections and evaluate the development and implementation of the health promotion activities on waste water use by applying an ecological model aimed at changing behaviour and by providing Bio-sand filter to promote hand wash practice which helps to reduce potential health risks among urban vegetable growers. Both quantitative and qualitative descriptive researches were conducted to identify the urban and peri urban community members’ knowledge and practices of the existing environmental health regulators and the perspectives of women and the youth on EcoHealth. Additional quasi experimental method; multiple baseline survey along with the EcoHealth Stress Process promotion method was employed to identify stressors, measure changes in environmental health promotion intervention and use of hand wash (biosand filter for hand wash). Six woredas from two subcities of the Addis Ababa City Administration were purposely selected, and a total of 845 (98.9% response rate) households participated in the quantitative study, while 142 community members (public sector offices, factories and establishments’ management and employee), participated in the qualitative survey. For quasi experimental method, six settings/blocks (of which 3 sites were provided with a bio-sand filter for hand washing) cultivated by 6 to 8 vegetable growers and their family members, were included in the intervention (multiple baseline survey). The findings revealed that about 77 percent of participants reported, knowledge of one or more of the selected environmental health and EcoHealth regulations. Ownership of assets and education tend to influence the public awareness of selected EcoHealth and environmental health regulations. Women and youth found to be significant contributors to better urban and peri-urban EcoHealth conditions and were the ones primarily affected by environmental hazards. The intervention study results also indicated evidence-based IEC interventions and ecological health promotion methods proved useful in promoting EcoHealth in an urban environment. Moreover, the biosand filter used to provide evidence of health promotion was found to be valuable for wastewater treatment and significantly reduced chemical, physical and biological contaminates from the wastewater. / Health Studies / D. Litt. et Phil. (Health Studies)

The aim of this research project was to assess and compare cardiovascular disease (CVD) risk in black males and females from an urban, working population in the Makana (Grahamstown) region of the Eastern Cape, South Africa. Two-hundred and ninety one individuals (males: n = 143, females: n = 148) with a mean age of 42.6 (±8.1) years were voluntarily recruited from the greater urban Makana (Grahamstown) area. Eight Cardiovascular disease (CVD) risks were assessed: stature and mass were obtained in order to calculate body mass index (BMI) (mass/stature2). Obesity, defined as a morphological risk, was classified according to the World Health Organisation (WHO) BMI criteria (BMI>30kg.m-2), as well as according to measures of waist circumference (WC) and body composition. Hypertension, hypercholesterolemia and type II diabetes, were grouped as cardiovascular (CV) risks. Hypertension was defined as a blood pressure greater than 140/90mmHg (JNC-7); hypercholesterolemia, as total cholesterol greater than 6.2mmol.L-1 (NCEP); and type II diabetes, as total glucose greater than 12mmol.L-1 (WHO). Physical activity, diet, tobacco use, and alcohol consumption and dependence were grouped as lifestyle-related risks. These were assessed by means of self-reporting through the use of various validated questionnaires. Finally, self-reporting of obesity, hypertension, hypercholesterolemia and type II diabetes was assessed, in addition to perception questions on individuals’ perceived body shape and size (Ziebland figures). Self-reported and perceived responses were then compared to actual measures. Females were significantly (p<0.001) heavier than the males (92.7kg compared to 72.1kg) and had significantly (p<0.001) higher BMIs than their male counterparts (37.6kg.m-2 compared to 25.7 kg.-2). They also recorded significantly (p<0.001) higher waist circumference (WC) values and had significantly (p<0.001) higher percentage and total body fat. Significantly (p<0.001) more females were obese (81%) compared to males (17%). While a higher percentage of males (25 % compared to 22%) presented with stage I hypertension (≥140/90mmHg, <160/95mmHg), significantly (p<0.05) more females (14% compared to 8%) presented with stage II hypertension (>160/95mmHg). The prevalence of hypercholesterolemia at a high level of risk (>6.2mmol.L-1) was relatively low (2.1 % of males, 3.4% of females), but notably more participants (22% of males and 26% of females) presented with the condition at a moderate level of risk (>5mmol.L-1). Type II diabetes was the least prevalent CV risk factor, with no males and only 3% of females presenting with the condition. Males consumed significantly (p<0.05) more in terms of total energy intake (9024 vs. 7234 kJ) and were significantly (p<0.05) more active (3315 compared to 2660 MET-mins.week). A significantly (p<0.05) higher percentage of males smoked (51.1% compared to 3.4%), consumed alcohol (73.4% compared to 46.6%) and were alcohol dependent (40% compared to 33.5%). Both males and females tended to be ignorant of their health status, with both samples under-reporting obesity, hypertension and hypercholesterolemia, while over-reporting type II diabetes. Furthermore, obesity was significantly (p<0.05) underestimated, with both male and female individuals perceiving themselves to be notably smaller than they actually were. Physical activity and diet were important determinants of CVD risk in this black urban sample of individuals. Obesity, in particular central adiposity, was the most notable risk (particularly in females), followed by hypertension (particularly in males). Although some risks presented at a moderate level of risk, a clustering of risk factors was evident in both samples, with 12.6% and 41.2% of males and females presenting with two risk factors, and 2.8% and 8.1% of males and females respectively presenting with three risks.

The purpose of the study was to investigate the cardiovascular disease (CVD) risk profile of black African females in the Makana region, Eastern Cape, South Africa. Baseline measures from 40 participants, who met the criteria, were compared against the 2003 South African Demographic and Health Survey (SADHS) and the 2013 South African National Health and Nutritional Examination Survey (SANHANES-1). The risk factors measured were anthropometric (stature, body mass and body mass index (BMI)), morphological (waist circumference (WC), fat mass and lean mass), cardiovascular (heart rate and blood pressure (BP)), physical activity (step count and energy expenditure), biochemical (glycated haemoglobin and full blood lipid profile) and behavioural (alcohol and tobacco use). Results showed significantly higher (p≤0.05) values for overweight/obesity (BMI 37.60 kg.m⁻²; WC 1130.58 mm; fat mass 45.23%) and high BP (130/88 mmHg) compared to the previous national surveys, highlighting these CVD risk factors as problematic. The subsequent sub-study aimed to assess the efficacy of a pedometer-based walking intervention on high BP. The walking programme (n=25) was based on individual step goals to be completed at a moderate-intensity on five days.week⁻¹ for 12 weeks. The same measurements were taken at monthly intervals, Week 0, Week 4, Week 8 and Week 12, with the addition of dietary intake and fitness level, and the exclusion of the behavioural variables. There were no significant differences (p≤0.05) in systolic and diastolic BP with the exercise intervention, although there was a strong, negative relationship with time for diastolic BP (r²=0.9857). This trend suggests that the lack of significance may be a result of poor compliance and/or the small sample size. Individual results, however, showed no compliance-result relationship for the two risk factors of interest: overweight/obesity and high BP. Future recommendations include supervised or group-based exercise interventions to improve compliance, and the addition of resistance training to the aerobic programme.

The purpose of this project was to evaluate the effectiveness of an educational lifestyle modification (LM) intervention on blood pressure (BP) among adults with prehypertension. Prehypertension is a precursor to hypertension (HTN) and is a public epidemic in the United States. Approximately 68 million (31%) U.S. adult’s aged ≥18 years have hypertension. Hypertension can cause significant target organ damage, lead to coronary heart disease, heart failure, stroke, and kidney failure. Early identification and the primary treatment of persons with prehypertension with LM have the potential to minimize the progression and delay the onset of comorbidities associated with hypertension. This quality improvement project retrospectively reviewed changes in blood pressure for a small sample (n=5) of patients diagnosed with prehypertension who received education about modifying lifestyle behaviors according to nationally accepted clinical practice guidelines. Blood pressure measurements were extracted from the medical record beginning at the time of the education through a three month period. Descriptive data indicates that all five patients had a decrease in systolic and diastolic blood pressure. The median systolic blood pressure at baseline was 129 mmHg decreasing to 121 mmHg at end of study period. The median diastolic blood pressure was 86 mmHg decreasing to 76 mmHg. Integration of lifestyle modification education and subsequent blood pressure monitoring during a routine primary care visit is feasible and may help motivate patients to implement changes and subsequently reduce blood pressure. Future studies should include identifying strategies for improving patient participation.

The purpose of this study was to explore and describe the EcoHealth markers and health promotion interventions in the behaviour and practices of vegetables growers in Addis Ababa. The objectives were to assess the urban and peri-urban community members’ knowledge and practices on the existing environmental health policies/regulations/guidelines, assess the perspectives of women and youth on urban and peri-urban EcoHealth promotions and protections and evaluate the development and implementation of the health promotion activities on waste water use by applying an ecological model aimed at changing behaviour and by providing Bio-sand filter to promote hand wash practice which helps to reduce potential health risks among urban vegetable growers. Both quantitative and qualitative descriptive researches were conducted to identify the urban and peri urban community members’ knowledge and practices of the existing environmental health regulators and the perspectives of women and the youth on EcoHealth. Additional quasi experimental method; multiple baseline survey along with the EcoHealth Stress Process promotion method was employed to identify stressors, measure changes in environmental health promotion intervention and use of hand wash (biosand filter for hand wash). Six woredas from two subcities of the Addis Ababa City Administration were purposely selected, and a total of 845 (98.9% response rate) households participated in the quantitative study, while 142 community members (public sector offices, factories and establishments’ management and employee), participated in the qualitative survey. For quasi experimental method, six settings/blocks (of which 3 sites were provided with a bio-sand filter for hand washing) cultivated by 6 to 8 vegetable growers and their family members, were included in the intervention (multiple baseline survey). The findings revealed that about 77 percent of participants reported, knowledge of one or more of the selected environmental health and EcoHealth regulations. Ownership of assets and education tend to influence the public awareness of selected EcoHealth and environmental health regulations. Women and youth found to be significant contributors to better urban and peri-urban EcoHealth conditions and were the ones primarily affected by environmental hazards. The intervention study results also indicated evidence-based IEC interventions and ecological health promotion methods proved useful in promoting EcoHealth in an urban environment. Moreover, the biosand filter used to provide evidence of health promotion was found to be valuable for wastewater treatment and significantly reduced chemical, physical and biological contaminates from the wastewater. / Health Studies / D. Litt. et Phil. (Health Studies)