Browsing by Author "Ramjith, Jordache"
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- ItemOpen AccessDeterminants of voluntary or coerced sexual debut among Black African female adolescents in Soweto, South Africa: Findings from The Birth to Twenty Plus cohort study(2018) Nyemba, Dorothy Chiwoniso; Ramjith, Jordache; Cornell, Morna; Mabaso, MusawenkosiEarly sexual debut whether voluntary or coerced increases exposure to high risk sex which leads to unplanned pregnancy, sexually transmitted infections including HIV and reproductive heal th problems during adolescence. This study aim s to examine the risk factors for age of sexual debut, either voluntary or coerced among Black African female adolescents from the Birth to Twenty cohort study in Soweto, South Africa . Part A is the study protocol which outlines the rationale for conducting this study , study aim, research methodology, analysis plan and ethical considerations. Part B forms the literature review which gives a summary of the existing literature and provides context for the dissertation. The objectives of the literature review were to identify published literature on determinants of either voluntary or coerced sexual debut in adolescents and identify gaps for further research. Part C is the manuscript presenting the results and discussion on the implications of key findings. The results showed that there are many Black African female adolescents who are engaging in early sexual debut and there is prevalenc e of coerced sexual debut among adolescents of similar age. Socio-economic status and maternal education were found to be significantly associated with coerced sexual debut. There is a need for interventions to delay sexual debut among young female adolescents from low socio-economic backgrounds and lower maternal education.
- ItemOpen AccessEnvironmental risk factors for asthma in 13-14 year old African children(2018) Ayuk, Adaeze Chikaodinaka; Erhlich, Rodney; Myer, Landon; Ramjith, Jordache; Zar, HeatherBACKGROUND: Asthma prevalence in African children is high and increasing, with more severe disease than that in high income countries. Specific factors driving the rising prevalence or disease severity are poorly understood. The aim of this study was to investigate environmental factors associated with asthma and severity in African children using data obtained from International Study of Asthma and Allergies in Childhood, (ISAAC) III. METHODS: A population based cross-sectional study of children aged 13-14 years from 10 African centres who participated in ISAAC III from randomly selected schools. The prevalence of asthma or severe asthma was calculated for each centre. Self-reported environmental exposures included engaging in physical exercise, television watching, biomass and ETS exposure, consumption of paracetamol, large family sizes and having pets in the home. Univariable and multivariable analyses were done adjusting for centre variations. Odds ratio and respective 95% confidence intervals (CI) were calculated. RESULTS: Amongst 28490 adolescents from 232 schools in 10 African centres (4 middle income and 6 low income), the prevalence of asthma was 12.8% (CI 12.4-13.2), while prevalence of severe disease was 8.7% (CI 8.4-8.0). Factors most strongly associated with asthma were maternal smoking (OR= 1.41; 95% CI: 1.23 - 1.64), exposure to open fire heating (OR=1.28; 95% CI: 1.08 - 1.51) and electric heating (OR=1.13; 95% CI: 1.01 - 1.28), engaging in strenuous exercise (OR= 1.29; 95% CI: 1.11 - 1.50 and monthly use of paracetamol (OR 1.23; 95% CI 1.13 - 1.33, while having an elder sibling was protective for asthma (OR=0.87; 95% CI 0.77 – 0.98). Factors strongly associated with severe asthma were maternal smoking (OR=1.61; 95% CI: 1.38 - 1.89), having a cat pet at home (OR=1.14; 95% CI: 1.04 - 1.25), engaging in≥3 weekly physical exercise (OR=1.42; 95% CI: 1.23 - 1.64) and monthly consumption of paracetamol (OR=1.20; 95% CI: 1.07 - 1.34). CONCLUSION: There was a high prevalence of severe asthma in African children. Several environmental exposures were associated with asthma or with severe disease. Strategies to reduce harmful environmental exposures must be strengthened to reduce the burden of childhood asthma in Africa.
- ItemOpen AccessFlexible modelling of risk factors on the incidence of pneumonia in young children in South Africa using piece-wise exponential additive mixed modelling(2021-01-11) Ramjith, Jordache; Roes, Kit C; Zar, Heather J; Jonker, Marianne AIntroduction Recurrent episodes of pneumonia are frequently modeled using extensions of the Cox proportional hazards model with the underlying assumption of time-constant relative risks measured by the hazard ratio. We aim to relax this assumption in a study on the effect of factors on the evolution of pneumonia incidence over time based on data from a South African birth cohort study, the Drakenstein child health study. Methods We describe and apply two models: a time-constant and a time-varying relative effects model in a piece-wise exponential additive mixed model’s framework for recurrent events. A more complex model that fits in the same framework is applied to study the continuously measured seasonal effects. Results We find that several risk factors (male sex, preterm birth, low birthweight, lower socioeconomic status, lower maternal education and maternal cigarette smoking) have strong relative effects that are persistent across time. When time-varying effects are allowed in the model, HIV exposure status (HIV exposed & uninfected versus HIV unexposed) shows a strong relative effect for younger children, but this effect weakens as children grow older, with a null effect reached from about 15 months. Weight-for-length at birth shows a time increasing relative effect. We also find that children born in the summer have a much higher risk of pneumonia in the 3-to-8-month age period compared with children born in winter. Conclusion This work highlights the usefulness of flexible modelling tools in recurrent events models. It avoids stringent assumptions and allows estimation and visualization of absolute and relative risks over time of key factors associated with incidence of pneumonia in young children, providing new perspectives on the role of risk factors such HIV exposure.
- ItemOpen AccessPrevalence of shoulder morbidity after treatment for breast cancer in South Africa(2018) Kramer, Nicole; Shamley, Delva; Ramjith, JordacheIntroduction: Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death among women and represents a considerable public health burden in South Africa and other low-middle income countries. Breast cancer management comprises single or combination treatment including surgery, radiotherapy and chemotherapy. Short and long-term complications of these treatments include shoulder morbidities such as pain, decreased range of motion, tightness, weakness, pain, numbness and lymphoedema, and may be present for up to 6 years post-surgery. An understanding of baseline demographic and clinical risk factors can guide rehabilitation and management strategies for high risk patients. Materials and Methods: This study was a cross-sectional analysis of the prevalence of shoulder pain and dysfunction in women attending their post-treatment annual follow up visit for unilateral breast carcinoma. The aim of this study was to quantify the burden of shoulder pain and disability in a tertiary academic hospital in Cape Town, South Africa, and identify potential risk factors for the development of shoulder morbidity. The primary objective of this study was to determine the prevalence of shoulder morbidity and the secondary objective was to evaluate associations between shoulder morbidity and risk factors such as treatment protocol or baseline demographics. Results: The majority of patients were of mixed ancestry, had their left side affected, received ALND and had undergone Modified Radical Mastectomy. The mean age was 60 years with a mean follow-up since surgery of 6 years. Three-quarters of patients reported a presence of pain or disability; 9% experienced severe pain and disability. Multivariable ordinal logistic regression analysis identified race, side, axillary surgery, chemotherapy and age as significant predictors of pain, and chemotherapy a significant predictor of disability. Discussion: The substantial burden of shoulder morbidity in this population represents a significant public health burden. The use of identified clinical and demographic characteristics may guide in the development of survivorship programmes incorporating surveillance and management of these high risk patients.