Browsing by Subject "Public Health"
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- ItemOpen AccessA descriptive analysis of suicides and their interface with healthcare facilities in the Western Cape, South Africa: 2011-2015(2022) Mgugudo-Sello, Ziyanda; Zweigenthal, VirginiaBACKGROUND: Suicide is a preventable public health problem affecting 800 000 people every year and 79% occurs in low to middle incomes countries. Males are mostly affected, and at-risk age groups are adolescents and young adults. Hanging, firearms and ingestion of pesticides are amongst the most common methods of suicide. Prevention strategies have been applied by various countries to target the use of common methods of suicide however there is little evidence that supports detection of suicide risk in healthcare facilities. This study profiles all suicides that occurred in the Western Cape during the year 2011-2015 and their interface with the healthcare facilities up to one year prior to death. OBJECTIVES: This study assesses the incidence of suicides in the Western Cape. It tests for associations between methods of suicide and demographic characteristics for suicide. Ascertains the characteristics of those suicide cases who made previous contact with a healthcare facility in the past 12 months and proposes context specific interventions for the prevention of suicides. METHODS: A retrospective descriptive study was conducted. All suicides recorded by the forensic pathology service during the years 2011-2015 were linked to patient data held by the provincial health data centre. A total of 3 561 suicides were recorded during the study period. Crude suicide rates were calculated using population denominator from the Statistics South Africa's national census projections. Multiple logistic regression was used to determine associations between the group utilising various methods of suicide and demographic characteristics. FINDINGS: Males were found to be four times more likely to die from suicide compared to females. The age groups most at risk were 20-39 years. Hanging was the method of choice by males and overdose on medication, in females. Two thirds of the 2 367 suicides were positively linked to healthcare facilities. Most cases who sought healthcare up to one year prior to suicide were males that presented with ‘other medical conditions' rather than mental health conditions. CONCLUSION: This study highlights missed opportunities for the detection of suicide risk for those who seek healthcare for all healthcare conditions. Although suicide rates have remained constant over the assessment period, a key focus for prevention should be interventions applied at healthcare facilities as well as other ‘upstream' preventions that reduce the availability of various methods for suicide.
- ItemOpen AccessA Systematic Review of Caregiver Interventions in Infancy to Enable Responsive Caregiving and Secure Attachment in Low and Middle-Income Countries(2018) Gilmour, Kirsty A; Swartz, Alison; Roman, NicoletteThe first 1000 days is recognised as the most sensitive period of development of an individual’s life. Infants in low and middle-income countries face significant risks to their development during this period. Research confirms that having a responsive, caring relationship between the infant and caregiver is a considerable protective factor for infants, and results in better longterm outcomes in cognition, language, academic achievement, social skills and behaviour. The aim of this review was to systematically examine the literature to identify interventions in low and middle-income settings that influence infant-caregiver responsivity and attachment and explore the characteristics of the interventions that contribute to its efficacy. Ten electronic databases were searched (Pubmed, Scopus, PsycINFO, PsycARTICLES, Africa-Wide, CINAHL, Health Source, ERIC, SocINDEX & Cochrane Library), as well as hand searching relevant reference lists for published articles in the English language from 1969-2018. A total of 11 765 studies were identified through the search strategy and 24 studies were included in the review. The included studies were critically appraised and then coded descriptively to enable a narrative synthesis of findings. Studies were from low and middle-income countries in Africa, Asia, Europe and South America and consisted predominantly of randomized control trials, but also quasi-experimental studies and a single cohort and qualitative study were included. All but two studies found positive effects on responsivity, attachment or both. For ten of the studies this effect was significant. The findings suggest implementing individual or group interventions in LMICS has a positive effect on caregiver-infant relationships and can be delivered successfully by trained non-professional staff.
- ItemOpen AccessA traitor in the ranks : hybridisation between two formerly allopatric Protea species(2017-12-15) Visser, Vernon
- ItemOpen AccessAbortion services in South Africa : challenges and barriers to safe abortion care : health care providers' perspectives(2010) Harries, Jane; Colvin, Christopher JUnsafe abortion is a preventable phenomenon and continues to be a major public health problem in many countries especially in the developing world. Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion, and a shortage of trained and willing abortion providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.
- ItemOpen AccessAcceptance and access : home-based HIV counselling and testing and barriers to care in rural Western Kenya(2009) Nakao, Jolene H; Mathews, CatherineHome-based HIV counselling and testing (HBCT) is a wayt to provide confidential HIV testing in a person's home. As home-based testing has not yet been evaluated on a wide scale in Kenya among adult individuals [over age 15], this project is designed to assess in rural Kenya 1) overall acceptance rates and variables that predict differential acceptance rates of home-based HIV testing, 2) reasons for refusal of home-based testing, and 3) barriers to seeking treatment for people who are HIV positive.
- ItemOpen AccessAccess to care in people living with HIV(2012) Du Toit, Elizabeth; Coetzee, David; Beyers, NuldaSouth Africa has the most people living with HIV (PLWH) in the world. With increased access to HIV Counselling and Testing (HCT) as well as expanded Antiretroviral Therapy (ART) treatment guidelines; there is a large and increasing number of people who need access to HIV care. Limited data and few studies have evaluated access to HIV care. A cross sectional survey with stratified random sampling was conductedfrom January – April 2011 to determine the proportion of PLWH in urban areas in thegreater Cape Town area who are accessing appropriate HIV care and factors associatedwith accessing care. The sampling frame for this study was the Zambia South Africa TBand AIDS Reduction (ZAMSTAR) Study. Self reported HIV positive adults were randomly selected. Self reported HIV negative adults or adults of unknown HIV status were also randomly selected in order to decrease possible stigmatisation. Consenting participants were interviewed and completed a questionnaire detailing their access to HIV testing and care. Participants who disclosed that they were HIV positive were included in the analysis. Access to appropriate HIV care was defined as one of three scenarios: 1. Receiving ART and having attended an ART clinic or collected ART medication within the last three months. 2. Undergoing ART work up and having attended an ART clinic within the last three months. 3. In PreART care having had a CD4 count in the last 6 months. 1257 participants were interviewed. 627(50%) reported being HIV positive, 487(39%) HIV negative and 143(11%) did not know or wish to disclose their status. Of the 627 HIV positive participants: 392 (63%) reported taking ART of whom 369 (94%) accessed appropriate HIV care. 25 (4 %) were being worked up for ART of whom 16 (64%) accessed appropriate HIV care. 210 (33%) were in PreART care, 81 (39%) having accessed appropriate HIV care. Females were 3.78 times more likely to be in appropriate care than males (p <0.001), and a person in the age category greater than 45 years was 4.63 times more likely to be in appropriate care than someone in the age category 15-24 (p= 0.002).
- ItemOpen AccessAdditional costs of FAS and PFAS learners in the classroom: An estimate for public primary schools in the Western Cape(2018) Makin, Emma; London, Leslie; Sinanovic, EdinaBackground: The Western Cape province of South Africa has the highest recorded prevalence rates of Fetal Alcohol Spectrum Disorders (FASD) in the world. In the last decade rates of fetal alcohol syndrome (FAS) and partial fetal alcohol syndrome (PFAS) prevalence of 68.0 - 89.2 per 1000 (May et al., 2007), 67.2 per 1000 (Urban et al., 2008), and 59.3 - 91.0 per 1000 (May et al., 2013) have been published after research was conducted in towns in the Western Cape (WC). Educating learners with FASD is a challenge as a result of the large range of cognitive impairments associated with heavy prenatal alcohol exposure. Determining a burden of cost to the education system may be one way to motivate for the development of prevention and intervention strategies. Methods: I designed questionnaires that were distributed to the educator and principal of a cohort of learners including learners with FAS and PFAS. Data were collected on educational impacts of variables associated with educator time use. Additional costs as a result of the use of educator's time by learners with FAS/PFAS were scaled up using risk differences and published statistics to reflect a cost burden to the WC Education Department. Results: The additional cost burden of disruptions caused by learners with FAS and PFAS for the WC Education Department is USD 7,010,166 in educator time for one academic year. The additional burden for learners with FAS/PFAS requiring additional assistance with lesson content to the WC is USD 5,754,885 in educator time for one academic year. The additional cost burden of public primary school learners with FAS/PFAS who had repeated a year of schooling was USD 3,876,565 in educator time based on 2012 salaries. Conclusions: These findings indicate that there is a large burden of cost to the education system when educator time is viewed as an economic input in education. Efforts need to be directed towards prevention programs to reduce the prevalence of learners with FAS/PFAS in the classroom. Educator training programs must be created to ensure that educators are equipped to manage the challenges posed by learners with FAS/PFAS in the classroom.
- ItemOpen AccessAddressing health inequalities in South Africa : policy insights and the role of improved efficiency(2002) Asbu, Eyob Zere; McIntyre, DianeThis study attempts to assess the equity and technical efficiency aspects of the South African health system. It empirically assesses the status qua and trends in equity as it relates to child morbidity and mortality and self-reported illness and utilization of different service providers in adulthood. Furthermore, an assessment of the technical efficiency and productivity of a sample of public sector hospitals is conducted. This is meant to explore the size of potential efficiency gains that is tantamount to the injection of additional resources, which are highly needed for addressing inequities in a scenario where mobilization of additional resources from the public purse is seriously constrained as a result of poor economic performance, stringent fiscal policies and competing priorities, among other things. Secondary data are used in the analyses. These include data from the Living Standards and Development Survey (LSDS) of 1993, conducted jointly by the World Bank and the South African Labour and Development Research Unit at the University of Cape Town, and data from the October Household Survey (OHS) series (OHS 1995 and OHS 1998) that are conducted annually by Statistics South Africa. For the analysis of hospital efficiency, data are obtained from annual statistical publications of provincial health departments. The equity analysis is done using concentration indices (and curves). In the adult population, standardized concentration indices are computed to rule out a possible confounding effect of the demographic variables, age and gender. Furthermore, utilization of services is standardized for need as measured by self-reported acute or chronic illness. Additionally, to identify some factors, which may be associated with inequities in child health, probit models are estimated. Data envelopment analysis (DEA) and DEA-based Maimquist productivity index are used to examine the state of hospital technical efficiency and productivity respectively. With the limited data available a tobit regression is also run to identify factors influencing the technical efficiency of hospitals. Overall, the findings of this study indicate that the huge income-related inequalities in health and health care that existed prior to the change of the political system in 1994 have been reduced significantly in the years after the installation of the new government. Analyses of the LSDS 1993 indicate significant pro-rich inequities in all the dimensions of equity in health and health care utilization examined in this study. Under-five mortality and child malnutrition manifest pro-rich inequalities of high magnitude. In the adult population, as is seen in many other studies, pro-poor inequities are seen in self-reported acute illness. This paradoxical pro-poor finding is, however, changed to pro-rich inequalities in the OHS 1995 and 1998 data. Inequalities in under-five mortality in the OHS 1998 data that do not show when income is used as a measure of socio-economic status (SES) are prominently seen when SES is proxied by race and residential location. This implies that the apparent bridging of inequities seen when income is used as a measure of SES may not enable us to definitively assert the absence of socio-economic inequities in health. Utilization statistics from all data sets indicate pro-poor horizontal inequities in the use of primary and other public health facilities, implying an appropriate targeting of public sector health care resources. The data clearly show that considerable health and health system inequities remain in South Africa. In order to rapidly address these inequities, additional resources are required to improve health and other health-promoting services in currently under-served areas and for specific disadvantaged groups. However, given the macro-economic context, the allocation of additional resources to the health sector is unlikely. The hospital sector, which absorbs the lion's share of the public health resources, seems to be plagued by high degrees of technical inefficiency. With the prevailing high levels of technical inefficiency and the adverse economic realities of the country, it would be difficult to mobilize additional resources needed for addressing existing inequities. Hence it is of paramount importance to address the existing technical inefficiencies in the hospital sector. Finally the study recommends that to address the inequities that besiege the country's health system, policies that transcend the health sector are needed and that there is an urgent need to rectify existing inefficiencies.
- ItemOpen AccessAdherence in HIV-positive women entering antenatal care on antiretroviral therapy: A cross-sectional study(2015) O'Sullivan, Briana Jean; Myer, LandonProper implementation of and adherence to antiretroviral therapy (ART) is significantly associated with better health and longer life in HIV-positive individuals. Consistent, adequate adherence has been shown to lead to a suppressed viral load. A low viral load delays the virus's progression and leads to better health outcomes for the individual. Adequate adherence is especially important among HIV-positive pregnant women. How well a woman adheres to her ART can not only improve her health during pregnancy but can protect the infant from HIV by preventing in utero transmission of the virus. Continuing ART protects against transmission via breastmilk later in the infant's life. While the benefits of good adherence are undeniable, the definition of adequate adherence varies widely in the literature. Taking 80 to 100% of pills as prescribed is commonly used as the threshold for adequate adherence levels. Various methods exist for measuring ART adherence, and while some are more reliable than others, there is no gold standard. This ambiguity in ART research extends to pregnant women, with even less known about HIV infected women established already on ART who then become pregnant. Changes in treatment protocols in the Western Cape and improvement of ART delivery throughout South Africa have resulted in this group of long-term users growing in size. Without more research into the barriers of ART adherence in these women, efforts to scale up treatment programs and to end mother to child transmission of HIV will ultimately fail. This dissertation is an exploration of these ideas. It begins to fill the gap in current knowledge related to ART compliance in pregnant women, and gives new insights into how specific barriers to adherence can adversely affect this specific group of established ART users.
- ItemOpen AccessAdherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report : a prospective cohort study(2010) Davies, Mary-Ann; Boulle, Andrew; Eley, BrianExcellent adherence to antiretroviral therapy (ART) is necessary if HIV-infected children are to experience the dramatically improved outcomes that this treatment affords. However, there is very limited data on adherence to antiretroviral therapy in Africa, with few studies that examine the predictive value of low technology measures of adherence in terms of viral and immune outcomes. In addition there are no long terms studies of adherence in young children in Africa.
- ItemOpen AccessAdherence to antiretroviral treatment (ART) among HIV-infected pregnant women starting treatment immediately vs delayed: a cohort study(2016) Langwenya, Nontokozo; Myer, Landon; Phillips, TammyIntroduction: Use of highly effective antiretroviral drugs to eliminate new paediatric HIV infections is the keystone of all prevention of mother-to-child transmission (PMTCT) programmes. Time on antiretroviral treatment (ART) before delivery reduces maternal viral load and decreases the risk of transmission in utero, during labour and whilst breastfeeding. Currently, many PMTCT programmes across Africa initiate HIV-infected pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care ("same-day" initiation). However concerns have been raised regarding patient readiness and whether same-day initiation in pregnancy may contribute to subsequent ART non-adherence. Methods: As part of a larger study of ART in pregnancy, consecutive ART-eligible pregnant women making their first antenatal care (ANC) visit at a primary care facility in Cape Town, South Africa were enrolled into a prospective cohort between March 2013 and June 2014. Before July 2013, eligibility was based on CD4 cell count ≤350 cells/μL ("Option A"), with a 1-2 week delay from the first ANC visit to ART initiation; thereafter all women were eligible regardless of CD4 cell count ("Option B+") and typically offered ART on the same day as first ANC visit. All women received standardized counselling before starting a fixed-dose regimen. Study interviews were conducted separately from the ART service through one week postpartum with self-reported adherence from 30- day recall. Results: Among 625 consecutive ART-eligible women (median age, 28 years; median gestation, 21 weeks; 55% newly diagnosed with HIV), 72% of women started ART same-day; this proportion was higher under "Option B+" versus "Option A" (p< 0.001). Of those with adherence assessments data available (n=618), 29% reported at least one missed ART dose during pregnancy. Missed doses were reported more frequently among women with previous use of PMTCT (p=0.014), of younger age (p=0.029) and starting ART under Option B+ (p=0.019). In women initiating ART same-day, 31% reported a missed dose compared to 23% among women who delayed ART start following first ANC visit (odds ratio, 1.07; 95% CI: 0.61 – 1.88). This finding did not vary after adjustment for demographic and clinical measures, and was consistent when restricted to women with CD4 cell counts ≤350 cells/μL. Conclusions: These results suggest same-day ART initiation in pregnant women is not associated with increased non-adherence during the antenatal period. While these results are reassuring for ART programmes implementing "Option B+", further research is required to examine adherence over time, particularly postpartum.
- ItemOpen AccessAdmission trends at Red Cross War Memorial Children's Hospital, Cape Town: 2004 to 2013(2016) Isaacs, Yumnah; Myer, Landon; Zar, Heather JBackground: Hospital database research has the potential to provide useful insights into health systems functioning, population health, clinical conditions and epidemiological trends thereof. This type of research is routinely done in countries that have large national hospital databases where results are usually extrapolated to the national population. South Africa does not have a national hospital database, but individual healthcare institutions, such as the Red Cross War Memorial Children's Hospital (RCCH) in Cape Town, collects routine patient data in a computerised database that if tapped should yield valuable information about child health of the catchment population as well as of the functioning of that health institution. Methods: Selected data from the RCCH database were converted into spreadsheet format and then exported into a statistical programme, Stata. Variables included patient demographic details, ICD-10 diagnostic codes, length of hospital stay and outcomes at discharge. Stata was used to clean and code the data and perform basic descriptive analyses of contained variables. Medians and interquartile ranges described numerical variables. Frequencies, proportions and percentages described categorical variables. Appropriate tests of statistical significance were performed where applicable. Admission and mortality trends were analysed across a decade and common conditions were explored. Findings and Conclusions: Overall admissions to RCCH increased by 9.3% across a decade while the number of new patients decreased by 8.6%, indicating an increase in readmissions. In-patient mortality decreased consistently across a decade despite an increase in admissions, which suggests an improvement in quality of care. The median ages of admissions and deaths increased across the decade, which correlates with less HIV and improved management thereof. Infections remain the commonest causes of in-hospital mortality. Admissions and mortality for diarrhoea and pneumonia displayed a consistent decline across 6 years corresponding with the introduction of new vaccines; however, diarrhoea and lower respiratory tract illness remained the commonest causes of medical admission. Injuries were the commonest reason for surgical admissions. Computerised hospital databases contain useful information for healthcare research.
- ItemOpen AccessAdolescent immunisation in Africa in the decade of vaccines(2019) Abdullahi, Leila Hussein; Hussey, Gregory D.; Wiysonge,Charles S.; Kagina, Benjamin M.N.Rationale: There are many public health benefits of targeting adolescent for immunisation. However, and in many settings, adolescents do not get optimal benefits from immunisation. In the decade of vaccines (2011-2020), adolescent immunisation is a topical subject. An up-to-date and synthesized research on adolescent immunisation is lacking. Overall purpose: The purpose of the PhD thesis was to characterize adolescent immunisation in the decade of vaccines. Research methods: First, we conducted a comprehensive narrative review of the literature (chapter 2) on adolescent immunisation. Then, we conducted systematic reviews (chapters 3 and 4). One of the systematic reviews assessed the strategies to improve uptake of vaccines among adolescents. The other systematic review assessed the knowledge, attitudes and practices of adolescents and their parents and teachers towards immunisation. Finally (chapter 5), we conducted a cross-sectional study to describe the challenges experienced, and lessons learnt during the introduction of national human papillomavirus (HPV) vaccination programmes in Africa. Findings: Adolescents are an important group to target with primary, booster or catch up immunisation. Some global initiatives have advocated for adolescent immunisation. Multiple reasons, among them, lack of knowledge and access to immunisation services are barriers to adolescent immunisation. There exist multiple strategies to improve uptake of vaccines among adolescents. For example, health education, financial incentives, mandatory vaccination, and class-based school vaccine delivery. The evidence suggests that a combination of strategies may be more effective than one strategy alone in enhancing uptake of vaccines by adolescents. Knowledge of vaccines, immunisation and vaccine preventable diseases was found to be suboptimal among key stakeholders of adolescent immunisation in Africa. We found a disconnect between the level of knowledge on immunisation and the uptake of vaccines, an interesting finding that warrants further research in Africa. Six African countries shared the lessons learnt and experiences during the national introduction of HPV vaccination programmes that targeted adolescent girls. There were similarities in the results among the participating countries. The challenges included: logistical coordination, identification of the target population, obtaining political support, integration with other school programmes and stakeholder engagement. A lesson learnt was that schools are a convenient site to access and vaccinate adolescents. Conclusion: Adolescent immunisation is not routinely practiced in many countries. The introduction of HPV vaccines has created an ideal opportunity to build platforms for adolescent immunisation. Research on adolescent immunisation is limited, more so in low and middle-income countries. Existing research shows a combination of strategies can be used to enhance uptake of vaccines among adolescents. Strong advocacy programmes are required to drive the global agenda of adolescent immunisation, particularly in Africa.
- ItemOpen AccessThe aims of the primary health care reforms in Finland between 1993-2015: a systematic review(2018) Malinen, Sanna; Olivier, JillAims: Empirical research has proven that a strong primary health care (PHC) system produces better health outcomes and therefore, PHC is an important part of a country's health system. This systematic review focuses on the intended aims and targets of PHC reforms conducted in Finland from 1993 onwards. It describes the challenges that the Finnish PHC system has faced, comparing the objectives and the problem with other similar countries, providing lessons from the Finnish experiences for other countries. Methods: A Campbell-styled systematic review was conducted. Databases including Ebsco, Pubmed/MEDLINE, Scopus, Google Scholar and a Finnish health science database Medic were searched. The keywords and MeSH Terms for the review included terms relating to 'health systems', 'primary care', 'reform', and 'Finland' (see Appendix B). English terms were used when using Medline, Scopus and EBSCO, and both Finnish and English terms were used when using Medic. Reference lists of included papers were also searched. Data was extracted and analysed by utilising thematic analysis. Results: 13 relevant papers were found that dealt with PHC policies or reforms implemented in Finland between 1993 and 2015. The aims of the reforms were classified under five themes, which were developed based on a prior scoping review and then tested during data extraction. The themes were: efficient governance and financing, adequate and equitable access, improved quality, increased patient choice and cooperation and integration of services. Conclusions: A number of policies and reforms have been implemented which have directly or indirectly aimed to strengthen the Finnish PHC system. Some policies have intended to strengthen PHC overall while others have focused on only one aspect or challenge. There has recently been a strong tendency to re-centralise health services, and the importance of patient choice and service integration have become increasingly important. Integration and cooperation of different service providers is one of the newest solutions when finding ways to strengthen weak PHC systems. This study shows that in policy success context matters. PHC strengthening needs to be high on the political agenda, and enough resources are needed. This study showed that there have been few durable or sustainable solutions, and further research is needed especially from the overall health systems perspective.
- ItemOpen AccessAir pollution exposure during pregnancy among rural Ugandan women(2022) Mahlaba, Harmony Boiketlo; Lesosky, MaiaIntroduction: Air pollution monitoring of hazardous pollutants such as CO (Carbon Monoxide) and PM (Particulate Matter) are important for assessing whether air pollution thresholds are not exceeded in the environment. There is sparce data that has been collected in the African region for air pollution monitoring. In this study PM and CO are measured. Air pollution in pregnancy is associated with poor lung function in infants, in later life. The overall aim of this dissertation is to investigate air pollution exposure during pregnancy among rural Ugandan women. Methods: This mini-dissertation covers two components; the research protocol (Part A) and a manuscript section (Part B). We measured the CO and PM 2.5 levels in the study location of the Kyamulibwa Health Demographic Surveillance Site (HDSS), with a total population size of 22,000. Our study population were pregnant women. Household energy use was measured using personal monitoring tools. The Dylos tool was used to measure PM 2.5 in the households, while the Lascar tool was used to measure CO once a week at two different points at the HDSS. Boxplots were used to compare the relationship between air pollution exposures (CO and PM 2.5) and respiratory symptoms. Boxplots were further used to compare the relationship between air pollution exposure and infant birth weight. Furthermore, logistic regression models were used to show associations between air pollution exposure levels and infant birth weight as well as respiratory symptoms respectively. Results: The boxplots and regression models showing the relationship between air pollution exposure and respiratory symptoms suggest that mothers who presented no respiratory symptoms had lower levels of air pollution exposure compared to mothers who presented one or more symptoms. The boxplots and regression models also showed that air pollution exposure may not be a factor in low birthweight. Infants with low birth weight had lower air pollution exposure compared to infants with normal and high birth weight. Conclusion: Although it is evident through the results that there is a relationship between air pollution exposure and respiratory symptoms, further research is necessary to understand context specific ways in which exposure to air pollution can be reduced in both households and the general outside environment.
- ItemOpen AccessAlcohol policy and regulation: public opinion amongst young adults in Khayelitsha, South Africa(2016) Ferrell, Britany; Matzopoulos, Richard; Saban, AminaSouth Africa has one of the highest rates of alcohol consumption in the world. It is important to study public opinion of alcohol regulatory policies as it plays a crucial role in the success of policy measures. There is a dearth of research on public opinion of alcohol policies in developing countries. This study is the first to explore public opinion of older and young adults on alcohol policy in South Africa. In addition, the drinking behavior of young adults was also investigated along with its relationship with policy support. Methods: The study sample consisted of 1728 young (n=513) and older adults (n=1215). Demographic details and opinion on 15 policy measures (Yes/No) were recorded for both groups. The survey of young adults included additional questions on drinking patterns. Univariate analysis of opinion on policy measures was performed for each group and compared using chi-square tests. Logistic regression was used to find the relationship between policy support levels and demographic factors and drinking behavior of young adults. Results: Complete data were recorded for 567 older adults and 402 younger adults. The majority of the participants (75-80 percent) agreed on restricted availability, increased pricing and greater enforcement measures. In contrast, only 65% of the participants were in favor of increased restrictions on alcohol marketing. Older adults were more supportive of earlier closing times of bars, a raise in minimum purchasing age, as well as an increase in pricing and taxes of alcohol (p<0.001). Females and employed participants were found to be more likely to support alcohol policy measures. Drinking patterns and behavior of young adults significantly predicted most policy measures after controlling for demographic factors. For example, policies on restricted alcohol availability, increase in taxes, and raids were supported by participants who reported that they mostly drank at big events. In contrast, these policies were opposed by those who drink alcohol every day and almost every day along with those who drink during street bashes Support for restrictions on the purchase age of alcohol was not predicted by drinking patterns of young adults Conclusion: It is important to increase the understanding and support of vulnerable groups, especially males and young adults, for policy measures. The relationship between drinking patterns and policy support levels indicates that regular tracking of drinking behavior is necessary for the success of these policies. The results support previous findings indicating that young people are more likely to resist alcohol regulations.
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- ItemOpen AccessAn Equity Analysis of the Burden from Alcohol Consumption in South Africa(2020) Correia, Fontes Mayara; London, Leslie; Ataguba, John; Harker-Burnhams, NadineBackground: Alcohol consumption remains one of the leading contributors to the risk of mortality worldwide. While literature sources are clear that alcohol consumption has a major negative impact on society and which is felt more severely amongst low-socioeconomic families, the literature on alcoholrelated harm on individuals and households in South Africa, especially from different socio-economic backgrounds, is very limited. This study represents an initial attempt to assess inequalities and inequity in alcohol consumption, at the household and individual levels, in South Africa using national household data. The objectives of this study are (1) to examine the usability of existing survey data in South Africa for assessing alcohol-related expenditure and impacts; (2) to provide a detailed description of alcohol consumption patterns in South Africa at the individual level using various equity stratifiers and (3) to assess the socioeconomic distribution of expenditure on alcoholic beverages at the household level in South Africa. Methods. For objective 1, all publicly available alcohol data sources for South African populations were scanned to examine their usability. A set of qualitative interviews with 10 key researchers in the alcohol policy and economics field in South Africa were undertaken to capture their experience and perceptions of alcohol data in South Africa. The analysis involved identifying databases known to key informants, exploring challenges in using the datasets for research and further analyzing any recommendations for how routine datasets could be better used to inform policy. For Objectives 2 and 3, this study used publicly available secondary data, including the National Income Dynamics Study (NIDS) and the Income Expenditure Survey (IES). The data have been anonymized and can be accessed from the DataFirst website. Results: There are differences in alcohol consumption patterns and alcohol expenditure among equity stratifiers. The findings show that the burden of alcohol consumption is heavier on the poor. Poorer households spend a significantly larger share of their total household consumption expenditure on alcoholic beverages than richer households—a case of regressivity in spending on alcoholic beverages. Spending on alcohol beverages became less regressive (i.e. a pro-poor ‘shift') between 1995 and 2000; and between 2005/06 and 2010/11. For alcohol consumption patterns, current drinkers are more prevalent among the rich; whereas binge drinkers are more prevalent among the poor. Binge drinking is a problem among the low-income, young individuals, male and African populations. The results also show that there are significant constraints limiting the quality and usefulness of alcohol data in South Africa. These constraints are related to (a) lack of accessibility of survey data, (b) lack of systematic and standardized measurement of alcohol consumption, (c) limited geographic coverage, (d) infrequent survey timing and (e) lack of public availability of industry data on price, production, distribution and consumption of alcohol. Conclusion: This study provides evidence that alcohol consumption in South Africa may be a reflection of genuine differences in consumption patterns among socioeconomic status, and the burden falls most heavily on poorer households and individuals. Based on the results, there is an opportunity to further reduce the regressivity of alcohol expenditure by implementing comprehensive alcohol harm-reduction policies. This study supports recommendations for the South African government to continue to push for evidence-based alcohol policies aiming to decrease alcohol consumption, especially for risky drinkers. However, limited data accessibility in South Africa could potentially impact on the implementation, monitoring and evaluation of relevant policy and interventions to address alcohol-related harms. Thus, for implementing evidence-based alcohol policy in South Africa to be successful, the government must have accessible, reliable and meaningful data for stakeholders and researchers to evaluate interventions and assess whether national alcohol policies aiming to decrease alcohol consumption have achieved their intended objectives.
- ItemOpen AccessAn exploration of knowledge, attitudes and practices of primary health care providers providing contraceptive and family planning services in Cape Town, South Africa: a qualitative study(2020) Fataar, Kulthum; Harries, Jane; Zweigenthal, VirginiaHealth care providers can play a significant role in empowering women to make informed decisions when selecting suitable contraceptive methods during contraceptive counselling. This study explores the experiences and perceptions of primary health care providers delivering contraceptives services in Cape Town to gain a deeper understanding of the delivery of contraceptive services. Ten in-depth interviews were conducted at five public primary health care facilities in urban areas in Cape Town, South Africa. Eligible participants included primary health care providers providing contraceptive services and willing to participate in the study. The qualitative software package NVivo was used to sort and manage data. Data was analysed using a thematic analysis approach. Overall, providers emphasized supporting women in contraceptive decision-making. Sexual and reproductive health training increased providers confidence to deliver appropriate contraceptive services. Furthermore, contraceptive prescribing practices were also influenced by medical eligibility criteria and women's preferred bleeding patterns. However, contraceptive prescribing practices were also influenced by providers' attitudes towards younger and older women. Challenges experienced by providers when providing contraceptive services included: contraceptive stockouts; time constraints of employed women accessing the service; and work pressure due to providing other health services. Health care providers play a critical role in facilitating women's right to accessing high quality contraceptive services. Providers in the study perceived themselves as negotiators during contraceptive counselling by considering both women's preferences and provider recommendations for contraception, whilst enabling women to make informed contraceptive decisions through provision of reproductive health information. Consequently, shifting contraceptive counselling to focus on shared decision-making may encourage autonomy during decision-making and help to limit the influence of provider attitudes on contraceptive prescribing and counselling.
- ItemOpen AccessAn investigation in the seasonal patterns of bacterial colonisation in childhood pneumonia(2022) Auckloo, Marie Belle Kathrina Mendoza; Lesosky, MaiaGlobally, pneumonia is a leading cause of morbidity and mortality in children younger than the age of 5 years, especially in low- and middle-income countries. The aetiology of paediatric pneumonia is complex, and its definitive determination remains challenging. S. pneumoniae, H. influenzae, M. catarrhalis, and S. aureus are among the most frequent bacterial causes of childhood pneumonia. Common to such recognised bacterial pathogens is the occurrence of asymptomatic bacterial colonisation or carriage of the nasopharynx, which in turn precedes disease development and progression. This study investigates the trends and patterns of bacterial carriage in the development of pneumonia in South African infants up to one year of life. It is hypothesised that respiratory bacterial carriage is considerably influenced by age and seasonality. Based on previously collected time-series data from the Drakenstein Child Health Study conducted in Paarl, South Africa, this study focuses on exploring the effects of season on nasopharyngeal carriage of pathogens occurring in the nasopharynx of young children with and without the occurrence of lower respiratory tract infection. Using logistic mixed effects models and taking into account the repeated measure structure of the data as well as seasonal components, we found that seasonal variations occur in the prevalence of nasopharyngeal carriage of respiratory pathogens in infants, with and without lower respiratory tract infection. With the inclusion of age-effects, these associations appeared to be highly complex. Understanding the factors that influence bacterial carriage, asymptomatic or not, is necessary to better understand the opportunities for and impact of intervention strategies against lower respiratory tract illness.