Data management instruments to protect the personal information of children and adolescents in sub-Saharan Africa

Recent data protection regulatory frameworks, such as the Protection of Personal Information Act (POPI Act) in South Africa and the General Data Protection Regulation (GDPR) in the European Union, impose governance requirements for research involving high-risk and vulnerable groups such as children and adolescents. Our paper's objective is to unpack what constitutes adequate safeguards to protect the personal information of vulnerable populations such as children and adolescents. We suggest strategies to adhere meaningfully to the principal aims of data protection regulations. Navigating this within established research projects raises questions about how to interpret regulatory frameworks to build on existing mechanisms already used by researchers. Therefore, we will explore a series of best practices in safeguarding the personal information of children, adolescents and young people (0-24 years old), who represent more than half of sub-Saharan Africa's population. We discuss the actions taken by the research group to ensure regulations such as GDPR and POPIA effectively build on existing data protection mechanisms for research projects at all stages, focusing on promoting regulatory alignment throughout the data lifecycle. Our goal is to stimulate a broader conversation on improving the protection of sensitive personal information of children, adolescents and young people in sub-Saharan Africa. We join this discussion as a research group generating evidence influencing social and health policy and programming for young people in sub-Saharan Africa. Our contribution draws on our work adhering to multiple transnational governance frameworks imposed by national legislation, such as data protection regulations, funders, and academic institutions

Inequality and mental healthcare utilisation among first-year university students in South Africa

Background Addressing inequalities in mental healthcare utilisation among university students is important for socio-political transformation, particularly in countries with a history of educational exclusion. Methods As part of the WHO World Mental Health International College Student Initiative, we investigated inequalities in mental healthcare utilisation among first-year students at two historically “White” universities in South Africa. Data were collected via a web-based survey from first-year university students (n = 1402) to assess 12-month mental healthcare utilisation, common mental disorders, and suicidality. Multivariate logistic regression models were used to estimate associations between sociodemographic variables and mental healthcare utilisation, controlling for common mental disorders and suicidality. Results A total of 18.1% of students utilised mental healthcare in the past 12 months, with only 28.9% of students with mental disorders receiving treatment (ranging from 28.1% for ADHD to 64.3% for bipolar spectrum disorder). Of those receiving treatment, 52.0% used psychotropic medication, 47.3% received psychotherapy, and 5.4% consulted a traditional healer. Treatment rates for suicidal ideation, plan and attempt were 25.4%, 41.6% and 52.9%, respectively. In multivariate regression models that control for the main effects of mental health variables and all possible joint effects of sociodemographic variables, the likelihood of treatment was lower among males (aOR = 0.57) and Black students (aOR = 0.52). An interaction was observed between sexual orientation and first generation status; among second-generation students, the odds of treatment were higher for students reporting an atypical sexual orientation (aOR = 1.55), while among students with atypical sexual orientations, the likelihood of mental healthcare utilisation was lower for first-generation students (aOR = 0.29). Odds of treatment were significantly elevated among students with major depressive disorder (aOR = 1.88), generalised anxiety disorder (aOR = 2.34), bipolar spectrum disorder (aOR = 4.07), drug use disorder (aOR = 3.45), suicidal ideation (without plan or attempt) (aOR = 2.00), suicide plan (without attempt) (aOR = 3.64) and suicide attempt (aOR = 4.57). Likelihood of treatment increased with level of suicidality, but not number of mental disorders. Conclusion We found very low mental healthcare treatment utilisation among first-year university students in South Africa, with enduring disparities among historically marginalised groups. Campus-based interventions are needed to promote mental healthcare utilisation by first-year students in South Africa, especially among male and Black students and first-generation students with atypical sexual orientations

Risk factors for poor mental health among adolescent mothers in South Africa

In South Africa, high rates of adolescent pregnancy and HIV pose prominent public health challenges with potential implications for mental wellbeing. It is important to understand risk factors for mental health difficulties among adolescent mothers affected by HIV. This study aims to identify the prevalence of likely common mental disorder among adolescent mothers (both living with and not living with HIV) and explores hypothesised risk factors for likely common mental disorder. Cross-sectional data from adolescent mothers (10–19 years; n=1002) utilised within these analyses are drawn from a cohort of young mothers residing in the Eastern Cape Province, South Africa. All mothers completed a detailed questionnaire consisting of standardised measures of sociodemographic characteristics, mental health, and hypothesised risk factors. Logistic regression models were utilised to explore associations between hypothesised risk factors and likely common mental disorder. Risk factors were clustered within a hypothesised socioecological framework and entered into models using a stepwise sequential approach. Interaction effects with maternal HIV status were additionally explored. The prevalence of likely common mental disorder among adolescent mothers was 12.6%. Adolescent mothers living with HIV were more likely to report likely common mental disorder compared to adolescent mothers not living with HIV (16.2% vs 11.2%, X2=4.41, p=0.04). Factors associated with likely common mental disorder were any abuse exposure (OR=2.54 [95%CI:1.20–5.40], p=0.01), a lack of perceived social support (OR=4.09 [95%CI:2.48–6.74], p=<0.0001), and community violence exposure (OR=2.09 [95%CI:1.33–3.27], p=0.001). There was limited evidence of interaction effects between risk factors, and maternal HIV status. Violence exposure and a lack of perceived support are major risk factors for poor mental health among adolescent mothers in South Africa. Violence prevention interventions and social support may help to reduce risk. Identified risk factors spanning individual, interpersonal, and community levels have the potential to impact adolescent maternal mental health

Prevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness

Background There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low- and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population. Methods Data were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods. Results A total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder. Conclusions Despite advances to promote greater social inclusion in post-apartheid SA, students who identify as female, students with atypical sexual orientations, and students with disabilities are nonetheless at increased risk of CMDs, although students who identify as Black and first-generation students are not

Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort.

The Sustainable Development Goals (SDGs) are a visionary and multi-sectoral agenda for human development. With less than a decade left to reach these targets, it is important to identify those at greatest risk of not meeting these ambitious targets. Adolescent mothers and their children are a highly vulnerable group. We mapped 35 SGD-related targets among 1,046 adolescent mothers and their oldest child (n = 1046). Questionnaires using validated scales were completed by 10- to 24-year-old adolescent girls and young women who had their first child before age 20 in an HIV-endemic district in the Eastern Cape province of South Africa. Maternal outcomes included 26 SDG-aligned indicators, while child-related outcomes included 9 indicators. Data was collected by trained researchers, following informed voluntary consent by the adolescent mothers and their caregivers. Frequencies and chi-square tests were conducted to compare progress along SDG-aligned indicators among adolescent mothers by HIV status. Overall, adolescent mothers reported low attainment of SDG-aligned indicators. While four in five adolescent mothers lived in poor households, nearly 93% accessed at least one social cash transfer and 80% accessed a child support grant for their children. Food security rates among adolescent mothers (71%) were lower than among their children (91%). Only two-thirds of adolescent mothers returned to school after childbirth, and only one-fifth were either studying or employed. Over half of adolescent mothers had experienced at least one type of violence (domestic, sexual or community). HIV-positive status was associated with higher rates of hunger and substance use, poorer school attendance, and higher rates of exposure to violence. Understanding progress and gaps in meeting the SDGs among highly vulnerable groups is critical, particularly for adolescent mothers and their children. These complex vulnerabilities suggest that programming for adolescent mothers must address their unique needs

Exploring the cognitive development of children born to adolescent mothers in South Africa

This study explores the cognitive development of children born to adolescent mothers within South Africa compared to existing reference data, and explores development by child age bands to examine relative levels of development. Cross-sectional analyses present data from 954 adolescents (10–19 years) and their first-born children (0–68 months). All adolescents completed questionnaires relating to themselves and their children, and standardized child cognitive assessments (Mullen Scales of Early Learning) were undertaken. Cognitive development scores of the sample were lower than USA reference population scores and relative performance compared to the reference population was found to decline with increasing child age. When compared to children born to adult mothers in the sub-Saharan African region, children born to adolescent mothers (human immunodeficiency virus [HIV] unexposed; n = 724) were found to have lower cognitive development scores. Findings identify critical periods of development where intervention may be required to bolster outcomes for children born to adolescent mothers

Barriers of mental health treatment utilization among first-year college students: First cross-national results from the WHO World Mental Health International College Student Initiative.

BACKGROUND: Although mental disorders and suicidal thoughts-behaviors (suicidal thoughts and behaviors) are common among university students, the majority of students with these problems remain untreated. It is unclear what the barriers are to these students seeking treatment. AIMS: The aim of this study is to examine the barriers to future help-seeking and the associations of clinical characteristics with these barriers in a cross-national sample of first-year college students. METHOD: As part of the World Mental Health International College Student (WMH-ICS) initiative, web-based self-report surveys were obtained from 13,984 first-year students in eight countries across the world. Clinical characteristics examined included screens for common mental disorders and reports about suicidal thoughts and behaviors. Multivariate regression models adjusted for socio-demographic, college-, and treatment-related variables were used to examine correlates of help-seeking intention and barriers to seeking treatment. RESULTS: Only 24.6% of students reported that they would definitely seek treatment if they had a future emotional problem. The most commonly reported reasons not to seek treatment among students who failed to report that they would definitely seek help were the preference to handle the problem alone (56.4%) and wanting to talk with friends or relatives instead (48.0%). Preference to handle the problem alone and feeling too embarrassed were also associated with significantly reduced odds of having at least some intention to seek help among students who failed to report that they would definitely seek help. Having 12-month major depression, alcohol use disorder, and suicidal thoughts and behaviors were also associated with significantly reduced reported odds of the latter outcome. CONCLUSIONS: The majority of first-year college students in the WMH-ICS surveys report that they would be hesitant to seek help in case of future emotional problems. Attitudinal barriers and not structural barriers were found to be the most important reported reasons for this hesitation. Experimental research is needed to determine whether intention to seek help and, more importantly, actual help-seeking behavior could be increased with the extent to which intervention strategies need to be tailored to particular student characteristics. Given that the preference to handle problems alone and stigma and appear to be critical, there could be value in determining if internet-based psychological treatments, which can be accessed privately and are often build as self-help approaches, would be more acceptable than other types of treatments to student who report hesitation about seeking treatment.status: publishe

WHO World Mental Health Surveys International College Student Project: Prevalence and Distribution of Mental Disorders

Increasingly, colleges across the world are contending with rising rates of mental disorders, and in many cases, the demand for services on campus far exceeds the available resources. The present study reports initial results from the first stage of the WHO World Mental Health International College Student project, in which a series of surveys in 19 colleges across 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States) were carried out with the aim of estimating prevalence and basic sociodemographic correlates of common mental disorders among first-year college students. Web-based self-report questionnaires administered to incoming first-year students (45.5% pooled response rate) screened for six common lifetime and 12-month DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, alcohol use disorder, and substance use disorder. We focus on the 13,984 respondents who were full-time students: 35% of whom screened positive for at least one of the common lifetime disorders assessed and 31% screened positive for at least one 12-month disorder. Syndromes typically had onsets in early to middle adolescence and persisted into the year of the survey. Although relatively modest, the strongest correlates of screening positive were older age, female sex, unmarried-deceased parents, no religious affiliation, nonheterosexual identification and behavior, low secondary school ranking, and extrinsic motivation for college enrollment. The weakness of these associations means that the syndromes considered are widely distributed with respect to these variables in the student population. Although the extent to which cost-effective treatment would reduce these risks is unclear, the high level of need for mental health services implied by these results represents a major challenge to institutions of higher education and governments. (PsycINFO Database Record (c) 2018 APA, all rights reserved).status: publishe

The applicability of the theory of planned behaviour in predicting adherence to antiretroviral therapy (ART) among a South African sample

Thesis (MSc)--University of Stellenbosch, 2011.ENGLISH ABSTRACT: The primary aim of the study was to determine the applicability of the theory of planned behaviour (TPB) in predicting adherence to ART among South African patients attending public health clinics. The second aim was to determine the relationship between self-reported adherence and viral load. The results from the hierarchical multiple regression analyses revealed that the linear combination of the variables of the TPB significantly explained 12% of the variance in intentions to adhere to ART. Perceived behavioural control was the only variable that significantly predicted intentions to adhere to ART. The inclusion of perceived stigma was not a useful addition to the model. The results also reflect the relationship between intentions to adhere to treatment and self-reported adherence, which was not significant. The TPB was unable to significantly account for variance in self-reported treatment adherence. When perceived stigma was added to the TPB, the model was still unable to significantly explain variance in self-reported adherence. Nonetheless, attitudes towards treatment were the only variable that significantly accounted for variance in self-reported treatment. It was concluded that interventions aimed at improving adherence among South African patients attending public health clinics, should aim to encourage positive attitudes towards treatment, should aim to increase perceived subjective norms, should increase the patients’ perceptibility that they are able to be adherent and should aim to decrease perceived stigma. Improving adherence to ART can result in increasing the quality of life of patients living with HIV/AIDS.AFRIKAANSE OPSOMMING: Die primêre doel van die studie was om vas te stel of die teorie van beplande gedrag (TPB soos voorgestel in die studie) antiretrovirale terapie (ART) nakoming onder Suid-Afrikaanse pasiёnte by publieke gesondheidsklinieke kan voorspel. Die sekondêre doel was om die verhouding tussen self-gerapporteerde volgehoue behandeling en virale lading te bereken. Die uitslae van die hiёrargiese veelvuldige regressie analise het getoon dat die linêere kombinasie van die veranderlikes van TPB 12% van die verandering in ART voornemens akkuraat kon voorspel. Waargenome gedragsbeheer was die enigste veranderlike wat ART voornemens akkuraat kon verklaar het. Die insluiting van waargenome stigma was nie beduidend ten opsigte van die model nie. Geen beduidende verband tussen voorneme om met behandeling vol te hou en self-gerapporteerde volgehoue-behandelingsgedrag word uitgebeeld. Waargenome gedragsbeheer kon wel ‘n bydrae lewer om verandering in die voorneme om met behandeling vol te hou verklaar. Die TPB kon egter nie ‘n verduideliking bied vir die verandering in self-gerapporteerde volgehouebehandelingsgedrag nie. Toe waargenome stigma by die TPB gevoeg is, was die model steeds nie daartoe instaat om die verandering in self-gerapporteerde volgehouebehandelingsgedrag te verklaar nie. Nietemin, houdings teenoor behandeling was die enigste veranderlike wat verandering in self-gerapporteerde gedrag verklaar. Daar is tot die gevolgtrekking gekom dat intervensies gerig op die verbetering van volhoubare gedrag onder Suid-Afrikaanse pasiёnte wat openbare gesondheidsklinieke bywoon,positiewe houding teenoor behandeling moet aanmoedig, subjektiewe norme verhoog, die pasiёnte se persepsie dat hulle instaat is om volhoubare gedrag kan toon moet verhoog en ook waargenome stigma moet verminder. Beter ART nakoming kan lei tot ‘n toename in die MIV/VIGS pasiёnt se kwaliteit van lewe

Common mental and substance use disorders among people seeking HIV testing

Thesis (D.Phil)--Stellenbosch University, 2017.ENGLISH SUMMARY: The baseline prevalence of common mental disorders (CMDs) and symptoms of distress, depression, anxiety and hazardous alcohol use prior to the receipt of a HIV diagnosis is unknown. The primary aim of this research was to determine the prevalence of CMDs, such as major depression, persistent depressive disorder, generalized anxiety, and alcohol use disorders among a sample of people seeking HIV testing. The second aim was to determine the extent of general distress among the sample of HIV test seekers. The third aim of the study was to determine the ability of the Hopkins Symptom Checklist (HSCL), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and the Alcohol Use Disorder Identification Test (AUDIT) to discriminate between CMD caseness and non-caseness. Utilizing a cross-sectional design, 500 participants were recruited while seeking HIV testing at five non-medical testing sites in the Western Cape, South Africa. The research version of the Structured Clinical Interview for the DSM-5 (SCID-RV) was administered to assess the CMDs. Furthermore, the extent of distress, depression, anxiety and hazardous alcohol use was assessed using the HSCL-25, BDI, BAI, and AUDIT, respectively. Descriptive statistics were used to evaluate the prevalence of CMDs and receiver operating characteristic (ROC) curve analysis was used to determine the effectiveness of the screening instruments in predicting CMD caseness against the SCID as gold standard. The results demonstrated that 28.4% (95% CI [24.45, 32.35]) of the sample had at least one common mental disorder. Elevated prevalence rates for major depression (14.4%; 95% CI [11.32, 17.48]), persistent depressive disorder (7.2%; 95% CI [4.93, 9.47]), generalized anxiety disorder (3.4%; 95% CI [1.81%, 4.99%]) and alcohol use disorder (19.6%; 95% CI [16.12, 23.08]) were reported. The results further showed that the HSCL-25, BDI, BAI, and the AUDIT were effective in identifying CMD caseness. Even the subscales of the HSCL-25 were successful in detecting most of the cases of depression (MDD, and PDD) and generalized anxiety. Of the sample, 41.2% were psychologically distressed, while 21% had moderate depression, 13.6% had moderate anxiety and 34.6% reported hazardous alcohol use. The findings of the research indicated that it is important to screen people for CMDs and distress prior to communicating an HIV diagnosis as these disorders may have a negative impact on quality of life and adherence to ART. A further contribution of the study is that the screening instruments may be used as proxies in identifying people seeking HIV testing with a CMD. Given that HIV testing and mental health services are available independently, fragmented services are provided in public health facilities in South Africa. Future research may need to focus on the integration of referral trajectories with routine screening and HIV testing.AFRIKAANS OPSOMMING: Die basislynvoorkoms van algemene geessteurings en simptome van depressie, angs en gevaarlike alkoholgebruik voor die ontvangs van ’n MIV-positiewe diagnose is nie bekend nie. Die primêre doelstelling van hierdie navorsing was om die voorkoms van algemene geessteurings te bepaal onder 'n steekproef van mense wat MIV-toetsing aanvra met insluiting van depressiewe versteuring, aanhoudende depressiewe versteuring, algemene angsversteuring, en alkoholgebruikversteuring. Die tweede doelstelling was om die vlakke van sielkundige nood onder mense wat ’n MIV-toets aanvra, te bepaal. Die derde doelstelling van die studie was om die effektiwiteit van die ‘Hopkins Symptom Checklist (HSCL)‘, ‘Beck Depression Inventory (BDI)’, ‘Beck Anxiety Inventory (BAI)’ en die ‘Alcohol Use Disorder Identification Test (AUDIT)’ in die bepaling van algemene geestesiekte ‘gevalmatigheid’ en ‘nie-gevalmatigheid’ te ondersoek. Die navorsing het ’n deursneenavorsingsontwerp gebruik. Vyfhonderd deelnemers is gewerf ten tyde van aanmeliding vir MIV-toetsing by vyf nie-mediese toetsplekke in die Wes-Kaap, Suid Afrika. Die navorsingsweergawe van die gestruktureerde kliniese onderhoud vir die DSM-5 (SCID 5), is gebruik om algemene geestessteurings te assesseer. Verder is die vlakke van sielkundige nood, depressie, angs en gevaarlike alkoholgebruik bepaal met behulp van onderskeidelik die HSCL-25, BDI, BAI en AUDIT. Beskrywende statistiek is gebruik om die voorkoms van algemene geessteurings te bepaal en ‘Ontvanger bedryfseienskapkurwe’ (OBE – ROC) analise is gebruik om die doeltreffendheid van die self-rapporteringsinstrumente te bepaal in die voorspelling van algemene geessteuring ‘caseness’ teen die SCID as goudstandaard. Die resultate het getoon dat ten minste 28.4% (95% vertrouensinterval (VI) [24.45, 32.35]) van die steekproef ’n algemene geessteuring het. ’n Verhoogde voorkoms van depressie (14.4%; 95% VI [11.32, 17.48]), aanhoudende depressie (7.2%; 95% VI [4.93, 9.47]), algemene angsversteuring (3.4%; 95% VI [1.81%, 4.99%]) en alkoholgebruikversteuring (19.6%; 95% VI [16.12, 23.08]) is aangemeld. Die resultate het verder getoon dat die HSCL-25, BDI, BAI, en die AUDIT effektief was vir die identifisering van gemeenskaplike geessteuring ‘caseness’. Selfs die subskale van die HSCL-25 was suksesvol met die opsporing van depressie (MDD en PDD), en algemene angs. Van die steekproef het 41.2% van die deelnemers sielkundige nood gehad, terwyl 21% matige depressie, 13.6% matige angs en 34.6% gevaarlike alkoholgebruik gehad het. Die bevindinge van die navorsing het aangedui dat dit belangrik is om mense vir algemene geessteurings en sielkundige nood te toets voor die bekendmaking van hulle MIV-diagnose, aangesien hierdie versteurings ’n negatiewe invloed op lewensgehalte en die nakoming van ARB kan hê. ’n Verdere bydrae van die studie is dat die graderingsinstrumente gebruik mag word vir die identifisering van mense met ’n hoe risiko vir algemene geessteurings wat MIV-toetsing ondergaan. Gegewe dat MIV-toetsing en geestesgesondheidsdienste onafhanklik is van mekaar, verskaf openbare gesondheidsfasiliteite in Suid-Afrika gefragmenteerde dienste. Toekomstige navorsing mag nodig wees om te fokus op die integrasie van verwysingstrajekte met roetine sifting en MIV toetsing