Browsing by Author "Alaba, Olufunke"

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    Adolescents’ Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective
    (2022-02-14) Hendricks, Gaironeesa; Savona, Natalie; Aguiar, Anaely; Alaba, Olufunke; Booley, Sharmilah; Malczyk, Sonia; Nwosu, Emmanuel; Knai, Cecile; Rutter, Harry; Klepp, Knut-Inge; Harbron, Janetta
    Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents’ perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16–18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity.
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    Association of neighbourhood and individual social capital, neighbourhood economic deprivation and self-rated health in South Africa - a multi-level analysis
    (Public Library of Science, 2013) Chola, Lumbwe; Alaba, Olufunke
    Social capital is said to influence health, mostly in research undertaken in high income countries' settings. Because social capital may differ from one setting to another, it is suggested that its measurement be context specific. We examine the association of individual and neighbourhood level social capital, and neighbourhood deprivation to self-rated health using a multi-level analysis. METHODS: Data are taken from the 2008 South Africa National Income Dynamic Survey. Health was self-reported on a scale from 1 (excellent) to 5 (poor). Two measures of social capital were used: individual, measured by two variables denoting trust and civic participation; and neighbourhood social capital, denoting support, association, behaviour and safety in a community. RESULTS: Compared to males, females were less likely to report good health (Odds Ratio 0.82: Confidence Interval 0.73, 0.91). There were variations in association of individual social capital and self-rated health among the provinces. In Western Cape (1.37: 0.98, 1.91) and North West (1.39: 1.13, 1.71), trust was positively associated with reporting good health, while the reverse was true in Limpopo (0.56: 0.38, 0.84) and Free State (0.70: 0.48, 1.02). In Western Cape (0.60: 0.44, 0.82) and Mpumalanga (0.72: 0.55, 0.94), neighbourhood social capital was negatively associated with reporting good health. In North West (1.59: 1.27, 1.99) and Gauteng (1.90: 1.21, 2.97), increased neighbourhood social capital was positively associated with reporting good health. CONCLUSION: Our study demonstrated the importance of considering contextual factors when analysing the relationship between social capital and health. Analysis by province showed variations in the way in which social capital affected health in different contexts. Further studies should be undertaken to understand the mechanisms through which social capital impacts on health in South Africa.
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    Effect of malaria on productivity in a workplace: the case of a banana plantation in Zimbabwe
    (2019-12-03) Lukwa, Akim T; Mawoyo, Richard; Zablon, Karen N; Siya, Aggrey; Alaba, Olufunke
    Background Malaria is known to contribute to reduction in productivity through absenteeism as worker-hours are lost thus impacting company productivity and performance. This paper analysed the impact of malaria on productivity in a banana plantation through absenteeism. Methods This study was carried out at Matanuska farm in Burma Valley, Zimbabwe. Raw data on absenteeism was obtained in retrospect from the Farm Manager. Malaria infection was detected using malaria Rapid Diagnostic Test. Measures of absence from work place were determined and included; incidence of absence (number of absentees divided by the total workforce), absence frequency (number of malaria spells), frequency rate (number of spells divided by the number of absentees), estimated duration of spells (number of days lost due to malaria), severity rate (number of days lost divided by number of spells), incapacity rate (number of days lost divided by the number of absentees), number of absent days (number of spells times the severity rate), number of scheduled working days (actual working days in 5 months multiplied by total number of employees), absenteeism rate. Results A total of 143 employees were followed up over a 5-month period. Malaria positivity was 21%, 31.5%, 44.8%, 35.7% and 12.6% for January 2014 to May 2014, respectively. One spell of absence [194 (86.6%)] was common followed by 2 spells of absence [30 (13.4%)] for all employees. Duration of spells of absence due to malaria ranged from 1.5 to 4.1 working-days, with general workers being the most affected. Incidence of absence was 143/155 (93.3%), with total of spells of absence of over a 5-month period totalling 224. The frequency rate of absenteeism was 1.6 with severity rate of absence being 2.4. and incapacity rate was 3.7. Conclusion Malaria contributes significantly to worker absenteeism. Employers, therefore, ought to put measures that protect workers from malaria infections. Protecting workers can be done through malaria educative campaigns, providing mosquito nets, providing insecticide-treated work suits, providing repellents and partnering with different ministries to ensure protection of workers from mosquito bites.
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    Experiences and social determinants of sexual violence and post-violence help-seeking behaviour among children and young people in Kenya
    (2023) Okova, Denis; Toska, Elona; Bounagnin, Bolade; Alaba, Olufunke
    This dissertation examined the social determinants of sexual violence experience and help- seeking among Kenyan young men and women. Sexual violence is a public health concern because its levels are unacceptably high in Kenya, and it is a known risk factor for HIV infection.This is an urgent issue because Kenya has the third-largest HIV epidemic in the world and almosthalf of new HIV infections occur among young people. Therefore, preventing sexual violence is only possible if predictors of sexual violence and response pathways are continuously investigated. This study used Kenya's 2019 Nationally Representative Violence against Children Survey (VACS) data focusing on young men and women aged 13-24 years old. Sexual violence was defined as reporting unwanted touching, forced sex, attempted forced sex, or experiencing physical forced sex/rape, either in one's lifetime or in the past year both of which were binary variables. Help-seeking behavior was indicated by knowing where to seek formal help, seeking formal help, receiving formal help, and informal disclosure all of which are binary variables. This study first documents the pathway of sexual violence from exposure to help-seeking among young men and women in Kenya. Logistic regression models were then fitted to investigate predictors of sexual violence experience over the past year and lifetime disclosure of sexual violence in young women, controlling for age, being in a relationship, education status, HIV/AIDS testing, orphanhood, and household poverty. This study had 1344 female and 788 male participants. Young women reported a higher lifetime prevalence of sexual violence compared with young men (25.2% vs. 11.4%, p=0.000). Of these lifetime experiences of sexual violence, more young women than young men informally disclosedthese acts (45.1% vs. 22.7%, p=0.002). Although 33.7% of young women and 33.1% of young men knew where to seek formal help after experiencing sexual violence, more young women thanyoung men sought formal help after experiencing sexual violence (11.3% vs 6.8%, p=0.248). Gender inequitable attitudes [AOR 3.07 (1.10–8.56); p=0.032], experiencing emotional violence at home [AOR 2.11 (1.17–3.81); p=0.014], and cyberbullying [AOR 5.90 (2.83–12.29);p=0.000] are risk factors for sexual violence among young women. Life skills training [AOR 0.22 v (0.07– 0.73); p=0.014] and positive parental monitoring [AOR 0.31 (0.10–0.99);p=0.048] are protective against sexual violence among young women. Positive parental monitoring [AOR 3.85 (1.56– 9.46);p=0.004] was also associated with increased likelihood of informal disclosure among young women. This study highlights the protective value of life skills training and positive parental monitoring in sexual violence prevention. Moreover, this analysis demonstrated the possible role of gender inequitable attitudes, cyberbullying, and emotional violence at home in fueling sexual violence. Future VACS might consider increasing sample sizes to increase robustness of analyses, especially on help-seeking.
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    Fidelity and costs of implementing the integrated chronic disease management model in South Africa
    (2021) Lebina, Limakatso; Alaba, Olufunke; Oni, Tolullah; Kawanga, Mary
    Background: The health systems in many low-middle income countries are faced with an increasing number of patients with non-communicable diseases within a high prevalence of infectious diseases. Integrated chronic disease management programs have been recommended as one of the approaches to improve efficiency, quality of care and clinical outcomes at primary healthcare level. The South African Department of Health has implemented the Integrated Chronic Disease Management (ICDM) Model in Primary Health care (PHC) clinics since 2011. Some of the expected outcomes on implementing the ICDM model have not been achieved, and there is a dearth of studies assessing implementation outcomes of chronic care models, especially in low-middle income countries. This thesis aims to assess the degree of fidelity, moderating factors of fidelity and costs associated with the implementation of the ICDM model in South African PHC clinics. Methods: The study was a cross-sectional study design using mixed methods and following the process evaluation conceptual framework. A total of sixteen PHC clinics in the Dr. Kenneth Kaunda (DKK) health district of the North West Province as well as the West Rand (WR) health district of the Gauteng Province, that were ICDM pilot sites were included in the study. The degree of fidelity in the implementation of the ICDM model was evaluated using a fidelity criterion from the four major components of the ICDM model as follows: facility reorganization, clinical supportive management, assisted self-support and strengthening of the support systems. In addition, the implementation fidelity framework was utilized to guide the assessment of ICDM model fidelity moderating factors. The data on fidelity moderating factors were obtained by interviewing 30 purposively selected healthcare workers. The abbreviated Denison Organizational Culture (DOC) survey was administered to 90 healthcare workers to assess the impact of three cultural traits (involvement, consistency and adaptability) on fidelity. Cost data from the provider's perspective were collected in 2019. The costs of implementing the ICDM model current activities for three (facility reorganization, clinical supportive management and assisted self-management) components and additional costs of implementing with enhanced fidelity were estimated. Costs data was collected from budget reviews, interviews with management teams, and other published data. Descriptive statistics were used to describe participants and clinics. Fidelity scores were summarized using medians and proportions and compared by facilities and health districts. Qualitative data were analysed thematically. Pearson correlation coefficient was utilized to assess the association between fidelity and culture. The annual ICDM model implementation costs per PHC clinic and patient per visit were presented in 2019 US dollars. Results: The 16 PHC clinics had comparable patient caseload, and a median of 2430 (IQR: 1685-2942) patients older than 20 years received healthcare services in these clinics over six months. The overall implementation fidelity of the ICDM model median score was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The highest clinic fidelity score was 86% (136/158), while the lowest was 66% (104/158). The fidelity scores for the four components of the ICDM model were very similar. A patient flow analysis indicated long (2-5 hours) waiting times and that acute and chronic care services were combined onto one stream. Interviews with healthcare workers revealed that the moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). Participants also indicated that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. The overall mean score for the DOC was 3.63 (SD = 0.58), the involvement cultural trait had the highest (3.71; SD = 0.72) mean score, followed by adaptability (3.62; SD = 0.56), and consistency (3.56; SD = 0.63). Although there were no statistically significant differences in cultural scores between PHC clinics, culture scores for all three traits were significantly higher in WR (involvement 3.39 vs 3.84, p= 0.011; adaptability 3.40 vs 3.73, p= 0.007; consistency 3.34 vs 3.68, p= 0.034). The mean annual cost of implementing the ICDM model was $148 446.00 (SD: $65 125.00) per clinic, and 84% ($124 345.00) was for current costs while additional costs for higher fidelity accounted for were 16% ($24 102.00). The mean cost per patient per visit was $6.00 (SD:$0.77). Conclusion: There was some variability of fidelity scores on the components of the ICDM model by PHC clinics, and there are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors influencing implementation fidelity of the ICDM model. Organizational culture needs to be purposefully influenced to enhance adaptability and consistency cultural traits of clinics to enhance the ICDM model's principles of coordinated, integrated, patient-centred care. Small additional costs are required to implement the ICDM model with higher fidelity. Recommendations: Interventions to enhance the fidelity of chronic care models should be tailored to specific activities that have low degree of adherence to the guidelines. Addressing some of the moderating factors like training and mentoring of staff members, role clarification and supply chain management could contribute to enhanced fidelity. Organizational culture enhancements to ensure that the prevailing culture is aligned with the planned quality advancements is recommended prior to the implementation of new innovative interventions. Further research on the cost-effectiveness of the ICDM model in middle-income countries is recommended.
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    Inpatient household economic burden of child malnutrition in Zimbabwe : a case study conducted at Harare Central hospital
    (2013) Masiiwa, Rufaro; Alaba, Olufunke
    Severe acute malnutrition is one of the leading underlying causes of mortality in children under the age of five years. Nearly one to two million child deaths worldwide can be attributable to this illness. Although it is considered to be a global public health issue, severe acute malnutrition imposes an uneven burden on health resources across the world, with low-income countries shouldering much of this burden. Like any illness, severe acute malnutrition imposes an economic burden on households that, if significantly large could result in the impoverishment of households. However, despite the existence of a large volume of literature on the intergenerational economic consequences of malnutrition, little is known about the short term household economic consequences of malnutrition. This mini-dissertation sets out to estimate the household economic burden imposed by severe acute malnutrition in children under the age of 5 years in Zimbabwe. Furthermore, it aims to investigate and evaluate household responses to the economic consequences of malnutrition and the effect of the responses on household economic welfare.
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    Maternal health : cost analysis of introducing the Umbiflow Velocity Doppler System at primary health level : a pilot study conducted at Kraaifontein Community Health Centre and Durbanville Day Clinic
    (2015) Chiwire, Plaxcedes; Alaba, Olufunke
    Background: A South African report, Saving Babies 2010-2011, reports 32,178 still births in a 2 year period of January 2010 to December 2011 within the 94% of the total hospitals who provide data to a Perinatal Problem Identification programme (PPIP). In order to deal with perinatal mortality, specifically Intra-Uterine Growth there is needed to equip the primary health care (PHC) with technology for monitoring. An instrument called the Umbiflow Doppler ultrasound machine has been developed and there is need to test its economic impact in the PHC. Methods: A cross- sectional analytical study was conducted in the Tygerberg Eastern Health District of the Metro Region of Western Cape, South Africa at two primary health care (PHC) facilities, one secondary level hospital, and one tertiary hospital namely Kraaifontein Community Health Centre (CHC), Durbanville Day Clinic, Karl Bremmer District Hospital, and Tygerberg Hospital respectively. The aim of the research was to conduct a cost analysis in the introduction of an Umbiflow Doppler machine in the primary health care with the major goal being to reduce the number of perinatal deaths in the public health system. A societal perspective was adopted. The cost analysis study was carried out on the already approved sample size of 139 patients stemming from the Umbiflow Clinical study. The inclusion criteria for patient participation was poor SF growth and late bookers >28 weeks attending Kraaifontein Community Health Care Centre and Durbanville Clinic for antenatal services.
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    Neighbourhood deprivation and adult adiposity in South Africa
    (2018) Dube, Masimba; Alaba, Olufunke
    Over the past three decades there has been a significant increase in adiposity - prevalence of accumulation of excess fat around some human organs - globally. This has been characterised by an increase of body mass index (BMI) among men and women. In Sub-Sahara Africa, South Africa has one of the highest prevalence of obesity and the country currently experiences some epidemiological transitions. Excess adiposity is a major risk factor for a number of non-communicable diseases creating a burden for individuals, families, the health care system and society at large (Colditz, 1999). Therefore, there are both direct and indirect costs that can be averted by effectively controlling the obesity epidemic. Still this can only be achieved when there is a good understanding of its determinants. This study sought to investigate association between neighbourhood deprivation and adult adiposity (a combination of body mass index and waist circumference), the association of neighbourhood deprivation and body mass index and waist circumference individually and to examine individual and household level determinants impacting adult adiposity. The study utilised the South African National Income Dynamic Survey (NIDS) 2012 (wave 3) and the ward level South African Index of Multiple Deprivation 2011 (SAIMD 2011) produced by Southern Africa Labour and Development Research Unit (SALDRU) and the Southern African Social Policy Research Institute/Insights (SASPRI) respectively. Individuals with high body mass index (BMI ≥ 25kg/m²) and an expanded waist circumference (WC ≥ 102cm for men and WC ≥ 88cm for women) were considered as having high adiposity. Multilevel logistic regression was used for data analysis due to hierarchical nature of the data to allow simultaneous examination of the impact of some socio-economic factors influencing adiposity. The results showed that individuals that were living in districts that are in quintile 3 (OR= 0.659; 95% CI 0.461, 0.942) of the multiple deprivation score had significantly lower odds of having high adiposity as compared to those living in the least deprived districts. Those living in districts that are in quintiles 3 (OR= 0.652; 95% 0.449, 0.945) and 4 (OR= 0.621; 95% 0.393, 0.983) of the multiple deprivation score were at significantly lower odds of having high BMI as compared to those living in the least deprived districts. When the analysis was stratified by gender the results showed that women living in districts in that are in quintiles 3 (OR= 0.654; 95% 0.450, 0.951) and 4 (OR= 0.624; 95% 0.394, 0.986) of the multiple deprivation score were at lower odds of having high adiposity as compared to women living in the least deprived district. The results for men on the other hand showed no association between adiposity and district level deprivation. Our results show that individual level characteristics and neighbourhood level deprivation regardless of how far distal has an impact on adiposity. Neighbourhood affluence seems to be a buffer that promotes weight gain. The impact of neighbourhood deprivation on adiposity is stronger among women as compared to men. However, further studies that employ a smaller area metric of analysis (preferably ward level) are required to better inform policy prescriptions of neighbourhood deprivation and adiposity.
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    Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa
    (2019-12-16) Lebina, Limakatso; Alaba, Olufunke; Ringane, Ashley; Hlongwane, Khuthadzo; Pule, Pogiso; Oni, Tolu; Kawonga, Mary
    Abstract Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess the implementation fidelity (adherence to guidelines) of the ICDM model. Methods A cross-sectional study in 16 PHC clinics in two health districts in South Africa: Dr. Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and maximum score of 158 was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was conducted to analyse waiting time and identify operational inefficiencies. ICDM items were scored based on structured observations, facility document reviews and structured questionnaires completed by healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test. Results The monthly patient headcount over a six-month period in these 16 PHC clinics was a median of 2430 (IQR: 1685–2942) individuals over 20 years. The DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00–9.33) vs 2.0 (IQR: 1.67–2.92)], and fewer medical officers per clinic [median 1 (IQR: 1–1) vs 3.5 (IQR:2–4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27–31)]; 77% [30/39 (IQR: 27–34)]; 77% [30/39 (IQR: 28–34)]; and 80% [35/44 (IQR: 30–37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR, 117–132); WR was 80% (126/158, IQR, 123–132) while DKK was 74% (117/158, IQR, 106–130), p = 0.1409. The lowest clinic fidelity score was 66% (104/158), while the highest was 86% (136/158). A patient flow analysis showed long (2–5 h) waiting times and one stream of care for acute and chronic services. Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model.
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    Rural internship job preferences of final year medical students in South Africa: a discrete choice experiment
    (2019) Jose, Maria; Alaba, Olufunke
    To achieve Sustainable Development Goal 3 in developing countries, Good health and wellbeing for all, the health workforce is vital however the unpopularity of rural medical practice results in widening healthcare inequalities between urban and rural areas. This study determined the heterogeneity in valuations for rural facility attributes by final year medical students at one South African public university to inform cost-effective recruitment policy recommendations. Focus groups conducted identified facility attributes, a D-efficient design was generated with 15 choice sets, each with two rural hospital alternatives and no opt-out option. An online, unlabelled discrete choice experiment (DCE) was conducted, the results effects coded, and mixed logit models applied. The final sample size was 193 (86,16% of the class), majority female 130 (66.33%), with urban origins 176 (89.80%), unmarried 183 (93.37%) and without children 193 (98.47%). Most had undergraduate rural medicine exposure 110 (56.12%) and intended to specialise 109 (55.61%). The main-effects mixed logit found advanced practical experience, hospital safety, correctly fitted personal protective equipment (PPE) and availability of basic resources the highest weighted attributes with their mean utilities increasing by 0.82, 0.64, 0.62 and 0.52 respectively (p=0.000). In contrast, increases in rural allowance and the provision of housing provided smaller mean utility increases of 0.001 (p<0.01) and 0.09 (p<0.05) respectively. The interaction terms; female, general practise and prior rural medicine exposure, were associated with higher weighting for hospital safety, mean utility increases 1.59, 1.82, 1.42 respectively (p=0.000). Participants were willing to pay ZAR 2636.45 monthly (95%CI: 1398.55;3874.355) to gain advanced practical experience (equivalent to 65.91% of current rural allowance). Medical students’ facility preferences have been found to be influenced by their gender, career aspirations and prior experienced with rural medicine. The policy recommendations derived from this research include publicising rural health facility “draw-cards” among medical graduates, such as the opportunity to gain practical experience, improving the physical and occupational safety at rural health facilities and providing greater transparency about rural facility attributes to medical graduates.
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    Social capital and household health-seeking behaviour for children in the context of urban neighbourhoods: The case of Khayelitsha in Western Cape, South Africa
    (2015) Mwase, Isaac; Alaba, Olufunke
    Globally, almost 8 million children died in 2010 before reaching the age of 5 largely due to preventable diseases. Analysis of the distribution of child mortality indicators highlights huge differentials that still exist both between and within regions. Prompt seeking of appropriate healthcare by caregivers is critical for effective management of childhood illnesses and ultimately for mortality reduction. Studies have shown that households can draw on social capital, including trust and social networks, to improve health outcomes for children. Other studies have demonstrated that health outcomes may significantly differ across different neighbourhoods of the same community. Therefore, understanding social capital and healthcare-seeking behaviour in the context of neighbourhoods can help in the formulation of responsive health policies and strategies that promote child health and overall well-being for different populations. The objective of this study was to investigate social capital factors that are associated with healthcare-seeking behaviour of caregivers when their children become ill, using the case of neighbourhoods in Khayelitsha TownShip in the Western Cape Province of South Africa.
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    Socio-economic factors associated with knowledge, attitudes, and practices response to the 2019 novel coronavirus (COVID-19) and preventive measures of COVID-19 in South Africa: An internet based cross-sectional study
    (2023) Orrie, Naadiya; Alaba, Olufunke
    As part of a comprehensive response for COVID-19 prevention and control, South Africa, as well as many other countries, implemented extensive health and hygiene interventions to curb the spread of the disease. Extensive educational campaigns on all social media platforms as well as government agencies have been implemented in South Africa, however, adherence to these interventions, is affected by people's knowledge, attitude, and practice (KAP) as well as the economic status for the given information to be effective. This KAP study was to examine changes in knowledge, attitudes and practices and socio-economic factors associated with the knowledge, attitude, and practice response to the 2019 novel coronavirus (COVID-19) and preventive measures of COVID-19 in South Africa: an internet-based cross-sectional study. Surveys in Egypt, Pakistan, Saudi Arabia, Malaysia, Vietnam, Jordan, Pakistan, China, Iran, Bangladesh, and Uganda revealed that most respondents had a good knowledge of COVID19. Methods The study used an analytical cross-sectional design, and it was conducted in South Africa. At the time of the study, it was impossible to do community-based surveys due to the COVID-19 pandemic, hence, data was collected online. Data was collected using an online electronic survey where participants completed the online questionnaire once. The survey was drawn up using REDCap software. The KAP results were analyzed as proportions and then the association between KAP and demographic characteristics was done using ordered logit regression models for knowledge, attitude, and practice scores. Results Of the 188 study participants, majority were females (57%) and about (43%) were males. For age and income, the means and standard deviations were [(36.84;10.89) & (R13 344.50; R14 765.23)]. A greater proportion of the participants resided in formal residents (74%), had at least attained matric education (74%), also resided in the Western Cape province (97%) and were employed full time (60%). Income was a significant predictor of knowledge and practices with a unit increase in income increasing the ordered log-odds scale of knowledge by 5.13, while reducing ordered log-odds (OLO) scale for practices by 1.28. While a unit increase in age increased the OLO of knowledge (0.02), attitudes (0.02) and practices (0.03). Having matric education increased the OLO of knowledge (0.75) and practices (1.06) compared to participants with less than grade 11 education, while for attitudes it reduced the OLO of attitudes by 1.12. Additionally, staying in an informal house reduced the OLO of knowledge (15.55), attitudes (0.08) and practices (44.97) compared to staying in flat or house. However, having access to water [knowledge (16.40) and practices (30.31)] and electricity [knowledge (1.80) and practices (49.96)] increased the OLO of knowledge and practices compared to not having access. While being full-time and part-time employed increased the OLO of attitudes and practices [full-time; attitudes(1.16) & practices (1.57)] ; [part-time; attitudes(0.25) & practices (0.44)]. Lastly, staying in formal residence area increased the OLO of knowledge (0.21), attitudes (1.67) and practices (0.02), compared to staying in informal residences. Regarding the knowledge dimension participants showed that they were knowledgeable [(65%;Good knowledge), (9%;Fair knowledge), (26%;Poor knowledge)]. While for attitudes participants generally reported poor attitudes [42%;(Poor attitudes), (35%;Fair attitudes) (23%;Good attitudes)]. Lastly, participants had fairly good practices [(62%;Good practices), (13%; Fair practices), (25%;Poor practices)]. Conclusion This study showed significantly higher proportions of people with good knowledge and good practices, however, it also recorded a greater proportion of the participants who had poor attitudes. This information would be useful in the formulation of policy for community projects addressing behavioural change and adds to the global data on the same subject. The personal responsibility narrative was used during the pandemic, however people found it difficult to adhere to lockdown restrictions thus multipronged action will be needed to address the factors that affect KAP.
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    Socioeconomic inequalities in the use of skilled birth delivery during childbirth in Ghana: a decomposition model
    (2018) Kpodotsi, Aseye; Alaba, Olufunke; Hunter, Jo Adam
    Equitable access to, and use of skilled birth attendance during delivery is vital for the achievement of the Sustainable Development Goals (SDGs) in reducing global maternal deaths to 70 deaths per 100, 000. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequities in the use of skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assessed the socioeconomic inequalities and the underlying factors related to the inequalities in the use of skilled birth attendants during delivery in Ghana. This study analysed data from the 2014 Ghana Demographic and Health Survey (GDHS) using a decomposable health concentration index. Concentration index (CI) and concentration curves were employed to measure the magnitude of socioeconomic inequality in the use of skilled birth attendants during child delivery. The concentration index was decomposed to identify the underlying factors causing the inequalities. Out of a total of the 1,305 women who gave birth in the year prior to the interview, 28% of the deliveries had no skilled birth attendants of which 60% lives in rural compared to 40% in urban. A concentration index of 0.147 showed a pro-rich utilization of skilled birth attendance during delivery. The decomposition analysis revealed that, wealth, education and location of residence were the major contributors to socioeconomic inequalities in the use of skilled birth attendants during child delivery among Ghanaian women. This study suggests that factors such as wealth, area of residence and education are worthy of increased attention in programmatic efforts, and policy interventions, because they are amenable to the reduction of observed inequality.
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    Socioeconomic inequalities of childhood obesity in South Africa
    (2016) Nakimuli, Brenda; Alaba, Olufunke; Govender, Veloshnee
    Obesity is a public health concern in both high- and low-middle income countries. In South Africa obesity is not only limited to adults but is also evidenced in children. In order to contribute useful insights for developing effective obesity policy and programme interventions, this study assesses socioeconomic (SE) inequalities related to childhood obesity in South Africa. Using data from the South African National Income Dynamics survey (2012), the study assesses the extent of SE inequalities in obesity using concentration index (CI). The study also assesses the determinants that underpin these inequalities using decomposition analysis of the CI. Overall, the positive CI from the results indicates that the burden of obesity is more concentrated among the rich compared to the poor with girls having slightly greater SE inequalities compared to boys. The decomposition analysis further indicated that the determinants of these inequalities were an interplay of individual (i.e. race), household (i.e. household head characteristics) and contextual (i.e. household location) level factors. These findings suggest that there is a continuous need for surveillance of obesity in children over time across different social economic status (SES) especially in low- and middle- income countries. Finally, the results suggest that both childhood obesity and inequalities are complex issues with different underlying determinants that vary with the different SES, gender and may require coordinated policy and programmatic interventions at individual, household and contextual level.
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    Socioeconomic status (SES), food insecurity and the double burden of malnutrition within South African households
    (2018) Brown, James Craig; Alaba, Olufunke
    The co-existence of under- and over-nutrition, termed the double burden of malnutrition (DBM), is associated with a high prevalence of both communicable and non-communicable diseases and is becoming a large public health concern. In general, DBM development is associated with populations undergoing a nutrition transition and urbanisation. DBM can exist at a population, household or individual level. The household form is particularly difficult to target with interventions, because households, and particularly mother-child pairs, are often consuming the same foods. For example, frequent consumption of energy dense and nutrient poor ('junk’) foods can concurrently result in overweight adults, but underweight children. Although, household DBM is linked with poverty and food insecurity and its prevalence is steadfastly increasing it is yet to be investigated in South Africa, despite this country being one of the most inequitable in the world. In addition, South Africa has a high prevalence of obesity (34% of adult females obese), undernutrition (9% of children underweight) and poverty (25% unemployment). with a high prevalence of poverty and food insecurity. Therefore, this study aims to estimate the prevalence, and examine the associated factors of DBM, in South African households. Using the nationally representative data from 2014, South Africa National Income Dynamic Survey wave 4, , the prevalence of household DBM pairs (overweight/obese mother and underweight/stunted child) was estimated. Multivariate logistic regression was applied to examine the relationship between mother-child DBM pairs and (i) socioeconomic status (per capita household income, number of household residents, and mother’s race, education, marital status, household head status), (ii) food security (per capita food expenditure), and (iii) potentially important confounders (mother’s age and urban/rural household). The regression was adjusted for mother’s age as a potential confounder. Mother-child DBM prevalence was 11% in this nationally representative sample of South Africa. Mother’s characteristics of being African (adjusted odds [aOR]: 1.3; 95% confidence intervals [95%CI]: 1.0-1.7) and married (aOR: 1.4, 95%CI: 1.1-1.6) were associated with increased odds of DBM. In contrast mother’s having tertiary education (aOR: 0.7, 95%CI: 0.5-1.0) and greater household per capita income (aOR: 0.9, 95%CI: 0.8-1.0) were protective against DBM. This South African household DBM prevalence is higher than most other developing countries and is associated with mother’s being African, married and having less education; as well as households with less per capita income. This high prevalence warrants urgent attention by policy makers to further investigate this issue in South Africa. Moreover, interventions such as Brazil’s “Green my Favela” should be considered to reduce the cost and increase the supply of nutritious foods to impoverishes households of South Africa.
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    The Economic Impact of Rheumatic Heart Disease (RHD) on the Health System of South Africa. A Cost of Illness Study.
    (2018) Hellebo, Assegid Getahun; Watkins, David; Alaba, Olufunke
    Background Rheumatic Heart Disease (RHD) is a disease of poverty that is neglected in developing countries. The consequences of RHD are increasingly becoming huge economic burden to the health system and consecutively the government. Despite RHD being preventable, most of the RHD related deaths happen in children and working age adults where the economic burden of premature death is high. Several strategies have been suggested to advance the escalation of disease severity in order to avoid medical cost including cost of surgery. However, lack of adequate evidence regarding the cost of treating RHD has hindered the needed decisions and interventions to prevent RHD related death. The main objective of this study was to evaluate the utilization of resources and quantify the annual average total cost related to RHD in a tertiary hospital in the Western Cape, South Africa. Methods A mixture of ingredients and step-down costing approaches were used to estimate the annual cost of RHD care from health system perspective. All costs were estimated in 2017 (base year) South African Rand (ZAR) and 3% discount rate in order to allow depreciation and opportunity cost. Data on service utilization rates were collected using a randomly selected sample of 100 patient medical records from the Global Rheumatic Heart Disease Registry (the REMEDY study), a registry of individuals living with RHD. Patient-level clinical data, including, prices and quantities of medications and laboratory tests, were collected from Groote Schuur Hospital (GSH). Step-down costing was used to estimate provider time costs and all other facility costs such as overheads. REMEDY and GSH data were aggregated to estimate the total annual costs of RHD care at GSH and the average annual per-patient cost among REMEDY participants. One-way univariate sensitivity analysis was conducted to deal with uncertainty. Results The total cost of RHD care at GSH was estimated at $2, 238, 294 (ZAR 27 million) in 2017, with surgery costs accounting for 65% of total costs. Per-patient average annual costs, which included outpatient care, cardiac medical and intensive care unit (ICU) care, cardiac catheterisation lab procedures, and heart valve surgery, was estimated at $4, 311 (ZAR 52, 000) per-patient annually. The cost of medications and consumables related to cardiac catheterisation and heart valve surgery were the main cost drivers. Conclusions RHD care consumes a significant level of tertiary hospital resources in South Africa, with annual perpatient costs much higher than many other non-communicable and infectious diseases. This analysis supports the scaling up of primary and secondary prevention programmes at primary health centres in order to reduce the future burden on tertiary services. The study may also inform resource allocation efforts related to RHD at tertiary centres and provide cost estimates for future studies of intervention cost-effectiveness.
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    The household economic impact of Rheumatic Heart Disease (RHD) in South Africa
    (2018) Oyebamiji, Oyeleke; Alaba, Olufunke; Watkins, David A
    Background: Rheumatic heart disease (RHD) remains a major public health concern in African countries due to the high rates of complications such as atrial fibrillation, stroke, infective endocarditis, and heart failure, all of which can result in premature death. In 2015, RHD was estimated to affect 33 million people globally and resulted in at least 320,000 deaths, nearly all of which were in low and middle-income countries. Comparing to other non-communicable diseases (NCDs), RHD imposes economic burden on households that if measures are not in place to mitigate this, it can impoverish such household. However, there are several literatures on the intergenerational economic consequences of other chronic diseases. But, there is no study regarding the household economic of RHD. This mini-dissertation sets out to estimate the household economic impact of RHD. Methods: This study was a follow-on study from the Global Rheumatic Heart Disease Registry (REMEDY), which was a multi-center, international, hospital-based prospective registry of patients with RHD. It was designed as a cohort study to document the disease characteristics and outcomes of individuals with RHD across many countries. We recruited participants in the REMEDY study who were resident in Cape Town and received care at Groote Schuur Hospital (GSH). This study made use of patient and household member surveys to estimate the economic consequences of RHD among households in which REMEDY participants reside. REMEDY registry participants (index cases), their caregivers, and other household members were considered as respondents. 100 REMEDY participants receiving care at GSH was sampled. This sample size was chosen to balance feasibility and precision and to align with a parallel study of the cost of RHD to the health system that aimed to sample medical records from the same 100 REMEDY participants. Patient and household data collection was carried out between September 2017 to December 2017. Direct costs, indirect costs, and the downstream economic behaviors (coping strategies) that lead to medical impoverishment and other consequences were estimated. Cost of illness (COI) was used to assess the effect of ill-health and health-related expenditure on the consumption possibilities of households. Direct costs comprise both medical and nonmedical costs, which may include both the financial cost of resources as well as opportunity costs (e.g., of capital items). Human capital approach was used to calculate indirect cost. Implicit in the human capital approach is the assumption that changes in health status of household members can be reflected by losses in productivity, and losses in income generation. Productivity losses was estimated using the new South Africa minimum wage rate per month as proxy. Coping was estimated with the direct costs (e.g., borrowing from friends or relatives, or taking out formal loans) or indirect costs (e.g., intra-household labor substitution) and can be cost prevention strategies (e.g., ignoring illness, non-treatment) to cost management strategies (e.g., borrowing, selling assets, or labor substitution). Economic costs were valued in United State dollar (USD) converted from South African rand (ZAR) in 2017. Results: Direct medical cost was estimated to ZAR 0, because all patients were exempt from medical fees. Total direct non-medical cost for outpatient and inpatient visits was estimated to be ZAR 27,000 (USD 2000) and 29,000 (USD 2200) (respectively) over 302 and 74 encounters (respectively), an average of ZAR 270 (USD 20) and ZAR 290 (USD 22) per patient (respectively). Indirect costs incurred over the 302 outpatient encounters and 74 hospital admissions were estimated to be ZAR 41,000 (USD 3100) and ZAR 26,000 (USD 1900) (respectively), an average of ZAR 410 (USD 31) and ZAR 260 (USD 19) per patient. Direct cost had a very high impact on the household and they were compelled to adopt coping. Households observed in the study recorded that seventeen percent of households took out loans at an average of ZAR 1200 (USD 91) per loan (range ZAR 100 to ZAR 7000) (range USD 7 to 500). Fifteen percent received financial gifts at an average of ZAR 800 (USD 61) per gift. Two percent sold assets valued at ZAR 5600 (USD 120) on average. Five percent engaged in multiple coping strategies. Also, HH had to cope with indirect cost of illness as 15% of household caregivers changed jobs and 10% worked extra hours. About 4% of household members dropped out of school. Four percent adopted more than one coping strategy. A considerable share of participants reported that they had reduced education to take care of the affected patient. Most of the caregivers of patients with RHD were spouses and children, and 6 % were heads of household. The total cost of RHD to the average affected household is valued at about ZAR 1600 annually. In total, the overall annual economic impact of RHD in this sample of 100 households affected by RHD was estimated at ZAR 160,000 (USD 12200) (ZAR 1600 per household) (USD 120), representing 4.4% of annual household income or 4.9% of annual household expenditure patient spending that exceeded 10% threshold was estimated to be 8% and increasing the threshold to 40 % of non- food expenditure reduced the prevalence of catastrophic spending to 4%. Conclusions: The economic impact of RHD in South Africa is substantial despite government efforts to provide free care. The total cost of RHD to the average affected household is valued at about ZAR 1600 annually. A broader and more robust range of social policies will be required to mitigate non-medical and indirect costs and reduce distortions in household economic activity.
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    The social determinants of multimorbidity in South Africa
    (2013-08-20) Alaba, Olufunke; Chola, Lumbwe
    Abstract Introduction Multimorbidity is a growing concern worldwide, with approximately 1 in 4 adults affected. Most of the evidence on multimorbidity, its prevalence and effects, comes from high income countries. Not much is known about multimorbidity in low income countries, particularly in sub-Saharan Africa. The aim of this study was to determine the prevalence of multimorbidity and examine its association with various social determinants of health in South Africa. Method The data used in this study are taken from the South Africa National Income Dynamic Survey (SA-NIDS) of 2008. Multimorbidity was defined as the coexistence of two or more chronic diseases in an individual. Multinomial logistic regression models were constructed to analyse the relationship between multimorbidity and several indicators including socioeconomic status, area of residence and obesity. Results The prevalence of multimorbidity in South Africa was 4% in the adult population. Over 70% of adults with multimorbidity were females. Factors associated with multimorbidity were social assistance (Odds ratio (OR) 2.35; Confidence Interval (CI) 1.59-3.49), residence (0.65; 0.46-0.93), smoking (0.61; 0.38-0.96); obesity (2.33; 1.60-3.39), depression (1.07; 1.02-1.11) and health facility visits (5.14; 3.75-7.05). Additionally, income was strongly positively associated with multimorbidity. The findings are similar to observations made in studies conducted in developed countries. Conclusion The findings point to a potential difference in the factors associated with single chronic disease and multimorbidity. Income was consistently significantly associated with multimorbidity, but not single chronic diseases. This should be investigated further in future research on the factors affecting multimorbidity.
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    Unmet need for contraception and its determinants among adolescent girls in Uganda: Findings from Demographic and Health Survey (2011).
    (2019) Magezi, Alex; Alaba, Olufunke
    Introduction Worldwide, an estimated 16 million adolescents fall pregnant annually among these; at least three (3) million have unsafe abortions performed. Similarly, in sub-Sharan Africa more than 50% of the pregnancies in adolescents are unintended and of those, more than half of them end in unsafe abortions (Susheela Singh and Jacqueline E. Darroch & Darroch, 2012). 24% of adolescent females get pregnant annually in Uganda, and most of these are unwanted and unintended pregnancies (Atuyambe et al., 2015). These statistics indicate a problem of unmet need for contraception in Uganda, more so among adolescents, and this calls for more impact studies around adolescent unmet needs for contraception if the problem is to be meaningfully mitigated. Methods An explorative quantitative secondary data analysis study was conducted to determine the unmet need for contraception and its determinants among adolescent girls in Uganda, based on 2011 Ugandan Demographic and Health Survey (UDHS) data. Results Focusing exclusively on female adolescent’s aged 15- 19 years (n= 541), STATA software logistic regression was done to test a model on factors that are significantly associated with unmet needs in the target population of the study. A third (30%) of the study population reported having an unmet need for contraception; the study also revealed that the educational status of an adolescent girl was statistically significant (p=0.002) and related to unmet needs. Married adolescent girls were four times more likely to have unmet needs than those who were never in a union (OR=4.63; 95% CI: 2.06-10.39; p<0.001). Likewise, those adolescent girls who reported living with a partner were twice as likely to have a higher unmet need compared to those having no partners (OR=2.83; 95% CI: 1.30-6.16; p=0.009). Conclusion Any efforts to address the unmet need for contraception among adolescents in Uganda would need specific attention on factors influencing the uptake of family planning services, education, marital status and place of residence being key determinant factors.
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    Willingness to pay for insecticide-treated mosquito nets in rural South-East Nigeria : an integration of socio-economic and socio-psychological models
    (2011) Nwosu, Chijioke Osinachi; Alaba, Olufunke
    Malaria is no doubt a severe public health problem especially in sub-Saharan Africa. It is endemic in Nigeria and insecticide-treated mosquito nets have been found to be effective in its control. However, the cost of commercially-sold ITNs in Nigeria is considered to be beyond the reach of many households. Therefore, it is essential to ascertain how much the average rural household is willing to pay for a family-size ITN.