Research Articles (School of Public Health)
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Item The relationship between food insecurity, the child support grant and childcare arrangements(University of Stellenbosch, 2024) Swart, Rina; Tyabashe-Phume, Babalwa Pearl; Zembe-Mkabile, WangaFood insecurity is endemic in South Africa because of high levels of poverty. Children in food-insecure households may be exposed to childcare instabilities. However, the role of social protection in mediating the relationship between food insecurity and childcare arrangements is not well understood. This study explored the relationship between food insecurity, childcare arrangements and the child support grant (CSG) in a township in Cape Town. The study design was mixed-methods; a hunger scale was administered to 120 participants and in-depth interviews conducted with 23 primary caregivers of children under 2 years of age. The findings indicated that despite being food insecure, many households had stable childcare arrangements, presumably because of the CSG and the age of the children at the time of the study. Further research is needed to unpack the relationship between food insecurity, childcare arrangements and the CSG.Item Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026(Elsevier Ltd, 2023) Okonji, Osaretin Christabel; Micah, Angela E; Bhangdia, Kayleigh; Cogswell, Ian E; Lasher, DylanBackground: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending.Item A call for social accountability within pharmacy education: concepts, relevance, and accreditation(Elsevier, 2023) Coetzee, Renier; Prisco, Jennifer L; Laudone, Thomas WIntroduction: Social accountability (SA) is a leap to excellence in health education. While pharmacists are ideally situated in the healthcare setting to practice SA through research, service, and practice, SA is underrepresented in pharmacy education. Commentary: Here the foundational concepts of SA, the relevance to pharmacy education, as well as the accreditation considerations for the implementation of SA are discussed. Implications: There is a need for SA to be implemented in pharmacy education to address health equity, quality, and improve patient health outcomes.Item The association between plant-based diets and dietary patterns with cardiometabolic risk in a sample of commercial taxi drivers in South Africa(MDPI Journal, 2023) Sekgala, Machoene Derrick; Lopes, Tatum; Zemlin, Annalise EdithThe consumption of unhealthy foods and a sedentary lifestyle predispose individuals to non-communicable diseases. This study investigated the distribution and the association of plant-based diets (PBDs) and dietary patterns in relation to the cardiometabolic risks in commercial taxi drivers. A cross-sectional analysis was conducted among males (19 years) who consumed street foods sold by vendors in the Cape Metropole. A validated questionnaire was administered, including a quantified 24 h dietary recall, and fasting blood samples were collected for biochemical analyses. Statistical analyses were performed to investigate the association between dietary habits and cardiometabolic risks, while adjusting for confounding variables. The analytic sample consisted of 189 males with a median age of 38 years. The taxi drivers who ranked in the top-third of the healthy plant-based diet index (hPDI) had a 1–4% lower likelihood of having raised triglycerides (TG). Furthermore, consumption patterns including refined grains and meat conferred a 33% lower likelihood of dysglycaemia (p = 0.049), while fish/seafood, potatoes, and vegetables conferred a 43% greater likelihood of low high-density lipoprotein cholesterol (HDL-C) (p = 0.026) and 44% greater probability of raised low-density lipoprotein cholesterol (LDL-C) (p = 0.027). Consumption patterns, including sugar-sweetened beverages and eggs, conferred a 37% greater probability of hypertension (p = 0.047) and 53% greater likelihood of subclinical inflammation (p = 0.017). These preliminary findings require larger and more elaborate studies to explore the associations between PBDs and dietary patterns in at-risk African populations, with or without sedentary lifestyles, and exposure to unhealthy food environments.Item Prevalence of depression, syndemic factors and their impact on viral suppression among female sex workers living with HIV in eThekwini, South Africa(BMC women's health, 2023) Phetlhu, Rene; Bhardwaj, Anvita; Comins, Carly A.; Guddera, VijayIntroduction Over half of female sex workers (FSW) in South Africa are living with HIV and clinical depression has been frequently documented among FSW. Data characterizing structural determinants of depression and the role of syndemic theory, synergistically interacting disease states, on viral suppression among FSW in South Africa are limited. Methods: Between July 2018-March 2020, non-pregnant, cisgender women (≥ 18 years), reporting sex work as their primary income source, and diagnosed with HIV for ≥ 6 months were enrolled into the Siyaphambili trial in eThekwini, South Africa. Using baseline data, robust Poisson regression models were used to assess correlates of depression and associations between depression and syndemic factors on viral suppression.Item Human capabilities of South African parents who have children with developmental disabilities(Aosis, 2023) Magidigidi, Lumka; Roman, Nicolette V; Sonn, Inge KBackground: Parenting a child with a developmental disability (DD) has a substantial influence on the lives of the parents or caregivers, as well as on how the family operates. This is frequently because of the adjustments in some daily practices that are crucial for parents’ or caregivers’ human capabilities to provide for childcare. There is not enough research done on human capabilities of parents or children with DD in South Africa. Objectives: This study investigated the available support in improving the human capabilities of parents or caregivers with children with DD and the bodily health and bodily integrity human capabilities of parents or caregivers with children with DD. Method: Qualitative interviews were conducted with 11 parents or caregivers of children aged between 1 and 8 years old with DD. This study used snowball sampling. Thematic data analysis was chosen to analyse the data collected. Results: The results of the study indicate that participants have difficulties bringing up their children because of the emotional strain that goes along with parenting a child with DD. In addition, participants were not able to afford decent and satisfactory shelter and had limited access to good quality food because they could not afford it.Item Reasons why insured consumers co-pay for medicines at retail pharmacies in Pretoria, South Africa(AOSIS, 2019) Mpanza, Ntobeko M.; Bradley, Hazel; Laing, RichardCostly prescription medicines with existing cheaper alternatives tend to be purchased by medically insured consumers of healthcare. In South Africa medical scheme members pay higher out-of-pocket payments for medicines than those without insurance.This study explored reasons for co-payments among insured Pretoria medical scheme members purchasing prescription medicines at private retail pharmacies, despite being insured and protected against such payments.Item Women’s perceptions and reflections of male partners and couple dynamics in family planning adoption in selected urban slums in Nigeria: A qualitative exploration(BMC, 2014) Aransiola, Joshua Oyeniyi; Akinyemi, Akanni Ibukun; Fatusi, Adesegun OlayiwolaNigeria is one of the countries where significant progress has not been recorded in contraceptive uptake despite decades of family planning programs while there are indications that slum dwellers may differ significantly from other urban dwellers in their sexual and reproductive behavior, including family planning uptake. This study therefore examined local notions regarding male partners’ involvement in family planning (FP) adoption by women in two selected urban slums areas in Nigeria – Ibadan (Southwest region) and Kaduna (Northwest region). Specifically, the study investigated women’s narratives about FP, perceived barriers from male partners regarding FP adoption by the women and how women negotiate male partners' cooperation for FP use.Item Intervention in mothers and newborns to reduce maternal and perinatal mortality in 3 provinces in South Africa using a quality improvement approach: Protocol for a mixed method type 2 hybrid evaluation(JMIR Publications, 2023) Chetty, Terusha; Singh, Yages; Mianda, SolangeThe COVID-19 pandemic undermined gains in reducing maternal and perinatal mortality in South Africa. The Mphatlalatsane Initiative is a health system intervention to reduce mortality and morbidity in women and newborns to desired levels. Our evaluation aims to determine the effect of various exposures, including the COVID-19 pandemic, and a system-level, complex, patient-centered quality improvement (QI) intervention (the Mphatlalatsane Initiative) on maternal and neonatal health services at 21 selected South African facilities. The objectives are to determine whether Mphatlalatsane reduces the institutional maternal mortality ratio, neonatal mortality rate, and stillbirth rate (objective 1) and improves patients’ experiences (objective 2) and quality of care (objective 3). Objective 4 assesses the contextual and implementation process factors, including the COVID-19 pandemic, that shape Mphatlalatsane uptake and variation.Item Sociodemographic and lifestyle factors and the risk of metabolic syndrome in taxi drivers: A focus on street food(Frontiers Media, 2023) Sekgala, Machoene Derrick; Opperman, Maretha; Mpahleni, BuhleIn South Africa, similar to other populous countries, the taxi industry is an important form of transportation that contributes to the country’s development. As a result, minibus taxi driving is an occupation characterized by strenuous activities such as long hours of driving, limited rest, and challenges related to securing passengers, among several others. Consequently, to combat stress, some commercial drivers resort to smoking, overeating unhealthy food sold at transportation interchange areas (i.e., taxi ranks), and participating in sedentary behaviors. Most of these activities are risk factors for metabolic syndrome (MetS).Item Asking the experts: Using cognitive interview techniques to explore the face validity of the mental wellness measure for adolescents living with HIV(MDPI, 2023) Orth, Zaida; Van Wyk, BrianThere has been an increased focus on the mental health of adolescents living with HIV (ALHIV), because evidence shows that poor mental health outcomes are associated with lower rates of adherence and retention in HIV care. However, the research to date has predominantly focused on addressing mental health problems and reducing symptoms of mental illness rather than strengthening mental wellness [positive mental health]. Consequently, little is known about the critical mental wellness indicators that should be targeted in services for ALHIV. There is a need for valid and appropriate measures of mental wellness to drive research and provide evidence on the mental wellness needs of ALHIV that would inform service delivery as well as the monitoring and evaluation of treatment outcomes. To this end, we developed the Mental Wellness Measure for Adolescents Living with HIV (MWM-ALHIV) for ALHIV in the South African context. In this paper, we report on the findings from a cognitive interview study with nine ALHIV aged 15–19 years receiving treatment at a public healthcare facility in the Cape Metropole, South Africa.Item Contraceptive service uptake and delivery preferences in perinatally and horizontally infected female adolescents living with HIV: Results from a South Africa-based mixed-methods study’(Elsevier, 2022) Olagbuji, Biodun; Cooper, Diane; Mathews, CatherineTo investigate whether contraceptive service uptake (including current contraceptive use), unmet need for contraception, unintended pregnancy, preferences for service provision, and providers among female adolescents living with HIV (ALHIV) vary with HIVacquisition route, that is, perinatal HIV acquisition vs horizontal HIV acquisition. public sector primary health care facilities, Cape Town, South Africa Participants: Sexually experienced female ALHIV aged 14-19 years (n = 303) including both peri/postnatally infected ALHIV (pALHIV) and horizontally infected ALHIV (hALHIV) and health care providers involved in HIV care and treatment services (n = 19) Main Outcome Measures: Current contraceptive use, unintended pregnancy.Item Linkage to HIV care and early retention in care rates in the universal test-and-treat era: A population-based prospective study in Kwazulu- Natal, South Africa(Springer, 2023) Nicol, Edward; Basera, Wisdom; Mukumbang, Ferdinand CHIV linkage, and retention are key weaknesses in South Africa’s national antiretroviral therapy (ART) program, with the greatest loss of patients in the HIV treatment pathway occurring before ART initiation. This study investigated linkage-to and early-retention-in-care (LTRIC) rates among adults newly diagnosed with HIV in a high-HIV prevalent rural district. We conducted an observational prospective cohort study to investigate LTRIC rates for adults with a new HIV diagnosis in South Africa. Patient-level survey and clinical data were collected using a one-stage-cluster design from 18 healthcare facilities and triangulated between HIV and laboratory databases and registered deaths from Department of Home Affairs. We used Chi-square tests to assess associations between categorical variables, and results were stratified by HIV status, sex, and age. Of the 5,637 participants recruited, 21.2% had confirmed HIV, of which 70.9% were women, and 46.5% were aged 25–34 years. Although 82.7% of participants were linked-to-care within 3 months, only 46.1% remained-in-care 12 months after initiating ART and 5.2% were deceased.Item A shared agenda for gender and Covid-19 research: Priorities based on broadening engagement in science(BMJ Publishing Group, 2023) George, Asha S; Lopes, Claudia A; Vijayasingham, LavanyaWhile the acute and collective crisis from the pandemic is over, an estimated 2.5million people died from COVID-19 in 2022, tens of millions suffer from long COVID and national economies still reel from multiple deprivations exacerbated by the pandemic. Sex and gender biases deeply mark these evolving experiences of COVID-19, impacting the quality of science and effectiveness of the responses deployed. To galvanise change by strengthening evidence-informed inclusion of sex and gender in COVID-19 practice, we led a virtual collaboration to articulate and prioritise gender and COVID-19 research needs. In addition to standard prioritisation surveys, feminist principles mindful of intersectional power dynamics underpinned how we reviewed research gaps, framed research questions and discussed emergent findings.Item African governments must build on Covid-19 responses to advance gender equality(NLM (Medline), 2023) Bello, Kéfilath; George, Asha; De Jong, MichelleGender inequality remains a major threat to development in Africa, with millions of women in the continent not reaching their full potential.1 The covid-19 pandemic and related quarantine and lockdown measures exacerbated these gender inequalities. The effects included increased reports of gender based violence,1-4 the economic consequences of reduced income and unemployment for women and families,5-13 and disruptions to essential health services.14-17 In addition, school closures as a part of responding to the pandemic, further exposed girls and adolescents to violence, unintended pregnancies, and a risk of permanent dropout from schools across the region.Item No pandemic preparedness and research without gender equality(NLM (Medline), 2023) Clark, Jocalyn; George, Asha; Khosla, RajatThe covid-19 emergency may have been declared over, but its effects are not. Pre-existing inequities worsened during the pandemic, and the crisis has hardened societal fault lines. Sex and gender mark many of these. Early on, sex and gender featured visibly as men seemed at higher risk of infection and hospital admission, and women of longer term illness and caregiving burdens. Over time, it became evident that covid-19 was exacerbating multiple and intersecting vulnerabilities, with substantial effects on women and girls: increased care burdens, amplified gender based violence during lockdowns, catastrophic drops in income and employment for women and families, disrupted essential health services, and school closures that heightened risk of unintended pregnancies and permanent dropouts.Item Using an intersectionality approach to transform health services for overlooked healthcare users and workers after Covid-19(NLM (Medline), 2023) Mothupi, Mamothena; Dasgupta, Jashodhara; Hosseini Jebeli, Seyede SedigheGlobally, government responses to the covid-19 pandemic reinforced prevailing patterns of privilege and prejudice and further entrenched the inequitable distribution of health and disease in different populations.1-3 These patterns reflect how the legacies of historical discrimination combine with existing power structures to shape, condone, and continue social disadvantage and the unequal distribution of resources. Analysis of these inequalities within health systems from the perspective of intersectionality can help us understand their drivers and find solutions to reduce them. Tackling these inequalities can also help transform health services for improved pandemic preparedness.4Item Application of consolidated framework for implementation research to improve Clostridioides difficile infection management in district hospitals(Elsevier, 2022) Legenza, Laurel; Coetzee, Renier; Rose, Warren E.Clostridioides difficile infection (CDI) contributes the global threats of drug resistant infections, healthcare acquired infections and antimicrobial resistance. Yet CDI knowledge among healthcare providers in low-resource settings is limited and CDI testing, treatment, and infection prevention measures are often delayed. To develop a CDI intervention informed by the local context within South African public district level hospitals, and analyze the CDI intervention and implementation process. A CDI checklist intervention was designed and implemented at three district level hospitals in the Western Cape, South Africa that volunteered to participate. Data collection included a retrospective medical records review of patients hospitalized with C. difficile test orders during the 90 days post-implementation. Patient outcomes and checklist components (e.g. antibiotics) were collected.Item Towards universal health coverage: What are the system requirements for effective large-scale community health worker programmes?(BMJ Publishing Group, 2019) Lehmann, Uta; Twum-Danso, Nana A Y; Nyoni, JenniferAgainst the background of efforts to strengthen health systems for universal health coverage and health equity, many African countries have been relying on lay members of the community, often referred to as community health workers (CHWs), to deliver primary healthcare services. Growing demand and great variability in definitions, roles, governance and funding of CHWs have prompted the need to revisit CHW programmes and provide guidance on the implementation of successful programmes at scale. Drawing on the synthesised evidence from two extensive literature reviews, this article determines foundational elements of functioning CHW programmes, focusing in particular on the systems requirements of large-scale programmes. It makes recommendations for the effective development of large-scale CHW programmes.Item Championing mental health at work: Emerging practice from innovative projects in the UK(Oxford University Press, 2014) Robinson, Mark; Tilford, Sylvia; Branney, PeterThis paper examines the value of participatory approaches within interventions aimed at promoting mental health and wellbeing in the workplace. Specifically the paper explores data from the thematic evaluation of the Mental Health and Employment project strand within the Altogether Better programme being implemented in England in the Yorkshire and Humber region, which was funded through the BIG Lottery and aimed to empower people across the region to lead better lives. The evaluation combined a systematic evidence review with semi-structured interviews across mental health and employment projects. Drawing on both evaluation elements, the paper examines the potential of workplace-based ‘business champions’ to facilitate organizational culture change within enterprises within a deprived regional socio-economic environment.