Occupational stress in a South African workforce: instrument testing, prevalence measurement and risk factor analysis

A research report submitted to the Faculty of Health Sciences of the University of the Witwatersrand in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Community Health (Public Health Medicine). May 2014Background Occupational stress represents a substantial public health challenge. Although there has been an extensive focus on this form of stress within the international setting, there appears to be a paucity of relevant evidence within South Africa. Specifically, within the local context, there are relatively few: (1) reliability testing studies of screening and assessment instruments, (2) prevalence analyses of occupational stress and (3) work-related stress management intervention designs. Methods A cross-sectional descriptive and analytical study was undertaken in a large tertiary hospital in Johannesburg. Primary data were collected between February 2013 and September 2013 using the Copenhagen Psychosocial Questionnaire (COPSOQ). A sample (n=166) of administrative staff was selected, stratified into front line staff (n=54), back office staff (n=90) and managers (n=22). Data analysis included reliability testing of the COPSOQ using the Cronbach‘s alpha statistic. Prevalence measurement was also undertaken to describe the distribution of stress and other variables across the study sample. Finally, logistic regression was used to estimate associations between the exposure variables and the stress outcome (at the p < 0.05 level of significance). Results The Cronbach‘s alpha range for the COPSOQ was 0.31 to 0.85. Two out of 24 scales of the instrument fell below the unacceptability threshold of 0.5. In terms of prevalence, the stress mean for the study sample (on a scale from 0 to 100) was 38.8 (SD 19.8). Furthermore, 68.1% (n=113) of the study sample had a stress value above the reference mean. There were also significant differences in the stress values by job category, with managers having the highest mean at 51.2 (SD 24.2). Adjusting for job category, risk factors significantly associated with occupational stress in the main logistic model were offensive behaviour (OR 3.38, 95% CI: 1.54 – 7.43), quantitative demands (OR 2.83, 95% CI: 1.35 – 5.92) and emotional demands (OR 2.32, 95% CI: 1.08 – 4.96), while quality of leadership (OR 0.32, 95% CI: 0.15 – 0.67) was a protective factor. Further analysis showed that the most harmful risk factor for females was work-family conflict (OR 4.03; 95% CI: 1.45 - 11.21), and for males was exposure to offensive behaviour (OR 4.63; 95% CI: 1.15 - 18.63). Finally, ordinal regression found offensive behaviour (OR 3.60; 95% CI: 1.92 - 6.75) and quantitative demands (OR: 2.38; 95% CI: 1.27 - 4.46) to be significant risks for moving from low stress to high stress, while a commitment to workplace (OR 0.46; 95% CI: 0.24 - 0.86) could help to prevent this. Conclusions The level of occupational stress in the study sample was high relative to reference values. An occupational stress intervention is recommended, which should include primary, secondary and tertiary prevention strategies (according to identified risks). Further development of the instrument is also recommended, so as to improve its reliability in the local context. Finally, future research into occupational stress should explore the impact of factors such as resource constraints and HIV/AIDS, and should include an expansion into other settings and occupational categories. Key words Occupational stress, questionnaire reliability, psychosocial risks, intervention design

Recommendations to improve the National Development Plan for Health

In November 2011, a draft National Development Plan (NDP) was released that addresses two of South Africa’s major challenges: poverty and inequity. Health and economic development are interdependent, presenting an important opportunity through the NDP to integrate health within goals of broader socio-economic development. Reviewing the NDP identified gaps based on evidence and the epidemiological risk profile of South Africa. Recommendations to improve the NDP and to deal with poverty and inequity should focus on prevention and addressing the social determinants of health, including: (i) a multisectoral approach to establish a comprehensive early childhood development programme; (ii) fiscal and legislative policies to bolster efforts to reduce the burden of non-communicable diseases; (iii) promoting and maintaining a healthy workforce; (iv) and promoting a culture of evidence-based priority setting. Achieving the goal of ‘a long and healthy life for all South Africans’ will require healthy public policies, well functioning institutional and physical infrastructure, social solidarity, and an active and conscientious civil society

Four-week forecasts of COVID-19 epidemic trajectories in South Africa, Chile, Peru and Brazil : a model evaluation

ABSTRACTIntroductionFrom the beginning of the COVID-19 pandemic, epidemiological models have been used in a number of ways to aid governments and organizations in efficient planning of resources and decision making. These models have elucidated important epidemiological transmission parameters, in addition to making short-term projections.>Methods>We constructed a compartmental mathematical model for the transmission, detection and prevention of SARS-CoV-2 infections for regions where Anglo American has mining operations. We fitted the model to publicly available data and used it to make short-term projections. Finally, we evaluated how the model performed by comparing short-term projections to actual confirmed cases, retrospectively.>FindingsConclusion<Our model produced four-week forecasts with a sufficiently high level of accuracy to guide operational and strategic planning for business continuity and COVID-19 responses in Anglo American mining sites