Browsing by Author "Slemming, Wiedaad"

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Early life risks and child development
(2018) Slemming, Wiedaad
Background Exposure to biological and psychosocial risks, particularly during the first three years of life, affects brain development and compromises the short- and long-term health and development of children, as well as their educational achievement and long-term productivity. This study sought to determine the effects of maternal and child environmental and psychosocial exposures during pregnancy and the first two years of the child’s life on growth and development outcomes in early childhood (up to 5 years) in an urban South African birth cohort. Methods Data used for this study was from the Birth to Twenty Plus (Bt20+) longitudinal birth cohort study, initiated in 1990 in the greater Johannesburg metropolitan area, South Africa. First, the associations between exposure to nine maternal risks, assessed in 1228 women, and subsequent infant birth weight was assessed. Second, the study examined the effects of risk exposure to the mother (and child) during pregnancy and the first year of a child’s life on stunting at age 2 years in 1098 mother–child pairs. Finally, the associations between ten demographic and psychosocial exposures occurring during the third trimester of pregnancy and the first two years of a child’s life and child development age 5 were examined in 636 mother-child pairs. Multivariable regression analyses were used to investigate associations between exposures and outcomes. Further analysis was undertaken to assess whether early life growth mediated the associations between maternal and household exposures and child development outcome at age 5. Results Unwanted pregnancy (or ambivalence) was associated with a ~156 g reduction in infant birth weight (β = −0.32, 95% confidence interval (CI): −0.51, −0.14). Tobacco use during pregnancy was negatively associated with BWZ (β = −0.32, 95% CI: −0.59, −0.05). Exposure to both these risks was associated with cumulative reductions in birth weight. Approximately 1 in 5 children were stunted at age 2 years, with males at greater risk than females. Higher maternal education was protective for females (adjusted odds ratio (AOR) = 0.35; 95% CI: 0.14, 0.87), while higher household SES was protective for males (AOR for richest SES group = 0.39; 95% CI: 0.16, 0.92). Males scored significantly lower than females on the developmental measure at age 5. Improved child developmental outcome was associated with higher birthweight for both sexes and superior linear growth in males. R-DPDQ scores increased by 0.84 units for every 1 SD increase in relative linear growth between birth and two years (β = 0.84 [95% CI 0.30, 1.39]). Socio-economic status (for both sexes) and maternal education for males were significant predictors of better child development. Growth status did not mediate the effects of socio-economic status (either sex) or maternal education (males) on developmental outcome. Conclusion Social factors, especially social determinants such as household SES and maternal education, were associated with early childhood growth and development in this context. Prenatal (using birthweight as a proxy) and postnatal growth were important for child development. Males were particularly vulnerable to poor growth and development in this cohort. The effects of household SES and maternal education on child development at 5 years were not mediated by linear growth between birth and 4 years.
Experiences of healthcare workers using the AwezaMed translation application in antenatal settings
(University of the Witwatersrand, Johannesburg, 2023-06) Cason, Caroline Marian; Slemming, Wiedaad; Wilken, Ilana
Introduction: Language barriers impede quality health care service in South Africa. Trained interpreters could alleviate this problem, but they are not employed in public or private health settings. Health care workers rely on informal interpreters, who do not necessarily provide an adequate service, and may be resentful of this extra task. AwezaMed is a smart application developed by the Council for Scientific and Industrial Research (CSIR) with content developed for maternal health settings. The aim of this study was to assess usability and user experience relating to AwezaMed. Methods: A user experience study was conducted using mixed methods. The systems usability scale (SUS) was employed, surveying 12 users, to generate a quantitative score, representing the overall usability of the system. Interviews were conducted with 14 users and analysed thematically to identify themes of usability and user experience, and recognise factors which contribute to use of the application. Results: The application (app) achieved a total score of 66.25, rating it between ‘OK/Fair’ and ‘Good’. Understandability, operability, attractiveness, and trust were important usability themes. Users also reported using the app as an aid to language learning. Factors which influenced the use of the app included previous experience with mHealth, experiencing a language barrier in health settings, and unavailability of, or problems with interpreters. Discussion: While the app was received positively, it did not meet users’ expectations, as two-way communication could not be achieved. Due to the often-strained relationship between healthcare workers and informal interpreters, there remains a demand for a usable, trustworthy mHealth solution. A framework is proposed, based on these findings, to evaluate mHealth translation applications in South Africa in the future.
Maternal perceptions of infant's body weight and childhood obesity in South Africa: a qualitative study in Soweto
(Wiley, 2023) Norris, Shane A.; Cohen, Emmanuel; Wrottesley, Stephanie V.; Prioreschi, Alessandra; Slemming, Wiedaad
From a socio-anthropological study focusing on maternal body weight perceptions and dietary practices towards infants living in Soweto (South Africa), we studied how lay sociocultural traits may lead to early childhood obesity. Most mothers tended to socially value and normalize fatness. This propensity led mothers, particularly older women at home, to adopt high-calorie feeding practices towards infants, although some mothers tended to question these lay norms. Further works must consider how lay (emic) sociocultural norms in African townships can contradict biomedical (etic) messages, conveying for the community thinness as the acceptable standard, and may expose infants to early obesity.
Mobile technology use in clinical research examining challenges and implications for health promotion in South Africa: mixed methods study
(JMIR Publications, 2024-04) Norris, Shane A.; Cohen, Emmanuel; Slemming, Wiedaad; Wrottesley, Stephanie V.; Prioreschi, Alessandra
Background: The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in lowand middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. Objective: This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. Methods: A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were “contactability of the participants” and “participants’ mobile number changes,” and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Results: Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Conclusions: Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice.
The effects of COVID-19 on paediatric therapeutic services at Chris Hani Baragwanath Academic Hospital
(University of the Witwatersrand, Johannesburg, 2024) McGrath, Robyn Lesley; Slemming, Wiedaad
Background: The COVID-19 pandemic has affected child health services worldwide, including in South Africa, where prioritisation of paediatric therapeutic services was lacking despite their vital role in health promotion and disease management. Aim: This study aimed to assess the impact of the COVID-19 pandemic on paediatric therapeutic services at a tertiary level hospital in Johannesburg, South Africa, focusing on service outputs, challenges, and innovations during 2020 and 2021. Methods: This study used a concurrent triangulation mixed methods approach. Quantitative analysis of service output data was combined with qualitative analysis of healthcare worker interviews. Integration was facilitated through a convergent design joint display during interpretation. Results: In 2020, patient contact sessions significantly decreased, particularly during lockdown phases, leading to missed diagnoses and adverse patient outcomes. Ineffective hospital management contributed to a lack of communication and direction for managers and clinicians which was worsened by the absence of national guidelines. Persistent trends of low service utilisation during the pandemic drove healthcare worker innovation, forcing healthcare workers to adopt a systems approach to decision making. Innovations centred on inter-professional communication and coordination, service re-evaluation and restructuring, new service delivery models, technology use, patient education and prioritisation, and adapting the duration and frequency of care. Conclusion: Paediatric services healthcare workers responded innovatively to pandemic challenges, with some solutions improving long-term service delivery efficiency. Insights from this study can enhance health system preparedness and inform planning for paediatric therapeutic services in South Africa, especially in anticipation of future events and the National Health Insurance scheme