The relationship between social cohession and the health status of adults in South Africa

A research report submitted to the Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the award of the Degree of Masters of Arts in the Demography and Population StudiesAlthough life expectancy has increased in South Africa (RSA), compared with other middle-income countries, health status is poor most especially among the black majority. Coupled with this are the burdens of infectious and non-communicable diseases. RSA has also shown evidence of weak social cohesion through prevalent racial and gender discrimination, income inequalities, and violence. While previous studies on the health status of adults in RSA has only examined its association with other social determinants, the relationship of adult health status and social cohesion, unlike in developed countries, remains under researched in South Africa and other African countries. Using the collective efficacy theory by Sampson and colleagues (1997), this study adds the ‘African perspective’ to the ongoing debate about the health importance of social cohesion. It examined the relationship between social cohesion and the health status of adults in South Africa. The levels and patterns of health across social cohesion and other socio-demographic characteristics were also examined. DATA AND METHODS: Data was drawn from the 2012 South African Social Attitudes Survey, a survey implemented annually by the Human Sciences Research Council. Social cohesion was assessed by drawing from the five measurable items from the work of Sampson and colleagues (1997) which encompass trust, a sense of belonging, shared values and helpless in both cash and kind. These items were subjected to principal component factor analysis with Promax rotation. Cronbach’s alpha (α) for this scale is 0.84. Scores were divided into tertiles of low, medium and high social cohesion. A cumulative stepwise logistic regression model was fitted on a weighted sample of 22,605,550 adults in South Africa aged 18 years or older to examine the nexus between social cohesion and self-rated health status. Sub-group analysis examined if the observed relationship differed by race. The data was analysed using STATA software version 14. All model diagnostics showed that the model fits reasonably for the data. The interpretation of results was made using odds ratios (ORs), and a 95% confidence was used. RESULTS: More than half of adults (54%) in South Africa reported themselves to be in good health while only about 17% reported that they were in poor health. The percentage of adults reporting good health is higher among adults in the highest tertile of social cohesion (59%), compared to 53% among those in the lowest tertile. Controlling for other characteristics, regression analysis showed that adults in lowest tertile [OR:0.70, CI:0.516 - 0.965] and moderate tertile [OR:0.79, CI:0.589 - 1.055] of social cohesion were less likely to report moderate or good health compared to adults in the highest tertile of social cohesion, but the relationship was only statistically significant among adults in the lowest tertile of social cohesion. Sub-group analysis by race showed that among all the racial groups (excluding Indian or Asian adults), black African [OR:0.68, CI:0.472-0.989], coloured [OR:0.63, CI:0.305-1.309], and white [OR:0.67, CI:0.293 1.545] adults residing in the lowest tertile of social cohesion were less likely to be in moderate or good health compared to those in the highest tertile of social cohesion, but the relationship was only statistically significant among black Africans. CONCLUSION AND RECOMMENDATION: The findings from this study demonstrate that social cohesion among adults in South Africa, particularly among black Africans, is important for improvement in health. It is therefore important that the government of South Africa intensifies efforts aimed at increasing social cohesion among adults, particularly among black Africans. This could be achieved through public awareness on the health importance of social cohesion and the need for neighbours to share similar values, trust one another and be willing to help. This is especially important if significant progress is to be made in achieving the sustainable development goals to improve the health of adults in the country by 2030.XL201

Sexuality education in the digital age : modelling the predictors of acceptance and behavioural intention to access and interact with sexuality information on social media

The authors gratefully acknowledge the Southern Africa Systems Analysis Centre (SASAC) and the University of the Witwatersrand for providing partial funding to support this study.Introduction Diverse literature on sexual health promotion using social media suggests that increasing information reach and interaction are crucial. This study integrated the unified theory of acceptance and use of technology (UTAUT) to model the predictors of young adults’ behavioural intention to use and interact with sexuality education on social media. Methods A total of 936 young adults in Kenya, Nigeria, and South Africa who had access to the internet and Facebook were recruited via Facebook’s advertising platform from 22 May 2020 to 8 June 2020. A structural equation model was fitted on the sample to identify the individual attributes associated with the intention to use and interact with sexuality information on social media. Results About 84% of the young adults in the sample consider social media an appropriate medium for sexual health communication, with Facebook being the most preferred (40%) digital platform for sexual health promotion. Results from the structural equation model showed that performance expectancy (β = 0.18, P < 0.001), social influence (β = 0.09, P = 0.047), effort expectancy (β = 0.25, P < 0.001), facilitating condition (β = 0.33, P < 0.001), and attitude (β = 0.10, P = 0.039) were significantly associated with the intention to access sexuality education on social media. These factors (except attitude) were also significantly associated with the intention to interact with sexual health information on social media. Conclusions Young people with internet access are amenable to receiving and interacting with sexuality information on social media. The use of social media for sexuality education is associated with whether such use is free of effort, endorsed by society, align with their engagements with other messages, and helps them achieve improvement in their sexual and reproductive health. Policy Implications Strategies to increase access and interaction with sexuality information on social media help young people make an informed decision about their sexuality. Such use should also be free of effort, align with the way they interact with other information on social media, and supported by the society.Publisher PDFPeer reviewe

Saving sex for marriage : an analysis of lay attitudes towards virginity and its perceived benefit for marriage

EO acknowledges funding support from the Southern Africa Systems Analysis Centre, National Research Foundation, South Africa, grant number: 118772, and the Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa.How do young people interpret virginity loss, and does saving sex for marriage have any socially constructed benefit for marriage? This study answers this question using data obtained from a peer-led Facebook group with more than 175,000 participants, mostly in African countries, particularly Nigeria. A reflexive thematic analysis was used to analyze 100 public wall posts and 3860 comments posted on the group between June 2018 and May 2019. Four distinctive interpretations of virginity loss comprising the gift, precondition, stigma, and process emerged from the data. These interpretations were also gendered, such that a woman’s virginity was interpreted as a gift but a stigma for men. The wall posts and comments further suggest that saving sex for marriage may have some culturally sensitive benefits, including trust, and marital sexual satisfaction. Altogether the findings expand the current understanding of the diverse perceived benefits of virginity that move beyond honour and respect to more complex benefits like trust in a union, sexual satisfaction and ultimate satisfaction in marriage.Publisher PDFPeer reviewe

The link between intimate partner violence and spousal resource inequality in lower- and middle-income countries

Objective There is an increasing need to understand how differential levels of resource inequality between spouses are associated with women's experience of intimate partner violence (IPV) in lower- and middle-income countries across four regions. This study aims to focus on four areas of relative power and resources between couples in a partnership: employment, job skills, earnings, and household making-decision across four lower- and middle-income regions. Method Data on 150,623 women was drawn from the most recent, harmonized Demographic and Health Survey (DHS) for 24 countries in West-Central Africa (WCA), East-Southern Africa (ESA), Middle East and North Africa (MENA), and South Asia (SA). Leveraging an event history framework, we fitted mixture cure models to illuminate both the likelihood of never experiencing IPV and the onset of IPV among women in their first union across the four regions. Results We found that women who are not in the labor market are less likely to experience violence compared to those who are in all places except MENA. Among couples in which both partners are in the labor market, women with lower job skills than their partner are less likely to experience violence. Inequality in earnings is associated with the onset of intimate partner violence in ESA and SA. Similarly, inequality in household decision-making is associated with the onset of the first spousal violence but only in ESA, MENA, and SA. Conclusion This study found vast heterogeneity in the different measures of spousal resource inequality and women's experience of IPV across LMIC settings. This underscores the imperative for interventions focused on enhancing women's economic outcomes to consider and confront the contextual norms associated with women's economic empowerment, in order to mitigate unintended adverse consequences.Peer reviewe

Community structure and timing of sexual activity among adolescent girls in Nigeria

Studies have linked the timing of sexual debut to unplanned pregnancies and sexually transmissible infections, including HIV. Current understandings of sexual debut among Nigerian adolescents focused on the roles of individual and familial characteristics. We leveraged the 2018 Nigeria Demographic and Health Survey data to examine how community features like affluence, ethnic diversity, and women empowerment may be associated with the timing of sexual debut among adolescent girls. The sample comprised 7449 adolescent girls who were usual residents in 6,505 households and 1,352 clusters or communities. Statistical associations between community characteristics and the onset of sexual debut were assessed using a two-level mixed-effects parametric survival model with Weibull distribution

Examining vulnerability and resilience in maternal, newborn and child health through a gender lens in low-income and middle-income countries : a scoping review

Funding This work was supported by the Bill & Melinda Gates Foundation under investment INV-015806 awarded to the Viable Helpers Development Organisation.Introduction Gender lens application is pertinent in addressing inequities that underlie morbidity and mortality in vulnerable populations, including mothers and children. While gender inequities may result in greater vulnerabilities for mothers and children, synthesising evidence on the constraints and opportunities is a step in accelerating reduction in poor outcomes and building resilience in individuals and across communities and health systems. Methods We conducted a scoping review that examined vulnerability and resilience in maternal, newborn and child health (MNCH) through a gender lens to characterise gender roles, relationships and differences in maternal and child health. We conducted a comprehensive search of peer-reviewed and grey literature in popular scholarly databases, including PubMed, ScienceDirect, EBSCOhost and Google Scholar. We identified and analysed 17 published studies that met the inclusion criteria for key gendered themes in maternal and child health vulnerability and resilience in low-income and middle-income countries. Results Six key gendered dimensions of vulnerability and resilience emerged from our analysis: (1) restricted maternal access to financial and economic resources; (2) limited economic contribution of women as a result of motherhood; (3) social norms, ideologies, beliefs and perceptions inhibiting women’s access to maternal healthcare services; (4) restricted maternal agency and contribution to reproductive decisions; (5) power dynamics and experience of intimate partner violence contributing to adverse health for women, children and their families; (6) partner emotional or affective support being crucial for maternal health and well-being prenatal and postnatal. Conclusion This review highlights six domains that merit attention in addressing maternal and child health vulnerabilities. Recognising and understanding the gendered dynamics of vulnerability and resilience can help develop meaningful strategies that will guide the design and implementation of MNCH programmes in low-income and middle-income countries.Publisher PDFPeer reviewe

Treatment seeking and antibiotic use for urinary tract infection symptoms in the time of COVID-19 in Tanzania and Uganda

Funding: CARE: COVID-19 and Antimicrobial Resistance in East Africa – impact and response is a Global Effort on COVID-19 (GECO) Health Research Award (MR/V036157/1) funded by UK Research and Innovation (Medical Research Council) and the Department of Health and Social Care (National Institute for Health Research).Background There is still little empirical evidence on how the outbreak of coronavirus disease 2019 (COVID-19) and associated regulations may have disrupted care-seeking for non-COVID-19 conditions or affected antibiotic behaviours in low- and middle-income countries (LMICs). We aimed to investigate the differences in treatment-seeking behaviours and antibiotic use for urinary tract infection (UTI)-like symptoms before and during the pandemic at recruitment sites in two East African countries with different COVID-19 control policies: Mbarara, Uganda and Mwanza, Tanzania. Methods In this repeated cross-sectional study, we used data from outpatients (pregnant adolescents aged >14 and adults aged >18) with UTI-like symptoms who visited health facilities in Mwanza, Tanzania and Mbarara, Uganda. We assessed the prevalence of self-reported behaviours (delays in care-seeking, providers visited, antibiotics taken) at three different time points, labelled as ‘pre-COVID-19 phase’ (February 2019 to February 2020), ‘COVID-19 phase 1’ (March 2020 to April 2020), and ‘COVID-19 phase 2’ (July 2021 to February 2022). Results In both study sites, delays in care-seeking were less common during the pandemic than they were in the pre-COVID phase. Patients in Mwanza, Tanzania had shorter care-seeking pathways during the pandemic compared to before it, but this difference was not observed in Mbarara, Uganda. Health centres were the dominant sources of antibiotics in both settings. Over time, reported antibiotic use for UTI-like symptoms became more common in both settings. During the COVID-19 phases, there was a significant increase in self-reported use of antibiotics like metronidazole (<30% in the pre-COVID-19 phase to 40% in COVID phase 2) and doxycycline (30% in the pre-COVID-19 phase to 55% in COVID phase 2) that were not recommended for treating UTI-like symptoms in the National Treatment Guidelines in Mbarara, Uganda. Conclusions There was no clear evidence that patients with UTI-like symptoms attending health care facilities had longer or more complex treatment pathways despite strict government-led interventions related to COVID-19. However, antibiotic use increased over time, including some antibiotics not recommended for treating UTI, which has implications for future antimicrobial resistance.Publisher PDFPeer reviewe

Saving sex for marriage:an analysis of lay attitudes towards virginity and its perceived benefit for marriage

How do young people interpret virginity loss, and does saving sex for marriage have any socially constructed benefit for marriage? This study answers this question using data obtained from a peer-led Facebook group with more than 175,000 participants, mostly in African countries, particularly Nigeria. A reflexive thematic analysis was used to analyze 100 public wall posts and 3860 comments posted on the group between June 2018 and May 2019. Four distinctive interpretations of virginity loss comprising the gift, precondition, stigma, and process emerged from the data. These interpretations were also gendered, such that a woman’s virginity was interpreted as a gift but a stigma for men. The wall posts and comments further suggest that saving sex for marriage may have some culturally sensitive benefits, including trust, and marital sexual satisfaction. Altogether the findings expand the current understanding of the diverse perceived benefits of virginity that move beyond honour and respect to more complex benefits like trust in a union, sexual satisfaction and ultimate satisfaction in marriage