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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    An assessment of the utilisation of stokvels or rotating savings and credit associations to influence healthy eating in South Africa
    (2024) Lukwa, Akim; Alaba, Olufunke; Lambert Vicki
    Background In South Africa, the prevalence of non-communicable diseases (NCDs) is rising alarmingly, closely linked to dietary habits shaped by socioeconomic conditions. Stokvels, traditional community-based savings groups, emerge as potential catalysts for nutritional intervention, particularly among urban populations facing the dual challenges of undernutrition and obesity. This extensive study delves into the roles of stokvels in improving food security, promoting health, and empowering women within the urban landscapes of sub-Saharan Africa. Methods The research utilized a mixed-method approach to investigate the role of stokvels in urban sub-Saharan Africa comprehensively. Firstly, a systematic literature review was conducted, meticulously analyzing 28 studies that delved into the socio-economic impacts of ROSCAs and ASCAs, providing a foundational understanding of the role of stokvels in the region. This was complemented by stakeholder mapping, where indepth interviews with 21 key stakeholders were conducted to identify the macro-level influencers on stokvel operations. These influencers included government policies, economic conditions, cultural norms, and technological advancements, offering a nuanced view of the external factors impacting stokvel functionality. Further, the research employed a realist evaluation, involving 60 participants, including 20 stokvel leaders and 40 general members. This qualitative approach facilitated an understanding of the contextual factors influencing decision-making within stokvels, particularly concerning food purchasing and consumption patterns. Lastly, the study incorporated a discrete choice experiment (DCE), engaging 200 stokvel members. This quantitative method assessed the factors impacting members' preferences for healthy foods, analyzing their choices against various attributes related to food procurement and consumption. Results The study's results presented a multi-dimensional understanding of stokvels' influence. The systematic literature review highlighted stokvels as catalysts for disciplined savings and financial literacy, indirectly contributing to improved nutritional choices and food security. The stakeholder mapping revealed that stokvel operations are significantly influenced by external factors such as government policies, economic conditions, cultural norms, and technological advancements, which shape their efficacy in achieving financial and health-related goals. The realist evaluation provided deep insights into how grocery stokvels shape food purchasing decisions. It was found that these stokvels often employ bulk buying strategies, which ensure food security and affordability for their members. This approach reflects the stokvels' emphasis on strategic, collective decisionmaking that prioritizes the welfare of all members. Lastly, the discrete choice experiment highlighted members' preferences regarding healthy food options. The study revealed a preference for cost-effective shopping options like "two-for-one" offers. It also underscored the significant role of household decision-makers in influencing food choices, showing a complex interplay between socio-economic status, cultural norms, and individual preferences in dietary habits. This aspect of the study offered valuable insights into the behavioural economics of food choice within the context of stokvels. Conclusion The comprehensive analysis concludes that stokvels are vital components of the urban food systems in sub-Saharan Africa. They significantly impact women's health and economic empowerment by influencing healthier eating habits and facilitating community engagement in health promotion. However, the effectiveness of stokvels is subject to various challenges, including economic constraints and the need for supportive infrastructural and policy frameworks. Recommendations To enhance the positive impact of stokvels, it is recommended that government policies should provide more robust support and integration of these groups into the formal economic framework. Health promotion strategies need to incorporate stokvels as platforms for disseminating nutritional education and influencing food choices. Future research should extend to other African nations, exploring the varied impacts of stokvels in different cultural and economic contexts to develop comprehensive, culturally sensitive, and region-specific health and nutritional interventions.
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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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    Determinants of wellbeing in adolescents and young adults ? a systematic review and case study
    (2025) Bodzo, Panashe; Alaba, Olufunke; Correia Fontes Mayara
    Background: Adolescents and young people make up the greatest proportion of Sub-Saharan Africa (SSA). Understanding and improving their wellbeing should be considered a priority as it is associated with improved individual and societal wellbeing. Subjective wellbeing and psychological wellbeing are the two widely researched conceptualisations of wellbeing. Research on their determinants in adolescent populations has been concentrated in the global north. Interventions designed for this context are not likely to work in SSA due to the unique challenges in SSA. The aim of this study was to review the literature on the determinants of subjective and psychological wellbeing in SSA and organise these factors according to Bronfenbrenner's socio-ecological model. As of 2021, no systematic review had synthesised the literature on the determinants of wellbeing for adolescents and young people in SubSaharan Africa. Methods: This paper is a combination of a systematic review and a case study. The case study was included to triangulate the results of the systematic review in order to determine whether there are differences between the wellbeing of adolescents and young people in upper-middle-income countries and low to lower-middle-income countries in SSA. The review is based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guidelines. A systematic search of the following databases was conducted: EBSCOhost, PubMed, Scopus, Google Scholar, OpenGrey and National Bureau of Economic Research (NBER). The search strategy included terminology on subjective and psychological wellbeing that is commonly used in the literature. The search strategy was guided by the literature review. For the case study, wave 5 data from the National Income Dynamic Study, which is a nationally representative longitudinal study conducted in South Africa was used. We ran a Probit regression with wellbeing as the predictor variable. Results: In total, 7701 results were returned, and 19 articles were eligible to be included in this review. Bronfenbrenner's socio-ecological model was used to classify and characterise the determinants of wellbeing for adolescents and young people identified in the systematic review and case study. The sample size for the case study was 6987, and age was restricted to 15 and 24. The mean age of this group was 19.31 (SD=2.84). 53% were females, and 49% resided in urban areas. 65% rated their wellbeing as average and above, and 17% were depressed, according to the CES-D-10 scale. Religion, intrinsic and extrinsic aspirations, household income and/or socio-economic status, trust in relatives and age were statistically significant (p<0.05) predictors of wellbeing among adolescents and young adults in SSA. Conclusion: This is the first study to systematically review and organise the determinants of wellbeing for adolescents and young adults in SSA. There is a need for multi-sectoral policies to aid in improving adolescent wellbeing. More research studies that use longitudinal data collected exclusively from adolescents and young people need to be conducted in SSA.
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    Double burden of malnutrition among women in South Africa: evidence from the demographic health survey
    (2025) Chiwawa, Tinotenda Gerald Geoffrey; Alaba, Olufunke
    Background: The global shifts in nutrition patterns have been associated with an increasing number of individuals experiencing multiple forms of malnutrition, collectively termed the double burden of malnutrition (DBM). It is defined as the coexistence of undernutrition and overnutrition within the same population, community, or individual. The phenomenon can manifest at individual, household, or population levels and has significant public health implications. Methodology: The thesis includes a comprehensive literature review examining theoretical, methodological, and empirical studies on the DBM among women. The findings reviewed that the DBM is now prevalent in the poorest low- or middle-income countries, which include Sub Saharan Africa. South Africa is one of the top five African countries with the highest prevalence of overweight and obese individuals, particularly among women (34%). Women are now at a heightened risk of experiencing the DBM. Most studies on the DBM involving women in South Africa were primarily focused on either household contexts or individual prevalence of Body Mass Index challenges. This study seeks to fill the research gap by examining socioeconomic inequalities in the DBM among non-pregnant women in South Africa and identifying the main contributing factors. The outcome variable for this study is the DBM and it was defined as the coexistence of underweight and overweight/obese non-pregnant women in South Africa. Data from the 2016 South Africa Demographic Health Survey was utilised to calculate the prevalence of the DBM among the selected women aged 15-49 years. The initial sample size was 11083 women, but due to missing data and the exclusion of pregnant women, the final sample size was reduced to 3262 non-pregnant women. The concentration curve and the concentration index were used to assess the socioeconomic inequalities. Finally, an in-depth decomposition analysis uncovered the key driving factors contributing to the observed inequalities. The data management, exploration, and analysis were done using Stata 17 statistical software. Results: A total of 39% (1261 out of 3262) of non-pregnant women were found to experience the DBM. The prevalence varied across demographic groups, with higher rates observed among women aged 35-44 years, unemployed, Black/African, unmarried, urban residents, and those in the middle wealth quintiles. Socioeconomic inequalities related to the DBM were evident, illustrated by a pro-rich distribution in the concentration curve and a positive CI value of 0.14. Factors such as education, employment, health insurance, marital status, and watching TV contributed positively to socioeconomic inequality, while factors like parity and place of residence exhibited negative contributions. Conclusion: The findings of this study provide valuable insights into the DBM among non-pregnant women in South Africa. The high prevalence of the DBM, particularly among certain demographic groups, underscores the need for targeted interventions. The socioeconomic inequalities related to DBM, as evidenced by a pro-rich distribution highlight the complex interplay of numerous factors. These findings suggest that addressing the DBM in South Africa among women requires a multifaceted approach considering the socioeconomic context.
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    Economic evaluation of cash "plus" interventions for risky sexual behaviour among adolescent girls & young women in low and middle-income countries: a systematic review
    (2025) Tibini, Vuyolwetu Thembekile; Alaba, Olufunke; Mchenga, Martina
    Background: Adolescent girls and young women (AGYW) are especially susceptible to risky sexual behaviours that increase their risk of HIV infection and other negative consequences related to their reproductive health, especially in low- and middle-income countries (LMICs). Globally, AGYW, who are between the ages of 15-24, are at risk of HIV infection at an average of 4900 every week, while in 2021 AGYW accounted for 63% of all new HIV infections. In response, cash transfer interventions have become a tool to lessen financial vulnerability and provide AGYW with the confidence to make safer decisions regarding their sexual health. However, cash transfer interventions alone might not adequately address the intricate social, biological, and economic issues that AGYW face. As a result, "cash plus" interventions which combine cash with complementary services such as training, health care, and skill development have piqued interest as potentially more effective fixes. The premise of this systematic review is to examine theeconomic evaluations of these "cash plus" programs and their effect on reducing risky sexual behaviours among AGYW in LMICs. Methods: The thesis first implemented a structured literature review. The structured literature delves into the implementation of cash transfers in LMICs and identifies any related shortcomings. Secondly, the structured literature review examines epidemiological evidence of risky sexual behaviours faced by AGYWs in LMICs; these include HIV acquisition, unplanned pregnancy, condomless sex, transactional sex, and multiple sexual partners. Finally, the structured literature review scrutinizes any cash transfer programs that have undergone economic evaluation to address the risky sexual behaviour among AGYWs in LMICs. After the structured literature review was completed, a systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed on several electronic databases, including EbscoHost, PubMed, Cochrane Library, Web of Science, and Scopus, along with relevant grey literature. The review included economic evaluations of cash "plus" interventions aimed at risky sexual behaviour among AGYW in LMICs and studies between 1 January 2000 – 31 December 2023. Studies were screened for eligibility based on pre-defined inclusion criteria, and data were extracted into a synthesis table. Costs were adjusted to 2023 U.S. dollars (USD) to standardize economic evaluations across studies. Full and partial economic evaluations, including cost effectiveness analysis (CEA), cost-utility analysis (CUA), and cost-benefit analysis (CBA), were analysed. The key gaps show how standard cash transfers for AGYW have a limited impact on complex needs, a lack of complementary support, and minimal long-term benefits. Cash Plus addresses these gaps by integrating additional components tailored to AGYW's needs, such as mentorship and skills training, which enhance resilience and support sustainable behavioural changes. However, the economic evaluation of Cash Plus interventions targeting AGYW's risky sexual behaviours in LMICs requires further work. The importance of this work is that it provides evidence of cost- effectiveness, scalability, and long-term economic impact, allowing for informed, resource- efficient decisions on implementing Cash Plus programs in LMICs. Results: This thesis' systematic review retrieved a total of 40 articles, six of which met the inclusion criteria. All these studies, conducted between 2018 and 2022, were based in Sub-Saharan Africa, specifically in Kenya, Uganda, and Liberia. The population covered in the six studies totalled 15,517 AGYW, with interventions targeting a wide age range of 12 to 24 years. The interventions included programs like DREAMS, Empowerment and Livelihood for Adolescents (ELA), Girl Empower Plus (GE+), and Bridge PLUS, among others. Economic evaluations revealed mixed results regarding the cost- effectiveness of the interventions. Five studies performed full economic evaluations using CEA and CBA. One study conducted a partial economic evaluation (cost analysis). The total unit cost for the six units was $2 446,90, but after adjusting for the 2023 value, the amount rose to $2 881,60. Conclusion: The thesis suggests that cash "plus" interventions aimed at reducing risky sexual behaviours among AGYW in Sub-Saharan Africa are cost-effective, particularly over longer time frames. The review highlights the need for further research into the long-term, non-monetary benefits of these interventions, such as improvements in health, education, and social well-being, to fully assess their value. The mixed economic evaluations and inflation-adjusted unit costs highlight the importance of ongoing research and careful resource allocation. The results underscore the importance of targeted, comprehensive strategies in addressing the complex needs of AGYW, while also pointing to the challenges of scaling such interventions in resource constrained environments.
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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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    Factors associated with partial health insurance coverage among households in Malawi
    (2025) Phiri, Jane; Alaba, Olufunke
    Health insurance has proven ideal for curbing the increase in household contribution towards health expenditure. However, despite efforts to expand health insurance in Sub-Saharan Africa, coverage has remained low and favouring higher-income groups. Malawi is among the countries that face this low uptake, with only 3% of the total population insured. Moreover, within insured households, coverage is often incomplete, leaving some members without protection. This partial insurance coverage increasingly contributes to a reliance on out-of-pocket expenditure (OOPE), a regressive and inequitable financing mechanism that disproportionately affects vulnerable households. However, there is dearth of evidence on factors associated with this phenomenon among households in Malawi, thus, understanding the dynamics of partially insured households is crucial to addressing these gaps, reducing financial barriers to healthcare, and promoting Universal Health Coverage (UHC). Methodology: This study aimed to examine the determinants associated with partially insured households in Malawi. The thesis is divided into three parts: a structured literature review, a journal manuscript and a policy brief. The literature review revealed that most studies in Africa and elsewhere have focused on individual health insurance coverage determinants and not intrahousehold health insurance coverage status determinants. In Malawi, this is coupled with a low health insurance uptake. There is also limited information on factors influencing households to insure some but not all members. This study therefore aimed to fill this gap in literature and inform health financing policies. This quantitative study used cross-sectional secondary Data from the 2019-2020 Multiple Indicator Cluster Survey (MICS). The individual health insurance status; insured and uninsured, was defined as coverage by any health insurance. Using unique identifiers (cluster number, household number and line number), every individual was grouped into their respective households. Consequently, household size was used to determine a household's health insurance coverage status where a household with all members as insured was categorized as fully insured, a household with at least one but not all members insured as partially insured and a household with no member covered as completely uninsured. A two-stage analysis approach was then utilized in this study. Firstly, descriptive statistics were used to analyse and compare fully insured households, partially insured households and completely uninsured households. Zoning into partially insured households, the second stage applied multivariate binary logistic regression to identify factors associated with health insurance coverage. Analysis was done using STATA statistical package version 18. Results: This study had 64,615 unique individuals from 22,886 households. Only 0.6% of individuals had health insurance. A higher proportion of the households were completely uninsured (22,649; 98.96%) with 228 households (1%) being partially insured and the remaining 9 households (0.04%) were fully insured. Household sizes differed significantly among fully, partially insured, and completely uninsured households (median of 1, 5, & 4 respectively; p-value=<0.001). Higher education levels of household heads were strongly associated with full and partial insurance coverage and in contrast, lower education levels, such as no education or primary education, were linked to a lack of insurance coverage (89% vs 50% vs 72%; p-value=<0.001). All fully insured households were from the richest quintile. Age of household head [AOR 1.025 (1.000-1.050);p-value=0.045], higher education level of an individual [ AOR 4.470 (1.519-13.154); p-value=0.007], an individual's access to media [AOR 2.276 (1.050-4.931); p-value=0.037] and a higher dependency ratio [AOR 1.655 (1.111-2.466);p-value=0.014] were positively associated with being an insured individual from a partially insured household with household size [AOR 0.813 (0.682-0.969); p-value=0.022] being negatively associated with the outcome. On the other hand, residential area, sex of an individual and region were not associated with health insurance ownership in partially insured households. Households, therefore, were partially insured mainly because of being with large household members (median size of 5), higher dependency ratio, media access, individuals having no or primary education and being from the poorest quintile. Conclusion: Socioeconomics and household dynamics influence health insurance coverage. This study highlights education, household size, wealth, dependency ratio, and media exposure as significant determinants influencing partial household health insurance enrolment. Partially insured households remain particularly vulnerable as they continue to face financial risks due to uninsured members, highlighting the need for targeted interventions to facilitate their transition to full coverage. The findings emphasize socioeconomic and informational disparities. Therefore, efforts to enhance health insurance enrolment should focus on improving education access, supporting larger and economically disadvantaged households, and leveraging media channels to raise awareness about the benefits of comprehensive health insurance coverage. Implementing policies that enhance affordability, and accessibility will also be essential in achieving universal coverage and reducing financial vulnerability among households. Moreover, these findings are timely given Malawi's commitment to UHC, Sustainable Development Goal 3, and regional targets such as the Abuja Declaration, reinforcing the need for equitable health financing policies that address partial household insurance coverage.
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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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    HIV self testing uptake and associated factors in Cape Town: a contextual framework
    (2025) Nyembwe, Doris; Alaba, Olufunke
    South Africa bears one of the highest HIV burdens globally, with nearly 8 million people living with the virus. Despite hosting the world's largest antiretroviral therapy (ART) program, HIV-related deaths remain significant, accounting for over 23% of all deaths in 2019. Early detection and timely initiation of ART are essential to prevent transmission, improve quality of life, and reduce HIV-related morbidity and mortality. However, insufficient testing coverage among males and younger individuals remains a concern. HIV self-testing (HIVST) has emerged as a promising strategy to bridge these gaps, offering a private and convenient option for individuals hesitant to access healthcare facilities. The World Health Organization (WHO) endorses HIVST as a complementary approach to enhance access, particularly for populations underserved by traditional testing methods. While research has examined HIVST uptake in various settings, little is known about the specific factors influencing its adoption in Cape Town. Given South Africa's unique socio-economic landscape and the disparities between urban and rural areas, understanding the factors shaping HIVST uptake is crucial for developing tailored interventions. This thesis seeks to address this gap by investigating and analyzing the demographic, socio-economic, and community-level factors associated with HIVST uptake in Cape Town. Methods: This study utilized a cross-sectional design to examine HIV testing uptake and associated factors in Cape Town, South Africa, between January and December 2022. The analysis leveraged routine HIV Testing Services (HTS) programmatic data collected by the Anova Health Institute. The dataset included a total of 266,284 observations: 30,785 for HIV self-testing (HIVST) and 235,499 for conventional HIV testing. Data were drawn from individuals aged 18 years and older across the eight subdistricts of the Cape Town metropolitan area: Eastern, Northern, Southern, Western, Khayelitsha, Klipfontein, Mitchells Plain, and Tygerberg. The data, comprising sociodemographic details and testing information, were deidentified with formal permission from Anova Health Institute and the Department of Health. Individual-level data was recorded through consent forms and HTS registers and subsequently transferred to Red Cap and Power BI for quality checks and analysis. Community-level data, including the number of healthcare facilities, new and registered ART patients, and child acute malnutrition rates, were sourced from City of Cape Town health profiles (2021). Predictors were selected based on a socio-ecological framework, capturing both individual- and community-level factors. Individual-level variables included age, gender, and HIV testing history. Community-level factors encompassed healthcare access (number of healthcare facilities), HIV burden (number of registered and new ART patients), and socioeconomic status (child acute malnutrition rate). Descriptive statistics summarize the frequencies of HIVST, and conventional testing variables stratified by subdistrict, alongside community-level factors. A bivariate logistic regression model was conducted to assess associations between individual predictors and HIV testing options. Subsequently, a multivariate logistic regression model was employed to evaluate the influence of both individual- and community-level predictors on HIV testing choices (conventional vs. HIVST). Odds ratios were calculated with 95% confidence intervals to quantify these associations. This methodology integrates diverse data sources and robust statistical approaches, enabling a comprehensive examination of the factors influencing the uptake of HIV self-testing in Cape Town. Results: The study had a sample size of 265,063 of which 234,853 (88.60%) had utilized conventional HIV testing method and 30,210 (11.40%) opting for self-testing. Majority of individuals undergoing conventional testing are adults aged 25- 49 (63.16%), followed by older adults aged 50+ (17.16%). Similarly, for self-testing, most users are also within the 25-49 age group (63.84%), but there is a higher proportion of young adults aged 20-24 choosing self-testing (23.72%) compared to conventional testing (15.59%). Additionally, adolescents aged 18-19 are more likely to opt for self-testing (7.75%) than conventional testing (4.08%). Regarding gender, females constitute a larger share of those undergoing conventional testing (65.62%) compared to males (34.38%). The trend is similar for self-testing, where females account for 65.32%, and males make up 34.68%. In terms of the last HIV test, self-testing is more prevalent among individuals who were tested within the past 12 months (63.51%), while conventional testing is more common among those whose last test was over a year ago. Subdistrict analysis shows that conventional testing is most frequent in Tygerberg (20.06%) and Khayelitsha (16.87%), followed by Western (13.24%) and Eastern (12.45%). In contrast, self-testing is more widely utilized in Western (19.38%), Southern (15.33%), and Mitchell's Plain (16.97%). The bivariate logistic regression indicated that age was a significant factor influencing self-testing preferences, with the likelihood of using HIVST decreasing with age. Individuals aged 20‐24 had 20% lower odds of using self‐testing compared to adolescents aged 18‐19 (OR = 0.80, 95% CI: 0.76–0.85, p < 0.005). Those aged 25‐49 had 47% lower odds compared to the adolescent group (OR = 0.53, 95% CI: 0.51–0.56, p < 0.005), and adults aged 50 and above had 86% lower odds (OR = 0.14, 95% CI: 0.13–0.15, p < 0.005). Additionally, for facility testing those who had tested for HIV within the last 12 months were more inclined towards self‐testing. In contrast, individuals who last tested more than 12 months ago were 77% less likely to choose self‐testing (OR = 0.23, 95% CI: 0.22–0.25, p < 0.005), and those who had never been tested were 40% less likely (OR = 0.60, 95% CI: 0.54–0.67, p < 0.005) to use self‐testing. HIVST was more popular among people living in areas with a high concentration of registered ART patients. Specifically, the odds of choosing self‐testing increased by 32% in high-density areas (≥30,001 registered ART patients) (OR = 1.32, 95% CI: 1.28–1.37, p < 0.005) and by 53% in medium-density areas (20,001–30,000 registered ART patients) (OR = 1.53, 95% CI: 1.49–1.58, p < 0.005), compared to areas with fewer than 20,000 registered ART patients. On the other hand, people living in areas with a higher number of healthcare facilities were more likely to choose conventional HIV testing. The odds of self‐testing decreased by 15% in subdistricts with a medium number of healthcare facilities (15–25 facilities) (OR = 0.85, 95% CI: 0.82–0.87, p < 0.005) and by 27% in areas with a high number of facilities (26 or more) (OR = 0.73, 95% CI: 0.71–0.76, p < 0.005), relative to areas with fewer than 15 facilities. Additionally, communities with a high number of newly enrolled ART patients (≥2,901) showed a 31% lower likelihood of opting for self-testing (OR = 0.69, 95% CI: 0.67–0.72, p < 0.005). Subdistrict variations were evident, with Southern (OR = 2.04, 95% CI: 1.94–2.13, p < 0.005) and Mitchell's Plain (OR = 2.12, 95% CI: 2.03–2.23, p < 0.005) showing more than twice the odds of self‐testing compared to the Eastern subdistrict. Other subdistricts with significantly higher odds of self-testing included Western (OR = 1.63, 95% CI: 1.56–1.71, p < 0.005) and Klipfontein (OR = 1.12, 95% CI: 1.06–1.18, p < 0.005). Conversely, Northern (OR = 0.52, 95% CI: 0.48–0.55, p < 0.005), Tygerberg (OR = 0.55, 95% CI: 0.52–0.57, p < 0.005), and Khayelitsha (OR = 0.97, 95% CI: 0.83–0.91, p < 0.005) had significantly lower odds. Finally, testing preferences assessed through the multivariate logistic regression model highlighted the influence of both individual- and community-level factors. Consistent with the bivariate analysis findings, age remained a strong predictor of HIVST. Individuals aged 20–24 had 23% lower odds of using self-testing compared to those aged 18–19 (OR = 0.77, 95% CI: 0.73–0.82, p < 0.005), while those aged 25–49 had 49% lower odds (OR = 0.51, 95% CI: 0.48–0.53, p < 0.005). The oldest age group (50 years and above) had 86% lower odds of choosing self-testing compared to the youngest group (OR = 0.14, 95% CI: 0.13–0.15, p < 0.005). 5 Individuals residing in communities with a medium (20,001–30,000) and high (≥30,001) number of registered ART patients had 240% (OR = 3.40, 95% CI: 3.18–3.65) and 182% (OR = 2.82, 95% CI: 2.70– 2.96, p < 0.005) higher odds of using self-testing, respectively, compared to those in areas with low ART caseloads (<20,000). Additionally, living in areas with more newly enrolled ART patients was negatively associated with self- testing. Residing in communities with a medium number of new ART patients (1,800–2,900) was associated with 68% lower odds of self-testing (OR = 0.32, 95% CI: 0.29–0.34, p < 0.001), while living in areas with a high number of new ART initiations (≥2,901) was associated with 81% lower odds (OR = 0.19, 95% CI: 0.18–0.21, p < 0.001), compared to areas with a low number of new ART patients (<1,800). Unlike in the bivariate analysis, gender also played a significant role in the multivariate model, with females having 8% lower odds of choosing self-testing compared to males (OR = 0.92, 95% CI: 0.90– 0.94, p < 0.005). Additionally, individuals who received a positive HIV test result had 9% lower odds of having used self-testing compared to those who tested negative (OR = 0.91, 95% CI: 0.84–0.98, p = 0.005). The number of healthcare facilities was also positively associated with self-testing uptake. Living in areas with a medium (15–25) or high (≥26) number of healthcare facilities increased the odds of self-testing by 13% and 34%, respectively (OR = 1.13, 95% CI: 1.09–1.17, p < 0.005; and OR = 1.34, 95% CI: 1.26–1.43, p < 0.005), compared to areas with a low number of facilities (0–14). Conclusion: In conclusion, the study underscores the complex interplay of individual and community-level factors influencing HIV testing preferences in Cape Town. Younger age, recent HIV testing history, male gender, and residence in areas with higher number of registered ART patient and more healthcare facilities were associated with increased likelihood of HIV self-testing (HIVST). Conversely, older age, female gender, living in communities with more newly initiated ART clients, and receiving a positive HIV diagnosis were linked to a lower likelihood of using HIVST. Geographic disparities across subdistricts further highlight the need for targeted, context-specific strategies to enhance HIV testing uptake, particularly among underrepresented groups, and to optimize the reach and impact of self-testing interventions.
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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 COVID-19 outcomes in south Africa
    (2025) Tshipetane, Anza; Alaba, Olufunke
    Background: This research addressed the crucial issue of socioeconomic inequalities associated with COVID-19 outcomes at the district level in South Africa. While previous literature has frequently relied on income as a measure of socioeconomic status, it's essential to recognize that socioeconomic standing is multifaceted and dynamic. In this study, we delved into these multidimensional factors shaping a population's SES, employing an intersectional approach that considers demographic, economic, and structural aspects of socioeconomic status. Our analysis aimed to understand how each of these dimensions, as well as their collective influence, impacts COVID-19 cases, recoveries, and deaths. The insights underline the need for targeted policy interventions that bolster support for vulnerable groups, enhance economic resilience through job creation and social grants, and improve public infrastructure to reduce overcrowding and ensure equitable access to basic utilities. Methods: The study utilised data amalgamated by the National Policy Data Observatory (NPDO), which synthesizes information from the National COVID-19 outcomes surveillance spanning from November 2019 to July 2022 and socioeconomic indicator data from the 2021 General Household Survey (GHS) . The study used 12 socioeconomic indicators across 53 districts to create four analytically backed domains of socioeconomic standing namely: sociodemographic index (average number of persons per household, proportion of female- headed households, and age dependency ratio and proportion of individuals over the age of 60), economic index (income, subsidised households, poverty and adult unemployment), infrastructural index (water, electricity, toilets and proportion of informal dwellings) and overall district socioeconomic index using the Principal Component Analysis technique. The relationship between these indices with COVID-19 cases, recoveries, and fatalities were further investigated using the Wagstaff concentration index of inequality and concentration curves. Results: Using factor loadings attained from PCA, we grouped our variables into the 3 domains of socioeconomic standing, validating the intersectional framework conceptualised in the study. The analysis revealed that when districts were ranked by the sociodemographic index, COVID-19 outcomes showed a pro-poor distribution across cases, recoveries, and fatalities, with concentration indices of -0.27 (p=0.01), -0.27 (p=0.01), and -0.16 (p=0.08) respectively. Groups experiencing greater sociodemographic deprivation, including those in complex households such as households with the elderly and female-headed households, suffered severe outcomes. The results showed a similar pattern with the economic index, with concentration indices of -0.22 (p=0.04), -0.21 (p=0.04), and -0.16 (p=0.07) for cases, recoveries, and mortalities respectively. This aligns with empirical literature where unemployment and lack of income exacerbated poor outcomes. The infrastructural index showed a pro-rich distribution with the concentration curve below the line of equality and concentration indices of +0.34 (p=0.0005), +0.34 (p=0.0006), and +0.30 (p=0.005) for cases, recoveries, and mortalities respectively. This along with evidence of dense population in metropolitans such as city of Johannesburg, eThekwini and City of Cape Town suggests that urbanization and subsequent overcrowding in well-developed areas increased the risk of spreading infection and worsening COVID-19 outcomes, supporting the narrative of calling COVID-19 the urban disease. Finally, the multidimensional SES index produced an overall pro-poor distribution with the concentration curve lying above the line of equality and concentration indices of -0.28 (p=0.01), -0.27 (p=0.01), and -0.20 (p=0.02) for cases, recoveries, and mortalities respectively. Using the sociodemographic, economic, and infrastructural indices, the analysis provided a statistically significant description of inequality in cases and recoveries but not in mortalities. Conclusion: The research provides compelling evidence of a 'social gradient' in health at the district level in South Africa. The results clearly demonstrate that poor socioeconomic status, as indicated by our broad multidimensional SES index, exacerbates negative health outcomes, with the main drivers being sociodemographic characteristics and economic deprivation. This indicates potential pressure points that policymakers can focus on.
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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.