Demographic and socioeconomic factors associated with under-5 mortality in KwaZulu-Natal, South Africa

Thesis (M.A.(Demography and Population Studies))--University of the Witwatersrand, Faculty of Humanities, School of Social Sciences, 2016BACKGROUND: Under-5 children in KwaZulu-Natal are highly exposed to dying before reaching five years of life. Studies have been conducted to understand the demographic and socioeconomic factors that influence under-5 mortality, both nationally and internationally, with some contradicting findings on the association between some socioeconomic and demographic factors and under-5 mortality. While some studies found child mortality to be significantly associated with rural geographical place of residence, the reverse has also been established. The purpose of this study was to examine the association between socioeconomic and demographic factors and under-5 mortality in KwaZulu-Natal, South Africa. DESIGN: The study was cross-sectional, and utilises 2011 Census secondary data set from Statistics SA. Overall, the census revealed that 55 476 children under the age of 5 had died in the 12 months prior to the census nationally. In KwaZulu-Natal this figure was 15 356. The 10% sample showed that 1 474 under-5 children had died in the same period in KwaZulu-Natal. STATA 12.0 was used for the analysis. Binary logistic regression model was used to examine the association between under-5 mortality and the independent variables. RESULTS: The major findings of the study indicated that (i) male children were 1.22 times more likely to die compared to female children under the age of 5 years; (ii) mothers who had no schooling (AOR=1.82); mothers with primary level of education (AOR=2.43); and mothers with secondary level of education (AOR=1.77), were more likely to experience under-5 mortality compared to mothers with tertiary level education; (iii) mothers whose age at first birth was between 15-19 years (AOR=1.47) and those whose age at first birth was between 25-34 years (AOR=2.14) were more likely to experience under-5 mortality compared to mothers whose age at first birth was between 35-49 years; (iv) Black mothers were more likely to experience under-5 mortality compared to Indian mothers (AOR=5.99); (v) mothers who were employed were 1.22 times more likely to experience under-5 mortality compared to unemployed mothers. Lastly, under-5 mortality was less likely amongst mothers in the medium households compared to those from low income households (AOR=0.65). CONCLUSION: This study found that socioeconomic and demographic factors substantively determine under-5 mortality in KwaZulu-Natal. Evidence from this study suggest that interventions aimed at reducing under-5 mortality should focus on black women, the younger women, the less educated and those with low household income.MT201

Factors influencing contraceptive use and sexual behaviour among women of reproductive age in Umlazi township, KwaZulu-Natal province, South Africa.

Doctoral Degree. University of KwaZulu-Natal, Durban.Access to safe and effective contraceptive methods is one of the cornerstones of reproductive health, worldwide. However, the degree to which women manage various aspects of their sexual lives, including the prevention of unplanned or unwanted pregnancies, infant and maternal mortality, and exposure to HIV and AIDS, continues to raise questions relating to health promotion concerns. Despite the implementation of various government interventions, unplanned pregnancies, termination of pregnancies, and maternal mortality remain relatively high in South Africa. While HIV infection has been well documented in South Africa, the risky sexual behaviour of South Africans remains a concern. The aim of this study was to examine the factors that influence contraceptive use and sexual behaviour among women of reproductive age in Umlazi Township, KwaZulu-Natal Province, South Africa. The specific research objectives were as follows: 1. To map evidence on factors influencing contraceptive use and sexual behaviour in South Africa through a systematic scoping review. 2. To determine the proportion of women of reproductive age using contraceptives in Umlazi Township, KwaZulu-Natal, South Africa. 3. To examine women’s knowledge of different contraceptive methods in Umlazi Township, KwaZulu-Natal province, South Africa. 4. To determine contraceptive methods used by women in Umlazi Township, KwaZulu- Natal province, South Africa. 5. To identify factors influencing contraceptive use and sexual behaviour among women of reproductive age in Umlazi Township, both from a user and provider perspective. 6. To explore the experiences of women of reproductive age regarding contraceptive use and risky sexual behaviours in Umlazi Township, South Africa. Methods The was a mixed-methods study, which utilised primary level data to answer objectives two to six. A systematic scoping review was conducted to address the first study objective. The study was conducted in a clinic-based setting among women of reproductive age in Umlazi Township under eThekwini Municipality in KwaZulu-Natal. The healthcare providers from the selected clinics and women of reproductive age attending the selected facilities, participated in the study. For quantitative study, data were collected through a structured questionnaire, coded and entered into Epi data manager (version 4.6). Stata version 15 was used to conduct quantitative data analysis. Multivariable logistic regression model was used to assess the level of the association between the predictor and outcome variables and the p-value < 0.05 was considered statistically significant. For qualitative study, women from four primary health care facilities were recruited through a combination of convenience and criterion-based sampling techniques. Using NVivo version 11, two skilled researchers independently conducted thematic data analysis, as a mechanism for quality assurance, before the results were collated and reconciled. Results Overall, 471 eligible women and 35 healthcare workers participated in the quantitative study. Fifteen women participated in the qualitative study. The quantitative study found that more than half (51.8%) of the women were aged 18–24 years, and only a handful (18.3%) had a tertiary qualification. The majority were single (89.0%) and unemployed participants accounted for 54.0% of the total sample. This study found that women who had talked about condoms with their partner/s in the past 12 months were more likely (p=< 0.0001) to have used condoms during their last sexual intercourse. Older women (aged 35-49 years) were more likely (p=0.035) to have used a condom during their last sexual encounter, compared to their younger counterparts. However, women who were exposed to physical partner violence (hitting and/or slapping), those who had been diagnosed with HIV and those whose sexual partners were diagnosed with HIV, did not show a significant association with condom use at last sex. This study showed a high proportion (84.1%) of women using contraception in the sample. This study further indicated that women with a secondary level of education (p=0.053) or a tertiary level of education (p=0.040), were more likely to use contraceptive methods compared to women with a lower education status. Older women aged 25-49 years who experienced pregnancy, whether planned (p=0.038) or unplanned (p=0.001), were more likely to use a contraceptive method. Furthermore, more than a third of healthcare providers (37.1%) were unsure whether modern contraceptives cause users to become promiscuous, and more than half (57%) had negative attitudes toward adolescent girls exploring contraceptive methods. Poor working conditions, long queues, and contraceptive stock-outs were cited by health care providers as deterrents to providing quality sexual behaviour counselling and modern contraceptive education to users. The qualitative study found that women were concerned about unpleasant contraceptive side effects such as prolonged or irregular menstrual periods, bleeding, weight gain, and/or severe pains. Some women stopped using their preferred contraceptive method or opted for a different contraceptive method due to undesirable side effects and/or contraceptive stock outs. Women also raised concerns that they were not adequately counselled or informed on the use or potential negative effects of various contraceptive methods available at health care facilities. Furthermore, perceived negative attitudes towards young women by health care providers, long waiting times and concerns over contraceptive efficacy, contributed to reduced contraceptive uptake. Conclusion This study adds to our knowledge of women's concerns and issues related to contraception access and use in Umlazi Township, KwaZulu-Natal. This study found that numerous factors influence contraceptive use and sexual behaviour. The amount to which women engage in unprotected sexual activities highlights the urgent need for a comprehensive, integrative, and adaptive educational approach to altering women's sexual behaviours. It is vital to make concerted educational efforts to eliminate existing hurdles that prevent young women from using contraception. Family planning strategies tailored to the needs of different groups of women should be targeted, including prioritising education opportunities, given the many benefits associated with these. The availability of comprehensive counselling services to support women who are experiencing short-term side effects is critical in order to ensure that they are able to cope with side effects or switch to a different method rather than completely discontinuing contraceptive use in order to avoid unintended pregnancy

Barriers and facilitating factors to HIV treatment among men in a high-HIV burdened district in KwaZulu-Natal, South Africa: A qualitative study

Despite enormous increases in the proportion of people living with HIV accessing treatment in sub-Saharan Africa, major gender disparities persist, with men experiencing lower rates of testing, linkage to treatment, and retention in care. In this study, we investigated the barriers and facilitating factors to HIV treatment among men in uThukela, a high-HIV-burdened district in KwaZulu-Natal province, South Africa. We conducted a qualitative study including nine Black African male participants who were recruited from 18 health care facilities in uThukela District, KwaZulu-Natal province. In-depth interviews were conducted with participants who linked to care and those who did not link to care at 3-month post HIV diagnosis. We used Atlas.ti for thematic analysis. Data were coded and linked to broader themes emerging across interviews. The median age was 40 years (interquartile range [IQR]: 31–41). This study identified the following key themes which emerged as barriers to HIV treatment among men in uThukela District: lack of emotional readiness, perceived medication side effects, fear of treatment non-adherence, perceived stigma and confidentiality concerns, and poor socioeconomic factors

Digital Intervention Services to Promote HIV Self-Testing and Linkage to Care Services: A Bibliometric and Content Analysis—Global Trends and Future Directions

Objective: The global burden of HIV remains a critical public health challenge, particularly in sub-Saharan Africa, home to over two-thirds of individuals living with HIV. HIV self-testing (HIVST) has emerged as a promising strategy endorsed by the World Health Organization to achieve UNAIDS targets. Despite its potential, challenges persist in linking self-testers to care post a positive result. Digital health interventions, including chatbots and mobile applications, offer innovative solutions to address this gap. However, a comprehensive bibliometric analysis of the collaboration and growth in the literature at the intersection of HIVST and digital interventions is lacking.Methods: The study employs a bibliometric approach, leveraging data from the Web of Science, to analyze the characteristics, citation pattern and content of 289 articles spanning 1992–2023. The analysis involves performance assessment, scientific collaboration analysis, science mapping, and content analysis. Key bibliometric indicators, such as annual growth rate, citation impact, and authorship patterns, are explored. Collaboration patterns among countries, institutions, and authors are elucidated, and thematic mapping provides insight into the key research themes.Results: The analysis reveals a dynamic and expanding field, with an annual scientific growth rate of 12.25%. Notable contributions come from diverse sources, including North America, Europe, and Africa. High-impact journals such as JMIR mHealth and uHealth play a crucial role in disseminating research findings. African authors, including Lebelonyane R, Ford N, and Lockman S, feature prominently, reflecting a positive trend in diverse authorship. Co-citation analysis highlights influential manuscripts, with systematic reviews dominating the top-cited articles. Collaboration analysis underscores strategic partnerships globally, particularly involving the United States, Australia, South Africa, and the United Kingdom.Conclusion: This bibliometrics analysis provides a comprehensive overview of the digital health landscape in HIVST and linkage to care. It identifies key contributors, high-impact journals, and collaborative networks. The thematic map reveals nuanced research domains, including alcohol dependence, men’s health, outcomes, and user acceptance. The findings offer insights for researchers, policymakers, and practitioners, guiding future directions in the evolving intersection of HIVST and digital health interventions

Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry

Background South Africa had an estimated 7.5 million people living with HIV (PLHIV), accounting for approximately 20% of the 38.4 million PLHIV globally in 2021. In 2015, the World Health Organization recommended the universal test and treat (UTT) intervention which was implemented in South Africa in September 2016. Evidence shows that UTT implementation faces challenges in terms of human resources capacity or infrastructure. We aim to explore healthcare providers (HCPs)’ perspectives on the implementation of the UTT strategy in uThukela District Municipality in KwaZulu-Natal province. Methods A qualitative study was conducted with one hundred and sixty-one (161) healthcare providers (HCPs) within 18 healthcare facilities in three subdistricts, comprising of Managers, Nurses, and Lay workers. HCPs were interviewed using an open ended-survey questions to explore their perceptions providing HIV care under the UTT strategy. All interviews were thematically analysed using both inductive and deductive approaches. Results Of the 161 participants (142 female and 19 male), 158 (98%) worked at the facility level, of which 82 (51%) were nurses, and 20 (12.5%) were managers (facility managers and PHC manager/supervisors). Despite a general acceptance of the UTT policy implementation, HCPs expressed challenges such as increased patient defaulter rates, increased work overload, caused by the increased number of service users, and physiological and psychological impacts. The surge in the workload under conditions of inadequate systems’ capacity and human resources, gave rise to a greater burden on HCPs in this study. However, increased life expectancy, good quality of life, and immediate treatment initiation were identified as perceived positive outcomes of UTT on service users. Perceived influence of UTT on the health system included, increased number of patients initiated, decreased burden on the system, meeting the 90-90-90 targets, and financial aspects. Conclusion Health system strengthening such as providing more systems’ capacity for expected increase in workload, proper training and retraining of HCPs with new policies in the management of patient readiness for lifelong ART journey, and ensuring availability of medicines, may reduce strain on HCPs, thus improving the delivery of the comprehensive UTT services to PLH

Linkage to HIV care following HIV self‑testing among men : systematic review of quantitative and qualitative studies from six countries in Sub‑Saharan Africa

DATA AVAILABILITY : All the data analysed and reported in this paper were from published literature, which is already in the public domain.Gender disparities are pervasive throughout the HIV care continuum in sub-Saharan Africa, with men testing, receiving treatment, and achieving viral suppression at lower rates, and experiencing mortality at higher rates, compared with women. HIV self-testing (HIVST) has been shown to be highly acceptable among men in sub-Saharan Africa. However, evidence on linkage to HIV care following a reactive HIVST result is limited. In this systematic review, we aimed to synthesize the quantitative and qualitative literature from sub-Saharan Africa on men’s rates of linkage to HIV care after receiving a reactive HIVST result. We systematically searched 14 bibliometric databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) fow diagram was used to document the screening results. The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of the included studies. Of 22,446 references screened, 15 articles were eligible for inclusion in this review. Linkage to HIV care following a reactive HIVST result was subject to several barriers: fnancial constraints due to travelling costs, potential long waiting hours at the clinics, stigma, discrimination, and privacy concerns. Men’s rates of seeking confrmatory testing and linking to HIV care following a reactive HIVST result were inconsistent across studies. Combining fnancial incentives with HIVST was found to increase the likelihood of linking to HIV care following a reactive HIVST result. The variable rates of linkage to HIV care following a reactive HIVST result suggest a need for further research and development into strategies to increase linkage to HIV care.http://link.springer.com/journal/10461School of Health Systems and Public Health (SHSPH

Risk factors for COVID-19 infection among healthcare workers. A first report from a living systematic review and meta-analysis

Health care workers (HCWs) are more than ten times more likely to be infected with coronavirus infectious disease 2019 (COVID-19) than the general population, thus demonstrating the burden of COVID- 19 among HCWs. Factors that expose HCWs to a differentially high-risk of COVID-19 acquisition are important to elucidate, enable appropriate public health interventions to mitigate against high risk and reduce adverse outcomes from the infection. We conducted a systematic review and meta-analysis to summarize and critically analyze the existing evidence on SARS-CoV-2 risk factors among HCWs. With no geographical limitation, we included studies, in any country, that reported (i) the PCR laboratory diagnosis of COVID-19 as an independent variable (ii) one or more COVID-19 risk factors among HCWs with risk estimates (relative risk, odds ratio, or hazard ratio) (iii) original, quantitative study design, and published in English or Mandarian. Our initial search resulted in 470 articles overall, however, only 10 studies met the inclusion criteria for this review. Out of the 10 studies included in the review, inadequate/ lack of protective personal equipment, performing tracheal intubation, and gender were the most common risk factors of COVID-19. Based on the random effects adjusted pooled relative risk, HCWs who reported the use of protective personal equipment were 29% (95% CI: 16% to 41%) less likely to test positive for COVID-19. The study also revealed that HCWs who performed tracheal intubations were 34% (95% CI: 14% to 57%) more likely to test positive for COVID-19. Interestingly, this study showed that female HCWs are at 11% higher risk (RR 1.11 95% CI 1.01e1.21) of COVID-19 than their male counterparts. This article presents initial findings from a living systematic review and meta-analysis, therefore, did not yield many studies; however, it revealed a significant insight into better understanding COVID-19 risk factors among HCWs; insights important for devising preventive strategies that protect them from this infection.http://www.e-shaw.netam2023School of Health Systems and Public Health (SHSPH

Risk factors for COVID-19 infection among healthcare workers. A first report from a living systematic review and meta-analysis

Health care workers (HCWs) are more than ten times more likely to be infected with COVID-19 compared to the general population, thus demonstrating the burden of COVID-19 among HCWs. Factors that expose HCWs to a differentially high-risk of COVID-19 acquisition are important to elucidate, to enable appropriate public health interventions to mitigate against high risk and reduce adverse outcomes from the infection. We conducted a systematic review and meta analysis to summarise and critically analyse the existing evidence on SARS-CoV-2 risk factors among HCWs. With no geographical limitation, we included studies, in any country, that reported (i) PCR laboratory diagnosis of COVID—19 as an independent variable (ii) one or more COVID-19 risk factors among health care workers with risk estimates (relative risk, odds ratio or harzard ratio) (iii) original, quantitative study design and published in English or Mandarian. Our initial search resulted in 470 articles overall, however, only 10 studies met the inclusion criteria for this review. Out of the 10 studies included in the review, inadequate/lack of protective personal equipment (PPE), performing tracheal intubation (PTI) and gender were the most common risk factors of COVID-19. Based on the random effects adjusted pooled relative risk, HCWs who reported use PPE were 29% (95% CI: 16% to 41%) less likely to test positive for COVID-19. The study also revealed that HCWs who performed tracheal intubations were 34% (95% CI: 14% to 57%) more likely to test positive for COVID-19. Interestingly, this study showed that female HCWs are at 11% higher risk (RR 1.11 95% CI 1.01-1.21) of COVID-19 than their male counterparts. This paper presents initial findings from a living systematic review and meta-analysis, therefore, did not yield many studies, however, it revealed a significant insight to better understand COVID-19 risk factors among HCWs; insights important for devising preventive strategies that protect them from this infection

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained