Browsing by Subject "Transportation"
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- ItemOpen AccessFactors associated with retention to care in an HIV clinic in Gabon, Central Africa(Public Library of Science, 2015) Janssen, Saskia; Wieten, Rosanne Willemijn; Stolp, Sebastiaan; Cremers, Anne Lia; Rossatanga, Elie Gide; Klipstein-Grobusch, Kerstin; Belard, Sabine; Grobusch, Martin PeterBACKGROUND: Retention to HIV care is vital for patients' survival, to prevent onward transmission and emergence of drug resistance. Travelling to receive care might influence adherence. Data on the functioning of and retention to HIV care in the Central African region are limited. METHODS: This retrospective study reports outcomes and factors associated with retention to HIV care at a primary HIV clinic in Lambaréné, Gabon. Adult patients who presented to this clinic between January 2010 and January 2012 were included. Outcomes were retention in care (defined as documented show-up for clinical visits, regardless of delay) or LTFU (defined as a patient not retained in care; on ART or ART naïve, not returning to care during the study period with a patient delay for scheduled visits of more than 6 months), and mortality. Cox regression analysis was used to assess factors associated with respective outcomes. Qualitative data on reasons for LTFU were obtained from focus-group discussions. RESULTS: Of 223 patients included, 67.3% were female. The mean age was 40.5 (standard deviation 11.4) years and the median CD4 count 275 (interquartile range 100.5-449.5) cells/μL. In total, 34.1% were lost to follow up and 8.1% died. Documented tuberculosis was associated with increased risk of being LTFU (adjusted hazard ratio (aHR) 1.80, 95% confidence interval (95% CI) 1.05-3.11, P = 0.03), whereas early starting anti-retroviral therapy (ART) was associated with a decreased risk of LTFU (aHR 0.43, 95%CI 0.24-0.76, P = 0.004), as was confirmed by qualitative data. CONCLUSIONS: Retention to HIV care in a primary clinic in Gabon is relatively poor and interventions to address this should be prioritized in the HIV program. Early initiation of ART might improve retention in care.
- ItemOpen Access"Perceived neighborhood walkability" and physical activity in four urban settings in South Africa(2019) Isiagi, Moses; Lambert, Estelle; Okop, Kufre JosephIntroduction. 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.
- ItemOpen AccessQuantifying the energy needs of the transport sector for South Africa: a bottom-up model(Energy Research Centre, University of Cape Town., 2012) Merven, Bruno; Stone, Adrian; Hughes, Alison; Cohen, BrettTransport is a large consumer of energy in South Africa and vital for economic development. Currently the transport sector consumes 28% of final energy, the bulk of which, 97%, is in the form of liquid fuels. As the population grows and becomes wealthier, so the demand for passenger transport and private vehicles increases; similarly, rising GDP drives the demand for freight transport. Supply interruptions are costly to the economy and careful long‐term planning is required to ensure that there is sufficient infrastructure to support the efficient functioning and growth of the transport sector in the future.