Philosophiae Doctor - PhD (Statistics and Population Studies)

Permanent URI for this collectionhttps://hdl.handle.net/10566/14933

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Determinants of Healthcare Services in South Africa: A Demographic analysis
(University of the Western Cape, 2025) Vondo Noloyiso
Healthcare access and utilisation in South Africa continue to show significant inequalities, as well as disparities in cost and service quality, despite global health service development. The purpose of this study is to examine the underlying deficiencies in dual healthcare access and utilisation, how people from different socioeconomic backgrounds access and afford the necessary healthcare services, which will then determine the shape of the care they receive. The study used secondary data derived from the nationally representative South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM V) to evaluate the underlying weaknesses in the healthcare access and utilisation system. For data analysis, STATA version 18 was used to address the research objectives and questions by performing three statistical techniques, namely the univariate, bivariate, and multivariate methods. The findings of the study established that younger, unemployed, and less-educated South Africans who rely on public facilities face healthcare access challenges because these facilities have insufficient staff members, combined with outdated infrastructure and extended waiting periods. In contrast, the private healthcare system primarily caters to elderly patients from higher- income brackets who have the financial ability to pay medical premiums and co-payments, along with additional healthcare expenses. Medical aid membership functions as the primary factor that enables private healthcare access, yet the covered population reaches only 16%, and besides, they spend half of the total national health expenditure, while public facilities, which serve most citizens, remain overwhelmed and underserved. Lastly, the study findings found that healthcare accessibility in South Africa remains fragmented because socioeconomic disparities, together with racial and spatial inequalities of the past, still play a critical role in affording one access to equitable healthcare. The study further discovered that employment, level of education, and population group differences are the leading contributing factors to healthcare access and utilisation.
The factors associated with women’s access to water for household use in sub-saharan Africa: a comparison between Burundi and Nigeria
(University of the Western Cape, 2025) Dania Elizabeth Avosuahi; Nsengiyumva Philomene
Water is vital to human life. A region or society without access to clean water is detrimental to human health and development. As the world’s population grows rapidly, households increasingly need reliable, clean drinking water. Safe drinking water promotes the population's survival, well-being, and overall functioning in various aspects of daily life. Lack of access to improved drinking water is a problem affecting young girls and women in Africa. The availability of clean, safe drinking water will reduce water scarcity in households and avoid the need to invest valuable, productive time in collecting water for household consumption. Every society needs improved drinking water sources to fulfil daily tasks and to advance Sustainable Development Goal (SDG) 6, which aims to provide "universal and equitable access to safe and affordable drinking water for all" by 2030. The availability of potable water near households in both urban and rural areas is crucial to promoting SDG 5, which focuses on achieving gender equality and empowering all women and girls. Extended travel to access drinking water for household consumption remains a significant challenge in sub-Saharan African (SSA) countries, particularly in Burundi and Nigeria. In determining the household's source of drinking water, the gender of the head of the household plays a significant role. This study utilised the Demographic and Health Survey (DHS) conducted in Nigeria in 2018 and in Burundi in 2017. In accordance with established procedures, the secondary data was requested from the DHS website, and access was duly granted. To perform the analysis, datasets were analysed using IBM SPSS (Statistical Package for the Social Sciences) version 30.0.0.0 (172). initially through univariate analysis, such as frequency distribution of a single variable; bivariate analysis, and Chi-squared including cross-tabulation of multiple variables testing to assess the association between variables (types of drinking water, travel times to access drinking water, age, educational level, marital status, place of residence, employment status, household wealth and household members); and Logistic regression analysis to identify the factors influencing women's access to drinking water. The study exclusively considered women-headed households aged 15 to 49 in Nigeria and Burundi, with households serving as the unit of analysis. Using logistic regression, we examine various demographic and socioeconomic factors, including age, education, marital status, residential location, occupational status, wealth index, and household composition, to investigate women’s access to household water in Burundi and Nigeria.
Women’s use of sub-cutaneous depot-medroxyprogesterone acetate in a basket of contraceptives among women in Nigeria: involvement of male partners
(University of the Western Cape, 2026) Nmadu, Awawu Grace
Background: More than one in ten married women or women in union worldwide are said to have an unmet need for family planning, meaning that they are exposed to pregnancy and do not wish to get pregnant but not using contraception. This exacerbates current challenges in reproductive health, such as maternal mortality, teen pregnancy, and the global spread of HIV. To lower a country's maternal and newborn mortality rates and stop the spread of infectious diseases like HIV/AIDS, contraceptive usage continues to play a pivotal role. Economic, social, and cultural constraints make it difficult for many women, especially those living in rural communities, to gain access to family planning services. The Nigeria Demographic and Health Survey (NDHS) reported that approximately 20 percent of women who did not want to get pregnant were not utilizing contraceptives. Men are increasingly acknowledged for their role in women's access to and use of family planning services. This is because male participation in family planning services has the potential to increase the adoption of contraceptives and improve their effective use and continuation through spousal communication. Men's role in determining whether or not a couple uses FP varies across settings and contexts. Women in sub-Saharan Africa (SSA), including Nigeria, are increasingly opting for injectable contraception as their preferred option. An increasing number of individuals are using depotmedroxyprogesterone acetate (DMPA-SC) for family planning (FP) since it is discreet, easy to use, and highly effective. In Nigeria, there is a paucity of information about factors influencing the adoption and uptake of DMPA-SC among women and especially regarding male partner involvement.
Investigating factors associated to reproductive health in sub-Saharan African countries
(University of the Western Cape, 2019) Mpilambo, Jacques Elengemoke
Background: In sub-Saharan Africa, nearly 20% of the total population falls in the age group of 15 to 24 years. In this region, this population group faces a large number of reproductive health problems. Even though the health officials concerned have implemented several health care programs, the youth, particularly girls, still have many problems, particularly lack of sexual health information, poor health care, inability to avoid early and unprotected sexual relationships, early marriage, early pregnancies, early childbearing, etc. Objectives: The aim of this study is to examine the trends and differentials in reproductive behaviour among young women in sub-Saharan African countries and to gain a better understanding of the utilization of reproductive health care services in their respective socio-cultural, economic and demographic circumstances. Data and Methods: The study used data from Demographic and Health Surveys (DHS) waves conducted between 2006 and 2016 in four sub-Saharan African countries namely Niger, Democratic Republic of Congo (DRC), Mali, and Malawi. Descriptive and multivariate analyses were used. Cross tabulation and Chi-square were applied to test for association between independents and outcome variables. At the multivariate level of analysis, the Generalized Linear Model (GLM) with logit and negative log-log link functions, were used. All analyses were performed using the Statistical Package for Social Sciences (SPSS) version 25.0.
Assessment of the factors associated with secondary school attendance and completion in South Africa: A demographic perspective
(University of the Western Cape, 2025) Showers, Viome Amakuro
Education is prioritised globally because it is key to driving socioeconomic development. While school participation at the basic education level (Grades 1-9) has been almost universal in South Africa, there are still gaps in the level of schooling for the upper secondary level. Consequently, a substantial proportion of the population does not complete secondary education, thereby inhibiting human capital formation. Optimising learners’ participation, progression, and the completion of educational training is a vital economic strategy. This study assesses the level of school attendance for upper-secondary school learners and school completion in South Africa. It also explores the sociodemographic factors associated with school attendance and school completion. South Africa is situated at the southern tip of the African continent. According to the 2022 census, its population was estimated to be over 62 million people, with a growth rate of 1.8% from 2011 to 2022. Females made up 51.5% of the population, while males accounted for 48.5%. Children and youths below 24 years made up about half of the entire population. There are four major racial groups which constitute the demographic composition. The Black or African racial group originates from the indigenous Bantu people and represents the predominant demographic, making up over 80% of the population. This is followed by the Coloured racial group, which made up about 8% of the population. They are the mixed descendants of the earliest European/Asian settlers and the indigenous African people.
The demographic aspects of women with disabilities and access to health care facilities in South Africa: a comparative study between 2013 and 2018
(University of the Western Cape, 2025) Abrams, Robynne Danielle
Disability is a normal part of human experience. However, disability is an underexplored topic among women in rural communities in South Africa, especially among women with disabilities (WWD) with regards to access to healthcare facilities. Previously, researchers have usually approached disability using the medical model, but the social model is critical to understand the way disability traverses with and is caused by other inequalities, such as race and gender. South Africa has been recognised by the World Bank as the most unequal country in the world. The inequalities that South Africans experience are encompassed in all areas of basic needs and service provision, especially among WWD who face differentiated disparity as a result of their gender, race and disability status. Thus, in the South African context, numerous social challenges exist in integrating equal and equitable access to healthcare for all, particularly for vulnerable populations such as WWD in rural areas. One of the key challenges include the poorly maintained and ill-functioning transportation services, along with inadequate and non-inclusive transport infrastructure. The demographic and socio-economic characteristics of WWD in rural settings influence and shape how frequently, how long and what mode of transportation they utilize when seeking medical treatment.
Examining the mortality rate due to teenage pregnancy in South Africa
(University of the Western Cape, 2024) Sithole Tronic
Regardless of the length of pregnancy, the maternal mortality rate represents the number of women who die within 42 days of pregnancy termination. In addition to being an important indicator of the functioning of the health system, maternal mortality is a significant global public health concern. South Africa has a high maternal mortality rate, similar to any other country. Pregnancy and childbirth are the most common causes of death in health facilities. During the postpartum period, most women in public hospitals and clinics are discharged ±6 hours after delivery. Consequently, most problems are not detected, and complications such as thromboembolism or sepsis cannot be detected. Maternal mortality factors were studied to develop relevant policies and programs. This study aimed to examine factors associated with teenage pregnancy in South Africa that contribute to maternal mortality. A mixed-method approach was used in this study. A descriptive study design was used to gain a deeper understanding of teenage pregnancy mortality rates in South Africa. Twenty (20) participants were selected for this study using a purposive sampling method. A one-on-one interview was conducted, and SPSS version 23.0 software was used for data analysis. The findings show that certain risk factors have been reduced through policies, such as education provision, which should be encouraged and strengthened. Mortality related to pregnancy and maternal health among adolescents is lower than that among adults. High blood pressure, abortion, and injuries are the leading causes of death in adolescents. Education and outreach programs to reduce maternal mortality rates could be enhanced by the results of this study. Sociodemographic characteristics and service delivery characteristics need to be studied in greater depth to improve practice and knowledge in public health education and healthcare delivery. The study concluded that there is a significant public health concern in South Africa related to maternal mortality, which contributes to the low life expectancy of women. Women are prevented from using health facilities because of socioeconomic factors and inadequate knowledge of danger signs. These pregnancy-related causes of death among adolescents in South Africa should be prioritized in policies and programs.
Flexible feature engineering using a network flow approach
(Universty of the Western Cape, 2024) Bodenstein, Gerhardus Jacobus
Feature engineering, a critical part of the data preparation and exploration phase in predictive modelling, involves transforming predictor variables to enhance interpretability and better understand their relationship with the response variable. In some cases, it also offers automatic handling of outliers and missing values. Many machine learning and data mining techniques perform better with discretised continuous variables or clustered levels of categorical variables, making feature engineering essential for improving the accuracy and robustness of predictive models. Furthermore, the feature engineering process often needs to incorporate business, operational, or best-practice constraints applicable to the final transformed predictor variables or newly created features. This thesis addresses two significant challenges in feature engineering. The first is the supervised discretisation of continuous predictors, which involves partitioning a predictor's domain into disjoint intervals while preserving a specified trend in the relationship with the response variable and adhering to side constraints.
Estimating household vulnerability to poverty at the municipality level in South Africa using the cluster analysis approach
(University of the Western Cape, 2023) Ahmed Abdelkarim Eldud Omer, Eldud; Tati, Gabriel; Stiegler , Nancy
Influence of data accuracy and non-use of quality information on reproductive health: a comparative study of Nigeria and South Africa
(University of the Western Cape, 2023) Oyekola, Adetooke Bukola; Sathiyasusuman, Appunni; Appunni, Sathiyasusuman
In healthcare settings, information systems play a critical role in providing safe, timely, and effective healthcare services. Decision-making on medical supplies, healthcare providers, service delivery, finance, and governance all depend on access to health information. To improve overall health services and processes, these information systems manage data collection, processing, storage, retrieval, and utilisation. The effectiveness of health systems depends on effective administration and data quality. Irrespective of the significance of health information systems, many low- and middle-income nations, such as South Africa and Nigeria, continue to encounter challenges with data accuracy and the use of high-quality information. Inaccurate data can lead to misinformed policy decisions and resource allocation, hindering efforts to improve reproductive health outcomes. Problems such as incomplete, outdated, unreported data, poor integration, and underutilisation of technology affect data quality and completeness. Data quality impacts decision-making, performance, and the ability to achieve national and international health goals. Government involvement and suitable policies are crucial for addressing these challenges and improving the effectiveness of health information systems.
Handling heteroskedasticity in the linear regression model
(University of the Western Cape, 2022) Farrar, Thomas; Blignaut, Rénette
This research project delves into the problem of heteroskedasticity in the linear regression model. Having defined the problem and its consequences for estimation and inference, a comprehensive literature review of existing methods for diagnosing and correcting for heteroskedasticity is undertaken, with special emphasis on heteroskedasticity tests. New theory on the statistical properties of the Ordinary Least Squares residuals is developed, leading to new models for estimating linear regression error variances. The most important of these models is the Auxiliary Linear Variance Model, which is further classified into sub-types (e.g., clustering, linear, penalised polynomial, spline). Model fitting techniques are discussed, which reduce to quadratic programming problems. An Auxiliary Nonlinear Variance Model is also developed, which can be fitted using a maximum quasi-likelihood method. Techniques for tuning of model hyperparameters and feature selection are discussed. Bootstrap methods of obtaining interval estimates for error variances are also proposed. A new heteroskedasticity test is constructed based on the auxiliary linear variance model. To make existing and new methods of handling heteroskedasticity more accessible to the practitioner, a new package called skedastic has been developed for R statistical software. Its functionality is described in detail.
Violence against women in Burkina Faso: A quantitative and qualitative study
(University of the Western Cape, 2022) Zakaliyat, Bonkoungou; Appunni, Sathiya
Many socio-anthropological and/or quantitative studies have attempted to address the issue of violence against women indirectly by focusing on the perceptions of the actors rather than on the fact of having suffered it directly. This is the case, for example, in Burkina Faso, with certain nationwide studies such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS) of 2003, 2006 and 2010. Thus, the direct measurement of the phenomenon, i.e. whether or not the phenomenon has been experienced, is rarely addressed through household surveys.
Determinants of health care use and mothers' preventative and curative health care practices in Burkina Faso
(University of the Western Cape, 2022) Badolo, Hermann; Susuman, Sathiya A.
In about two-thirds of all countries in sub-Saharan Africa, low coverage of effective interventions to prevent maternal and child deaths has been attributed to both weaknesses in the supply and demand for health services. These interventions require access to and use of health services. Conceptually, the availability, quality of health care, financial and geographical accessibility, socio-economic and demographics factors and cultural barriers are the main factors associated with health care use. These associated factors and the causes of low utilization of health services have been studied by several authors in Burkina Faso and other countries, often from the point of view of health care demand or supply.
The dynamics of modern method contraception among sexually active unmarried adolescents in Nigeria
(University of the Western Cape, 2022) Ojoniyi, Olaide; Stiegler, Nancy
It is just stating the obvious to aver that young people in all regions are reaching puberty earlier and are habitually engaging in sexual activity at a younger age, and thereafter, marrying later. As a result, they are sexually exposed for a longer time before marriage than has historically been the case, and as such, are at higher risk of unintended pregnancy and sexually transmitted infections. Needless to say, nonmarital sexual activity is increasing among adolescents. However, less than half of those who want to avoid pregnancy are using a modern method of contraception.
Assessment of the potential of hospital birth records to estimate the number of births: A case study of Germiston and Nkomazi Local Municipalities
(University of the Western Cape, 2020) Nhlapo, Mosidi Sarah; Stiegler, Nancy
The advantage of a well-developed health information system is the significant role played by records produced by such a system beyond recording medical history of individuals. They are the foundation for birth registrations which when fully complete is an important tool for acquiring data necessary for planning and monitoring child and maternal health in a country. This study aimed to investigate the potential of hospital birth records to estimate the number of births in the country and supplement birth registrations data. Data was abstracted from public facilities where births occur in two municipalities; Germiston in Gauteng and Nkomazi in Mpumalanga for the period 2014 to 2016. Modified version of the BORN Data Quality Framework (BORN-DQF) of the Ontario Agency for Health Protection and Promotion (2016) was used to assess the contents and quality of hospital birth records.
Challenges of postgraduate students at the University of the Western Cape 2009 - 2013
(University of the Western Cape, 2019) Lewis, Priscilla-Anne; Holtman, Lorna
In South Africa, postgraduate education is a catalyst in national development and poverty alleviation that is widely acknowledged by the state and higher education institutions, such as the University of the Western Cape (UWC). Previously disadvantaged universities in South Africa were systematically moulded by apartheid planning and the prevailing social-economic-political order of the time. The structural legalised differences between historically white and historically black institutions created the key inequities between them. Unjust laws and institutionalised racism caused historical black universities (HBUs), such as the University of the Western Cape, also known as the University for the left, to lag behind with the intake of postgraduate students. Prior to 1994, students, who were fortunate enough to attend university, were mostly limited to studying towards an undergraduate degree, diploma or a certificate course, in the fields of teaching, nursing or law enforcement. The dawn of democracy opened up new possibilities; however, a major sphere of concern, was the need to speedily transform the education system, to make it inclusive for all. Systematically, institutions of higher learning focussed more on postgraduate education, as it was a stepping stone to improve enrolment growth research output, and collaborative partnerships, at national and international level. However, socio-economic factors, such as the lack of funding, were major constraints, as most postgraduate students were challenged to pay registration fees, or accommodation deposits, upon registration.
Differentials in unemployment duration across households in South Africa: A two-level modelling approach
(University of the Western Cape, 2018) Lartey, Nathaniel; Tati, Gabriel
This study aimed to examine the structural changes affecting the duration of unemployment across households in South Africa. It made use of existing datasets from the Labour Force Survey produced by Statistics South Africa, covering a period of six years (2011-2016). Relations among demographic and household variables were explored to determine how they related to unemployment duration. On the basis of the relations identified, a predictive analysis of unemployment duration was attempted using two-level modelling. The results suggest a significant difference in the duration of unemployment, according to the individual socio-demographic characteristics and the household moderating variables. More specifically, the greatest share percentage of both men and women experiencing long-term unemployment were found within the age group 25-34 years. The study also found that the percentage share of Non-White population groups experiencing longer duration of unemployment was more than for the White population group. Another variable found to have great influence on the duration of unemployment was the individual’s previous work experience. Going beyond the individual’s socio-demographic characteristics to consider household variables. It was found that unemployed workers living in households headed by a female are more vulnerable to longer unemployment duration. The study found individuals living in smaller households displaying longer unemployment duration. Also, it was found that individuals living in less endowed households (households where no one or few people were in gainful employment) were more vulnerable to experiencing longer unemployment spells. The study concluded with some recommendations for employment policy and follow-up research.
Fostering collaboration amongst business intelligence, business decision makers and statisticians for the optimal use of big data in marketing strategies
(University of the Western Cape, 2019) De Koker, Louise; Tati, Gabriel
The aim of this study was to propose a model of collaboration adaptable for the optimal use of big data in an organisational environment. There is a paucity of knowledge on such collaboration and the research addressed this gap. More specifically, the research attempted to establish whether leadership, trust and knowledge sharing influence collaboration among the stakeholders identified at large organisations. The conceptual framework underlying this research was informed by collaboration theory and organisational theory. It was assumed that effective collaboration in the optimal use of big data possibly is associated with leadership, knowledge sharing and trust. These concepts were scientifically hypothesised to determine whether such associations exist within the context of big data. The study used a mixed methods approach, combining a qualitative with a quantitative study. The qualitative study was in the form of in-depth interviews with senior managers from different business units at a retail organisation in Cape Town. The quantitative study was an online survey conducted with senior marketing personnel at JSE-listed companies from various industries in Cape Town. A triangulation methodology was adopted, with additional in-depth interviews of big data and analytics experts from both South Africa and abroad, to strengthen the research. The findings of the research indicate the changing role of the statistician in the era of big data and the new discipline of data science. They also confirm the importance of leadership, trust and knowledge sharing in ensuring effective collaboration. Of the three hypotheses tested, two were confirmed. Collaboration has been applied in many areas. Unexpected findings of the research were the role the chief data officer plays in fostering collaboration among stakeholders in the optimal use of big data in marketing strategies, as well as the importance of organisational structure and culture in effective collaboration in the context of big data and data science in large organisations. The research has contributed to knowledge by extending the theory of collaboration to the domain of big data in the organisational context, with the proposal of an integrated model of collaboration in the context of big data. This model was grounded in the data collected from various sources, establishing the crucial new role of the chief data officer as part of the executive leadership and main facilitator of collaboration in the organisation. Collaboration among the specified stakeholders, led by the chief data officer, occurs both horizontally with peers and vertically with specialists at different levels within the organisation in the proposed model. The application of such a model of collaboration should facilitate the successful outcome of the collaborative efforts in data science in the form of financial benefits to the organisation through the optimal use of big data.
Developing a model of school climate unique to secondary schools in South Africa: A multilevel analysis approach
(University of the Western Cape, 2018) Winnaar, Lolita Desiree; Blignaut, Rénette; Zuze, Linda
The educational landscape in South Africa is unique and has also seen many changes since the dawn of democracy more than 20 years ago. The apartheid education system was marred by severe inequalities between schools and, for this reason, the democratic government post 1994 established a number of policies and interventions in an attempt to improve access, equity and quality between schools. The country has made significant advances in improving access to education. This is reflected in the Millennium Development Goals progress indicators showing that, as of 2013, almost all learners between the ages of 7 and 15 were enrolled in schools. While great strides have also been made with regard to equity, evidence shows that many schools in South Africa are still largely inequitable. Education quality, however, is an area that is still of grave concern and the matter requires much attention from educational stakeholders. International studies, such as the Trends in International Mathematics and Science Study (TIMSS) and the Progress in International Reading Literacy Study (PIRLS), use learner performance to measure the quality of the system. Such studies consistently report that South Africa is performing poorly and that large inequalities still exist between schools in the country. Improved quality is associated with effective schools and, in South Africa, only 20% of schools have been found to be functional or effective. Much of research focussed on school effectiveness, both nationally and internationally, however has been explained by factors in the school, including the appropriateness of curriculum content, infrastructure, resources in the school and teacher content knowledge. These factors have been found to be strongly correlated with effective schools.
Inequalities in the use of maternal and reproductive health services in Sierra Leone
(University of the Western Cape, 2019) Tsawe, Mluleki; Susuman, Sathiya A.
This thesis extends the literature on the trends and magnitude of health inequalities in the area of maternal and reproductive health services in Sierra Leone, and particular across sub-Saharan Africa. It attempted to provide a good understanding of, not only the determinants of maternal and reproductive healthcare use, but also factors that enable health inequalities to exist in Sierra Leone. This is an appropriate topic in population health studies as it aims to address important questions on the research agenda in the context of sub-Saharan Africa, particularly in a country with poor health outcomes such as Sierra Leone. A proper understanding of not only the coverage rates of population health outcomes but also the extent of health inequalities as well as the factors that contribute to these inequalities is crucial for any government. The thesis applied various techniques in the analysis of DHS data (from 2008 and 2013 rounds) in an attempt to answer the research questions.

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