Browsing by Author "Garba, Muhammed Faisal"

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    Open Access
    Access to Tuberculosis testing among adolescents living with Human Immunodeficiency Virus in the Eastern Cape, South Africa: social factors and theoretical considerations
    (2022) van Staden, Quintin; Toska, Elona; Garba, Muhammed Faisal
    Background: Addressing adolescent tuberculosis (TB) is a critical step towards eliminating TB in high burden countries, especially in HIV endemic communities. South Africa has the highest rates of TB/HIV co-infection and the largest population of adolescents living with HIV (ALHIV) in the world – contributing substantial risk to TB-related morbidity and mortality in this already vulnerable cohort. Previous research on TB has largely overlooked adolescents and ALHIV which has left knowledge – and potential service provision – gaps, but also opportunities for important research. TB among ALHIV is a complex public health challenge, needing to be understood in the context of the unique socio-emotional life stage of adolescence. This dissertation aims to provide insights into the critical first step in the ALHIV TB care cascade: access to TB testing. Through quantitative analysis, I explore the social factors that promote or prevent ALHIV from accessing TB testing in South Africa. Methods: In this longitudinal study, I analysed the Mzantsi Wakho cohort data from n=1046 ALHIV (10-19 years old) from 53 health facilities across the Amathole district of the Eastern Cape. N= 933 (89%) ALHIV – those who participated in the second and third cohort waves – were included in this analysis. Data were collected through self-reported questionnaires, assisted by trained and experienced researchers three times between 2014/2015 to 2017/2018. The selection of social factors that influence access to the outcome of TB testing was informed by an extensive scoping literature review. These factors were initially categorised using WHO's social determinants of health framework, which applies the Ecological Model. Thereafter, factors were filtered through the People Centred Model of TB care – to draw focus to the factors pertaining to the individual (both inter- and intrapersonal) rather than factors imbedded in health systems and services. Analysis was conducted in four steps: First descriptive analyses was used to summarise sociodemographic characteristics, relevant TB clinical data and HIV related factors at each interview (T2 and T3). Secondly, cross tabulation and frequencies of factors were done, comparing ALHIV who tested for TB to those that did not. Thirdly, univariate analysis was performed to identify factors with statistically significant associations with having a TB test or not. Lastly, multivariate regression models of these significant factors were run, both for each time point and over time (across both time points) using a stepwise approach by Hosmer-Lemeshow. The “why” or “how” these specific factors affected the probability of TB testing were then explored through the application of sociological theories and concepts, including the life course approach, social action theory and habitus. Findings: Consistently experiencing the following factors over time were linked to greater odds of TB testing: being 15 years and older (OR 1.43, CI 1.06-1.92, p 0.019), female ALHIV (OR 1.34, CI 1.02-1.75, p 0.033), in a relationship at both time points (OR 1.79, CI 1.23-2.62, p 0.002) and having had a viral load test each year (OR 1.50, CI 1.11-2.02, p 0.008). Having TB symptoms at either wave 2 or 3 was associated with TB testing (OR 1.46, CI 1.08-1.96, p 0.013). At Wave 2, no sim card phone (OR 0.64, CI 0.47-0.85, p 0.002) and having to pay R10 or more to get to the clinic (OR 0.68, CI 0.51-0.92, p 0.011) were associated with lower odds of TB testing, while viral load testing in the past year (OR 1.74, CI 1.26-2.40, p 0.001), living in a rural setting (0R 1.54, CI 1.10-2.16, p 0.012), being 15 years and older (OR 1.60, CI 1.19- 2.15, p 0.002) and reporting any TB symptoms (OR 1.72, CI 1.29-2.30, p< 0.001) were associated with higher odds of TB testing. At Wave 3, when most of the participants were in late adolescence being 15 years and older (OR 1.61, CI 1.19-2.19, p 0.002), living in informal housing (OR 1.58, CI 1.07-2.37, p 0.023), being in a relationship (OR 1.58, CI 1.15-2.18, p.005), experienced community violence (OR 1.43, CI 1.05-1.96, p 0.023), food security (OR 1.53, CI 1.11-2.11, p 0.010) and experienced any TB symptoms (OR 1.65, CI 1.25-2.20, p 0.001) had higher odds of reporting TB testing. Discussion and Conclusion: In this Eastern Cape cohort of ALHIV, factors linked to where ALHIV live (living rurally, cost to get the clinic more than R10, living in informal housing and having experienced community violence) as a reflection of the deep structural issues that shape health symptoms and healthcare access, who they are (age, sex) and their close emotional and nutritional support (being in a relationship, food security) have shown to strongly influence TB testing. Some of these factors are directly linked to increasing risk of TB exposure or vulnerability to TB: rural residence, informal housing and unsafe communities. To delve into why these factors shaped TB testing in ALHIV, sociological theories and concepts were applied to these findings. This dissertation took a holistic approach to bridge a critical knowledge gap in ALHIV's entry into TB care, extending our biomedical understanding with applied sociological frameworks. The work of this dissertation could enhance the current HIV services package offered to ALHIV by creating an awareness and identifying adolescents that may not be reached by current TB testing services. With this insight, TB services in South Africa, and perhaps broader afield, can introduce targeted interventions and social protection measures tailored to address adolescent TB testing, particularly in terms of integrating TB testing into HIV services.
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    Open Access
    Experiences and integration of Nigerian migrants in the United States and United Kingdom
    (2024) Alabi, Tunde; Garba, Muhammed Faisal
    As the rate of migration from Africa to the West increases, host countries' migration policies and migrants' everyday experiences are increasingly intercepted by discriminatory behaviours based on intersectional identities. The discrimination and inequalities have implications for migrants' overall well-being. This study investigated the experiences and integration of Nigerian migrants in the United States (US) and the United Kingdom (UK), focusing on three projects: selfidentification and understanding of immigrant integration, migrants' wellbeing (employment and health), and Covid-19. Specifically, the study set out to investigate (1) how Nigerian migrants selfidentify and how they understand the concept of “immigrant integration”; (2) the influence of seven factors (gender, religion, names, duration of stay, education, place of education and migrant) on the labour market and health experiences of Nigerian migrants; (3) differences in migration experiences of Nigerian migrants between the US and UK; (4) the effects of Covid-19 on the employment and health of migrants. The study adopted a multi-theoretic approach, resting on theories and concepts such as intersectionality, assimilation, integration, cultural hybridity, multiculturalism, cultural (dis)similarity, etc. In addition, I tested the assumption of some theories, including Muslim and hijab penalties, gender socialization theory, human capital theory, time-income explanation, and healthy immigrant effect. The mixed method of data collection was adopted. Two hundred and fifty-six survey responses (129 from the US and 127 from the UK) and 31 in-depth interviews (17 and 14 from the US and UK, respectively) were analysed. I used Statistical Package for Social Sciences (SPSS) version 27 for the quantitative data. I ran statistical tests such as chi-square, Ttest, analysis of variance and regression models at the inferential level. For the qualitative data, I used Nvivo (Version 12) and adopted the steps in the thematic analysis, including different levels of coding. The study found that (1) most Nigerian migrants demonstrated a hybrid identity. However, they identified with the Nigerian culture more than the host culture. Their justifications revolve around food, attire, language/accent, citizenship, and duration of stay. Despite overwhelming identification with the country of origin, Nigerian migrants primarily conceived of immigrant integration as the process of “sinking,” “copying,” “learning,” “adopting,” “assimilating,” and “adopting” the culture of the host country. (2) Gender, place of education, duration of stay, and migration status were statistically associated with at least one of the five dependent variables (labour market outcome, labour market equality, health outcome, access to healthcare, and experience of discrimination). Women experienced discrimination in healthcare settings more than men. A certificate education in the host country increased the chance of a better labour market experience. Migrants' experiences in the host country became positive with increasing duration of stay. Permanent residents reported more favourable labour market outcomes than migrants with temporary visas. (3) Nigerian migrants in the US reported better labour market and health outcomes than their counterparts in the UK. However, each health system has its challenges. Nigerian migrants in the US paid financially for health, while those in the UK paid emotionally with long waiting times. (4) The effects of Covid-19 on migrants' employment were not uniform. Covid-19 was a blessing to migrants with formal and regular jobs, but the pandemic negatively affected those who worked in the less regulated sector. However, the impact of Covid-19 on health was primarily negative for Nigerian migrants. Expanding on the concept of “relational integration,” I submit that Nigerian migrants are doing relatively well in the host countries. Although they experience inequality and intersectional discrimination in the host countries, Nigerian migrants in the US and UK perceived their experiences as much better than when they were in Nigeria. However, migrants did not necessarily have increasingly positive experiences; I used the concept of de-integration to explain how some Nigerian migrants had negative experiences after initial positive encounters due to changes in migration policies in the host countries and natural phenomena. Keywords: Immigrant integration; De-integration; Migration management; Migrant health; Labour market; Covid-19; “japa”
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    Identifying the socio-economic impacts of the 2019-2020 refugee occupation and COVID-19 related restrictions on immigrant-owned businesses in the urban informal sector of Greenmarket Square, Cape Town
    (2022) Madurai, Micheala; Garba, Muhammed Faisal
    The socio-economic impacts of the 2019-2020 Greenmarket Square refugee occupation and the COVID-19 pandemic related restrictions are the central focus of this study. More specifically, the impacts of both - the occupation and the pandemic related restrictions - on African immigrant-owned businesses in the informal craft market of Greenmarket Square (GMS). This research explored this impact using a qualitative approach. Participants were selected using a non-probability purposive sampling approach to include both men and women immigrants from Africa who traded in the GMS craft market from a stall. Interviews were conducted both face-to-face and via telephone and supplemented by direct non-participant observation. The main findings included that the refugee occupation and associated noise, smells and crime repelled the primary customers – tourists. Discrimination between the immigrant stall owners and refugees and vice versa was also rife at this time. A few months later, COVID-19 arrived in South Africa and the related travel restrictions, lockdowns and trading limitations negatively impacted the potential for economic recovery of the entrepreneurs. Participants of this research shared insight about their economic hardships, which they faced with minimal external support. Participants needed to initiate survival tactics to generate any income. The knock-on impact included the suspension of remittances for families in their countries of origin. Although these businesses have started operating again, there are still challenges. These informal craft businesses will take a long time to get back to previous levels of income generation; however, stall-owners remain optimistic. Understanding how the African immigrant stall-owners navigated these challenges provides insight into immigrant livelihoods and survival strategies, as well as indicating their determination and capacity to strive against the odds.
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    Non-governmental organisations and poverty reduction in the north west and east regions of Cameroon
    (2021) Nsah, Edwin Saka; Garba, Muhammed Faisal
    Literature on NGOs and poverty reduction shows inconsistencies in NGOs adding value to poverty reduction. E.g. some researchers have criticized developmental NGOs for not supporting the needy. Contrarily, some have argued that NGOs provide for the underprivileged. NGOs in Cameroon do not pose issues different from the above. What worries Cameroonians most is the fact that a high number of developmental NGOs are created in the same areas. On the other hand, poverty is getting widespread in the same areas serviced by these NGOs. This study analyses why NGOs participate in poverty reduction programmes given that these programmes do not reduce poverty. To achieve the aim of the study, six objectives were established: (1) Establishing the reasons for continued increase in poverty in the selected regions. (2) Exploring how NGO staffs and their beneficiaries perceive poverty. (3) Understanding the nature of participation (4) Understanding reasons donors give funding to NGOs. (5) Investigating the challenges NGOs encounter. (6) Finally formulating suggestions that may lead to better integration of programmes designed. The study was conducted in Cameroon and a qualitative research design was used. Access into the field was established through informal telephone calls, emails, and covering letters to General Managers seeking their consent to use their organisations for this research. Purposive and Snowball sampling was used to select the study participants based on their links with the study NGOs. The study adopted the triangulation approach. The study found that selected NGOs programmes continue to fail because there were extraneous variables which account for ineffectiveness in NGOs poverty reduction programmes. For example, poverty reduction in any nation is the duty of every government and its citizens to fight against poverty and NGOs only assist as support mechanisms towards the realization of government obligations to its citizens, here the government and it citizen were not doing enough to fight poverty. Attributing poverty reduction only to NGOs is demanding too much from them. In conclusion, NGOs are purporting to have made real achievements in poverty alleviation but in reality their programmes are benefitting only a few from the grave effects of poverty because they are more involved with charity work. The study suggests that, dialogue with all NGOs stakeholders will reduce possible contradiction and will improve coordination and collaboration between the actors.
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    The capacity to mediate: the role of the African Union in the Grand Ethiopian Renaissance Dam dispute between Ethiopia, Egypt and Sudan.
    (2023) Masipa, Moyahabo; Garba, Muhammed Faisal
    Watercourses and their importance to human life and development is evident in water's role in energy generation, agriculture, cultural practices and human sanitation. In light of an increasing climate change crisis and diminishing fresh water supply, a corresponding need has arisen for freshwater to meet the demands of an ever-industrialising population. Managing water resources across borders of any scale is challenging however transboundary basins present a specific challenge. In the absence of effective management and protection of water resources, there is an increased risk of a water scarce future. Research has largely focused on how a state's nocompliance to treaties and agreements have shaped the hydro-political realities of a given basin. However, little research has paid attention to the influence of institutional capacity of supranational organisation to effectively execute their mandate of peace and security within the realm of environmental disputes between states. At the level of the African Union these incapacities have become visibilised in the limited role as mediator in the Grand Ethiopian Renaissance Dam dispute between Ethiopia, Egypt and Sudan. In this regard, the research investigates how the organisation's institutional capacities have affected its efficacy as a mediator in the transboundary water dispute. Using a critical institutionalist approach, the dissertation aims to understand how issues of capacity may influence the AU's ability to manage future water disputes beyond the GERD on the continent, given the lack of a coherent legal framework on the management and use of transboundary watercourses.