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Jayaweera RT, Goin DE, Twine R, Neilands TB, Wagner RG, Lippman SA, Kahn K, Pettifor A, Ahern J. Violence Related to Daily Water and Sanitation Needs in South Africa. Am J Trop Med Hyg 2023; 109:170-173. [PMID: 37253439 PMCID: PMC10323990 DOI: 10.4269/ajtmh.22-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/10/2023] [Indexed: 06/01/2023] Open
Abstract
There is a critical lack of research on violence experienced by women when meeting their daily water and sanitation needs. This short report describes the cumulative lifetime incidence of exposure to violence when using the toilet or collecting water (water, sanitation, and hygiene [WASH]-related violence) and identifies associated health and behavioral risks. Data from 1,870 participants collected in 2013-2015 from a longitudinal cohort of young women in rural South Africa were included in this analysis. We found that exposure to WASH-related violence was high: 25.9% experienced violence when collecting water or when using the toilet. Those who experienced violence were more likely to report pregnancy, an older partner, unprotected sex, experience of intimate partner violence, engaging in transactional sex, depressive symptoms, and anxiety. Future research should investigate the location and type of violence experienced and examine how WASH-related violence is related to health outcomes to identify gender-centered WASH interventions that reduce violence exposure.
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Affiliation(s)
| | - Dana E. Goin
- University of California, San Francisco, San Francisco, California
| | - Rhian Twine
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ryan G. Wagner
- University of the Witwatersrand, Johannesburg, South Africa
| | - Sheri A. Lippman
- University of California, San Francisco, San Francisco, California
- University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- University of the Witwatersrand, Johannesburg, South Africa
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer Ahern
- University of California, Berkeley, Berkeley, California
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Sharma N, Palo SK, Bhimarasetty DM, Kandipudi KLP, Purty AJ, Kumar T, Basu S, Alice A, Velavan A, Madhavan S, Rongsen-Chandola T, Arora NK, Dixit S, Pati S, Taneja Malik S. Community Dynamics and Engagement Strategies in Establishing Demographic Development and Environmental Surveillance Systems: A Multi-Site Report from India. Healthcare (Basel) 2023; 11:healthcare11030411. [PMID: 36766985 PMCID: PMC9914790 DOI: 10.3390/healthcare11030411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Six diverse Demographic Development and Environmental Surveillance System (DDESS) sites were established in urban slum, urban resettlement, peri-urban, rural, and tribal areas located in Northern, North-East, Eastern, and Southern regions of India from June 2020 to March 2022. Understanding the community dynamics and engaging people in the community is critically important in the process of establishing DDESS. We ascertained the barriers, challenges, and facilitators during the establishment of multiple DDESS sites across India. METHODS This was a cross-sectional descriptive mixed-methods study. RESULTS Multiple barriers and challenges encountered were reported in the process of community engagement (CE), such as geographical inaccessibility, language barriers, adverse weather, non-responsiveness due to perceived lack of individual benefit or financial gain, fear of contracting COVID-19, COVID-19 vaccine hesitancy, etc. Facilitators in the CE process were pre-existing links with the community, constitution of community advisory boards, community need assessment, concomitant delivery of outreach health services, and skill-building facilities. CONCLUSION Most community barriers in the development of DDESS sites in resource-limited settings can be overcome through a multipronged approach, including effective community engagement by focusing on demonstrating trust at the local level, enlisting community mobilization and support, utilizing pre-existing community linkages, initiating community diagnosis, and meeting perceived community health needs.
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Affiliation(s)
- Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Subrata Kumar Palo
- Regional Medical Research Centre, Bhubaneshwar 751023, India
- Correspondence: (S.K.P.); (S.B.); Tel.: +91-844-752-7452 (S.B.)
| | | | | | - Anil J. Purty
- Pondicherry Institute of Medical Sciences, Puducherry 605014, India
| | - Tivendra Kumar
- Centre for Health Research and Development, Society for Applied Studies, New Delhi 110016, India
| | - Saurav Basu
- Public Health Foundation of India, Gurugram 122002, India
- Correspondence: (S.K.P.); (S.B.); Tel.: +91-844-752-7452 (S.B.)
| | - Alice Alice
- Regional Medical Research Centre, Bhubaneshwar 751023, India
| | - A. Velavan
- Pondicherry Institute of Medical Sciences, Puducherry 605014, India
| | - Sathish Madhavan
- INCLEN-Mawphlang DDESS, East Khasi Hills District, Shillong 793108, India
| | | | | | - Shikha Dixit
- The INCLEN Trust International, New Delhi 110020, India
| | | | - Shikha Taneja Malik
- Department of Biotechnology, National Biopharma Mission, Biotechnology Industry Research Assistance Council (BIRAC), New Delhi 110003, India
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3
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Mattila P, Davies J, Mabetha D, Tollman S, D’Ambruoso L. Burden of mortality linked to community-nominated priorities in rural South Africa. Glob Health Action 2022; 15:2013599. [PMID: 35060841 PMCID: PMC8786241 DOI: 10.1080/16549716.2021.2013599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/26/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Community knowledge is a critical input for relevant health programmes and strategies. How community perceptions of risk reflect the burden of mortality is poorly understood. OBJECTIVE To determine the burden of mortality reflecting community-nominated health risk factors in rural South Africa, where a complex health transition is underway. METHODS Three discussion groups (total 48 participants) representing a cross-section of the community nominated health priorities through a Participatory Action Research process. A secondary analysis of Verbal Autopsy (VA) data was performed for deaths in the same community from 1993 to 2015 (n = 14,430). Using population attributable fractions (PAFs) extracted from Global Burden of Disease data for South Africa, deaths were categorised as 'attributable at least in part' to community-nominated risk factors if the PAF of the risk factor to the cause of death was >0. We also calculated 'reducible mortality fractions' (RMFs), defined as the proportions of each and all community-nominated risk factor(s) relative to all possible risk factors for deaths in the population . RESULTS Three risk factors were nominated as the most important health concerns locally: alcohol abuse, drug abuse, and lack of safe water. Of all causes of deaths 1993-2015, over 77% (n = 11,143) were attributable at least in part to at least one community-nominated risk factor. Causes of attributable deaths, at least in part, to alcohol abuse were most common (52.6%, n = 7,591), followed by drug abuse (29.3%, n = 4,223), and lack of safe water (11.4%, n = 1,652). In terms of the RMF, alcohol use contributed the largest percentage of all possible risk factors leading to death (13.6%), then lack of safe water (7.0%), and drug abuse (1.3%) . CONCLUSION A substantial proportion of deaths are linked to community-nominated risk factors. Community knowledge is a critical input to understand local health risks.
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Affiliation(s)
- Pyry Mattila
- South Karelia Social and Health Care District (Eksote), Finland
| | - Justine Davies
- Institute of Applied Health Research University of Birmingham, UK
| | - Denny Mabetha
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH), Accra, Ghana
| | - Lucia D’Ambruoso
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Public Health, National Health Service, Grampian, Scotland, UK
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Tsuro U, Oladimeji KE, Pulido-Estrada GA, Apalata TR. Risk Factors Attributable to Hypertension among HIV-Infected Patients on Antiretroviral Therapy in Selected Rural Districts of the Eastern Cape Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11196. [PMID: 36141463 PMCID: PMC9517599 DOI: 10.3390/ijerph191811196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Antiretroviral therapy has improved HIV patients' quality of life and life expectancy. However, complications have emerged in the form of hypertension. In the rural Eastern Cape, there is minimal information about HIV-infected people. The current study intended to evaluate the factors associated with hypertension in HIV-infected individuals receiving antiretroviral therapy in rural areas of South Africa's Eastern Cape. METHODS For this cohort study, HIV-positive people taking antiretroviral therapy aged 15 and up were recruited at random from several rural locations in the Eastern Cape. Using Cox univariate and multivariate analyses, the key predictors of hypertension were found. RESULTS Of the total participants (n = 361), 53% of individuals had hypertension. In the Cox multivariate model, patients that had hypertension heredity, BMI ≥ 25 kg/m2, eGFR < 60 mL/min/1.73 m2, advanced and severe CD4 counts, 1TFE and 1T3E regimens, and the male gender were found to be at greater risk of hypertension. CONCLUSIONS The findings of this study indicate that hypertension is a prevalent concern among HIV patients receiving antiretroviral therapy. HIV patients should have their blood pressure checked regularly, and they should be screened for high blood pressure and given treatment for it.
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Affiliation(s)
- Urgent Tsuro
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
| | - Kelechi E. Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
- College of Graduate Studies, University of South Africa, Pretoria 0001, South Africa
| | | | - Teke R. Apalata
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa
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5
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Atkins K, MacPhail C, Maman S, Khoza N, Twine R, G-Olive FX, Pettifor A, Kahnd K. "The sky is the limit; I am going there": experiences of hope among young women receiving a conditional cash transfer in rural South Africa. CULTURE, HEALTH & SEXUALITY 2022; 24:1077-1091. [PMID: 33950799 PMCID: PMC9724634 DOI: 10.1080/13691058.2021.1919315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
Young women in South Africa face elevated risk of HIV infection compared to male peers. Cash transfers may mitigate their risk for HIV; however, there is limited understanding of mechanisms of impact. We explored hope as one potential mechanism. Longitudinal qualitative analysis was used to explore how cash transfer recipients in the HPTN 068 study conceptualised hope and how the intervention influenced their hope over time. We found the intervention increased confidence, alleviated financial stressors and instilled in young women the belief that a better life, defined as being educated, independent and supportive to family, was attainable. Findings support hope as a critical outcome of cash transfer and other economic strengthening interventions.
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Affiliation(s)
- Kaitlyn Atkins
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg, School of Public Health, Baltimore, MD, USA
| | - Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Nomhle Khoza
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F. Xavier G-Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen Kahnd
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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Gregson CL, Madanhire T, Rehman A, Ferrand RA, Cappola AR, Tollman S, Mokoena T, Micklesfield LK, Wade AN, Fabian J. Osteoporosis, Rather Than Sarcopenia, Is the Predominant Musculoskeletal Disease in a Rural South African Community Where Human Immunodeficiency Virus Prevalence Is High: A Cross-Sectional Study. J Bone Miner Res 2022; 37:244-255. [PMID: 34694025 PMCID: PMC10071443 DOI: 10.1002/jbmr.4464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 01/18/2023]
Abstract
The rollout of antiretroviral therapy globally has increased life expectancy across Southern Africa, where 20.6 million people now live with human immunodeficiency virus (HIV). We aimed to determine the prevalence of age-related osteoporosis and sarcopenia, and investigate the association between HIV, bone mineral density (BMD), muscle strength and lean mass, and gait speed. A cross-sectional community-based study of individuals aged 20-80 years in rural South Africa collected demographic and clinical data, including HIV status, grip strength, gait speed, body composition, and BMD. Sarcopenia was defined by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines, and osteoporosis as BMD T-score ≤ -2.5 (if age ≥50 years). The mean ± standard deviation (SD) age of 805 black South African participants was 44.6 ± 14.8 years, 547 (68.2%) were female; 34 (13.2%) were men, and 129 (23.6%) women had HIV, with 88% overall taking anti-retroviral therapy. A femoral neck T-score ≤ -2.5, seen in four of 95 (4.2%) men and 39 of 201 (19.4%) women age ≥50 years, was more common in women with than without HIV (13/35 [37.1%] versus 26/166 [15.7%]; p = 0.003). Although no participant had confirmed sarcopenia, probable sarcopenia affected more men than women (30/258 [11.6%] versus 24/547 [4.4%]; p = .001]. Although appendicular lean mass (ALM)/height2 index was lower in both men and women with HIV, there were no differences in grip strength, gait speed, or probable sarcopenia by HIV status. Older age, female sex, lower ALM/height2 index, slower gait speed, and HIV infection were all independently associated with lower femoral neck BMD. In conclusion, osteoporosis rather than sarcopenia is the common musculoskeletal disease of aging in rural South Africa; older women with HIV may experience greater bone losses than women without HIV. Findings raise concerns over future fracture risk in Southern Africa, where HIV clinics should consider routine bone health assessment, particularly in aging women. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Tafadzwa Madanhire
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Andrea Rehman
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, & Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshepiso Mokoena
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - June Fabian
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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7
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Kabudula CW, Houle B, Ohene-Kwofie D, Mahlangu D, Ng N, Van Minh H, Gómez-Olivé FX, Tollman S, Kahn K. Mortality transition over a quarter century in rural South Africa: findings from population surveillance in Agincourt 1993-2018. Glob Health Action 2021; 14:1990507. [PMID: 35377287 PMCID: PMC8986310 DOI: 10.1080/16549716.2021.1990507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Mortality burden in South Africa since the mid-1990s has been characterized by a quadruple disease burden: HIV/AIDS and tuberculosis (TB); other communicable diseases (excluding HIV/AIDS and TB), maternal causes, perinatal conditions and nutritional deficiencies; non-communicable diseases (NCDs); and injuries. Causes from these broad groupings have persistently constituted the top 10 causes of death. However, proportions and rankings have varied over time, alongside overall mortality levels. Objective To provide evidence on the contributions of age and cause-of-death to changes in mortality levels in a rural South African population over a quarter century (1993–2018). Methods Using mortality and cause-of-death data from the Agincourt Health and Socio-Demographic Surveillance System (HDSS), we derive estimates of the distribution of deaths by cause, and hazards of death by age, sex, and time period, 1993–2018. We derive estimates of life expectancies at birth and years of life expectancy gained at age 15 if most common causes of death were deleted. We compare mortality indicators and cause-of-death trends from the Agincourt HDSS with South African national indicators generated from publicly available datasets. Results Mortality and cause-of-death transition reveals that overall mortality levels have returned to pre-HIV epidemic levels. In recent years, the concentration of mortality has shifted towards older ages, and the mortality burden from cardiovascular diseases and other chronic NCDs are more prominent as people living with HIV/AIDS access ART and live longer. Changes in life expectancy at birth, distribution of deaths by age, and major cause-of-death categories in the Agincourt population follow a similar pattern to the South African population. Conclusion The Agincourt HDSS provides critical information about general mortality, cause-of-death, and age patterns in rural South Africa. Realigning and strengthening the South African public health and healthcare systems is needed to concurrently cater for the prevention, control, and treatment of multiple disease conditions.
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Affiliation(s)
- Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Demography, The Australian National University, Canberra, Australia.,CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Daniel Ohene-Kwofie
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Mahlangu
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nawi Ng
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hoang Van Minh
- Center for Population Health Sciences, Hanoi University of Public Health, Ha Noi, Vietnam
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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8
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Herbst K, Juvekar S, Jasseh M, Berhane Y, Chuc NTK, Seeley J, Sankoh O, Clark SJ, Collinson MA. Health and demographic surveillance systems in low- and middle-income countries: history, state of the art and future prospects. Glob Health Action 2021; 14:1974676. [PMID: 35377288 PMCID: PMC8986235 DOI: 10.1080/16549716.2021.1974676] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
Health and Demographic Surveillance Systems (HDSS) have been developed in several low- and middle-income countries (LMICs) in Africa and Asia. This paper reviews their history, state of the art and future potential and highlights substantial areas of contribution by the late Professor Peter Byass.Historically, HDSS appeared in the second half of the twentieth century, responding to a dearth of accurate population data in poorly resourced settings to contextualise the study of interventions to improve health and well-being. The progress of the development of this network is described starting with Pholela, and progressing through Gwembe, Balabgarh, Niakhar, Matlab, Navrongo, Agincourt, Farafenni, and Butajira, and the emergence of the INDEPTH Network in the early 1990'sThe paper describes the HDSS methodology, data, strengths, and limitations. The strengths are particularly their temporal coverage, detail, dense linkage, and the fact that they exist in chronically under-documented populations in LMICs where HDSS sites operate. The main limitations are generalisability to a national population and a potential Hawthorne effect, whereby the project itself may have changed characteristics of the population.The future will include advances in HDSS data harmonisation, accessibility, and protection. Key applications of the data are to validate and assess bias in other datasets. A strong collaboration between a national HDSS network and the national statistics office is modelled in South Africa and Sierra Leone, and it is possible that other low- to middle-income countries will see the benefit and take this approach.
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Affiliation(s)
- Kobus Herbst
- DSI-MRC South African Population Infrastructure Network, Durban, South Africa
- Population Science, Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Vadu Rural Health Program, Pune, India
| | - Momodou Jasseh
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Janet Seeley
- Population Science, Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Osman Sankoh
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
- Njala University, University Secretariat, Njala, Sierra Leone
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - Samuel J. Clark
- Department of Sociology, The Ohio State University, Columbus, Ohio, USA
| | - Mark A. Collinson
- DSI-MRC South African Population Infrastructure Network, Durban, South Africa
- SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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9
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Sack DE, Wagner RG, Ohene-Kwofie D, Kabudula CW, Price J, Ginsburg C, Audet CM. Pregnancy-related healthcare utilisation in Agincourt, South Africa, 1993-2018: a longitudinal surveillance study of rural mothers. BMJ Glob Health 2021; 6:e006915. [PMID: 34620615 PMCID: PMC8499259 DOI: 10.1136/bmjgh-2021-006915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/17/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Pregnancy-related health services, an important mediator of global health priorities, require robust health infrastructure. We described pregnancy-related healthcare utilisation among rural South African women from 1993 to 2018, a period of social, political and economic transition. METHODS We included participants enrolled in the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga Province, South Africa, a population-based longitudinal cohort, who reported pregnancy between 1993 and 2018. We assessed age, antenatal visits, years of education, pregnancy intention, nationality, residency status, previous pregnancies, prepregnancy and postpregnancy contraceptive use, and student status over the study period and modelled predictors of antenatal care utilisation (ordinal), skilled birth attendant presence (logistic) and delivery at a health facility (logistic). RESULTS Between 1993 and 2018, 51 355 pregnancies occurred. Median antenatal visits, skilled birth attendant presence and healthcare facility deliveries increased over time. Delivery in 2018 vs 2004 was associated with an increased likelihood of ≥1 additional antenatal visits (adjusted OR (aOR) 10.81, 95% CI 9.99 to 11.71), skilled birth attendant presence (aOR 4.58, 95% CI 3.70 to 5.67) and delivery at a health facility (aOR 3.78, 95% CI 3.15 to 4.54). Women of Mozambican origin were less likely to deliver with a skilled birth attendant (aOR 0.42, 95% CI 0.39 to 0.45) or at a health facility (aOR 0.43, 95% CI 0.41 to 0.46) versus South Africans. Temporary migrants reported fewer antenatal visits (aOR 0.35, 95% CI 0.33 to 0.38) but were more likely to deliver with a skilled birth attendant (aOR 1.91, 95% CI 1.66 to 2.2) or at a health facility (aOR 1.4, 95% CI 1.24 to 1.58) versus permanent residents. CONCLUSION Pregnancy-related healthcare utilisation and skilled birth attendant presence at delivery have increased steadily since 1993 in rural northeastern South Africa, aligning with health policy changes enacted during this time. However, mothers of Mozambican descent are still less likely to use free care, which requires further study and policy interventions.
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Affiliation(s)
- Daniel E Sack
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan G Wagner
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Ohene-Kwofie
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa W Kabudula
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jessica Price
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carren Ginsburg
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carolyn M Audet
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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10
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Etoori D, Rice B, Reniers G, Gomez-Olive FX, Renju J, Kabudula CW, Wringe A. Patterns of engagement in HIV care during pregnancy and breastfeeding: findings from a cohort study in North-Eastern South Africa. BMC Public Health 2021; 21:1710. [PMID: 34544409 PMCID: PMC8454048 DOI: 10.1186/s12889-021-11742-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eliminating mother-to-child transmission of HIV (MTCT) in sub-Saharan Africa is hindered by limited understanding of HIV-testing and HIV-care engagement among pregnant and breastfeeding women. METHODS We investigated HIV-testing and HIV-care engagement during pregnancy and breastfeeding from 2014 to 2018 in the Agincourt Health and Demographic Surveillance System (HDSS). We linked HIV patient clinic records to HDSS pregnancy data. We modelled time to a first recorded HIV-diagnosis following conception, and time to antiretroviral therapy (ART) initiation following diagnosis using Kaplan-Meier methods. We performed sequence and cluster analyses for all pregnancies linked to HIV-related clinic data to categorise MTCT risk period engagement patterns and identified factors associated with different engagement patterns using logistic regression. We determined factors associated with ART resumption for women who were lost to follow-up (LTFU) using Cox regression. RESULTS Since 2014, 15% of 10,735 pregnancies were recorded as occurring to previously (51%) or newly (49%) HIV-diagnosed women. New diagnoses increased until 2016 and then declined. We identified four MTCT risk period engagement patterns (i) early ART/stable care (51.9%), (ii) early ART/unstable care (34.1%), (iii) late ART initiators (7.6%), and (iv) postnatal seroconversion/early, stable ART (6.4%). Year of delivery, mother's age, marital status, and baseline CD4 were associated with these patterns. A new pregnancy increased the likelihood of treatment resumption following LTFU. CONCLUSION Almost half of all pregnant women did not have optimal ART coverage during the MTCT risk period. Programmes need to focus on improving retention, and leveraging new pregnancies to re-engage HIV-positive women on ART.
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Affiliation(s)
- David Etoori
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Rice
- MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Georges Reniers
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gomez-Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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11
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Eyre RW, House T, Xavier Gómez-Olivé F, Griffiths FE. Bayesian belief network modelling of household food security in rural South Africa. BMC Public Health 2021; 21:935. [PMID: 34001089 PMCID: PMC8130258 DOI: 10.1186/s12889-021-10938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/28/2021] [Indexed: 11/14/2022] Open
Abstract
Background Achieving food security remains a key challenge for public policy throughout the world. As such, understanding the determinants of food insecurity and the causal relationships between them is an important scientific question. We aim to construct a Bayesian belief network model of food security in rural South Africa to act as a tool for decision support in the design of interventions. Methods Here, we use data from the Agincourt Health and Socio-demographic Surveillance System (HDSS) study area, which is close to the Mozambique border in a low-income region of South Africa, together with Bayesian belief network (BBN) methodology to address this question. Results We find that a combination of expert elicitation and learning from data produces the most credible set of causal relationships, as well as the greatest predictive performance with 10-fold cross validation resulting in a Briers score 0.0846, information reward of 0.5590, and Bayesian information reward of 0.0057. We report the resulting model as a directed acyclic graph (DAG) that can be used to model the expected effects of complex interventions to improve food security. Applications to sensitivity analyses and interventional simulations show ways the model can be applied as tool for decision support for human experts in deciding on interventions. Conclusions The resulting models can form the basis of the iterative generation of a robust causal model of household food security in the Agincourt HDSS study area and in other similar populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10938-y.
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Affiliation(s)
- Robert W Eyre
- Spectra Analytics, 70 Gracechurch Street, London, EC3V 0HR, UK
| | - Thomas House
- Department of Mathematics, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances E Griffiths
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. .,University of the Witwatersrand, Johannesburg, South Africa.
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12
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Areru HA, Dangisso MH, Lindtjørn B. Births and deaths in Sidama in southern Ethiopia: findings from the 2018 Dale-Wonsho Health and Demographic Surveillance System (HDSS). Glob Health Action 2021; 13:1833511. [PMID: 33115376 PMCID: PMC7598947 DOI: 10.1080/16549716.2020.1833511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Sidama is one of the most densely populated areas in Ethiopia. Information about the demographic characteristics is scarce, and most studies were census based on interviews. Earlier population studies from Ethiopia did not sufficiently address the validity of measuring births, deaths, and age-composition. Objective To investigate the population characteristics in Sidama with an emphasis on fertility estimates, age, and death reporting. Methods This is a mixed-method cross-sectional study, conducted in Sidama in southern Ethiopia, using baseline data of newly established Dale-Wonsho Health and Demographic Surveillance System site in 2018. We used quantitative data of 5179 randomly selected households having 25,144 individuals. We collected information on deaths in the same study period and population from the traditional burial associations (Iddir). Qualitative data were collected using focus group discussions, and in-depth interviews. Life tables, age reliability indices and logistic regression were used to analyse the data. Results The total fertility rate was 2.9 children/woman, the crude birth rate was 22.8/1000 population and the crude death rate was 5.2/1000 population. The dependency ratio was 66/100 working-age population. Urban residents had higher birth rates (OR = 1.4 (95% CL: 1.05–1.78), and women with basic education had lower birth rates (OR = 0.6 (95% CL: 0.46–0.78) compared to those with no education. The age accuracy indices showed unreliable age reporting. The number of deaths increased from 29 to 132 when death reports from the Iddirs were included. There was under-reporting of neonatal and deaths of young children. Substituting national and regional mortality estimates, the life expectancy declined to an average of 53 years (range 48–58 years). Conclusion The fertility rate in Sidama is lower than previously reported and is affected by age, residence and education. As we have identified important measurement and reporting errors, future demographic surveillance sites should consider these limitations.
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Affiliation(s)
- Hiwot Abera Areru
- School of Public Health, Hawassa University , Hawassa, Ethiopia.,Centre for International Health, University of Bergen , Bergen, Norway
| | | | - Bernt Lindtjørn
- School of Public Health, Hawassa University , Hawassa, Ethiopia.,Centre for International Health, University of Bergen , Bergen, Norway
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13
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Shangase N, Pence B, Lippman SA, Dufour MSK, Kabudula CW, Gómez-Olivé FX, Kahn K, Pettifor A. Built Environment and HIV Linkage to Care in Rural South Africa. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 43:133-141. [PMID: 33818211 PMCID: PMC9684657 DOI: 10.1177/0272684x211006590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background We assessed built environment (residential density, landuse mix and
aesthetics) and HIV linkage to care (LTC) among 1,681 (18–49 years-old)
residents of 15 Mpumalanga villages, South Africa. Methods Multilevel models (linear-binomial) were used for the association between
built environment, measured using NEWS for Africa, and LTC from a clinical
database of 9 facilities (2015–2018). Additionally, we assessed
effect-measure modification by universal test-and-treat policy (UTT). Results We observed, a significant association in the adjusted 3-month probability of
LTC for residential density (risk difference (RD)%: 5.6, 95%CI: 1.2–10.1),
however, no association for land-use mix (RD%: 2.4, 95%CI: −0.4, 5.2) and
aesthetics (RD%: −1.2, 95%CI: −4.5–2.2). Among those diagnosed after UTT,
residents of high land-use villages were more likely to link-to-care than
those of low land-use villages at 12 months (RD%: 4.6, 95%CI: 1.1–8.1,
p < 0.04), however, not at 3 months (RD%: 3.0, 95%CI: −2.1–8.0,
p > 0.10). Conclusion Findings suggest, better built environment conditions (adequate
infrastructure, proximity to services etc.) help facilitate LTC. Moreover,
UTT appears to have a protective effect on LTC.
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Affiliation(s)
- Nosipho Shangase
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Sheri A Lippman
- Department of Medicine, University of California, San Francisco, California, United States.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mi-Suk Kang Dufour
- Department of Medicine, University of California, San Francisco, California, United States
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Farrell MT, Kobayashi LC, Montana L, Wagner RG, Demeyere N, Berkman L. Disparity in Educational Attainment Partially Explains Cognitive Gender Differences in Older Rural South Africans. J Gerontol B Psychol Sci Soc Sci 2021; 75:e161-e173. [PMID: 32211786 DOI: 10.1093/geronb/gbaa035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Direction and magnitude of gender differences in late-life cognitive function are inextricably tied to sociocultural context. Our study evaluates education and literacy as primary drivers of gender equality in cognitive performance among middle-aged and older adults in rural South Africa. METHOD Data were collected on 1,938 participants aged 40-79 from Agincourt, South Africa. Cognitive function was measured via the Oxford Cognitive Screen-Plus, a tablet-based assessment with low literacy demands. Four cognitive domains were derived through confirmatory factor analysis: episodic memory, executive function, visual spatial, and language. Structural equation models tested domain-specific gender effects, incrementally controlling for demographic, education, health, and socioeconomic variables. RESULTS In the model adjusting only for demographic factors, men outperformed women on executive function and visual-spatial domains. Adding education and literacy to the model revealed a robust female advantage in episodic memory, and reduced the magnitude of male advantage in executive function and visual and spatial by 47% and 42%, respectively. Health and socioeconomic factors did not alter patterns of gender associations in subsequent models. DISCUSSION In this older South African cohort, gender inequality in cognitive performance was partially attributable to educational differences. Understanding biopsychosocial mechanisms that promote cognitive resilience in older women is critically important given the predominantly female composition of aging populations worldwide.
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Affiliation(s)
- Meagan T Farrell
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Livia Montana
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nele Demeyere
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, UK
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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15
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Ameh S. Evaluation of an integrated HIV and hypertension management model in rural south africa: a mixed methods approach. Glob Health Action 2021; 13:1750216. [PMID: 32316885 PMCID: PMC7191904 DOI: 10.1080/16549716.2020.1750216] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: A summary of Soter Ameh's PhD thesis titled, 'An integrated HIV and hypertension management model in rural South Africa: A mixed methods approach' is presented here. In responding to the dual high burden of non-communicable diseases (NCDs) and HIV in South Africa, the national government initiated an integrated chronic disease management (ICDM) model in health facilities as a pilot programme. The aim of the ICDM model is to leverage the successes of the innovative HIV treatment programme for NCDs to improve the quality of care and health outcomes of adult patients.Objectives: The specific objectives of this study were to: (1) determine the quality of care provided in the integrated model in 2013, (2) describe patients' and operational managers' perceptions of quality of care in the integrated model in 2013, and (3) assess effectiveness of the integrated model in controlling CD4 counts (>350 cells/mm3) and blood pressure (<140/90 mmHg) of patients from 2011 to 2013.Methods: A combination of quantitative and qualitative methods was used to assess and describe the quality of care in the model. Effectiveness of the model in controlling patients' blood pressure (BP) and CD4 counts was assessed in selected PHC facilities in the Bushbuckridge municipality in Mpumalanga province, South Africa.Results: The findings showed the suboptimal quality of care in five of the eight priority dimensions of care used as leverage for the NCD programme. The ICDM model had a small but significant effect on BP control for hypertension patients receiving treatment.Conclusions: The HIV programme needs to be more extensively leveraged for hypertension treatment to achieve an optimal BP control in the study area. These findings could have policy relevance for low- and middle-income countries currently undertaking proof of concept studies to demonstrate the feasibility of implementing an integrated chronic disease care model.
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Affiliation(s)
- Soter Ameh
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Gobal Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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16
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Ameh S, Gómez-Olivé FX, Kahn K, Tollman S, Klipstein-Grobusch K. Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study. BMJ Open 2020; 10:e037580. [PMID: 33148729 PMCID: PMC7640524 DOI: 10.1136/bmjopen-2020-037580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE In 2011, The National Department of Health introduced the Integrated Chronic Disease Management (ICDM) model as a pilot programme in selected primary healthcare facilities in South Africa. The objective of this study was to determine individual-level and facility-level predictors of controlled CD4 count and blood pressure (BP) in patients receiving treatment for HIV and hypertension, respectively. DESIGN A panel study. SETTING AND PARTICIPANTS This study was conducted in the Bushbuckridge Municipality, South Africa from 2011 to 2013. Facility records of patients aged ≥18 years were retrieved from the integrated chronic disease management (ICDM) pilot (n=435) and comparison facilities (n=443) using a three-step probability sampling process. CD4 count and BP control are defined as CD4 count >350 cells/mm3 and BP <140/90 mm Hg. A multilevel Least Absolute Shrinkage and Selection Operator binary logistic regression analysis was done at a 5% significance level using STATA V.16. PRIMARY OUTCOME MEASURES CD4 (cells/mm3) count and BP (mm Hg). RESULTS Compared with the comparison facilities, patients receiving treatment in the pilot facilities had increased odds of controlling their CD4 count (OR=5.84, 95% CI 3.21-8.22) and BP (OR=1.22, 95% CI 1.04-2.14). Patients aged 50-59 (OR=6.12, 95% CI 2.14-7.21) and ≥60 (OR=7.59, 95% CI 4.75-11.82) years had increased odds of controlling their CD4 counts compared with those aged 18-29 years. Likewise, patients aged 40-49 (OR=5.73, 95% CI 1.98-8.43), 50-59 (OR=7.28, 95% CI 4.33-9.27) and ≥60 (OR=9.31, 95% CI 5.12-13.68) years had increased odds of controlling their BP. In contrast, men had decreased odds of controlling their CD4 count (OR=0.12, 95% CI 0.10-0.46) and BP (OR=0.21, 95% CI 0.19-0.47) than women. CONCLUSION The ICDM model had a small but significant effect on BP control, hence, the need to more effectively leverage the HIV programme for optimal BP control in the setting.
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Affiliation(s)
- Soter Ameh
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Francesc X Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), Accra, Ghana
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), Accra, Ghana
- Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), Accra, Ghana
- Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Kerstin Klipstein-Grobusch
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Stoner MC, Kilburn K, Hill LM, MacPhail C, Selin A, Kimaru L, Khoza N, Hove J, Twine R, Kahn K, Pettifor A. The effects of a cash transfer intervention on sexual partnerships and HIV in the HPTN 068 study in South Africa. CULTURE, HEALTH & SEXUALITY 2020; 22:1112-1127. [PMID: 31496383 PMCID: PMC7061081 DOI: 10.1080/13691058.2019.1655591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
Evidence on cash transfer interventions for HIV prevention in adolescent girls and young women is unclear and indicates that they may not work uniformly in all settings. Qualitative interviews were conducted with 22 girls and young women post-intervention to determine how a cash transfer study (HPTN 068) in South Africa was perceived to influence sexual behaviours and to explore mechanisms for these changes. Participants described how the intervention motivated them to increase condom use, have fewer partners, end risky relationships and access HIV testing services at local primary health clinics. Changes were attributed to receipt of the cash transfer, in addition to HIV testing and sexual health information. Processes of change included improved communication with partners and increased negotiation power in sexual decision-making. Economic empowerment interventions increase confidence in negotiating behaviours with sexual partners and are complementary to sexual health information and health services that provide young women with a foundation on which to make informed decisions about how to protect themselves.
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Affiliation(s)
- Marie C.D. Stoner
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Kelly Kilburn
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Global Health, George Washington University, Washington, DC, USA
| | - Lauren M Hill
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, NSW, Australia
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amanda Selin
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Linda Kimaru
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomhle Khoza
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Hove
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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Characteristics Associated With Human Immunodeficiency Virus Transmission Networks Involving Adolescent Girls and Young Women in Human Immunodeficiency Virus Prevention Trials Network 068 Study. Sex Transm Dis 2020; 46:e46-e49. [PMID: 30985638 DOI: 10.1097/olq.0000000000000954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We combined behavioral survey data from the human immunodeficiency virus (HIV) Prevention Trials Network 068 study with phylogenetic information to determine if cluster membership was associated with characteristics of young women and their partners. Clusters were more likely to involve young women from specific villages and schools, indicating some localized transmission.Supplemental digital content is available in the text.
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Rosenberg M, Gómez‐Olivé FX, Wagner RG, Rohr J, Payne CF, Berkman L, Kahn K, Tollman S, Bärnighausen T, Kobayashi LC. The relationships between cognitive function, literacy and HIV status knowledge among older adults in rural South Africa. J Int AIDS Soc 2020; 23:e25457. [PMID: 32202047 PMCID: PMC7086300 DOI: 10.1002/jia2.25457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/02/2019] [Accepted: 01/22/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Although HIV prevalence is exceptionally high in South Africa, HIV testing rates remain below targeted guidelines. Older adults living with HIV are substantially more likely to remain undiagnosed than younger people. Cognitive function and literacy could play key roles in HIV status knowledge due to the decision-making processes required around weighing the costs and benefits of testing, navigating testing logistics and processing results. We aimed to assess the independent relationships among each of cognitive function, literacy and education with HIV status knowledge in a population-based sample of older adults living in a rural South African community with high HIV prevalence. METHODS We analyzed data from a population-based study of 5059 men and women aged 40 years and older in rural South Africa (Health and Aging in Africa: A Longitudinal Study of an INDEPTH community (HAALSI)). HAALSI surveys, conducted between 2014 and 2015, queried self-reported literacy, educational attainment and HIV status knowledge. Laboratory tests were conducted to assess true HIV sero-status. Cognitive function was assessed with a battery of cognitive tests measuring time orientation, immediate and delayed recall, and numeracy and coded using confirmatory factor analysis as a z-standardized latent variable. We estimated the relationship between the outcome of HIV status knowledge and each of three exposures: (1) latent cognitive z-score, (2) literacy and (3) education, using confounder-adjusted modified Poisson regression models in the study population overall and stratified by HIV sero-status. RESULTS We found that HIV status knowledge was higher among those with higher cognitive z-scores (adjusted Prevalence Ratio (aPR) (95% CI): 1.18 (1.14, 1.21) per standard deviation unit), and among literate participants (aPR (95% CI): 1.24 (1.16, 1.32) vs. non-literate participants). Taken together, the associations with literacy and cognitive function completely attenuated the otherwise positive association between educational attainment and HIV status knowledge. The magnitudes of effect were generally similar among laboratory-confirmed HIV-negative and HIV-positive participants. CONCLUSIONS Campaigns that target older adults in rural South Africa with HIV testing messages should carefully consider the cognitive and literacy levels of the intended audience. Innovations to ease the cognitive load associated with HIV testing could prove fruitful to increase HIV status knowledge.
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Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology and BiostatisticsIndiana University School of Public Health‐BloomingtonBloomingtonINUSA
| | - F. Xavier Gómez‐Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
- Umeå Centre for Global Health ResearchDivision of Epidemiology and Global HealthDepartment of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Julia Rohr
- Center for Population and Development StudiesHarvard UniversityCambridgeMAUSA
| | - Collin F. Payne
- School of Demography, Research School of Social SciencesAustralian National UniversityCanberraAustralia
| | - Lisa Berkman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Center for Population and Development StudiesHarvard UniversityCambridgeMAUSA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- INDEPTH NetworkAccraGhana
| | - Till Bärnighausen
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Center for Population and Development StudiesHarvard UniversityCambridgeMAUSA
- Africa Health Research InstituteDurbanSouth Africa
- Heidelberg Institute of Global HealthFaculty of Medicine and University HospitalUniversity of HeidelbergHeidelbergGermany
| | - Lindsay C. Kobayashi
- Department of EpidemiologySchool of Public HealthUniversity of MichiganAnn ArborMIUSA
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Anstey Watkins J, Wagner F, Xavier Gómez-Olivé F, Wertheim H, Sankoh O, Kinsman J. Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site. Am J Trop Med Hyg 2020; 100:1378-1390. [PMID: 30994091 PMCID: PMC6553901 DOI: 10.4269/ajtmh.18-0171] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Knowledge and practices of rural South African populations with regard to antibiotic access and use (ABACUS) remain understudied. By using the case of four villages in the north east of the country, our aim was to investigate popular notions and social practices related to antibiotics to inform patient-level social interventions for appropriate antibiotic use. To achieve this, we investigated where community members (village residents) were accessing and sourcing medication, and what they understood antibiotics and antibiotic resistance (ABR) to be. Embedded within the multicountry ABACUS project, this qualitative study uses interviews and focus group discussions. A sample of 60 community members was recruited from the Agincourt Health and Demographic Surveillance System, situated in Mpumalanga Province, from April to August, 2017. We used the five abilities of seek, reach, pay, perceive, and engage in access to healthcare as proposed by Levesque’s “Access to Healthcare” framework. Respondents reported accessing antibiotics prescribed from legal sources: by nurses at the government primary healthcare clinics or by private doctors dispensed by private pharmacists. No account of the illegal purchasing of antibiotics was described. There was a mix of people who finished their prescription according to the instructions and those who did not. Some people kept antibiotics for future episodes of infection. The concept of “ABR” was understood by some community members when translated into related Xitsonga words because of knowledge tuberculosis and HIV/AIDS treatment regimens. Our findings indicate that regulation around the sale of antibiotics is enforced. Safer use of antibiotics and why resistance is necessary to understand need to be instilled. Therefore, context-specific educational campaigns, drawing on people’s understandings of antibiotics and informed by the experiences of other diseases, may be an important and deployable means of promoting the safe use of antibiotics.
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Affiliation(s)
- Jocelyn Anstey Watkins
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Fezile Wagner
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Nijmegen, The Netherlands.,Nuffield Department of Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom.,Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Osman Sankoh
- Statistics Sierra Leone, Freetown, Sierra Leone.,International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) Network, Accra, Ghana.,Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - John Kinsman
- Department of Public Health Sciences, Global Health (Division of International Health - IHCAR), Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health (Umeå Centre for Global Health Research), Umeå University, Umeå, Sweden
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21
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Hove J, D'Ambruoso L, Mabetha D, van der Merwe M, Byass P, Kahn K, Khosa S, Witter S, Twine R. 'Water is life': developing community participation for clean water in rural South Africa. BMJ Glob Health 2019; 4:e001377. [PMID: 31263583 PMCID: PMC6570987 DOI: 10.1136/bmjgh-2018-001377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/06/2019] [Accepted: 05/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background South Africa is a semiarid country where 5 million people, mainly in rural areas, lack access to water. Despite legislative and policy commitments to the right to water, cooperative governance and public participation, many authorities lack the means to engage with and respond to community needs. The objectives were to develop local knowledge on health priorities in a rural province as part of a programme developing community evidence for policy and planning. Methods We engaged 24 participants across three villages in the Agincourt Health and Socio-Demographic Surveillance System and codesigned the study. This paper reports on lack of clean, safe water, which was nominated in one village (n=8 participants) and in which women of reproductive age were nominated as a group whose voices are excluded from attention to the issue. On this basis, additional participants were recruited (n=8). We then held a series of consensus-building workshops to develop accounts of the problem and actions to address it using Photovoice to document lived realities. Thematic analysis of narrative and visual data was performed. Results Repeated and prolonged periods when piped water is unavailable were reported, as was unreliable infrastructure, inadequate service delivery, empty reservoirs and poor supply exacerbated by droughts. Interconnected social, behavioural and health impacts were documented combined with lack of understanding, cooperation and trust between communities and authorities. There was unanimity among participants for taps in houses as an overarching goal and strategies to build an evidence base for planning and advocacy were developed. Conclusion In this setting, there is willingness among community stakeholders to improve water security and there are existing community assemblies to support this. Health and Socio-Demographic Surveillance Systems provide important opportunities to routinely connect communities to resource management and service delivery. Developing learning platforms with government and non-government organisations may offer a means to enable more effective public participation in decentralised water governance.
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Affiliation(s)
- Jennifer Hove
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia D'Ambruoso
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Denny Mabetha
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria van der Merwe
- Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
| | - Peter Byass
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonto Khosa
- Department of Health, Mpumalanga Provincial Government, Mbombela, South Africa
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, Scotland, UK
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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22
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Fearon E, Wiggins RD, Pettifor AE, MacPhail C, Kahn K, Selin A, Gómez-Olivé FX, Hargreaves JR. Friendships Among Young South African Women, Sexual Behaviours and Connections to Sexual Partners (HPTN 068). AIDS Behav 2019; 23:1471-1483. [PMID: 30684099 DOI: 10.1007/s10461-019-02406-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Friends could be influential on young women's sexual health via influences on sexual behaviours and as connections to sexual partners, but are understudied in sub-Saharan Africa. We cross-sectionally surveyed 2326 13-20 year-old young women eligible for grades 8-11 in rural South Africa about their sexual behaviour and up to three sexual partners. Participants each described five specific but unidentified friends and the relationships between them in an 'egocentric' network analysis design. We used logistic regression to investigate associations between friendship characteristics and participants' reports of ever having had sex (n = 2326) and recent condom use (n = 457). We used linear regression with random effects by participant to investigate friendship characteristics and age differences with sexual partners (n = 633 participants, 1051 partners). We found that it was common for friends to introduce young women to those who later became sexual partners, and having older friends was associated with having older sexual partners, (increase of 0.37 years per friend at least 1 year older, 95% CI 0.21-0.52, adjusted). Young women were more likely to report ever having had sex when more friends were perceived to be sexually active (adjusted OR 1.85, 95% CI 1.72-2.01 per friend) and when they discussed sex, condoms and HIV with friends. Perception of friends' condom use was not associated with participants' reported condom use. While this study is preliminary and unique in this population and further research should be conducted, social connections between friends and sexual partners and perceptions of friend sexual behaviours could be considered in the design of sexual health interventions for young women in South Africa.
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Affiliation(s)
- Elizabeth Fearon
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9 SH, UK.
| | - Richard D Wiggins
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Audrey E Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
- Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Amanda Selin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9 SH, UK
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23
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Myroniuk TW, White MJ, Gross M, Wang R, Ginsburg C, Collinson M. Does It Take a Village? Migration among Rural South African Youth. POPULATION RESEARCH AND POLICY REVIEW 2018; 37:1079-1108. [PMID: 31543557 PMCID: PMC6754111 DOI: 10.1007/s11113-018-9493-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
Abstract
In a rural African context, the saying, "it takes a village to raise a child," suggests that community characteristics are substantially important in children's lives as they transition to adulthood. Are these contextual factors also related to youth migration? Demographers are uncertain about how community characteristics improve our understanding of an individual's propensity to migrate, beyond individual and household factors. In many low and middle-income country settings, youth become migrants for the first time in their lives to provide access to resources that their families need. We employ discrete-time event history models from the 20032011 Agincourt Health and socio-Demographic Surveillance System in rural South Africa to test whether markers of development in a village are associated with the likelihood of youth and young adults migrating, distinguishing between becoming temporary and permanent migrants during this critical life cycle phase. We find that village characteristics indeed differentially predict migration, but not nearly as substantially as might be expected.
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Affiliation(s)
- Tyler W Myroniuk
- (1) George Mason University, Department of Sociology and Anthropology
| | - Michael J White
- (1) Brown University, Population Studies and Training Center, Department of Sociology
| | - Mark Gross
- (1) Cabrini University, Sociology and Criminology Department
| | - Rebecca Wang
- (1) Brown University, Population Studies and Training Center, Department of Sociology
| | - Carren Ginsburg
- (1) MRC/ Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Mark Collinson
- (1) MRC/ Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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24
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Ralston M, Schatz E, Menken J, Gómez-Olivé FX, Tollman S. Policy Shift: South Africa's Old Age Pensions' Influence on Perceived Quality of Life. J Aging Soc Policy 2018; 31:138-154. [PMID: 30474517 DOI: 10.1080/08959420.2018.1542243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Noncontributory pensions serve as an important resource for poverty-affected households in low- and middle-income countries. This study explores how a recent policy change to pension receipt influences perceived quality of life among older South Africans. We use survey data from the longitudinal World Health Organization Study on global AGEing and adult health and from the Agincourt Health and Socio-Demographic Surveillance System census. We find pension receipt to have a positive impact on both men's and women's perceived quality of life. These findings hold when controlling for prior well-being status. We find a significant moderating factor of physical limitations on the relationship between pension receipt and quality of life. Individuals reporting the highest levels of physical limitation report a larger increase in their quality of life upon pension receipt than those with less severe physical limitations. We conclude that despite the well-documented household income-pooling in this population, pension receipt still leads to a significant positive impact on pensioners' perceived quality of life.
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Affiliation(s)
- Margaret Ralston
- a Department of Sociology , Mississippi State University , Mississippi , Mississippi State , USA
| | - Enid Schatz
- b Departments of Health Sciences, and Women's & Gender Studies , University of Missouri , Columbia , Missouri , USA.,c MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Jane Menken
- c MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,d CU Population Center, Institute of Behavioral Science , University of Colorado , Boulder , Colorado , USA
| | - Francesc Xavier Gómez-Olivé
- c MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Stephen Tollman
- c MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,e INDEPTH Network , Accra , Ghana
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Abstract
The connection between migration and health has long been established, but relatively little is known about this relationship for older persons, particularly in sub-Saharan Africa (SSA). In this paper, we examine migration selection with regards to health status among older individuals in Malawi, by testing whether older migrants differ from non-migrants in health status before migration. To do so, we use data from the Malawi Longitudinal Study of Families and Health, a longitudinal panel dataset that includes a relatively large number of individuals at older ages. We focus on three measures: mental health, physical health, and HIV status. We find that the relationship between migration and health selection differs by gender. Older women who are HIV-positive are nearly 10 times more likely to migrate compared to their HIV-negative counterparts. For men, those with better mental health are less likely to migrate in the future. These results suggest that, although research in some settings shows that migrants have better health before moving, some older migrants have worse health than their non-migrant peers, and may, therefore, add to the already-heavy burden on rural health centres in Africa.
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Affiliation(s)
- Jacob Kendall
- Social Work Department, Taylor University, 236 W Reade Avenue, Upland, IN 46989, 765-998-5353,
| | - Philip Anglewicz
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, 504-988-7324,
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Anglewicz P, VanLandingham M, Manda-Taylor L, Kohler HP. Health Selection, Migration, and HIV Infection in Malawi. Demography 2018; 55:979-1007. [PMID: 29704193 PMCID: PMC5993628 DOI: 10.1007/s13524-018-0668-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite its importance in studies of migrant health, selectivity of migrants-also known as migration health selection-has seldom been examined in sub-Saharan Africa (SSA). This neglect is problematic because several features of the context in which migration occurs in SSA-very high levels of HIV, in particular-differ from contextual features in regions that have been studied more thoroughly. To address this important gap, we use longitudinal panel data from Malawi to examine whether migrants differ from nonmigrants in pre-migration health, assessed via SF-12 measures of mental and physical health. In addition to overall health selection, we focus on three more-specific factors that may affect the relationship between migration and health: (1) whether migration health selection differs by destination (rural-rural, rural-town, and rural-urban), (2) whether HIV infection moderates the relationship between migration and health, and (3) whether circular migrants differ in pre-migration health status. We find evidence of the healthy migrant phenomenon in Malawi, where physically healthier individuals are more likely to move. This relationship varies by migration destination, with healthier rural migrants moving to urban and other rural areas. We also find interactions between HIV-infected status and health: HIV-infected women moving to cities are physically healthier than their nonmigrant counterparts.
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Affiliation(s)
- Philip Anglewicz
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street Suite 2210, New Orleans, LA, 70112, USA.
| | - Mark VanLandingham
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street Suite 2210, New Orleans, LA, 70112, USA
| | - Lucinda Manda-Taylor
- Malawi College of Medicine, John Chiphangwi Learning Resource Centre, University of Malawi, 3rd Floor, Private Bag 360, Chichiri Blantyre 3, Malawi
| | - Hans-Peter Kohler
- Department of Sociology and Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA, 19104-6299, USA
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Garenne M, Collinson MA, Kabudula CW, Gómez-Olivé FX, Kahn K, Tollman S. Improving completeness of birth and death registration in rural Africa. LANCET GLOBAL HEALTH 2018; 4:e604-5. [PMID: 27539803 DOI: 10.1016/s2214-109x(16)30146-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/29/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Michel Garenne
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France; Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France.
| | - Mark A Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Morris-Paxton AA, Rheeder P, Ewing RMG, Woods D. Detection, referral and control of diabetes and hypertension in the rural Eastern Cape Province of South Africa by community health outreach workers in the rural primary healthcare project: Health in Every Hut. Afr J Prim Health Care Fam Med 2018; 10:e1-e8. [PMID: 29781685 PMCID: PMC5913786 DOI: 10.4102/phcfm.v10i1.1610] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/03/2017] [Accepted: 11/09/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-communicable diseases, mainly cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, are responsible for approximately 63% of all deaths occurring worldwide in any given year. The majority of these deaths have occurred in low- and middle-income countries (LMICs). The latest World Health Organization (WHO) report shows that the increase in diabetes is also most pronounced in the LMICs. The South African Labour and Development Research Unit estimated a 9% prevalence within the adult population in 2016. In the Eastern Cape Province, hypertensive heart disease has become the second most common cause of death, followed by diabetes, the third most common cause of death.Aim and setting: The aim of this study was to report on the follow-up of patients in the community with known hypertension or diabetes or who were deemed at-risk (as identified during a prior community-wide survey). METHODS Data were collected via a household primary health screening, monitoring and follow-up process, which included taking anthropometric measurements, blood pressure (BP) and blood glucose and referring to clinics for further testing and treatment where necessary. RESULTS Of the 1885 participants followed up by the community health outreach workers, 1702 were known to be hypertensive and 183 were deemed at-risk [of these, only 24 (13.2%) had normal or high normal systolic BP readings]. There were 341 participants with diabetes and 34 at-risk of diabetes [of these, 28 (82%) had levels of 11 mmol/l or higher at follow-up]. There was a significant improvement in BP and glucose control over repeated visits. CONCLUSION In this rural area of the Eastern Cape, South Africa, the follow-up of patients with hypertension or diabetes as well as those individuals at-risk adds value to hypertension and glucose control.
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Eyre RW, House T, Gómez-Olivé FX, Griffiths FE. Modelling fertility in rural South Africa with combined nonlinear parametric and semi-parametric methods. Emerg Themes Epidemiol 2018; 15:5. [PMID: 29507596 PMCID: PMC5833110 DOI: 10.1186/s12982-018-0073-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Central to the study of populations, and therefore to the analysis of the development of countries undergoing major transitions, is the calculation of fertility patterns and their dependence on different variables such as age, education, and socio-economic status. Most epidemiological research on these matters rely on the often unjustified assumption of (generalised) linearity, or alternatively makes a parametric assumption (e.g. for age-patterns). Methods We consider nonlinearity of fertility in the covariates by combining an established nonlinear parametric model for fertility over age with nonlinear modelling of fertility over other covariates. For the latter, we use the semi-parametric method of Gaussian process regression which is a popular methodology in many fields including machine learning, computer science, and systems biology. We applied the method to data from the Agincourt Health and Socio-Demographic Surveillance System, annual census rounds performed on a poor rural region of South Africa since 1992, to analyse fertility patterns over age and socio-economic status. Results We capture a previously established age-pattern of fertility, whilst being able to more robustly model the relationship between fertility and socio-economic status without unjustified a priori assumptions of linearity. Peak fertility over age is shown to be increasing over time, as well as for adolescents but not for those later in life for whom fertility is generally decreasing over time. Conclusions Combining Gaussian process regression with nonlinear parametric modelling of fertility over age allowed for the incorporation of further covariates into the analysis without needing to assume a linear relationship. This enabled us to provide further insights into the fertility patterns of the Agincourt study area, in particular the interaction between age and socio-economic status.
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Affiliation(s)
- Robert W Eyre
- 1Centre for Complexity Science, University of Warwick, Coventry, CV4 7AL UK
| | - Thomas House
- 2School of Mathematics, University of Manchester, Manchester, M13 9PL UK
| | - F Xavier Gómez-Olivé
- 3Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances E Griffiths
- 4Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK.,5Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
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Hullur N, D'Ambruoso L, Edin K, Wagner RG, Ngobeni S, Kahn K, Tollman S, Byass P. Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study. J Glob Health 2018; 6:010406. [PMID: 27231542 PMCID: PMC4871061 DOI: 10.7189/jogh.06.010406] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND South Africa faces a complex burden of disease consisting of infectious and non-communicable conditions, injury and interpersonal violence, and maternal and child mortality. Inequalities in income and opportunity push disease burdens towards vulnerable populations, a situation to which the health system struggles to respond. There is an urgent need for health planning to account for the needs of marginalized groups in this context. The study objectives were to develop a process to elicit the perspectives of local communities in the established Agincourt health and socio-demographic surveillance site (HDSS) in rural north-east South Africa on two leading causes of death: HIV/AIDS and violent assault, and on health surveillance as a means to generate information on health in the locality. METHODS Drawing on community-based participatory research (CBPR) methods, three village-based groups of eight participants were convened, with whom a series of discussions were held to identify and define the causes of, treatments for, and problems surrounding, deaths due to HIV/AIDS and violent assault. The surveillance system was also discussed and recommendations generated. The discussion narratives were the main data source, examined using framework analysis. RESULTS The groups identified a range of social and health systems issues including risky sexual health behaviors, entrenched traditional practices, alcohol and substance abuse, unstable relationships, and debt as causative. Participants also explained how compromised patient confidentiality in clinics, insensitive staff, and a biased judicial system were problematic for the treatment and reporting of both conditions. Views on health surveillance were positive. Recommendations to strengthen an already well-functioning system related to maintaining confidentiality and sensitivity, and extending ancillary care obligations. CONCLUSION The discussions provided information not available from other sources on the social and health systems processes through which access to good quality health care is constrained in this setting. On this basis, further CBPR in routine HDSS to extend partnerships between researchers, communities and health authorities to connect evidence with the means for action is underway.
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Affiliation(s)
- Nitya Hullur
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Lucia D'Ambruoso
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kerstin Edin
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan G Wagner
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sizzy Ngobeni
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH - An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Stephen Tollman
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH - An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Peter Byass
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Clark SJ, Wakefield J, McCormick T, Ross M. Hyak mortality monitoring system: innovative sampling and estimation methods - proof of concept by simulation. Glob Health Epidemiol Genom 2018; 3:e3. [PMID: 29868228 PMCID: PMC5870438 DOI: 10.1017/gheg.2017.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 01/21/2023] Open
Abstract
Traditionally health statistics are derived from civil and/or vital registration. Civil registration in low- to middle-income countries varies from partial coverage to essentially nothing at all. Consequently the state of the art for public health information in low- to middle-income countries is efforts to combine or triangulate data from different sources to produce a more complete picture across both time and space - data amalgamation. Data sources amenable to this approach include sample surveys, sample registration systems, health and demographic surveillance systems, administrative records, census records, health facility records and others. We propose a new statistical framework for gathering health and population data - Hyak - that leverages the benefits of sampling and longitudinal, prospective surveillance to create a cheap, accurate, sustainable monitoring platform. Hyak has three fundamental components: Data amalgamation: A sampling and surveillance component that organizes two or more data collection systems to work together: (1) data from HDSS with frequent, intense, linked, prospective follow-up and (2) data from sample surveys conducted in large areas surrounding the Health and Demographic Surveillance System (HDSS) sites using informed sampling so as to capture as many events as possible;Cause of death: Verbal autopsy to characterize the distribution of deaths by cause at the population level; andSocioeconomic status (SES): Measurement of SES in order to characterize poverty and wealth. We conduct a simulation study of the informed sampling component of Hyak based on the Agincourt HDSS site in South Africa. Compared with traditional cluster sampling, Hyak's informed sampling captures more deaths, and when combined with an estimation model that includes spatial smoothing, produces estimates of both mortality counts and mortality rates that have lower variance and small bias.
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Affiliation(s)
- S. J. Clark
- Department of Sociology, The Ohio State University, Columbus, Ohio, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- ALPHA Network, London, UK
| | - J. Wakefield
- Department of Statistics, University of Washington Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - T. McCormick
- Department of Statistics, University of Washington Seattle, Washington, USA
- Department of Sociology, University of Washington, Seattle, Washington, USA
| | - M. Ross
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sennott C, Reniers G, Gómez-Olivé FX, Menken J. Premarital Births and Union Formation in Rural South Africa. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 42:187-196. [PMID: 28825898 DOI: 10.1363/42e2716] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT In rural South Africa, women often delay union formation until they are in their late 20s, though premarital first births are common. METHODS Longitudinal data from the Agincourt Health and Socio-Demographic Surveillance System in rural South Africa were used to examine the relationship between premarital birth and union entry among 55,158 nonmigrant women aged 10-35 who took part in at least one annual census from 1993 to 2012. Discrete-time event history models were used to determine whether the likelihood of union formation differed between women who had had a premarital first birth and those who had not. Associations between single motherhood and union type (marriages or nonmarital partnerships) were identified using logistic regression. RESULTS Forty-five percent of women had had a premarital first birth and 25% had entered a first union. Women who had had a premarital first birth were less likely than other women to have entered a first union (odds ratio, 0.6). Women who had had a premarital birth in the past year were more likely than those without a premarital birth to have entered a union (1.5), but women had reduced odds of union formation if they had had a birth 1-2 years earlier (0.9) or at least five years earlier (0.8). Unions formed within two years of a premarital birth had an elevated likelihood of being nonmarital partnerships (1.2-1.4). CONCLUSIONS Single motherhood is common in the Agincourt HDSS, and women with a premarital first birth face challenges in establishing committed unions with partners.
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Affiliation(s)
- Christie Sennott
- assistant professor, Department of Sociology, Purdue University, West Lafayette, IN, USA; and visiting researcher, MRC/Wits Rural Public Health and Health Transitions Research Unit, University of the Witwatersrand, Johannesburg, South Africa,
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Ameh S, Klipstein-Grobusch K, D'ambruoso L, Kahn K, Tollman SM, Gómez-Olivé FX. Quality of integrated chronic disease care in rural South Africa: user and provider perspectives. Health Policy Plan 2018; 32:257-266. [PMID: 28207046 PMCID: PMC5400067 DOI: 10.1093/heapol/czw118] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 11/12/2022] Open
Abstract
The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model. In 2013, we conducted a case study of the seven PHC facilities in the rural Agincourt sub-district in northeast South Africa. Focus group discussions (n = 8) were used to obtain data from 56 purposively selected patients ≥18 years. In-depth interviews were conducted with operational managers of each facility and the sub-district health manager. Donabedian’s structure, process and outcome theory for service quality evaluation underpinned the conceptual framework in this study. Qualitative data were analysed, with MAXQDA 2 software, to identify 17 a priori dimensions of care and unanticipated themes that emerged during the analysis. The manager and patient narratives showed the inadequacies in structure (malfunctioning blood pressure machines and staff shortage); process (irregular prepacking of drugs); and outcome (long waiting times). There was discordance between managers and patients regarding reasons for long patient waiting time which managers attributed to staff shortage and missed appointments, while patients ascribed it to late arrival of managers to the clinics. Patients reported anti-hypertension drug stock-outs (structure); sub-optimal defaulter-tracing (process); rigid clinic appointment system (process). Emerging themes showed that patients reported HIV stigmatisation in the community due to defaulter-tracing activities of home-based carers, while managers reported treatment of chronic diseases by traditional healers and reduced facility-related HIV stigma because HIV and NCD patients attended the same clinic. Leveraging elements of HIV programmes for NCDs, specifically hypertension management, is yet to be achieved in the study setting in part because of malfunctioning blood pressure machines and anti-hypertension drug stock-outs. This has implications for the nationwide scale up of the ICDM model in South Africa and planning of an integrated chronic disease care in other low- and middle-income countries.
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Affiliation(s)
- Soter Ameh
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Kerstin Klipstein-Grobusch
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lucia D'ambruoso
- Institute of Applied Health Sciences and Centre for Sustainable International Development University of Aberdeen, UK
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana,Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Stephen M Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana,Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana
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Dietary Habits and Eating Practices and Their Association with Overweight and Obesity in Rural and Urban Black South African Adolescents. Nutrients 2018; 10:nu10020145. [PMID: 29382137 PMCID: PMC5852721 DOI: 10.3390/nu10020145] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to investigate differences/similarities in dietary habits and eating practices between younger and older, rural and urban South African adolescents in specific environments (home, community and school) and their associations with overweight and obesity. Dietary habits, eating practices, and anthropometric measurements were performed on rural (n = 392, mean age = 13 years) and urban (n = 3098, mean age = 14 years) adolescents. Logistic regression analysis was used to examine the associations between dietary habits and eating practices, with overweight and obesity risk. Differences in dietary habits and eating practices by gender and by site within the three environments were identified. After adjusting for gender, site, dietary habits, and eating practices within the home, community and school environment, eating the main meal with family some days (OR = 1.78, 95% CI = 1.114-2.835; p ≤ 0.02), eating the main meal with family almost every day (OR = 1.61, 95% CI = 1.106-2.343; p ≤ 0.01), and irregular frequency of consuming breakfast on weekdays (OR = 1.38, 95% CI = 1.007-1.896; p ≤ 0.05) were all associated with increased risk of overweight and obesity. For "Year 15" adolescents, irregular frequency of consuming breakfast on weekends within the home environment (OR = 1.53, 95% CI = 1.099-2.129, p ≤ 0.01), was associated with increased risk of overweight and obesity. For both early- and mid-adolescents, being male (OR = 0.401, 95% CI = 0.299-0.537; p ≤ 0.00; OR = 0.29, 95% CI = 0.218-0.397; p ≤ 0.00) was associated with reduced risk of overweight and obesity, while residing in a rural setting (OR = 0.55, 95% CI = 0.324-0.924; p ≤ 0.02) was associated with reduced risk of overweight and obesity only among early-adolescents. Only dietary habits and eating practices within the home environment were associated with increased risk of overweight and obesity.
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Rheeder P, Morris-Paxton AA, Ewing RMG, Woods D. The noncommunicable disease outcomes of primary healthcare screening in two rural subdistricts of the Eastern Cape Province, South Africa. Afr J Prim Health Care Fam Med 2017; 9:e1-e7. [PMID: 29113445 PMCID: PMC5675926 DOI: 10.4102/phcfm.v9i1.1466] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Middle and lower income countries are challenged with a double burden of disease: while still coping with the onslaught of Human Immunodeficiency Virus (HIV) and increasing levels of tuberculosis (TB), there is a considerable increase in the level of noncommunicable diseases (NCDs). The poor are especially disadvantaged and are at an increased risk for NCDs. Adequate healthcare resources for this environment can only be allocated once the extent and exact nature of the problem is determined.Aim and setting: The aim of this study was to collect demographic and NCD-related data in the poorest community of the poorest province of South Africa in order to determine the extent of the problem and advise on allocation of resources accordingly. METHODS Data were collected via a household primary health screening process, which included taking anthropometric measurements, blood pressure and blood glucose and referring to clinics for further testing and treatment where necessary. RESULTS It was found that the population screened was generally older, consisted of women, and had a high incidence of obesity and hypertension. Of note was the fact that in those without known hypertension, close to 40% of individuals had possible newly diagnosed hypertension. This increased with increase in age and body mass index (BMI). The total prevalence of diabetes was close to 5%, but possible new diabetes was considerably lower at approximately 1%. CONCLUSION In this rural area of the Eastern Cape, South Africa, undiagnosed hypertension is a major concern and renewed efforts at detection and control are warranted.
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Affiliation(s)
- Paul Rheeder
- Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria.
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Stoner MCD, Pettifor A, Edwards JK, Aiello AE, Halpern CT, Julien A, Selin A, Twine R, Hughes JP, Wang J, Agyei Y, Gomez-Olive FX, Wagner RG, MacPhail C, Kahn K. The effect of school attendance and school dropout on incident HIV and HSV-2 among young women in rural South Africa enrolled in HPTN 068. AIDS 2017; 31:2127-2134. [PMID: 28692544 PMCID: PMC5599334 DOI: 10.1097/qad.0000000000001584] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the association between school attendance, school dropout, and risk of incident HIV and herpes simplex virus type 2 (HSV-2) infection among young women. DESIGN We used longitudinal data from a randomized controlled trial in rural Mpumalanga province, South Africa, to assess the association between school days attended, school dropout, and incident HIV and HSV-2 in young women aged 13-23 years. METHODS We examined inverse probability of exposure weighted survival curves and used them to calculate 1.5, 2.5, and 3.5-year risk differences and risk ratios for the effect of school attendance on incident HIV and HSV-2. A marginal structural Cox model was used to estimate hazard ratios for the effect of school attendance and school dropout on incident infection. RESULTS Risk of infection increased over time as young women aged, and was higher in young women with low school attendance (<80% school days) compared with high (≥80% school days). Young women with low attendance were more likely to acquire HIV [hazard ratio (HR): 2.97; 95% confidence interval (CI): 1.62, 5.45] and HSV-2 (HR: 2.47; 95% CI: 1.46, 4.17) over the follow-up period than young women with high attendance. Similarly, young women who dropped out of school had a higher weighted hazard of both HIV (HR 3.25 95% CI: 1.67, 6.32) and HSV-2 (HR 2.70; 95% CI 1.59, 4.59). CONCLUSION Young women who attend more school days and stay in school have a lower risk of incident HIV and HSV-2 infection. Interventions to increase frequency of school attendance and prevent dropout should be promoted to reduce risk of infection.
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Affiliation(s)
- Marie C D Stoner
- aDepartment of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA bMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa cDepartment of Maternal and Child Health, University of North Carolina, Chapel Hill, North Carolina, USA dEpidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden eDepartment of Biostatistics, University of Washington fFred Hutchinson Cancer Research Center, Seattle, Washington gDepartment of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA hINDEPTH Network, Accra, Ghana, West Africa iSchool of Health and Society, University of Wollongong, New South Wales, Australia jWits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa
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Twine R, Hundt GL, Kahn K. The 'experimental public' in longitudinal health research: views of local leaders and service providers in rural South Africa. Glob Health Res Policy 2017; 2:26. [PMID: 29202094 PMCID: PMC5683227 DOI: 10.1186/s41256-017-0046-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/28/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The concept of 'experimental public' has been recently applied to publics involved in clinical trials. This term could also be applied to publics involved in longitudinal research such as health and demographic surveillance systems. The ethics of practice and public engagement with these experimental publics are of key importance and include issues of informed consent, confidentiality, collection of body tissue samples and fair local benefit. METHODS Individual (n = 11) and focus group (n = 5) qualitative semi-structured interviews were conducted with 56 local leaders and service providers regarding their views about research activities in a longitudinal health research study site run by the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) in rural South Africa. Deductive and inductive thematic analysis was undertaken using NVivo software to identify the emergent themes. RESULTS There was an understanding of the usefulness of collecting demographic data, but reasons for gathering other contextual data such as on food security, as well as the reasons for collection of blood was less clear. While appreciation was expressed for feedback of individual results such as blood pressure levels during home-based data collection, there were requests for more results from biomarkers, and for these to be given at home, rather than at the clinic. There were reports of indirect refusals, and offers by leaders to assist in reducing refusal rates. There were concerns about confidentiality, especially in the publication of results. Some leaders would have liked to receive more individual level data for planning of services, although they understood this would breach confidentiality. Service providers were concerned about the withdrawal of some services post intervention trials. CONCLUSIONS This experimental public has, over time, developed a nuanced understanding of the reasons for research and the procedures undertaken. Discussions concerning fair benefit ranged from requests for more individual clinically-relevant results for participants, to understanding how research results could assist in planning of public health services at local and national levels. The concerns illustrate the complexity of the ethics of practice which has implications for policy, practice and governance for those working in longitudinal health research sites globally.
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Affiliation(s)
- Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gillian Lewando Hundt
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Kabudula CW, Houle B, Collinson MA, Kahn K, Gómez-Olivé FX, Tollman S, Clark SJ. Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001-13: a population surveillance analysis. Lancet Glob Health 2017; 5:e924-e935. [PMID: 28807190 PMCID: PMC5559644 DOI: 10.1016/s2214-109x(17)30297-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/27/2017] [Accepted: 07/06/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Understanding the effects of socioeconomic disparities in health outcomes is important to implement specific preventive actions. We assessed socioeconomic disparities in mortality indicators in a rural South African population over the period 2001-13. METHODS We used data from 21 villages of the Agincourt Health and socio-Demographic Surveillance System (HDSS). We calculated the probabilities of death from birth to age 5 years and from age 15 to 60 years, life expectancy at birth, and cause-specific and age-specific mortality by sex (not in children <5 years), time period, and socioeconomic status (household wealth) quintile for HIV/AIDS and tuberculosis, other communicable diseases (excluding HIV/AIDS and tuberculosis) and maternal, perinatal, and nutritional causes, non-communicable diseases, and injury. We also quantified differences with relative risk ratios and relative and slope indices of inequality. FINDINGS Between 2001 and 2013, 10 414 deaths were registered over 1 058 538 person-years of follow-up, meaning the overall crude mortality was 9·8 deaths per 1000 person-years. We found significant socioecomonic status gradients for mortality and life expectancy at birth, with outcomes improving with increasing socioeconomic status. An inverse relation was seen for HIV/AIDS and tuberculosis mortality and socioeconomic status that persisted from 2001 to 2013. Deaths from non-communicable diseases increased over time in both sexes, and injury was an important cause of death in men and boys. Neither of these causes of death, however, showed consistent significant associations with household socioeconomic status. INTERPRETATION The poorest people in the population continue to bear a high burden of HIV/AIDS and tuberculosis mortality, despite free antiretroviral therapy being made available from public health facilities. Associations between socioeconomic status and increasing burden of mortality from non-communicable diseases is likely to become prominent. Integrated strategies are needed to improve access to and uptake of HIV testing, care, and treatment, and management of non-communicable diseases in the poorest populations. FUNDING Wellcome Trust, South African Medical Research Council, and University of the Witwatersrand, South Africa.
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Affiliation(s)
- Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Demography, Australian National University, Canberra, ACT, Australia; CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA
| | - Mark A Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Department of Science and Technology/Medical Research Council, South African Population Research Infrastructure Network (SAPRIN), Acornhoek, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Samuel J Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA; INDEPTH Network, Accra, Ghana; Department of Sociology, The Ohio State University, Columbus, OH, USA
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Space-time variations in child mortality in a rural South African population with high HIV prevalence (2000-2014). PLoS One 2017; 12:e0182478. [PMID: 28837576 PMCID: PMC5570377 DOI: 10.1371/journal.pone.0182478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 07/19/2017] [Indexed: 11/19/2022] Open
Abstract
Objective The aim of the study was to identify the key determinants of child mortality ‘hot-spots’ in space and time. Methods Comprehensive population-based mortality data collected between 2000 and 2014 by the Africa Centre Demographic Information System located in the UMkhanyakude District of KwaZulu-Natal Province, South Africa, was analysed. We assigned all mortality events and person-time of observation for children <5 years of age to an exact homestead of residence (mapped to <2m accuracy as part of the DSA platform). Using these exact locations, both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection were used to identify clusters of childhood mortality events in both space and time. Findings Of the 49 986 children aged < 5 years who resided in the study area between 2000 and 2014, 2010 (4.0%) died. Childhood mortality decreased by 80% over the period from >20 per 1000 person-years in 2001–2003 to 4 per 1000 person-years in 2014. The two scanning spatial techniques identified two high-risk clusters for child mortality along the eastern border of the study site near the national highway, with a relative risk of 2.10 and 1.91 respectively. Conclusions The high-risk communities detected in this work, and the differential risk factor profile of these communities, can assist public health professionals to identify similar populations in other parts of rural South Africa. Identifying child mortality hot-spots will potentially guide policy interventions in rural, resource-limited settings.
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Ranganathan M, MacPhail C, Pettifor A, Kahn K, Khoza N, Twine R, Watts C, Heise L. Young women's perceptions of transactional sex and sexual agency: a qualitative study in the context of rural South Africa. BMC Public Health 2017; 17:666. [PMID: 28830394 PMCID: PMC5568133 DOI: 10.1186/s12889-017-4636-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 07/26/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Evidence shows that HIV prevalence among young women in sub-Saharan Africa increases almost five-fold between ages 15 and 24, with almost a quarter of young women infected by their early-to mid-20s. Transactional sex or material exchange for sex is a relationship dynamic that has been shown to have an association with HIV infection. METHODS Using five focus group discussions and 19 in-depth interviews with young women enrolled in the HPTN 068 conditional cash transfer trial (2011-2015), this qualitative study explores young women's perceptions of transactional sex within the structural and cultural context of rural South Africa. The analysis also considers the degree to which young women perceive themselves as active agents in such relationships and whether they recognise a link between transactional sex and HIV risk. RESULTS Young women believe that securing their own financial resources will ultimately improve their bargaining position in their sexual relationships, and open doors to a more financially independent future. Findings suggest there is a nuanced relationship between sex, love and gifts: money has symbolic meaning, and money transfers, when framed as gifts, indicates a young woman's value and commitment from the man. This illustrates the complexity of transactional sex; the way it is positioned in the HIV literature ignores that "exchanges" serve as fulcrums around which romantic relationships are organised. Finally, young women express agency in their choice of partner, but their agency weakens once they are in a relationship characterised by exchange, which may undermine their ability to translate perceived agency into STI and HIV risk reduction efforts. CONCLUSIONS This research underscores the need to recognise that transactional sex is embedded in adolescent romantic relationships, but that certain aspects make young women particularly vulnerable to HIV. This is especially true in situations of restricted choice and circumscribed employment opportunities. HIV prevention educational programmes could be coupled with income generation trainings, in order to leverage youth resilience and protective skills within the confines of difficult economic and social circumstances. This would provide young women with the knowledge and means to more successfully navigate safer sexual relationships.
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Affiliation(s)
- Meghna Ranganathan
- Department of Global Health and Development, Faculty of Public Health and Policy, The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
- MRC/Wits Rural Public Health and Health Transitions Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health & Society, University of Wollongong, Wollongong, NSW Australia
| | - Audrey Pettifor
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
- MRC/Wits Rural Public Health and Health Transitions Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - Nomhle Khoza
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charlotte Watts
- Department of Global Health and Development, Faculty of Public Health and Policy, The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Lori Heise
- Department of Global Health and Development, Faculty of Public Health and Policy, The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Sennott C, Mojola S. 'Behaving well': the transition to respectable womanhood in rural South Africa. CULTURE, HEALTH & SEXUALITY 2017; 19:781-795. [PMID: 27931171 PMCID: PMC5769451 DOI: 10.1080/13691058.2016.1262062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Few studies of the transition to adulthood in Africa analyse young people's own definitions of the events that confer adult status, and how adulthood is actually attained. This paper examines the experience of transitioning to womanhood in rural Mpumalanga Province, South Africa, drawing on interviews with 18 women aged 18-39. Three primary experiences characterised this transition: puberty and emerging body awareness, spending time with boys, and having a child. More important than the timing of these experiences, however, was whether women 'behaved well' and maintained respectability as they transitioned to adulthood. Behavioural standards reinforcing ideal femininity were focused on dress, manner and talk, and were particularly stringent for mothers. Findings emphasise the value of emic models of adulthood for understanding how youth experience this transition and provide an important counter-narrative to the literature focused primarily on the risk African youth face during this period of change in the life course.
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Affiliation(s)
- Christie Sennott
- Department of Sociology, Purdue University, IN, USA
- Department of Sociology, Purdue University, IN, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanyu Mojola
- Department of Sociology and Institute of Behavioral Science, University of Colorado Boulder, USA
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Anglewicz P, VanLandingham M, Manda-Taylor L, Kohler HP. Cohort profile: internal migration in sub-Saharan Africa-The Migration and Health in Malawi (MHM) study. BMJ Open 2017; 7:e014799. [PMID: 28515195 PMCID: PMC5541335 DOI: 10.1136/bmjopen-2016-014799] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The Migration and Health in Malawi (MHM) study focuses on a key challenge in migration research: although it has long been established that migration and health are closely linked, identifying the effect of migration on various health outcomes is complicated by methodological challenges. The MHM study uses a longitudinal panel premigration and postmigration study design (with a non-migrant comparison group) to measure and/or control for important characteristics that affect both migration and health outcomes. PARTICIPANTS Data are available for two waves. The MHM interviewed 398 of 715 migrants in 2007 (55.7%) and 722 of 1013 in 2013 (71.3%); as well as 604 of 751 (80.4%) for a non-migrant reference group in 2013. The total interviewed sample size for the MHM in both waves is 1809. These data include extensive information on lifetime migration, socioeconomic and demographic characteristics, sexual behaviours, marriage, household/family structure, social networks and social capital, HIV/AIDS biomarkers and other dimensions of health. FINDINGS TO DATE Our result for the relationship between migration and health differs by health measure and analytic approach. Migrants in Malawi have a significantly higher HIV prevalence than non-migrants, which is primarily due to the selection of HIV-positive individuals into migration. We find evidence for health selection; physically healthier men and women are more likely to move, partly because migration selects younger individuals. However, we do not find differences in physical or mental health between migrants and non-migrants after moving. FUTURE PLANS We are preparing a third round of data collection for these (and any new) migrants, which will take place in 2018. This cohort will be used to examine the effect of migration on various health measures and behaviours, including general mental and physical health, smoking and alcohol use, access to and use of health services and use of antiretroviral therapy.
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Affiliation(s)
- Philip Anglewicz
- Department of Global Community Health and Behavioral Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Mark VanLandingham
- Department of Global Community Health and Behavioral Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | - Hans-Peter Kohler
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kabudula CW, Houle B, Collinson MA, Kahn K, Gómez-Olivé FX, Clark SJ, Tollman S. Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993-2013. BMC Public Health 2017; 17:424. [PMID: 28486934 PMCID: PMC5424387 DOI: 10.1186/s12889-017-4312-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/26/2017] [Indexed: 01/16/2023] Open
Abstract
Background Virtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population. Methods We estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993–2013. Results From the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males. Conclusions This typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact on continued progress in reducing preventable mortality and improving health across the life course. Integrated healthcare planning and program delivery is required to improve access and adherence for HIV and non-communicable disease treatment. These findings from a local, rural setting over an extended period contribute to the evidence needed to inform further refinement and advancement of epidemiological transition theory. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4312-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Demography, The Australian National University, Canberra, Australia.,CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA
| | - Mark A Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana.,Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana.,Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Samuel J Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA.,INDEPTH Network, Accra, Ghana.,Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana.,Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Economic Resources and HIV Preventive Behaviors Among School-Enrolled Young Women in Rural South Africa (HPTN 068). AIDS Behav 2017; 21:665-677. [PMID: 27260180 DOI: 10.1007/s10461-016-1435-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Individual economic resources may have greater influence on school-enrolled young women's sexual decision-making than household wealth measures. However, few studies have investigated the effects of personal income, employment, and other financial assets on young women's sexual behaviors. Using baseline data from the HIV Prevention Trials Network (HPTN) 068 study, we examined the association of ever having sex and adopting sexually-protective practices with individual-level economic resources among school-enrolled women, aged 13-20 years (n = 2533). Age-adjusted results showed that among all women employment was associated with ever having sex (OR 1.56, 95 % CI 1.28-1.90). Among sexually-experienced women, paid work was associated with changes in partner selection practices (OR 2.38, 95 % CI 1.58-3.58) and periodic sexual abstinence to avoid HIV (OR 1.71, 95 % CI 1.07-2.75). Having money to spend on oneself was associated with reducing the number of sexual partners (OR 1.94, 95 % CI 1.08-3.46), discussing HIV testing (OR 2.15, 95 % CI 1.13-4.06), and discussing condom use (OR 1.99, 95 % CI 1.04-3.80). Having a bank account was associated with condom use (OR 1.49, 95 % CI 1.01-2.19). Economic hardship was positively associated with ever having sex, but not with sexually-protective behaviors. Maximizing women's individual economic resources may complement future prevention initiatives.
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Wilkinson A, Pettifor A, Rosenberg M, Halpern C, Thirumurthy H, Collinson MA, Kahn K. The employment environment for youth in rural South Africa: A mixed-methods study. DEVELOPMENT SOUTHERN AFRICA 2017; 34:17-32. [PMID: 28190915 PMCID: PMC5300739 DOI: 10.1080/0376835x.2016.1259986] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
South Africa has high youth unemployment. This paper examines the predictors of youth employment in rural Agincourt, Mpumalanga Province. A survey of 187 out-of-school 18-24 year olds found only 12% of women and 38% of men were currently employed. Men with skills/training were significantly more likely to report employment, mostly physical labour (aOR: 4.5; CI: 1.3, 15.3). In-depth interviews with 14 of the youth revealed women are perceived more suitable for formal employment, which is scarce informing why women were more likely to pursue further education and yet less likely to be employed. Ten key informants from local organisations highlighted numerous local youth employment resources while, in contrast, all youth in the sample said no resources were available, highlighting a need for the organisations to extend their services into rural areas. As these services are focused on entrepreneurship, programs to increase financial literacy and formal employment opportunities are also needed.
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Affiliation(s)
- Andra Wilkinson
- Carolina Population Center, 206 W. Franklin St., Room 208, Chapel Hill, North Carolina, 27516, USA; Department of Maternal and Child Health Department, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7445 Chapel Hill, North Carolina, 27599-7445, USA
| | - Audrey Pettifor
- Carolina Population Center, 206 W. Franklin St., Room 208, Chapel Hill, North Carolina, 27516, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7435, Chapel Hill, North Carolina, 27599-7435, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Faculty of Health Sciences, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
| | - Molly Rosenberg
- Carolina Population Center, 206 W. Franklin St., Room 208, Chapel Hill, North Carolina, 27516, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7435, Chapel Hill, North Carolina, 27599-7435, USA
| | - Carolyn Halpern
- Carolina Population Center, 206 W. Franklin St., Room 208, Chapel Hill, North Carolina, 27516, USA; Department of Maternal and Child Health Department, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7445 Chapel Hill, North Carolina, 27599-7445, USA
| | - Harsha Thirumurthy
- Carolina Population Center, 206 W. Franklin St., Room 208, Chapel Hill, North Carolina, 27516, USA; Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411 Chapel Hill, North Carolina, 27599-7411, USA
| | - Mark A Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Faculty of Health Sciences, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa; Centre for Global Health Research, Umeå University, SE-901 87, Umeå, Sweden; Indepth Network, P.O. Box KD 213, Accra, Ghana
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Faculty of Health Sciences, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa; Centre for Global Health Research, Umeå University, SE-901 87, Umeå, Sweden; Indepth Network, P.O. Box KD 213, Accra, Ghana
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Mukasa O, Mushi HP, Maire N, Ross A, de Savigny D. Do surveys with paper and electronic devices differ in quality and cost? Experience from the Rufiji Health and demographic surveillance system in Tanzania. Glob Health Action 2017; 10:1387984. [PMID: 29157182 PMCID: PMC5700525 DOI: 10.1080/16549716.2017.1387984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 10/02/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Data entry at the point of collection using mobile electronic devices may make data-handling processes more efficient and cost-effective, but there is little literature to document and quantify gains, especially for longitudinal surveillance systems. OBJECTIVE To examine the potential of mobile electronic devices compared with paper-based tools in health data collection. METHODS Using data from 961 households from the Rufiji Household and Demographic Survey in Tanzania, the quality and costs of data collected on paper forms and electronic devices were compared. We also documented, using qualitative approaches, field workers, whom we called 'enumerators', and households' members on the use of both methods. Existing administrative records were combined with logistics expenditure measured directly from comparison households to approximate annual costs per 1,000 households surveyed. RESULTS Errors were detected in 17% (166) of households for the paper records and 2% (15) for the electronic records (p < 0.001). There were differences in the types of errors (p = 0.03). Of the errors occurring, a higher proportion were due to accuracy in paper surveys (79%, 95% CI: 72%, 86%) compared with electronic surveys (58%, 95% CI: 29%, 87%). Errors in electronic surveys were more likely to be related to completeness (32%, 95% CI 12%, 56%) than in paper surveys (11%, 95% CI: 7%, 17%).The median duration of the interviews ('enumeration'), per household was 9.4 minutes (90% central range 6.4, 12.2) for paper and 8.3 (6.1, 12.0) for electronic surveys (p = 0.001). Surveys using electronic tools, compared with paper-based tools, were less costly by 28% for recurrent and 19% for total costs. Although there were technical problems with electronic devices, there was good acceptance of both methods by enumerators and members of the community. CONCLUSIONS Our findings support the use of mobile electronic devices for large-scale longitudinal surveys in resource-limited settings.
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Affiliation(s)
- Oscar Mukasa
- Impact evaluation Thematic Section, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), University of Basel, Basel, Switzerland
| | - Hildegalda P. Mushi
- Impact evaluation Thematic Section, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Nicolas Maire
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), University of Basel, Basel, Switzerland
| | - Amanda Ross
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), University of Basel, Basel, Switzerland
| | - Don de Savigny
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), University of Basel, Basel, Switzerland
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Issaka AI, Agho KE, Renzaho AMN. The Impact of Internal Migration on under-Five Mortality in 27 Sub-Saharan African Countries. PLoS One 2016; 11:e0163179. [PMID: 27784029 PMCID: PMC5082597 DOI: 10.1371/journal.pone.0163179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022] Open
Abstract
Objective The literature on the impact of internal migration on under-five mortality in sub-Saharan Africa has been limited. This study examined the impact of internal migration on under-five mortality rate in 27 sub-Saharan African countries. Design The analysis used cross-sectional data from the most recent Demographic and Health Surveys of 27 sub-Saharan African countries. Information on the number of live births and the number of under-five deaths in the five years preceding the surveys in these countries was examined. Using variables from which migration data were generated, four migration statuses were computed, and the impact of each migration status on under-five mortality was analysed by using multivariate Cox proportional hazards regression models. Results Of the 96333 live births, 7036 deaths were reported. In the unadjusted model, we found that, compared to urban non-migrant mothers, hazard of under-five mortality was 20% [HR: 1.20; 95% confidence interval (CI): (1.06–1.35)], 40% [HR: 1.40; 95% CI: (1.29–1.53)], and 43% [HR: 1.43; 95% CI: (1.30–1.58)] higher among urban-rural migrant, rural non-migrant, and rural-urban migrant mothers respectively. The likelihood of children dying did not change considerably when country and demographic variables were adjusted for. However, after controlling for health care service utilization factors, the results remained consistently significant for rurality. That is, mortality rates remained significantly higher among children of rural non-migrant [(HR: 1.20; 95% CI: (1.08–1.33), P-value (p) < 0.001] and rural-urban migrant [HR: 1.29; 95% CI: (1.15–1.45), p < 0.001] mothers than those of urban non-migrant mothers. Conclusion Although under-five child mortality rate declined by 52% between 1990 and 2015 (from 179 to 86 per1000 live births) in sub-Saharan Africa, the continent still has the highest rate in the world. This finding highlights the need to consider providing education and health care services in rural areas, when implementing interventions meant to reduce under-five mortality rates among internal migrant mothers.
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Affiliation(s)
- Abukari I. Issaka
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
- * E-mail:
| | - Kingsley E. Agho
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Andre M. N. Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
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Garenne M, Collinson MA, Kabudula CW, Gómez-Olivé FX, Kahn K, Tollman S. Completeness of birth and death registration in a rural area of South Africa: the Agincourt health and demographic surveillance, 1992-2014. Glob Health Action 2016; 9:32795. [PMID: 27782873 PMCID: PMC5081031 DOI: 10.3402/gha.v9.32795] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/09/2016] [Accepted: 09/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background Completeness of vital registration remains very low in sub-Saharan Africa, especially in rural areas. Objectives To investigate trends and factors in completeness of birth and death registration in Agincourt, a rural area of South Africa covering a population of about 110,000 persons, under demographic surveillance since 1992. The population belongs to the Shangaan ethnic group and hosts a sizeable community of Mozambican refugees. Design Statistical analysis of birth and death registration over time in a 22-year perspective (1992–2014). Over this period, major efforts were made by the government of South Africa to improve vital registration. Factors associated with completeness of registration were investigated using univariate and multivariate analysis. Results Birth registration was very incomplete at onset (7.8% in 1992) and reached high values at end point (90.5% in 2014). Likewise, death registration was low at onset (51.4% in 1992), also reaching high values at end point (97.1% in 2014). For births, the main factors were mother's age (much lower completeness among births to adolescent mothers), refugee status, and household wealth. For deaths, the major factors were age at death (lower completeness among under-five children), refugee status, and household wealth. Completeness increased for all demographic and socioeconomic categories studied and is likely to approach 100% in the future if trends continue at this speed. Conclusion Reaching high values in the completeness of birth and death registration was achieved by excellent organization of the civil registration and vital statistics, a variety of financial incentives, strong involvement of health personnel, and wide-scale information and advocacy campaigns by the South African government.
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Affiliation(s)
- Michel Garenne
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France.,Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France.,FERDI, Université d'Auvergne, Clermont-Ferrand, France; /
| | - Mark A Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana.,Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana.,Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana.,Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Hussain-Alkhateeb L, Petzold M, Collinson M, Tollman S, Kahn K, Byass P. Effects of recall time on cause-of-death findings using verbal autopsy: empirical evidence from rural South Africa. Emerg Themes Epidemiol 2016; 13:10. [PMID: 27777600 PMCID: PMC5069872 DOI: 10.1186/s12982-016-0051-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Verbal autopsy (VA) is a widely used technique for assigning causes to non-medically certified deaths using information gathered from a close caregiver. Both operational and cultural factors may cause delays in follow-up of deaths. The resulting time lag-from death to VA interview-can influence ways in which terminal events are remembered, and thus affect cause-of-death assignment. This study investigates the impact of recall period on causes of death determined by VA. METHODS A total of 10,882 deaths from the Agincourt Health and Demographic Surveillance System (HDSS) with complete VAs, including recall period, were incorporated in this study. To measure seasonal effect, cause specific mortality fractions (CSMFs) were calculated and compared by every cause for VAs undertaken within six months of death and those undertaken from six to 12 months of death. All causes were classified into eight broad categories and entered in a multiple logistic regression to explore outcome by recall period in relation to covariates. RESULTS The majority of deaths (83 %) had VAs completed within 12 months. There was a tendency towards longer recall periods for deaths of those under one year or over 65 years of age. Only the acute respiratory, diarrhoeal and other unspecified non-communicable disease groups showed a CSMF ratio significantly different from unity at the 99 % confidence level between the two recall periods. Only neonatal deaths showed significantly different OR for recall exceeding 12 months (OR 1.69; p value = 0.004) and this increased when adjusting for background factors (OR 2.58; p value = 0.000). CONCLUSION A recall period of up to one year between death and VA interview did not have any consequential effects on the cause-of-death patterns derived, with the exception of neonatal causes. This is an important operational consideration given the planned widespread use of the VA approach in civil registration, HDSS sites and occasional surveys.
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Affiliation(s)
- Laith Hussain-Alkhateeb
- Health Metrics, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden
| | - Max Petzold
- Health Metrics, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden ; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Collinson
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Accra, Ghana ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Accra, Ghana ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; INDEPTH Network, Accra, Ghana ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Byass
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kabudula CW, Houle B, Collinson MA, Kahn K, Tollman S, Clark S. Assessing Changes in Household Socioeconomic Status in Rural South Africa, 2001-2013: A Distributional Analysis Using Household Asset Indicators. SOCIAL INDICATORS RESEARCH 2016; 133:1047-1073. [PMID: 28931968 PMCID: PMC5579134 DOI: 10.1007/s11205-016-1397-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/18/2016] [Indexed: 06/07/2023]
Abstract
Understanding the distribution of socioeconomic status (SES) and its temporal dynamics within a population is critical to ensure that policies and interventions adequately and equitably contribute to the well-being and life chances of all individuals. This study assesses the dynamics of SES in a typical rural South African setting over the period 2001-2013 using data on household assets from the Agincourt Health and Demographic Surveillance System. Three SES indices, an absolute index, principal component analysis index and multiple correspondence analysis index, are constructed from the household asset indicators. Relative distribution methods are then applied to the indices to assess changes over time in the distribution of SES with special focus on location and shape shifts. Results show that the proportion of households that own assets associated with greater modern wealth has substantially increased over time. In addition, relative distributions in all three indices show that the median SES index value has shifted up and the distribution has become less polarized and is converging towards the middle. However, the convergence is larger from the upper tail than from the lower tail, which suggests that the improvement in SES has been slower for poorer households. The results also show persistent ethnic differences in SES with households of former Mozambican refugees being at a disadvantage. From a methodological perspective, the study findings demonstrate the comparability of the easy-to-compute absolute index to other SES indices constructed using more advanced statistical techniques in assessing household SES.
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Affiliation(s)
- Chodziwadziwa W. Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Demography, The Australian National University, Canberra, Australia
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA
| | - Mark A. Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Samuel Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA
- INDEPTH Network, Accra, Ghana
- Department of Sociology, University of Washington, Seattle, WA USA
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