Browsing by Author "Isiagi, Moses"

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    "Perceived neighborhood walkability" and physical activity in four urban settings in South Africa
    (2019) Isiagi, Moses; Lambert, Estelle; Okop, Kufre Joseph
    Introduction. In Africa, studies on the associations between the perceived neighbourhood walkability and physical activity, particularly, by socio-economic status (SES) remain scarce. This study explores these associations by validating the Neighbourhood Environmental Walkability Scale (NEWS-Africa) in an urban setting of South Africa to gain a better understanding of the construct of neighbourhood “walkability”. Methods. A convient sample of residents from four suburbs in urban metropole (n=52, 18-65yr, 81% women) in the Western Cape Province, South Africa (viz. Langa, Khayelitsha, Pinelands and Table View) were recruited through invitations following community gatherings and church services. Measures were obtained on perceived neighbourhood walkability, self-reported and measured physical activity and socio-economic status. Langa and Khayelitsha represented two primarily low-SES townships, whereas Pinelands and Table View represented suburbs of a higher-SES. Participants completed the 76-item (13 subscales) NEWS-Africa survey by structured interviews and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire. Objective data on physical activity was collected using accelerometers, and ground-truthing was used to assess the neighbourhood environment using global information systems (GIS) in a 1000m buffer around each geocoded household. The research was carried out in three parts: 1) Evaluating the reliability and construct validity of the NEWS-Africa instrument between the two-SES groups. 2) Examining some of the walkability constructs and subscales of the NEWS-Africa instrument using GIS and ground-truthing, and the extent to which the SES of communities influenced these associations. 3) Examining the differences in self-reported physical activity (domains), measured physical activity (MVPA) when groups are divided according to SES, GIS walkability (1000m buffers) and if the data support the notion of utilitarian walking in low SES groups, irrespective of the built environment attributes. Results. For the combined-SES groups, the test-retest reliability indicated a good reliability with 10 out of the 13 scales of the NEWS-Africa being significantly and positively correlated. The Spearman’s correlations ranged from (rs = -0.43, p=0.00 to rs = 0.79, p=0.00). For construct validity of the NEWS -Africa instrument against self-reported physical activity, only three scales were related to walking for transport: Neighbourhood surroundings scale (rs= -0.34, p=0.01), Safety from Traffic scale (rs =0.34, p< 0.05) and people in the low-SES and combined SES perceived public bus/ train stops to be nearer than they actually were (rs =-0.50, P< 0.05). Of the 13 scales of the NEWS-Africa questionnaire, 6 were significantly correlated to GIS-measured walkability index parameters. The Roads and walking paths scale was positively associated with GIS-measured walkability (rs = 0.3), and the Stranger danger scale was negatively associated with GIS-measured walkability (rs = -0.4). When we considered GIS-measured Land use mix, 3 of the NEWS- Africa scales were correlated (For the entire sample, the scales including Places for walking, cycling and playing overall scale (rs = 0.3), and Neighbourhood surroundings scale (rs = 0.3), were positively associated respectively). Conversely, Stranger danger scale was inversely correlated (rs = -0.6). Intersection density measured with GIS was significantly and positively associated with the Roads and walking paths scale for all groups combined (rs = 0.3). For GIS-measured walkability, self-report physical and measured physical activity, there were no associations in any of the domains for self-reported physical activity within the 1000m buffer for all groups. However, for the objectively measured physical activity in the 1000m buffer, vigorous physical activity (rs = -0.39) was inversely associated with intersection density in the low-SES and moderate (rs = -0.29) and total MVPA (rs = -0.31) were inversely associated with Intersection density in the high SES. Conclusions: The overall results of the current study across all chapters generally show a mismatch between the perceived and objectively-assessed built environment, particularly in low-income communities. Furthermore, in low-SES communities, we failed to show the expected relationships between attributes of the built environment and physical activity, suggesting that physical activity in these communities is more utilitarian in nature, and as such, may not be as influenced by aspect of the built environment. In summary, the data suggest that the environment (including crime rates, poor access to physical activity facilities and public transportation predominantly made by buses) has less of an association with physical activity in LMICs and more disadvantaged communities, where physical activity is used for utilitarian, rather than recreational purposes. This study stemmed from the need to broaden research on the relationship between the built environment and physical activity, considering walkability constructs. These findings also suggest that the definition of the construct of walkability be re-examined, in relation to low SES settings.
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    Prevalence of babies born with neural tube defects and geospatial mapping of therapeutic services: a systematic review
    (2025) Zolo Ossou, Andre Yvan; Maswime, Salome; Isiagi, Moses
    Introduction: Neural tube defects (NTDs) are an important global health concern with high morbidity and mortality. Enhancing access to healthcare for children born with NTDs is crucial for improving health systems and service delivery. Methods: We conducted a systematic review to assess the global prevalence of NTDs and the accessibility of healthcare services. Our search spanned databases like PubMed, EMBASE, and Scopus, focusing on NTD prevalence, healthcare service mapping, and access barriers. We followed a standardized data extraction process, and the study is registered with PROSPERO (CRD42023425843). Results: From 3 067 records, 65 studies met our inclusion criteria, mainly focusing on newborns. The study durations range from six months to 40 years. The NTD prevalence was between 0.4 and 215.13 per 10 000 births, with Spina Bifida, Anencephaly, and Encephalocele being the most common. The African Region was the WHO region with the highest prevalence while the Western Pacific Region had the lowest prevalence. One study used geospatial mapping to identify healthcare access barriers. Conclusion: Our study revealed wide disparities in the prevalence rates of neural tube defects with the African region having the highest prevalence. Geospatial mapping was not used to assess access to healthcare services for children born with NTDs in almost all the studies. This underscores the global challenge of access to surgical care for children born with NTDs and the need for strengthening healthcare services in settings with high prevalences.
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    Pulmonary rehabilitation in Africa (community-driven citizen science approach): (a focus on COPD in low-resourced communities in South Africa)
    (2025) Isiagi, Moses; Van Zyl-Smit, Richard; Okop, Kufre Joseph
    Chronic Obstructive Pulmonary Disease (COPD) represents a significant global health challenge, particularly in low-and middle-income countries (LMICs), especially in Africa. Pulmonary rehabilitation (PR) is a well-established intervention to address COPD in High income countries (HICs) and has been incorporated into the healthcare systems in many settings. However, its implementation and population-level delivery in Africa are almost non-existent. This dissertation explored COPD management and PR services in low-resourced African settings, specifically focusing on a disadvantaged peri-urban community in South Africa. The study utilized a 3-pronged approach which we believe holds significant potential to investigate and perhaps, address these challenges. The purpose of this study was to examine the current state of PR services in low-resourced settings in LMICs, evaluate healthcare providers' clinical awareness and support in Africa, and explore COPD risk perceptions and prevention preference in the study setting. In addition, the study utilizes the findings and lessons learnt to support the development of community-driven PR implementation strategies in the disadvantaged African setting using a participatory approach. Methods: The methodology encompassed three distinct components: First, a systematic review was conducted to gain understanding and map the landscape of home-based and community-based PR programmes in low-resourced African settings registered with PROSPERO (CRD42023480324). Second, a cross-sectional virtual electronic survey was administered between January and March 2020, targeting African clinicians with Pan-African Thoracic Society and South African Thoracic Society networks. Finally, a participatory community-based Citizen science project was implemented in the Klipfontein health district, incorporating focus group discussions, Citizen science interviews, and advocacy workshops. Results: The study revealed a significant gap in research regarding PR programmes in African settings, with no published studies comparing home-based and community-based PR delivery models in the region. The closest relevant research was a Brazilian protocol for home-based cardiac rehabilitation. However, the survey of healthcare professionals from 23 countries demonstrated awareness and recognition of PR as an effective intervention for COPD. Despite significant implementation challenges, over 85% of the surveyed healthcare professionals expressed confidence in PR programmes' ability to improve symptoms and reduce patient exacerbation. Insights from Citizen science indicate limited community awareness of COPD, often confused with general respiratory conditions like asthma. Discussions and EpiCollect findings show that while communities recognize risk factors such as smoking and environmental exposure, there is a pressing need for targeted education about COPD before effectively implementing PR interventions. Furthermore, participants in the study were willing to participate in a community-driven PR intervention and listed important strategies that would make this intervention accessible, acceptable, and sustainable. Conclusion: This study presents a novel approach to COPD risk perception and PR implementation in resource-limited settings. The need for pulmonary rehabilitation is well documented and understood at a scientific and specialist pulmonologist level. Local logistics, training, funding, and staffing challenges hindered the implementation. Community-based "out-of-hospital" PR programmes are well-described in high-income countries. However, they are almost non- existent in low-income settings. At the patient level, the lack of awareness of the diagnosis, understanding and access to treatment may inadvertently be the most important factor limiting the access of patients with COPD to an effective PR intervention. While traditional 'medical science' methods have been instrumental in increasing access to PR in low-income settings, the potential of a more Citizen science approach with engagement at the community level with healthcare staff, patients, and community members is promising. This approach may facilitate the development and implementation of a better multilayered and acceptable programme to those who need it most (the vulnerable population in disadvantaged communities in Africa), offering hope for the future of COPD management in Africa.
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    The Relationship between Physical Activity and the Objectively-Measured Built Environment in Low- and High-Income South African Communities
    (2021-04-07) Isiagi, Moses; Okop, Kufre Joseph; Lambert, Estelle Victoria
    There is limited data concerning the built environment and physical activity (PA) in a country with a history of socio-politically motivated, spatial and economic disparities. We explored the extent to which objectively measured attributes of the built environment were associated with self-report or device-measured PA in low- and high-socioeconomic status (SES) communities. Methods: In a convenient sample of residents (n = 52, aged 18–65 years) from four urban suburbs in low- and high-income settings near Cape Town, South Africa, self-reported transport- and leisure-time PA, and device-measured moderate-to-vigorous PA (MVPA) data were collected. Built environment constructs derived from individual-level street network measures (1000 m buffer, ArcGIS, 10.51) were obtained. We assessed PA between four groups, based on income and GIS walkability (derived by a median split, low or high SES and low or high walkable). Results: No relationships between self-reported MVPA and GIS-measured walkability were found. Only intersection density was significantly, inversely associated with moderate and total MVPA (rho = −0.29 and rho = −0.31, respectively, p < 0.05). In the high SES group, vigorous PA was inversely associated with intersection density (rho = −0.39, p < 0.05). Self-report transport PA differed between groups (p < 0.013). Conclusions: Results suggest that the construct of walkability may relate to volitional (leisure) and utilitarian (transport) PA differently, in highly inequitable settings.