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Using implementation science to address quadruple burden of disease in SA

07 November 2024 | Story André Damons | Photo Supplied

Implementation Science Workshop 2024 — Building capacity for the use of implementation science. The Principal Investigators of the project; Dr Phindile Shangase from UFS, left, and Dr Lebogang Mogongoa from the Central University of Technology, with Dr Shalini Ahuja from King’s College London, centre, who facilitated the workshops.

The Division of Public Health at the University of the Free State (UFS) together with the Central University of Technology (CUT), held a successful workshop (first phase) for their project: Capacity building for the use of implementation science in various typologies in low- and middle-income countries for the prevention and/or management of the quadruple burden of disease.

According to the National Institute for Health as well as the World Health Organisation, implementation science supports innovative approaches to identifying, understanding, and overcoming barriers to the adoption, adaptation, integration, scale-up and sustainability of evidence-based interventions, tools, policies, and guidelines. Implementation research therefore pertains to gathering and analysing implementation evidence of effectiveness that determines if the intervention works in real-world circumstances.

The Principal Investigator at UFS is Dr Phindile Shangase from the Division of Public Health, supported by colleagues in the Division, as well as the CUT team, led by Dr Lebogang Mogongoa. The first phase of the project took place from 14-17 October 2024 with the first two days held at UFS.

In this co-funded project, UFS and CUT engage in partnership capacity building for academics and postgraduate students. At the UFS, the project is funded by the Office of the Deputy Vice-Chancellor: Research and Internationalisation and resulted from the CUT and UFS Joint Research Programme Research Grant 9th Call.

Contributing to evidence-based policies and practices

Dr Shangase says the workshops of this project were well attended by academics, researchers, postgraduate and postdoctoral students from different disciplines, and community organisations, including programme managers, as well as clinicians from the Department of Health. Other stakeholders and international students who could not travel for face-to-face interactions attended live on UFS YouTube.

Workshops were facilitated by Dr Shalini Ahuja from King’s College, London, who is an international expert and experienced in this field through engaging in research as well as field facilitation in various low- and middle-income countries.

Says Dr Shangase: “Implementation science is the study of methods and strategies to promote the systematic uptake of research findings. It contributes to evidence-based policies and practices and ensures that they are implemented effectively to achieve their intended outcomes, through the identification of barriers and facilitators to implementation. These strategies can therefore be integrated effectively into routine practice in healthcare, public health, and other fields.

“Reviewed studies indicate that the effectiveness of implementation research is noted in the identification and investigation of factors that address disparities in healthcare delivery and outcomes, including those within the health systems and in the population. In simple terms, the goal of implementation science is to understand how and why some interventions succeed while others fail, and to identify the best ways to integrate research-backed interventions into real-world settings for maximum impact and to ensure they continue to be used and remain effective over time,” says Dr Shangase.

Purpose of project

According to her, in the context of South Africa, implementation science has potential to assist in addressing the quadruple burden of disease which comprise of these colliding epidemics: maternal, newborn and child health; HIV/AIDS and tuberculosis (TB); non-communicable diseases (e.g. cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes); and violence and injury.

The purpose of this project, explains Dr Shangase, is to capacitate academics and postgraduate students at the UFS and CUT as well as community stakeholders with knowledge and skills regarding the processes and factors involved in the successful integration of evidence-based public health improvement interventions into routine practice and policy.

“Implementation science offers a strategic, data-driven approach for South Africa, especially in addressing the country’s unique and complex healthcare challenges. These advantages stem from its focus on translating evidence-based interventions into real-world practice, addressing the quadruple burden of disease and helping overcome systemic obstacles to effective healthcare delivery.

“These advantages make implementation science a vital tool for improving health outcomes and achieving sustainable public health progress in South Africa.”

The next phase of this project is expected to be more innovative and takes place between February and March in 2025 with the inclusion of a multistakeholder team.

News Archive

Childhood obesity should be curbed early

2017-03-15

Description: Child obesity Tags: Child obesity

Serious intervention by parents is required to deal
with childhood obesity. Prof Louise van den Berg and
a group of final-year PhD students worked on a study
about the prevalence of obesity in six-year-olds in
South Africa.
Photo: Supplied

If your child is overweight when they start school at the age of six, unless you do something about it at that point, the indications are they are going to be overweight teenagers and obese adults. This is according to University of the Free State’s Prof Louise van den Berg.

Evidence has shown that overweight children and teenagers have a greater risk of developing lifestyle diseases such as type 2 diabetes, hypertension and cardiovascular disease later in life, and dying prematurely.

Obesity is a global pandemic rapidly spreading among adults and children, in developed and developing countries alike.

Dr Van den Berg worked with Keagan Di Ascenzo, Maryke Ferreira, Monja-Marie Kok, Anneke Lauwrens, all PhD students with the Department of Nutrition and Dietetics, to conduct the study. Their research found that children who are overweight by the time they turn six should be screened for weight problems.

Why six-year-olds?
Children who are overweight between the ages of two and five are five times more likely to be overweight when they are 12. There are two periods in a normal life cycle when the body makes new fat cells. The first is in the uterus and the second is around the age of six. The second phase lasts from the age of six to puberty.

The study assessed the prevalence of obesity in six-year-olds as part of a campaign in South Africa to raise awareness of the problem among parents and educators.

A total of 99 children were chosen from seven schools in Mangaung, the capital city of Free State. The schools were chosen from quintile four and five schools, which when measured by their own resources and economic circumstances, are well resourced and serve largely middle-class and wealthy communities.

The children’s weight, height and waist circumference were measured and used to calculate a body mass index score and waist-to-height ratio. Both these figures are good predictors for future lifestyle disease risks such as type 2 diabetes, hypertension and cardiovascular disease. A person with a good waist-to-height ratio can wrap a piece of string equal to their height around their waist at least twice.

When the children had a higher body mass index, they also had an increased waist to height ratio. The study found one in four children from the schools surveyed were overweight when they started primary school.

Nipping the fat in the bud
Although there are many factors that play a role in preventing childhood obesity, parents’ perceptions of their children’s weight play an important role. A recent study found that more than 50% of parents underestimate the weight of their obese children. These parents remain unaware of the risks their children face and are not motivated to take any action.

At least half of the parents whose children are overweight struggle to recognise their children’s weight problems fearing that they will be labelled or stigmatised. By the time they turn six overweight children should be referred to dieticians and nutritionists who are qualified to guide their parents in getting them to eat well and be more physically active at pre-primary and primary school.

The high prevalence of weight problems among six-year-olds found in this study is an urgent call to healthcare professionals to step up and empower parents, educators and children with the necessary skills for healthy dietary practices and adequate physical activity.

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