Browsing by Author "Chirinda, Witness"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Completeness of patient-held records: observations of the Road-to-Health Booklet from two national facility-based surveys at 6 weeks postpartum, South Africa
    (Edinburgh University Global Health Society, 2018) Ramraj, Trisha; Goga, Ameena E.; Larsen, Anna; Ramokolo, Vundli; Bhardwaj, Sanjana; Chirinda, Witness; Jackson, Debra; Nsibande, Duduzile; Ayalew, Kassahun; Pillay, Yogan; Lombard, Carl J.; Ngandu, Nobubelo K.
    BACKGROUND Continuity of care is important for child well-being in all settings where postnatal retention of mother-infant pairs in care remains a challenge. This analysis reports on completeness of patient-held infant Road to Health Booklets (RtHBs), amongst HIV exposed and unexposed infants during the first two years after the RtHB was launched country-wide in South Africa. METHODS Secondary data were analysed from two nationally representative, cross-sectional surveys, conducted in 2011-12 and 2012-13. These surveys aimed to measure early effectiveness of the national programme for preventing vertical HIV transmission. Participants were eligible for this analysis if they were 4-8 weeks old, receiving their six-week immunisation, not needing emergency care and had their RtHBs reviewed. Caregivers were interviewed and data abstracted from RtHBs. RtHB completeness across both surveys was defined as the proportion of RtHBs with any of the following indicators recorded: infant birth weight, BCG immunisation, maternal syphilis results and maternal HIV status. A partial proportional odds logistic regression model was used to identify factors associated with completeness. Survey sampling weights were included in all analyses. RESULTS Data from 10 415 (99.6%) participants in 2011-12 and 9529 (99.2%) in 2012-13 were analysed. Overall, recording of all four indicators increased from 23.1% (95% confidence interval (CI) = 22.2-24.0) in 2011-12 to 43.3% (95% CI = 42.3-44.4) in 2012-13. In multivariable models, expected RtHB completeness (ie, recording all four indicators vs recording of <4 indicators), was significantly (P<0.05) associated with survey year, marital status, socio-economic status, maternal antenatal TB screening, antenatal infant feeding counselling, delivery at a clinic or hospital and type of birth attendant. CONCLUSIONS Routine patient-held infant health RtHB, a critical tool for continuity of care in high HIV/TB prevalence settings, was poorly completed, with less than 50% of the RtHB showing expected completeness. However, government efforts for improved usage of the booklet were evidenced by the near doubling of completeness from 2011 to 2013. Education about its importance and interventions aiming at optimising its use without violating user privacy should be continued.
  • Thumbnail Image
    Item
    An investigation into the health and well-being of older people in South Africa.
    (University of the Western Cape, 2014) Chirinda, Witness; Susuman, Sathiya A.
    Populations are rapidly growing older across the globe. In South Africa, life expectancy has been on the increase over the past decade, and the proportion of older people is projected to increase dramatically over the coming years. Whilst this is a remarkable achievement, it does not mean that additional years of life will be healthy. To this end, the question being asked by researchers and policy makers is whether people are living longer and healthier lives? In order to answer this important question, health expectancies have been developed which combine morbidity and mortality data into a single index that measures population health. The health expectancies have become standard measures of population health across first world countries. Unfortunately, there is little awareness about their use in developing countries, including South Africa. The aim of this study was to estimate health expectancies based on various objective and subjective measures, in order to give a first comprehensive analysis of the health and wellbeing of older people in South Africa. The data were drawn from two nationally representative surveys namely; the WHO-Study on Global Ageing and Adult Health (SAGE) and the South African National HIV Incidence, Prevalence, Behaviour and Communication Survey (SABSSM) surveys. The results are presented in the form of five manuscripts each submitted for publication. The first manuscript estimates sexually active life expectancies and factors associated with sexual activity. The results show that older people are gaining more years of sexual activity. HIV in older women and chronic conditions in older men reduced odds of sexual activity. The second manuscript found that there was both absolute and relative compression of morbidity in older people between 2005 and 2012, based on self-rated health measure. The third manuscript estimates happy life expectancy and examines factors associated with happiness in older people. Happy life expectancy was greater for men than women, and wealth status was the strongest predictor of happiness. In the fourth manuscript, subjective and objective measures were used to estimate health expectancies. The former showed a more positive outlook compared to the latter. Gender differentials were evident in that although women live longer than men, they spent a greater part of their lifetime in poorer health than men. The fifth manuscript goes a crucial step further, to estimate the contribution of specific diseases to disability. This is important for policymakers as this identifies entry points of interventions aimed at reducing the onset and burden of disability in the elderly population. The most contributors of disability were musculoskeletal and cardiovascular diseases. The thesis concludes that the health of older people is complex and multidimensional, and therefore requires several measures to give a comprehensive analysis. When measured using subjective measures, it can be concluded that the health of older people has been improving. However, a different conclusion could be reached, if objective measures are used. It is important to continue to monitor the health status of older people, and make appropriate interventions in order to improve their health, wellbeing and quality of life.
  • Thumbnail Image
    Item
    Uptake and predictors of early postnatal follow–up care amongst mother–baby pairs in South Africa: Results from three population–based surveys, 2010–2013
    (Edinburgh University Global Health Society, 2017) Larsen, Anna; Cheyip, Mireille; Aynalem, Getahun; Dinh, Thu–ha; Jackson, Debra; Ngandu, Nobubelo Kwanele; Chirinda, Witness; Mogashoa, Mary; Kindra, Gupreet; Lombard, Carl; Goga, Ameena
    BACKGROUND Achieving World Health Organization (WHO) recommendations for postnatal care (PNC) within the first few weeks of life is vital to eliminating early mother–to–child transmission of HIV (MTCT) and improving infant health. Almost half of the annual global deaths among children under five occur during the first six weeks of life. This study aims to identify uptake of three PNC visits within the first six weeks of life as recommended by WHO among South African mother–infant pairs, and factors associated with uptake. METHODS We analyzed data from three facility–based, nationally representative surveys (2010, 2011/12 and 2012/13) primarily designed to determine the effectiveness of the South African program to prevent MTCT. This analysis describes the proportion of infants achieving the WHO recommendation of at least 3 PNC visits. Interviews from 27 699 HIV–negative and HIV–positive mothers of infants aged 4–8 weeks receiving their six week immunization were included in analysis. Data were analyzed using STATA 13.0 and weighted for sample ascertainment and South African live births. We fitted a multivariable logistic regression model to estimate factors associated with early PNC uptake. RESULTS Over half (59.6%, 95% confidence interval (CI) = 59.0–60.3) of mother–infant pairs received the recommended three PNC visits during the first 6 weeks; uptake was 63.1% (95% CI = 61.9–64.3) amongst HIV exposed infants and 58.1% (95% CI = 57.3–58.9) amongst HIV unexposed infants. Uptake of early PNC improved significantly with each survey, but varied significantly by province. Multivariable analysis of the pooled data, controlling for survey year, demonstrated that number of antenatal visits (4+ vs <4 Adjusted odds ratio (aOR) = 1.13, 95% CI = 1.04–1.23), timing of initial antenatal visits (≤12 weeks vs >12 weeks, aOR = 1.13, 95% CI = 1.04–1.23), place of delivery (clinic vs hospital aOR = 1.5, 1.3–1.6), and infant HIV exposure (exposed vs unexposed aOR = 1.2, 95% CI = 1.1–1.2) were the key factors associated with receiving recommended PNC visits. CONCLUSIONS Approximately 40% of neonates did not receive three or more postnatal care visits in the first 6 weeks of life from 2010–2013. To improve uptake of early PNC, early antenatal booking, more frequent antenatal care attendance, and attention to HIV negative women is needed.