Browsing by Author "Jessica Price"

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    Can verbal autopsies be used on a national scale Key findings and lessons from South Africas national causeofdeath validation study
    (CO-ACTION PUBLISHING) M Maqungo; N Nannan; B Nojilana; E Nichols; E et al; Jessica Price; Kathleen Kahn; Chodziwadziwa Kabudula
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    Essential health services delivery in South Africa during COVID-19: Community and healthcare worker perspectives
    (2022-12-08) Samanta T. Lalla-Edward; Atiya Mosam; Jennifer Hove; Agnes Erzse; Teurai Rwafa-Ponela; Jessica Price; Athini Nyatela; Sizwe Nqakala; Kathleen Kahn; Stephen Tollman; Karen Hofman; Susan Goldstein
    Background: Between May 2020 and February 2022, South Africa’s health system bore strain as it battled mitigating the coronavirus pandemic. The country’s pandemic response was scrutinized. This period also brought into focus pre-existing shortcomings in the healthcare system and its governing bodies. Contextually, there is a paucity in literature on the experiences of healthcare providers and users. This study aimed to contribute information on COVID-19, with the intention of providing guidance on preparing for future infectious disease outbreaks. Methods: Cross sectional exploratory qualitative methodology was employed using semi-structured interviews and focus group discussions with community members (CM) and healthcare workers (HCW) from two South African study sites: (a) rural Bushbuckridge (run by Agincourt Health and Socio-Demographic Surveillance Site) and (b), Regions D and F in Johannesburg Metropole. Results: After interviewing 42 CMs and 43 HCWs, it emerged that mandated process changes while minimizing COVID-19 exposure, necessitated healthcare personnel focusing on critical care treatment at the expense of less acute ones. COVID-19 isolation protocols, extensive absenteeism and HCWs with advanced skills being perceived as more adept to treat COVID-19 patients contributed to HCWs experiencing higher workloads. Fears regarding contracting and transmitting COVID-19, suering financial losses, and not being able to provide adequate advice to patients were recurrent themes. Dissemination of relevant information among healthcare facility personnel and communities suered due to breakdowns in communication. Conclusion: Concessions and novel strategies to avail medication to patients had to be created. Since providence was lacking, government needs to formulate health intervention strategies that embrace health literacy, alternate methods of chronic medication dispensation, improved communication across health care platforms and the use of telehealth, to circumvent the threats of possible further infectious disease outbreaks.
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    Pregnancy-related healthcare utilisation in Agincourt, South Africa, 1993–2018: a longitudinal surveillance study of rural mothers
    (2021-10-01) Sack, Daniel; Ryan G Wagner; Daniel Ohene-Kwofie; Chodziwadziwa W Kabudula; Jessica Price; Carren Ginsburg; Carolyn M Audet
    ntroduction Pregnancy-related health services, an important mediator of global health priorities, require robust health infrastructure. We described pregnancy-related healthcare utilisation among rural South African women from 1993 to 2018, a period of social, political and economic transition. Methods We included participants enrolled in the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga Province, South Africa, a population-based longitudinal cohort, who reported pregnancy between 1993 and 2018. We assessed age, antenatal visits, years of education, pregnancy intention, nationality, residency status, previous pregnancies, prepregnancy and postpregnancy contraceptive use, and student status over the study period and modelled predictors of antenatal care utilisation (ordinal), skilled birth attendant presence (logistic) and delivery at a health facility (logistic).
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    Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making
    (2021-10-25) Lucia D’Ambruoso; Jessica Price; Eilidh Cowan; Gerhard Goosenf; Edward Fottrell; Kobus Herbst; Maria van der Merwe; Jerry Sigudla; Justine Davies; Kathleen Kahn
    Background: Recognising that the causes of over half the world’s deaths pass unrecorded, the World Health Organization (WHO) leads development of Verbal Autopsy (VA): a method to understand causes of death in otherwise unregistered populations. Recently, VA has been developed for use outside research environments, supporting countries and communities to recognise and act on their own health priorities. We developed the Circumstances of Mortality Categories (COMCATs) system within VA to provide complementary circumstantial categorisations of deaths. Objectives: Refine the COMCAT system to (a) support large-scale population assessment and (b) inform public health decision-making. Methods: We analysed VA data for 7,980 deaths from two South African Health and SocioDemographic Surveillance Systems (HDSS) from 2012 to 2019: the Agincourt HDSS in Mpumalanga and the Africa Health Research Institute HDSS in KwaZulu-Natal. We assessed the COMCAT system’s reliability (consistency over time and similar conditions), validity (the extent to which COMCATs capture a sufficient range of key circumstances and events at and around time of death) and relevance (for public health decision-making). Results: Plausible results were reliably produced, with ‘emergencies’, ‘recognition, ‘accessing care’ and ‘perceived quality’ characterising the majority of avoidable deaths. We identified gaps and developed an additional COMCAT ‘referral’, which accounted for a significant proportion of deaths in sub-group analysis. To support decision-making, data that establish an impetus for action, that can be operationalised into interventions and that capture deaths outside facilities are important. Conclusions: COMCAT is a pragmatic, scalable approach enhancing functionality of VA providing basic information, not available from other sources, on care seeking and utilisation at and around time of death. Continued development with stakeholders in health systems, civil registration, community and research environments will further strengthen the tool to capture social and health systems drivers of avoidable deaths and promote use in practice settings.
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    “We Were Afraid”: Mental Health Effects of the COVID-19 Pandemic in Two South African Districts
    (2022-07-28) Teurai Rwafa-Ponela; Jessica Price; Athini Nyatela; Sizwe Nqakala; Atiya Mosam; Agnes Erzse; Samanta Tresha Lalla-Edward; Jennifer Hove; Kathleen Kahn; Stephen Tollman; Karen Hofman; Susan Goldstein
    The impacts of pandemics are recognized to go beyond infection, physical suffering, and socio-economic disruptions. Other consequences include psychological responses. Using a mental wellbeing lens, we analyzed COVID-19-related stressors in healthcare workers (HCWs) and community members who provided and regularly accessed health services in South Africa, respectively. From February to September 2021, during the second COVID-19 wave we conducted a qualitative study in one urban and one rural district. In-depth interviews and focus group discussions were used to collect data among 43 HCWs and 51 community members purposely and conveniently selected. Most participants experienced mental health challenges regarding multiple aspects of the COVID-19 pandemic and its resulting lockdown, with a few reporting positive adjustments to change. COVID-19 impacts on mental health were consistent among both HCWs and community members in urban and rural alike. Participants’ COVID-19-induced psychological responses included anxiety and fear of the unknown, perceived risk of infection, fear of hospitalization, and fear of dying. Physical effects of the pandemic on participants included COVID-19 infection and associated symptoms, possibilities of severe illness and discomfort of using personal protective equipment. These distresses were exacerbated by social repercussions related to concerns for family wellbeing and infection stigma. Lockdown regulations also intensified anxieties about financial insecurities and social isolation. At times when common coping mechanisms such as family support were inaccessible, cultural consequences related to lack of spiritual gatherings and limited funeral rites posed additional stress on participants. In preparation for future public health emergencies, recognition needs to be given to mental health support and treatment.