Equity in maternal health in South Africa: analysis of health service access and health status in a national household survey

Background: South Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources. Methods: Analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data. Findings: Poorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile (95%CI adjusted odds ratio = 1.2-6.1). Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group. Conclusions: Aside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health

THE RELATIONSHIP BETWEEN ENGAGEMENT AND PERCEIVED ACADEMIC, PERSONAL, AND SOCIAL OUTCOMES FOR SENIOR INTERNATIONAL UNDERGRADUATE STUDENTS IN RESEARCH UNIVERSITIES

The purpose of this study was to examine the extent to which five engagement benchmarks that encompass educationally purposeful activities namely: (i) level of academic challenge , (ii) active and collaborative learning ,(iii) student-faculty interaction , (iv) enriching educational experiences and (v) supportive campus environment predict various dimensions of self- reported or perceived academic, personal, and social development/ growth for senior international students at Research Universities. The benchmarks were regressed against the following self-reported outcomes: i) acquiring a broad general education, acquiring job or work-related knowledge and skills, thinking critically and analytically, working effectively with others learning effectively on your own, and understanding yourself. Results indicated that for this sub-population, a supportive campus environment and the level of academic challenge were the best predictors of the self- assessed outcomes. Students had lower means in the student-faculty interaction and enriching educational experiences indicating less engagement in these benchmarks. On average, students reported gaining more in thinking critically and analytically and acquiring a broad and general education, although their average gains were still lower compared to the grand mean for the overall NSSE 2005 sample

Anthropogenic effects on sustainability of fish biodiversity in Tyume River, Eastern Cape, South Africa

To determine the anthropogenic effects on the sustainability of fish biodiversity in Tyhume River, a mixture of ecological, economic and institutional parameters were used. To measure ecological parameters, 10 study sites were selected to represent varying intensities of anthropogenic effects on habitat, to represent typical river zones, and to correspond with historical survey sites for trend analysis. In these study sites, habitat characteristics that represent geomorphology (habitat quantity), water quality and ‘alien’ (non–native) fishes were used to determine anthropogenic effects on habitat and fish assemblage. The measured geomorphology characteristics included current velocity, wetted width and depth. The water quality characteristics used were temperature, pH and conductivity. To determine the effects of native and non-native on indigenous fish species in situ, electro fishing was used in riffles, small pools and runs; as well, in situ seine-netting was done in pools. The riches of river fish species was measured, using numbers abundance and longitudinal distribution indices. It was established that only 11percent of the Tyhume River habitat was relatively near natural, while 89percent exhibited anthropogenic habitat modification. Three major sources ofanthropogenic modification on habitat were identified. The major contributor of anthropogenic effects was Binfield Park Dam which accounted for 43percent of modification. The second source of anthropogenic effects on habitat was Alice urban area where storm water runoff accounted for 28percent of modification. Agricultural and livestock grazing, the third anthropogenic effect, accounted for 18percent of modification. The Eastern Cape Rocky, Sandelia bainsii Castelnau, 1861 and Border Barb, Barbus trevelyani Günther, 1868, exhibited reduced distribution. B. trevelyani longitudinal distribution was less than 25 km along the river continuum, with sporadic presence in the sandy foothills. S. bainsii was not found in the Lowland Zone, while previously this species extended from the mountainous zone to the confluence of the Tyhume and Keiskamma Rivers in the Lowland Zone. These indices supported the homogenization theory, as reflected by increased dissimilarity for two indigenous fish species, S. bainsii and B. trevelyani, among study sites. S. bainsii was previously distributed from source to confluence, while B. trevelyani recorded a 50percent decline at the study site below the Binfield Park Dam. To assign economic value to ecosystem services and assess post Rio-institutional parameters two hypothetical scenarios were developed from the ecological survey; one depicting current conditions and another depicting improved ecosystem services. Using a structured interview questionnaire, five ecosystem services in need of restoration were described to respondents. Applying the contingent valuation method respondents were asked a dichotomous choice question on willingness to pay (WTP). Results of the economic study from 209 personal interviews revealed, individuals were willing to pay an additional R 32.00 on their monthly water bill or R 384.00 annually. Generalizing this to 2 829 households living in the Alice and Ntselamanzi urban areas, a total value of R 1 086 336 would be realized annually. This was equivalent to the Nkonkobe Municipality annual budget for storm water management in Alice urban area. Costs/benefits revealed a positive net present value (NPV) = 1, which, in line with economic theory, meant gainers were able to compensate losers The institutional part of the economic survey sought to determine the effects of post Rio Earth Summit institutional measures on sustainable management of Tyhume River fish assemblage. A desk review of Rio Declaration and three South African statutes were used namely; Constitution Act 108 of 1996 (South African Constitution 1996); the National Environmental Management Biodiversity Act No. 10 of 2004 (NEMBA 2004), the National Environmental Management Act (NEMA) No. 107 of 1998 (NEMA 1998), and the National Water Act No. 36 of 1998 (NWA 1998). The Institutional and Analytic Development (IAD) Framework, coupled with requirements for sustainability of Multiple Use Resource Domains were used for the analysis. De Jure, the statutes had internationalization of environmental costs through “polluter pays principle”, while sustainable use was the overarching goal. De facto, the community participation, a requisite of post Rio measures, was low; however 89percent of community respondents were willing to join an environmental conservation group. This, coupled with the fact that 77percent of those interviewed supported the establishment of a Tyhume River Restoration Fund, provided scope for a broad based community participation framework This study contributes to sustainable use of Tyhume River and other lotic systems by generating information on the link between anthropogenic effects on fish biodiversity, economic value of ecosystems services and institutional mechanisms

Influence of Career Information on Choice of Degree Programme among Regular and Self-Sponsored Students in Public Universities, Kenya

Choosing a degree programme to study in the university is a critical career task that is a major turning point in a student's life which not only is a start to workplace readiness, but also establishes the student in a career path that opens as well as closes life opportunities. Failure to achieve this task may cause dissatisfaction within the individual and difficulty in handling later career tasks. This career task is influenced by various factors. This study aimed at determining the influence of career information on choice of degree programme among students in public universities in Kenya. The study used the ex post facto design that adopted the causal comparative research technique and data was collected from 500 randomly selected students using questionnaires. Percentages, means and standard deviations were used to describe the quantitative data and independent samples t-test was used to analyze the data and to test hypotheses. The findings of the study revealed that career information had a high influence on the choice of degree programme of students in public universities. Further analysis of the results indicated that no statistically significant differences existed between the mean scores of influences of career information between regular and self-sponsored students. The study concluded that provision of career information was a significant factor in influencing the choice of degree programme of all the students in public universities. The study recommended that the Ministry of Education (MoE) ensures that in all secondary schools in Kenya, the career guidance department is functional with adequate career information resources and activities, to facilitate career development among students. The study also recommended the training and equipping of career guidance counsellors in schools to enhance their competence in assisting the students in making career decisions. Keywords: Degree programme, career information, career task, public university, regular and self-sponsored students

Development of a Virtual Environment-Based Electrooculogram Control System for Safe Electric Wheelchair Mobility for Individuals with Severe Physical Disabilities

Conventional wheelchairs are predominantly manual or joystick-operated electric wheelchairs. However, operating these wheelchairs can be difficult or impossible for individuals with severe physical disabilities. Due to losing control of their physical limbs, they depend on an attendant for assistance. As a remedy, bio-signals may be used as a control mechanism since they are readily available and can be acquired from any body part. This research proposes to use EOG signals to vail a control mechanism and test it in a virtual and actual electric wheelchair. The main contribution of the study is an investigation of the use of EOG to control an electric wheelchair in a virtual environment to determine safe control parameters for wheelchair use in complex environments. A customized data acquisition circuit was developed to acquire single-channel EOG signals using wet electrodes. The acquired signal was filtered and processed using feature extraction and classification techniques in MATLAB software. Two customized control environments were developed in Unity 3D, one with equally partitioned sections and the other with sections decreasing in size as the robot wheelchair approaches the target. Twenty-two test subjects (mean age 24.5, std 1.5) participated in the study, controlling the robot wheelchair in real-time with non or least instances of collision and oversteering. The system achieved an accuracy of 96.5% with a response time of 0.7s, translating to an ITR of 70.6 bits/min. Overall, the participants managed to navigate the virtual environment with a completion time of 101.94s ± 19.71 and 109.07s ± 13.25 for the male and female participants, respectively. In the scene with decreasing section sizes, 72% and 54% instances of collision and oversteering were reported, respectively, highlighting the need to consider the complexity of the control environment and the sufficiency of the participants' control skills to ensure safety in operations. The results confirm the usefulness of EOG as a control interface, with little or no need for recalibration. It provides a promising avenue for individuals with severe physical disabilities to operate wheelchairs independently in complex environments, enhancing their quality of life

Prevalence and factors associated with metabolic syndrome in an urban population of adults living with HIV in Nairobi, Kenya

Introduction: Metabolic syndrome affects 20-25% of the adult population globally. It predisposes to cardiovascular disease and Type 2 diabetes. Studies in other countries suggest a high prevalence of metabolic syndrome among HIV-infected patients but no studies have been reported in Kenya. The objective of this study was to assess the prevalence and factors associated with metabolic syndrome in adult HIV-infected patients in an urban population in Nairobi, Kenya. Methods: in a cross-sectional study design, conducted at Riruta Health Centre in 2016, 360 adults infected with HIV were recruited. A structured questionnaire was used to collect data on socio-demography. Blood was collected by finger prick for fasting glucose and venous sampling for lipid profile. Results: Using the harmonized Joint Scientific Statement criteria, metabolic syndrome was present in 19.2%. The prevalence was higher among females than males (20.7% vs. 16.0%). Obesity (AOR = 5.37, P < 0.001), lack of formal education (AOR = 5.20, P = 0.002) and family history of hypertension (AOR = 2.06, P = 0.029) were associated with increased odds of metabolic syndrome while physical activity (AOR = 0.28, P = 0.001) was associated with decreased odds. Conclusion: Metabolic syndrome is prevalent in this study population. Obesity, lack of formal education, family history of hypertension, and physical inactivity are associated with metabolic syndrome. Screening for risk factors, promotion of healthy lifestyle, and nutrition counselling should be offered routinely in HIV care and treatment clinics

Mosquito control by abatement programmes in the United States: perspectives and lessons for countries in sub-Saharan Africa.

Africa and the United States are both large, heterogeneous geographies with a diverse range of ecologies, climates and mosquito species diversity which contribute to disease transmission and nuisance biting. In the United States, mosquito control is nationally, and regionally coordinated and in so much as the Centers for Disease Control (CDC) provides guidance, the Environmental Protection Agency (EPA) provides pesticide registration, and the states provide legal authority and oversight, the implementation is usually decentralized to the state, county, or city level. Mosquito control operations are organized, in most instances, into fully independent mosquito abatement districts, public works departments, local health departments. In some cases, municipalities engage independent private contractors to undertake mosquito control within their jurisdictions. In sub-Saharan Africa (SSA), where most vector-borne disease endemic countries lie, mosquito control is organized centrally at the national level. In this model, the disease control programmes (national malaria control programmes or national malaria elimination programmes (NMCP/NMEP)) are embedded within the central governments' ministries of health (MoHs) and drive vector control policy development and implementation. Because of the high disease burden and limited resources, the primary endpoint of mosquito control in these settings is reduction of mosquito borne diseases, primarily, malaria. In the United States, however, the endpoint is mosquito control, therefore, significant (or even greater) emphasis is laid on nuisance mosquitoes as much as disease vectors. The authors detail experiences and learnings gathered by the delegation of African vector control professionals that participated in a formal exchange programme initiated by the Pan-African Mosquito Control Association (PAMCA), the University of Notre Dame, and members of the American Mosquito Control Association (AMCA), in the United States between the year 2021 and 2022. The authors highlight the key components of mosquito control operations in the United States and compare them to mosquito control programmes in SSA countries endemic for vector-borne diseases, deriving important lessons that could be useful for vector control in SSA

Mr Bank Specific Determinants of Nonperforming Loans in Kenya

Purpose: This paper aims to explore the bank-specific determinants of Nonperforming Loans in Kenya. To achieve this objective, the study considers four bank-specific variables that are expected to affect the magnitude of non-performing loans. These variables are bank size as measured by banks' total assets, loan-to-deposit ratio, capital adequacy ratio, and interest rates. Methodology: The study used a causal research design. Aggregated data on all 43 Kenyan banks were collected from secondary sources. Time series regression was applied to the data. Results: The study finds that there is a positive relationship between bank size and non-performing loans. It also observes that there is a negative relationship between loans-to-deposit ratio and non-performing loans. The study further observes that there is a negative correlation between capital adequacy ratio and non-performing loans in Kenya. Finally, the study establishes that there is a positive relationship between the interest rate and non-performing loans in Kenya. Implications: The study recommends that banks should revise their interest rates downwards to enable borrowers to afford the loans and avert the cases of default. Banks should also invest in proper infrastructure for screening borrowers to avoid cases of loan default