• Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home

      Mabhala, Mzwandile A.; Yohannes, Asmait; Asmait Skin Care (MDPI, 2019-11-21)
      Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, the reasons that led to their homelessness, and propose a conceptual explanation. Method: We conducted 26 semi-structured interviews in three centres for homeless people in Cheshire, North West of England. Results: Three categories—education, employment, and health—emerged from the data and provided a theoretical explanation for the reasons that led to their homelessness. These are vital not only for the successful negotiation of one’s way out of homelessness, but also for achieving other social goods, including social connections, social mobility, and engaging in positive social relationships. Conclusion: Participants catalogued the adverse childhood experiences, which they believe limited their capacity to meaningfully engage with the social institution for social goods, such as education, social services, and institutions of employment. Since not all people who have misfortunes of poor education, poor health, and loss of job end up being homeless, we contend that a combination of these with multiple adverse childhood experiences may have weakened their resilience to traumatic life changes, such as loss of job and poor health.
    • Being homeless in an unequal society: A qualitative analysis of stories of homeless people

      Mabhala, Mzwandile A. (Oxford University Press (OUP), 2018-11-21)
    • Common causes of EID sample rejection in Zimbabwe and how to mitigate them

      editor: Torpey, Kwasi; Chiku, Charles; orcid: 0000-0003-3455-598X; email: charleschiku@gmail.com; Zolfo, Maria; Senkoro, Mbazi; Mabhala, Mzwandile A.; Tweya, Hannock; Musasa, Patience; Shukusho, Fungai D.; Mazarura, Exervia; Mushavi, Angela; et al. (Public Library of Science, 2019-08-08)
      Early infant diagnosis (EID) of HIV provides an opportunity for early HIV detection and access to appropriate Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of exposed infants, born to HIV-positive mothers. However, DBS rejection rates in Zimbabwe have been exceeding the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL), in Harare. The aim of this study was to determine the DBS sample rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the samples were collected. This is an analytical cross-sectional study using routine DBS sample data from the NMRL in Harare, Zimbabwe, between January and December 2017.A total of 34 950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected. Reasons for rejection were insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross-contamination (6%), mismatch of information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities were five times more likely to be rejected compared to those from a central hospital. Rejection rates were above the set target of <2%. The reasons for rejection were ‘pre-analytical’ errors including labelling errors, missing or inconsistent data, and insufficient blood collected. Samples collected at primary healthcare facilities had higher rejection rates.
    • A comparison of the yield and relative cost of active tuberculosis case-finding algorithms in Zimbabwe

      Machekera, Shepherd; Wilkinson, Ewan; Hinderaker, Sven G.; Mabhala, Mzwandile A.; Zishiri, Christopher; Ncube, Ronald; Sandy, Charles; Timire, Collins; Takarinda, Kudakwashe; Sengai, Tonderai; et al. (International Union Against Tuberculosis and Lung Disease, 2019-06-21)
      Setting: 10 districts and 3 cities in Zimbabwe Objective: To compare the yield and relative cost of identifying a case of tuberculosis (TB) if the National TB Programme (NTP) used one of three World Health Organisation (WHO)-recommended algorithms (2c,2d,3b) instead of Zimbabwe’s active case finding (ACF) algorithm Design: Cross-sectional study using data from the Zimbabwe ACF project. Results: 38,574 people were screened from April-December 2017 and 488 (1.3%) were diagnosed with TB. WHO-2d had the least number of people needing a chest X-ray (CXR) at 13,710 (35.5%) and bacteriological confirmation at 2,595 (6.7%). If the NTP had used the WHO recommended algorithms, fewer TB cases would have been diagnosed - 18% (88 cases) with algorithm 2b, 25% (122 cases) algorithm 2d, and only 7% (34 cases) with algorithm 3b. The relative cost-per-case of TB diagnosed for the Zimbabwe algorithm at $565 was over three times that of WHO 3b algorithm ($180) which was the cheapest. Conclusion: The Zimbabwe ACF algorithm had the highest yield but at a considerable cost when compared to WHO algorithms. The trade-off between cost and yield needs to be reviewed by the NTP and changing to use algorithm 3d considered.
    • Does the Association between Depressive Symptomatology and Physical Activity Depend on Body Image Perception? A Survey of Students from Seven Universities in the UK

      El Ansari, Walid; Stockton, Christine; Phillips, Ceri; Mabhala, Mzwandile A.; Stoate, Mary; Adetunji, Hamed; Deeny, Pat; John, Jill; Davies, Shân; Parke, Sian; et al. (MDPI, 2011-01-25)
      This cross-sectional study assessed the association between depression and PA in university students of both genders and the role of body image perception as a potential effect modifier. Undergraduate students (N = 3706) from seven universities in the UK completed a self-administered questionnaire that assessed sociodemographic information; a range of health, health behaviour and health awareness related factors; the modified version of Beck’s Depression Inventory (M-BDI); educational achievement, and different levels of physical activity (PA), such as moderate PA (at least 5 days per week moderate exercise of at least 30 minutes), and vigorous PA (at least 3 days per week vigorous exercise of at least 20 minutes). Only 12.4% of the sample achieved the international recommended level for moderate PA, and 33.1% achieved the recommendations for vigorous PA. Both moderate and vigorous PA were inversely related to the M-BDI score. Physically active students, regardless of the type of PA, were significantly more likely to perceive their health as good, to have higher health awareness, to perform strengthening exercises, and to be males. The stratified analyses indicated that the association between depression and PA differed by body image. In students perceiving their body image as ‘just right’, moderate (>4th percentile) and high (>5th percentile) M-BDI scores were inversely related to vigorous PA. However, in students who perceived their body image as ‘overweight’, the inverse association was only significant in those with high M-BDI scores. We conclude that the positive effect of PA on depression could be down modulated by the negative impact of a ‘distorted’ body image on depression. The practical implications of these findings are that PA programmes targeting persons with depressive symptoms should include effective components to enhance body image perception.
    • Eating Behaviours of British University Students: A Cluster Analysis on a Neglected Issue

      Tanton, Jina; Dodd, Lorna; Woodfield, Lorayne; Mabhala, Mzwandile A.; Newman University; University of Chester (Hindawi Publishing Corporation, 2015-10-13)
      Unhealthy diet is a primary risk factor for noncommunicable diseases. University student populations are known to engage in health risking lifestyle behaviours including risky eating behaviours. The purpose of this study was to examine eating behaviour patterns in a population of British university students using a two-step cluster analysis. Consumption prevalence of snack, convenience, and fast foods in addition to fruit and vegetables was measured using a self-report “Student Eating Behaviours” questionnaire on 345 undergraduate university students. Four clusters were identified: “risky eating behaviours,” “mixed eating behaviours,” “moderate eating behaviours,” and “favourable eating behaviours.” Nineteen percent of students were categorised as having “favourable eating behaviours” whilst just under a third of students were categorised within the two most risky clusters. Riskier eating behaviour patterns were associated with living on campus and Christian faith. The findings of this study highlight the importance of university microenvironments on eating behaviours in university student populations. Religion as a mediator of eating behaviours is a novel finding.
    • The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review.

      Odiba, Jephthah O.; Mabhala, Mzwandile A.; University of Chester (Scientific Research Publishing, 2015-04-24)
      Background: Insulin therapy has been the mainstay in managing women with gestational diabetes mellitus (GDM), but some disadvantages of insulin have led to the use of glyburide, which is inexpensive in some countries, to manage GDM. However, there has been debate over its effectiveness, efficacy and safety when compared to insulin for maternal glycaemic control, and some adverse neonatal outcomes in GDM. Method: A systematic review of eight randomised controlled trial (RCT) studies was undertaken to compare glyburide and insulin. Studies involving 849 participants were included in the quantitative analysis. Results: There was no significant difference between glyburide and insulin in maternal fasting (P = 0.09; SMD: 0.13; 95% CI: ﹣0.02 to 0.28) and postprandial (P = 0.45; SMD: 0.05; 95% CI: ﹣0.09 to 0.19) glycaemic control and glycosylated hae-moglobin (P = 0.35; SMD: 0.08; 95% CI: ﹣0.08 to 0.24). When compared with insulin, glyburide had an increase risk ratio (RR) for neonatal hypoglycaemia (P = 0.0002; RR: 2.27; 95% CI: 1.47 to 3.51) and large for gestational age babies (P = 0.03; RR: 1.60; 95% CI: 1.06 to 2.41). Estimation of standard mean difference shows that neonatal birth weight was significantly higher in subjects receiving glyburide than in the insulin group (P = 0.002; SMD: 0.21; 95% CI: 0.08 to 0.35). Conclusions: Glyburide was seen to be clinically effective and a safer alternative to insulin for maternal glycaemic control in GDM women. It is affordable, convenient and requires no comprehensive educative training at the time of initiation of therapy. However, its adverse outcomes—neonatal hypogly-caemia, high neonatal birth weight and large for gestational age babies—call for careful monitoring of GDM patients for any need for supplemental insulin.
    • Effectiveness of nitric oxide agents in preventing the early onset of pre-eclampsia and possible modification of metabolic factors in high-risk pregnancies

      Nnate, Daniel; Massey, Alan; Ridgway, Victoria; Mabhala, Mzwandile A.; University of Chester (International prospective register of systematic reviews, 2018-11-28)
      Pre-eclampsia is a pregnancy-specific condition which affects at least 2 - 8% of pregnancies and is the major cause of foetal growth restriction, small gestational age and increased rate of preterm birth from induced labour and caesarean section. The rate of early-onset of pre-eclampsia raises serious concern; and the most affected population are nulliparous women, women with chronic hypertension, multiple pregnancies and those with chronic diseases. Increasing the bioavailability of nitric oxide (NO) in the endothelial system through the timely administration of NO agents could minimise the metabolic precursors of pre-eclampsia which may be a cost-effective intervention in preventing the complications related to the ailment. While the effectiveness and safety of suggested interventions for the prevention of pre-eclampsia on maternal and neonatal health is being deliberated, evidence on the role of NO in the pathogenesis of preeclampsia is well recognised. Nitric oxide agents have been proven to be effective in preventing complications from pre-eclampsia; however, there is limited evidence on NO agents in preventing its early onset in high risk pregnancies. Previous studies on pre-eclampsia prevention with NO agents lacks the criteria required to achieve optimum effects; and the benefit of administering NO agents before 20 weeks’ gestation is yet to be established.
    • Evaluating the Use of Vitamin D Supplementation to Improve Glycaemic Outcome in Type 2 Diabetes Mellitus Patients: A Systematic Review of Evidence

      Mabhala, Mzwandile A.; Babanumi, Adetoyosi; Olagunju, Anthony; Akata, Eloho; Yohannes, Asmait; Universty of Chester; Mount Sinai Hospital, Ambulatory Surgery Centre (Scientific Research Publishing, 2017-09-22)
      Background: The evidence indicates that vitamin D [25(OH)D] improves glycaemic outcomes in type 2 Diabetes mellitus patients. The outcome measures used to determine the accuracy of this hypothesis are: glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG) and homeostasis model assessment-insulin resistance (HOMA-IR). Methods: We performed a systematic review and meta-analysis which included all previous randomised controlled trial (RCT) studies that assessed the effects of vitamin D on glucose metabolism. We carried out an extensive electronic database search of published and unpublished RCTs, evaluating the association between vitamin D and glycaemic outcomes in type 2 diabetes mellitus patients. We searched Cochrane Library, PubMed, EMBASE, CINAHL Plus with Full Text, MEDLINE, BioMed Central, Turning Research Into Practice (TRIP), Health Technology Assessment (HTA), and Latin American and Caribbean Health Sciences (LILIACS) between the years 2005 and 2016. The full texts of relevant studies were retrieved and a snowballing technique was used to discover further studies missed from the initial database search. This was done by hand-searching for references within the retrieved articles. Results: A total of 17 studies were included in the review. The pooled effect of 15 studies that measured HbA1c showed an insignificant effect of vitamin D on HbA1c (Mean difference (MD) = −0.06 mmol/l; 95% CI = −0.26 to 0.14; I2 = 76%). A pooled analysis of seven studies that measured the effect of vitamin D on blood glucose also found no significant effect of vitamin D on T2DM (MD = −0.03 mmol/l; 95% CI = −0.69 to 0.63; I2 = 76%). Three studies that analysed the effect of vitamin D on insulin sensitivity also observed no significant effect (MD = −1.51 mmol/l; 95% CI = −3.61 to 0.60; I2 = 67%). Conclusion: In conclusion, although vitamin D has been extensively studied in relation to some glycaemic outcomes and some indications that increased plasma vitamin D concentrations might be linked to prevention of T2DM, firm universal conclusions about its benefits cannot be drawn. Further studies with better designed trials and larger sample sizes are needed to draw firmer conclusions
    • Evaluation of the Broseley Health Technology Pilot

      Mabhala, Mzwandile A.; Bailey, Jan; Davies, Miriam; Enyinna, Chinwe; University of Chester
      This document reports on the evaluation of a health technology pilot, which was delivered by Shropshire Council’s Public Health Team. This service evaluation explored the usability and acceptability of three consumer smart devices in a group of older adults who live within the community. The devices are the “Echo Dot”, “Echo Show” and “Fitness Tracker”. The intention of the evaluation was to identify whether these devices meet the needs of its users, their experiences using the equipment and the impact of having and using this equipment.
    • Feeling Healthy? A Survey of Physical and Psychological Wellbeing of Students from Seven Universities in the UK

      El Ansari, Walid; Stock, Christiane; Snelgrove, Sherrill; Hu, Xiaoling; Parke, Sian; Davies, Shân; John, Jill; Adetunji, Hamed; Stoate, Mary; Deeny, Pat; et al. (MDPI, 2011-04-27)
      Abstract: University students’ physical and psychological health and wellbeing are important and comprise many variables. This study assessed perceived health status in addition to a range of physical and psychological wellbeing indicators of 3,706 undergraduate students from seven universities in England, Wales and Northern Ireland. We compared differences in these variables between males and females, and across the participating universities. The data was collected in 2007–2008. A self-administered questionnaire assessed socio-demographic information (e.g., gender, age), self-reported physical and psychological health data, as well as questions on health awareness, health service use, social support, burdens and stressors and university study related questions. While females generally reported more health problems and psychological burdens, male students felt that they received/had fewer persons to depend on for social support. The comparisons of health and wellbeing variables across the different universities suggested some evidence of ‘clustering’ of the variables under study, whereby favourable situations would be exhibited by a cluster of the variables that is encountered at some universities; and conversely, the clustering of less favourable variables as exhibited at other universities. We conclude that the level of health complaints and psychological problems/burdens is relatively high and calls for increased awareness of university administrators, leaders and policy makers to the health and well-being needs of their students. The observed clustering effects also indicate the need for local (university-specific) health and wellbeing profiles as basis and guidance for relevant health promotion programmes at universities.
    • Health inequalities as a foundation for embodying knowledge within public health teaching: a qualitative study

      Mabhala, Mzwandile A.; University of Chester (BioMed Central, 2013-06-28)
      Introduction: Recent UK health policies identified nurses as key contributors to the social justice agenda of reducing health inequalities, on the assumption that all nurses understand and wish to contribute to public health. Following this policy shift, public health content within pre-registration nursing curricula increased. However, public health nurse educators (PHNEs) had various backgrounds, and some had limited formal public health training, or involvement in or understanding of policy required to contribute effectively to it. Their knowledge of this subject, their understanding and interpretation of how it could be taught, was not fully understood. Methodology This research aimed to understand how public health nurse educators’ professional knowledge could be conceptualised and to develop a substantive theory of their knowledge of teaching public health, using a qualitative data analysis approach. Qualitative in-depth semi-structured interviews (n=26) were conducted with eleven university-based PHNEs. Results Integrating public health into all aspects of life was seen as central to the knowing and teaching of public health; this was conceptualised as ‘embodying knowledge’. Participants identified the meaning of embodying knowledge for teaching public health as: (a) possessing a wider vision of health; (b) reflecting and learning from experience; and (c) engaging in appropriate pedagogical practices. Conclusion The concept of public health can mean different things to different people. The variations of meaning ascribed to public health reflect the various backgrounds from which the public health workforce is drawn. The analysis indicates that PHNEs are embodying knowledge for teaching through critical pedagogy, which involves them engaging in transformative, interpretive and integrative processes to refashion public health concepts; this requires PHNEs who possess a vision of what to teach, know how to teach, and are able to learn from experience. Their vision of public health is influenced by social justice principles in that health inequalities, socioeconomic determinants of health, epidemiology, and policy and politics are seen as essential areas of the public health curriculum. They believe in forms of teaching that achieve social transformation at individual, behavioural and societal levels, while also enabling learners to recognise their capacity to effect change.
    • Health literacy: The public health perspective

      Horah, Mike; Mabhala, Mzwandile A.; Department of Health ; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses health literary and how general literacy as a key determinant of health.
    • Health Promoting Behaviours and Lifestyle Characteristics of Students at Seven Universities in the UK

      El Ansari, Walid; Stock, Christiane; John, Jill; Deeny, Pat; Phillips, Ceri; Snelgrove, Sherrill; Adetunji, Hamed; Hu, Xiaoling; Parke, Sian; Stoate, Mary; et al. (PMID, 2011-12-01)
      AIMS: University students' wellbeing and health promoting and damaging behaviours are important and comprise many parameters. The purpose of this study was to assess a range of health behaviours and lifestyle characteristics of 3,706 undergraduate students from seven universities in England, Wales and Northern Ireland. We compared differences in these parameters between males and females, and across the participating universities. METHODS: A self-administered questionnaire assessed socio-demographic information (e.g., gender, age), nutrition, dietary intake and food consumption patterns, as well as the importance of healthy eating, three levels of physical activity, restful sleep, tobacco smoking, use of illicit substance (recreational drugs), frequency of binge drinking and problem drinking. The data was collected in 2007-2008. RESULTS: While females generally reported lower use of tobacco, illicit substances and alcohol (binge drinking/problem drinking) and consumed more fruits and vegetables, male students had a higher level of physical activity, consumed less sweets and had more restful sleep. When lifestyle characteristics of students were compared between the different universities we observed some 'clustering' of the parameters under study, whereby favourable health practices would be exhibited at some universities; and conversely, the clustering of less favourable practices exhibited at other participating sites. CONCLUSIONS: We conclude that only a minority of students exhibited positive health practices above recommended levels and the level of binge drinking and problem drinking was high. This calls for increased awareness of university administrators, leaders and policy makers to the risky health habits of their students. The observed clustering effects also indicate the need for local (university-specific) health profiles as basis and guidance for relevant health promotion programmes at universities
    • How Do I Look? Body Image Perceptions among University Students from England and Denmark

      El Ansari, Walid; Vodder Clausen, Susanne; Mabhala, Mzwandile A.; Stockton, Christine; University of Gloucestershire; University of Chester; Benfield University (MDPI, 2010-02-21)
      This study examined differences in body image perception between university students in two European countries, United Kingdom and Denmark. A total of 816 British and 548 Danish university students participated in a cross-sectional survey. A self-administered questionnaire assessed socio-demographic information, body image perception (as “too thin”, “just right” or “too fat”), and the association of related factors with body image perception (nutrition behaviour, social support, perceived stressors and quality of life). The proportions of students who perceived themselves as “too thin”, “just right”, or “too fat” were 8.6%, 37.7%, and 53.7% respectively. Multi-factorial logistic regression analysis showed that students who perceived themselves as “too fat” were more likely to be from the British university, to be females, to be older than 30 years, to report stress due to their financial situation and were less likely to have a high quality of life. The findings highlight the need for interventions with focus on healthy food choices whilst acknowledging financial stressors and quality of life.
    • Inadequate dried blood spot samples for Early Infant Diagnosis, how common and what are the reasons for rejection in Zimbabwe?

      Chiku, Charles; Zolfo, Maria; Senkoro, Mbazi; Mabhala, Mzwandile A.; Tweya, Hannock; Musasa, Patience; Shukusho, Fungai D.; Mazarura, Exervia; Mushavi, Angela; Mangwanya, Douglas; et al. (PLoS, 2019-08-31)
      Background Early infant diagnosis (EID) of HIV in infants provides an opportunity for early detection of the infection and early access to Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of HIV-exposed infants, born from HIV positive mothers. However, DBS rejection rates have been exceeding in Zimbabwe the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL). The aim of this study was to determine the DBS samples rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the sample was collected. Methods Analytic cross-sectional study using routine DBS samples data from the NMRL in Harare, Zimbabwe, between January and December 2017. Results A total of 34.950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected and reasons for rejections were: insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross contamination (6%), mismatch information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities had five times likelihood to be rejected compared to those from a central hospital. Conclusion Rejection rates were above the set target of 2%. The reasons for rejection were ‘pre-analytical’ errors including labeling errors, sample damage, missing or inconsistent data, and insufficient volume. Samples collected at primary healthcare facilities had higher rejection rates.
    • Making Sense of Health Improvement and Well-being

      Wilson, Frances; Massey, Alan; Mabhala, Mzwandile A.; University of Chester (McGraw-Hill / Open University Press, 2014-10-01)
      This chapter explores concepts and definitions of health, health improvement, and well-being. These concepts will be deconstructed and critiqued in the context of underpinning theory and evidence of the individual, community and population approaches to health improvement and well-being. This is undertaken to allow the reader to appreciate the differences and similarities of these concepts. It will allow the reader to appreciate the contribution of these concepts to providing health, public health to the promotion of health improvement and well-being. The use of case studies will facilitate the integration of these concepts with practice in the fields of health, improvement, and well-being
    • A meta-analysis of type 1 diabetes mellitus, all-cause and cause-specific mortality

      Eloho, Akata; Cooper, Helen; Bowen-Jones, David; Mabhala, Mzwandile A.; University of Chester (PROSPERO, 2016-04-16)
      A meta-analysis of type 1 diabetes mellitus, all-cause and cause-specific mortality
    • New psychoactive substances: the use and the associated health and social harm in Telford and Wrekin

      Mabhala, Mzwandile A.; University of Chester (Oxford University Press, 2017-10-20)
      Background: Although NPS use is increasing, the scale of their use and harms remains unclear. Reports from the United Kingdom show downward trends in drug use in England and Wales among 11 to 15-year-olds, but also a steady increase in NPS use. However, NPS use remains lower than that of many traditional illicit drugs. This paper presents the correlations between age and the awareness, use and accessibility of NPS in Telford and Wrekin local authority, England. Methods: A self-administered questionnaire completed by 204 participants assessed socio-demographic information and awareness, accessibility, effects, uses, and health and social harms of NPS. Their mean age was 25.7 years (SD = 10.9). Data analysis used the IBM SPSS statistical package version 21, with significance level set at p < 0.05 and confidence interval at 95%. Spearman’s correlation coefficiencies (rho) determined associations between variables. Results: Descriptive statistics showed that 85.8% of respondents were aware of NPS, 33% knew other users, and 9.8% had ever used it. 40.2% said that access to NPS was easy, 35.8% very easy. The study showed a rho of 0.3 between age and knowing of NPS (P ≤ 0.000); rho of 0.5 between age and knowing NPS users (P ≤ 0.000); rho of 0.28 between age and number of NPS users they knew (P ≤ 0.000); rho of 0.14 between age and the number of times they accept and consume NPS (P ≤ 0.040); rho of 0.042 between age and being offered NPS by someone you know (P = 0.548); rho of 0.11 between age and being offered NPS by strangers (P = 0.097); and rho of 0.08 between age and perceived ease of access to NPS (P = 0.253). Conclusion: While young people’s NPS use remains low, they are more likely to use them than the general population. Despite young people’s high levels of NPS awareness, their knowledge of higher numbers of NPS users raises concerns about their exposure. We recommend making more effort to prevent uptake of NPS amongst this group.
    • The Perspective of Socioeconomic Inequalities and Infectious Disease in 21st Century

      Massey, Alan; Mabhala, Mzwandile A.; University of Chester (OMICS Group International, 2016-04-20)
      At the turn of the new century, the United Nations set a series of global health goals to be achieved by 2015. Amongst the eight Millennium Development Goals (MDGs), goal six aimed to combat HIV, malaria and other diseases.