Browsing by Author "Alaba, Olufunke A"

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    The cost and cost-effectiveness of a text-messaging based intervention to support management of hypertension in South Africa
    (2017) Hongoro, Danleen James; Alaba, Olufunke A; Meheus, Filip
    This project assessed the cost and cost-effectiveness of hypertension management in South Africa within the context of a text messaging-based intervention (StAR* study) conducted in an urban public-sector clinic in Cape Town. The StAR* study is a community randomized trial that investigated the effect of adherence support via short messaging service (SMS) on treatment adherence and patient outcomes for the management of hypertension at Vanguard CHC in Cape Town (Bobrow et al. 2016). Patients received behavioral text messages as reminders for them to collect and take their medication on time. The StAR* study, consisted of three arms that ran in parallel: participants in the control arm received unrelated messages; patients in the information-only arm received one-way information messages twice a week; and patients in the interactive arm received interactive SMS-texts at the same frequency as those in the information only arm (Bobrow et al. 2016). Patients in the interactive arm could respond to the messages and trigger a response from the healthcare provider. The text messaging based intervention was shown to improve hypertension outcomes over a 12-month period in hypertension patients by improving adherence and retention in care. The study showed, in the one-way intervention arm an improvement in adherence (measured by medication refill rates) and a small reduction in systolic blood pressure (2.2mm Hg reduction over 12months) (Bobrow et al. 2016). In this study, we assessed the cost and cost effectiveness of the StAR* intervention under routine care management at Vanguard CHC. We also assessed the cost of hypertension management from the health system perspective and the cost of accessing hypertension care from the patient perspective. A combination of the ingredients approach and step-down costing was used to cost hypertension care from a health system perspective while a questionnaire was administered to 250 patients to estimate patient costs. The primary outcomes were the average cost of hypertension care and the incremental cost of the text message-based adherence intervention (StAR* intervention), compared to usual care, per millimetre of mercury (mmHg) reduction in systolic blood pressure. Results of the study show that the average health system cost for hypertension management is R262 per visit and the patient cost of accessing hypertension care is R172 per visit. The text messaging based intervention was found to have low implementation costs in this pilot phase. The monthly incremental cost of the text messaging based intervention cost was R4 per person. The incremental cost-effectiveness ratio of the intervention was R22 per mm Hg reduction. This study provides the first contemporary assessment of hypertension management costs and the cost-effectiveness of mobile-based hypertension adherence support in South Africa. Future work will seek to estimate the long-term cost-effectiveness of this intervention and the cost of scaling it to the provincial and national levels.
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    Drivers of socioeconomic inequalities of child hunger during COVID-19 in South Africa: evidence from NIDS-CRAM Waves 1–5
    (2022-11-16) Alaba, Olufunke A; Hongoro, Charles; Thulare, Aquina; Lukwa, Akim T
    Background Child hunger has long-term and short-term consequences, as starving children are at risk of many forms of malnutrition, including wasting, stunting, obesity and micronutrient deficiencies. The purpose of this paper is to show that the child hunger and socio-economic inequality in South Africa increased during her COVID-19 pandemic due to various lockdown regulations that have affected the economic status of the population. Methods This paper uses the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM WAVES 1–5) collected in South Africa during the intense COVID-19 pandemic of 2020 to assess the socioeconomic impacts of child hunger rated inequalities. First, child hunger was determined by a composite index calculated by the authors. Descriptive statistics were then shown for the investigated variables in a multiple logistic regression model to identify significant risk factors of child hunger. Additionally, the decomposable Erreygers' concentration index was used to measure socioeconomic inequalities on child hunger in South Africa during the Covid-19 pandemic. Results The overall burden of child hunger rates varied among the five waves (1–5). With proportions of adult respondents indicated that a child had gone hungry in the past 7 days: wave 1 (19.00%), wave 2 (13.76%), wave 3 (18.60%), wave 4 (15, 68%), wave 5 (15.30%). Child hunger burden was highest in the first wave and lowest in the second wave. The hunger burden was highest among children living in urban areas than among children living in rural areas. Access to electricity, access to water, respondent education, respondent gender, household size, and respondent age were significant determinants of adult reported child hunger. All the concentrated indices of the adult reported child hunger across households were negative in waves 1–5, suggesting that children from poor households were hungry. The intensity of the pro-poor inequalities also increased during the study period. To better understand what drove socioeconomic inequalites, in this study we analyzed the decomposed Erreygers Normalized Concentration Indices (ENCI). Across all five waves, results showed that race, socioeconomic status and type of housing were important factors in determining the burden of hunger among children in South Africa. Conclusion This study described the burden of adult reported child hunger and associated socioeconomic inequalities during the Covid-19 pandemic. The increasing prevalence of adult reported child hunger, especially among urban children, and the observed poverty inequality necessitate multisectoral pandemic shock interventions now and in the future, especially for urban households.
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    Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa
    (2021-07-02) Alaba, Olufunke A; Hongoro, Charles; Thulare, Aquina; Lukwa, Akim Tafadzwa
    Background: The United Nations’ 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for “leaving no one behind”. However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa’s and India’s Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children’s health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition. Methods: Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities. Results: The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (−0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother’s education, and mother’s age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries. Conclusions: The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother’s education, and mother’s age. In conclusion, if socioeconomic inequalities in children’s health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely “some under-five children will be left behind”.
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    Non-communicable diseases and economic outcomes in South Africa: a cohort study for the period of 2008-2018
    (2019) Mfolozi, Odwa; Alaba, Olufunke A
    Background: The total number of people living with non-communicable diseases in South Africa currently is unknown even though non-communicable diseases (NCDs) was accountable for 60% of the top ten causes of death in South Africa for the year 2015. In 2016, according to Stats SA, noncommunicable diseases were accountable for 57.4% of all deaths in South Africa. In 2011 they were accountable for 23% of years of life lost and 33% of disability adjusted life years. Government total expenditure is also unknown but it is estimated at more than one billion rands per annum for low to middle income countries such as South Africa. NCDs negatively impact the labour market by decreasing labour productivity, increasing employee turnover and early retraction from the labour market. This further decreases individual and household income especially for the urban poor who carry the heaviest non-communicable disease burden in South Africa and contributes to the medical poverty trap as well as, worsening income inequality in South Africa. Objective: This dissertation investigates the association between non-communicable diseases and labour market participation (LFP) and the effect it has on household income (HHI). Methods: Using the longitudinal data from the National Income Dynamics Study (NIDS) with information on labour force participation, household income and diseases such as high blood pressure, diabetes, cancer, chronic lung disease, heart problems, stroke, arthritis; were used for analysis. The analysis used the 2008 (wave1), 2012 (wave 3) and 2016 (wave 5) data sets from the NIDS. The analysis is restricted to the population aged 18 years to 65years. The Study examines these associations using logistic and linear regression models for NCDs exposed households and non NCDs exposed households, comparing the two for differences and the effect observed on labour force participation and household Income. The control variables include location, age, race, gender, marital status and level of education. The NCDs are treated as exposure variables with labour Force Participation (LFP) and House Hold Income (HHI) being outcome variables. The study is guided by a conceptual framework that views the household as a unitary function. Lastly, the Policy Brief summarises the issues at hand, the findings and concludes with policy recommendations. Results: LFP: Based on the regression results, as a group NCDs show a negative relationship with labour force participation as a non-significant decrease but individually it depends on the type of NCD an individual is exposed to. Cancer, stroke and heart attacks are negatively associated with labour force participation. Asthma, diabetes and hypertension are positively associated with labour force participation. When an individual suffers from one NCD the relationship/association depends on the type of NCD, If and when an individual is burdened by a second or third NCD (Co-morbidities) the relationship with LFP tends to be positive (an increase in LFP). HHI: Counterintuitively as a group NCDs is associated positively with household income; a significant increase of 15% at 5 % level of significance. However, individually, hypertension, cancer, asthma, heart problems and stroke have a negative relationship (a decrease) with household income except Diabetes. Objectively there is insufficient evidence to conclude that NCDs decrease household income via decreasing labour force participation indirectly contributing to poverty in South Africa, as majority of household income comes from wages and remittances. Individually almost all NCDs (with Cancer and Hypertension having significant results) decrease household income but as a group increase household income. This requires further investigation into the NCD burdened household dynamics in South Africa. Conclusion: Therefore, as recommended by the WHO; individual specific interventions will be more effective than population-based interventions to alleviate the ripple effects of the non-communicable disease burden in low to middle income countries (LMIC). Universal Health Care and up scaled prioritisation at Primary Health Care level is needed as NCDs accounted for half the global burden of disease but only received 2% of international donations compared to human immune-deficiency virus (HIV/AIDS) that accounted for 4% of the global burden of disease receiving 29% of international donations and grants.
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    Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme
    (BioMed Central, 2018-01-04) Goudge, Jane; Alaba, Olufunke A; Govender, Veloshnee; Harris, Bronwyn; Nxumalo, Nonhlanhla; Chersich, Matthew F
    Background: Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper we ask whether the new scheme has assisted in efforts to move towards UHC. Methods: Using a cross-sectional survey across four of South Africa’s nine provinces, we interviewed 1329 government employees, from the education and health sectors. Data were collected on socio-demographics, insurance coverage, health status and utilisation of health care. Multivariate logistic regression was used to determine if service utilisation was associated with insurance status. Results: A quarter of respondents remained uninsured, even higher among 20–29 year olds (46%) and lower-skilled employees (58%). In multivariate analysis, the odds of an outpatient visit and hospital admission for the uninsured was 0.3 fold that of the insured. Cross-subsidisation within the scheme has provided lower-paid civil servants with improved access to outpatient care at private facilities and chronic medication, where their outpatient (0.54 visits/month) and inpatient utilisation (10.1%/year) approximates that of the overall population (29.4/month and 12.2% respectively). The scheme, however, generated inequities in utilisation among its members due to its differential benefit packages, with, for example, those with the most benefits having 1.0 outpatient visits/month compared to 0.6/month with lowest benefits. Conclusions: By introducing the scheme, the government chose to prioritise access to private sector care for government employees, over improving the availability and quality of public sector services available to all. Government has recently regained its focus on achieving UHC through the public system, but is unlikely to discontinue GEMS, which is now firmly established. The inequities generated by the scheme have thus been institutionalised within the country’s financing system, and warrant attention. Raising scheme uptake and reducing differentials between benefit packages will ameliorate inequities within civil servants, but not across the country as a whole.