Vaccine hesitancy and related factors among South African adults in 2021: unpacking uncertainty versus unwillingness

BackgroundAmidst widespread public health recommendations and availability of COVID-19 vaccinations, half of South African adults are vaccinated against COVID-19. This study investigated the socio-behavioral determinants of vaccine hesitancy in South Africa, where vaccine hesitancy was separated into unwilling ness and uncertainty to take a COVID-19 vaccine.MethodsData was collected from a large-scale public survey during June–October 2021 that included online and telephonic surveys. Vaccination hesitancy was based on the question “When available, would you take the COVID 19 vaccine?,” with responses categorized into those who were willing, unwilling, and uncertain about taking a COVID-19 vaccine. Multinomial regression examined the association between socio-behavioral variables and vaccine hesitancy.ResultsOverall, 73.8% reported they would definitely or probably take the vaccine, 16.4% were uncertain and 9.9% reported they probably or definitely would not (n = 16,988). Younger age, White and Colored population groups, no influenza vaccination history, previous vaccination refusal, knowing someone who experienced a serious vaccination side-effect, misperceptions about vaccine benefits, cultural or religious discouragement from taking a COVID-19 vaccination, lack of governmental confidence, concerns about side-effects, perceived lack of safety information, and lack of trust in the pharmaceutical industry and in the information from health care providers were all associated with higher odds of being uncertain and unwilling to take a COVID-19 vaccination. Strengths of association for unwillingness and uncertainty varied by the explanatory variables. Concern about effectiveness due to fast development was associated with uncertainty to take the vaccine but not with unwillingness. Concerns about side-effects had stronger associations with uncertainty than with unwillingness, while previous vaccine refusal, misperceptions of the protective benefits of vaccines, White population group, religious/cultural discouragement, and lack of trust in the pharmaceutical industry and health care providers’ information had stronger associations with unwillingness than uncertainty.ConclusionThe determinants of COVID-19 vaccine hesitancy should be addressed in interventions to improve vaccine uptake. Public health interventions and health communication can be prioritized and tailored to the different forms of vaccination hesitancy

Mapping the Burden of Hypertension in South Africa: A Comparative Analysis of the National 2012 SANHANES and the 2016 Demographic and Health Survey

This study investigates the provincial variation in hypertension prevalence in South Africa in 2012 and 2016, adjusting for individual level demographic, behavioural and socio-economic variables, while allowing for spatial autocorrelation and adjusting simultaneously for the hierarchical data structure and risk factors. Data were analysed from participants aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES) 2012 and the South African Demographic and Health Survey (DHS) 2016. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported health professional diagnosis or on antihypertensive medication. Bayesian geo-additive regression modelling investigated the association of various socio-economic factors on the prevalence of hypertension across South Africa’s nine provinces while controlling for the latent effects of geographical location. Hypertension prevalence was 38.4% in the SANHANES in 2012 and 48.2% in the DHS in 2016. The risk of hypertension was significantly high in KwaZulu-Natal and Mpumalanga in the 2016 DHS, despite being previously nonsignificant in the SANHANES 2012. In both survey years, hypertension was significantly higher among males, the coloured population group, urban participants and those with self-reported high blood cholesterol. The odds of hypertension increased non-linearly with age, body mass index (BMI), waist circumference. The findings can inform decision making regarding the allocation of public resources to the most affected areas of the population

The Implications of the Developmental Origins of Health and Disease on Public Health Policy and Health Promotion in South Africa

The developmental origins of health and disease (DOHaD) hypothesis states that environmental influences in utero and in early life can determine health and disease in later life through the programming of genes and/or altered gene expression. The DOHaD is likely to have had an effect in South Africa during the fifty years of apartheid; and during the twenty years since the dawn of democracy in 1994. This has profound implications for public health and health promotion policies in South Africa, a country experiencing increased prevalence of noncommunicable diseases (NCDs) and risk factors and behaviours for NCDs due to rapid social and economic transition, and because of the DOHaD. Public health policy and health promotion interventions, such as those introduced by the South African Government over the past 20 years, were designed to improve the health of pregnant women (and their unborn children). They could in addition, through the DOHaD mechanism, reduce NCDs and their risk factors in their offspring in later life. The quality of public health data over the past 40 years in South Africa precludes the possibility of proving the DOHaD hypothesis in that context. Nevertheless, public health and health promotion policies need to be strengthened, if South Africa and other low and middle income countries (LMICs) are to avoid the very high prevalence of NCDs seen in Europe and North America in the 50 years following the Second World War, as a result of socio economic transition and the DOHaD

Prevalence of multimorbidity of cardiometabolic conditions and associated risk factors in a population-based sample of South Africans : a cross-sectional study

Objectives Ageing populations have led to a growing prevalence of multimorbidity. Cardiometabolic multimorbidity (CM), the co-existence of two or more cardiometabolic disorders in the same person, is rapidly increasing. We examined the prevalence and risk factors associated with CM in a population-based sample of South African adults. Study design Data were analysed on individuals aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES), a cross sectional population-based survey conducted in 2011-2012. Methods CM was defined as having ≥2 of hypertension, diabetes, stroke and angina. Hypertension was defined as blood pressure ≥140/90 mmHg or self-reported antihypertensive medication use. Diabetes was defined by HbA1c≥6.5% or self-reported medication use. Stroke and angina were assessed by self-report. Multivariable logistic regression was used to investigate the sociodemographic and modifiable risk factors associated with CM. The association of CM with the functional status of individuals was examined using logistic regression, where functional status was measured by the WHO DAS 2.0 12-item instrument. Results Of the 3832 individuals analysed, the mean age was 40.8 years (S.D. 18.3), 64.5% were female and 18% were ≥60 years. The prevalence of CM was 10.5%. The most prevalent CM cluster was hypertension and diabetes (7.3%), followed by hypertension and angina (2.6%) and hypertension and stroke (1.9%). Of the individuals with diabetes, nearly three quarters had multimorbidity from co-occurring hypertension, angina and/or stroke and of those with hypertension, 30% had co-occurring diabetes, angina and/or stroke. Age (30-44 years Adjusted Odds Ratio (AOR)=2.68, 95% CI: 1.15 - 6.26), 45-59 years AOR=16.32 (7.38 - 36.06), 60-74 years AOR=40.14 (17.86 - 90.19), and ≥75 years AOR=49.54 (19.25 - 127.50) compared with 15-29 years); Indian ethnicity (AOR=2.58 (1.1 - 6.04) compared with black African ethnicity), overweight (AOR=2.73 (1.84 - 4.07)) and obesity (AOR=4.20 (2.75 - 6.40)) compared with normal or underweight) were associated with increased odds of CM. When controlling for age, sex and ethnicity, having ≥2 conditions was associated with significantly higher WHO DAS percentage scores (β=5.4, S.E.=1.1, p<0.001). Conclusions A tenth of South Africans have two or more cardiometabolic conditions. The findings call for immediate prioritisation of prevention, screening and management of cardiometabolic conditions and their risk factors to avert large scale health care costs and adverse health outcomes associated with multimorbidity.Publisher PDFPeer reviewe

Healthrise diabetes dataset noPII.

South Africa is experiencing a rapidly growing diabetes epidemic that threatens its healthcare system. Research on the determinants of diabetes in South Africa receives considerable attention due to the lifestyle changes accompanying South Africa’s rapid urbanization since the fall of Apartheid. However, few studies have investigated how segments of the Black South African population, who continue to endure Apartheid’s institutional discriminatory legacy, experience this transition. This paper explores the association between individual and area-level socioeconomic status and diabetes prevalence, awareness, treatment, and control within a sample of Black South Africans aged 45 years or older in three municipalities in KwaZulu-Natal. Cross-sectional data were collected on 3,685 participants from February 2017 to February 2018. Individual-level socioeconomic status was assessed with employment status and educational attainment. Area-level deprivation was measured using the most recent South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and hypertension diagnosis. The prevalence of diabetes was 23% (n = 830). Of those, 769 were aware of their diagnosis, 629 were receiving treatment, and 404 had their diabetes controlled. Compared to those with no formal education, Black South Africans with some high school education had increased diabetes prevalence, and those who had completed high school had lower prevalence of treatment receipt. Employment status was negatively associated with diabetes prevalence. Black South Africans living in more deprived wards had lower diabetes prevalence, and those residing in wards that became more deprived from 2001 to 2011 had a higher prevalence diabetes, as well as diabetic control. Results from this study can assist policymakers and practitioners in identifying modifiable risk factors for diabetes among Black South Africans to intervene on. Potential community-based interventions include those focused on patient empowerment and linkages to care. Such interventions should act in concert with policy changes, such as expanding the existing sugar-sweetened beverage tax.</div

Prevalence Ratios (PR) and Standard Errors (SE) for diabetes treatment (n = 769).

Prevalence Ratios (PR) and Standard Errors (SE) for diabetes treatment (n = 769).</p

Sample description.

South Africa is experiencing a rapidly growing diabetes epidemic that threatens its healthcare system. Research on the determinants of diabetes in South Africa receives considerable attention due to the lifestyle changes accompanying South Africa’s rapid urbanization since the fall of Apartheid. However, few studies have investigated how segments of the Black South African population, who continue to endure Apartheid’s institutional discriminatory legacy, experience this transition. This paper explores the association between individual and area-level socioeconomic status and diabetes prevalence, awareness, treatment, and control within a sample of Black South Africans aged 45 years or older in three municipalities in KwaZulu-Natal. Cross-sectional data were collected on 3,685 participants from February 2017 to February 2018. Individual-level socioeconomic status was assessed with employment status and educational attainment. Area-level deprivation was measured using the most recent South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and hypertension diagnosis. The prevalence of diabetes was 23% (n = 830). Of those, 769 were aware of their diagnosis, 629 were receiving treatment, and 404 had their diabetes controlled. Compared to those with no formal education, Black South Africans with some high school education had increased diabetes prevalence, and those who had completed high school had lower prevalence of treatment receipt. Employment status was negatively associated with diabetes prevalence. Black South Africans living in more deprived wards had lower diabetes prevalence, and those residing in wards that became more deprived from 2001 to 2011 had a higher prevalence diabetes, as well as diabetic control. Results from this study can assist policymakers and practitioners in identifying modifiable risk factors for diabetes among Black South Africans to intervene on. Potential community-based interventions include those focused on patient empowerment and linkages to care. Such interventions should act in concert with policy changes, such as expanding the existing sugar-sweetened beverage tax.</div

Inclusivity questionnaire diabetes.

Inclusivity in global research questionnaire. (DOCX)</p