Electronic Theses and Dissertations (Masters)

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Levels and factors associated with homicide-related deaths in a rural South African population
(2011-03-25) Otieno, George Omondi
Background: World Health Organization (WHO) estimates that more than 1.6 million people die every year because of violence and out of these deaths, homicide accounts for almost one third. Ninety percent (90%) of homicide are thought to occur in low and middle income countries. South Africa has one of the most disturbing rates of homicide in the world. These high homicide rates besides resulting in reduced life expectancy also have serious health, social and economic consequences. Aim: The study aimed at quantifying the burden as well as and identifying factors associated with homicide deaths in rural KwaZulu-Natal in South Africa during the period of 2000 to 2008. Objectives: To estimate a 9 year period (2000-2008) homicide incidence rates as well as identify factors associated with homicide-related deaths. Further, the analysis described spatial distribution of homicide-related deaths in a rural South African population. Design: Analytical longitudinal study. Methods: Using data drawn from the Verbal Autopsies (VAs) conducted on all deaths recorded during annual demographic and health surveillance over a 9-year period (2000-2008), Kaplan-Meier (K-M) survival estimates of incidence rates were used to estimate the cumulative probability of death until the end of the period. Estimates were reported by sex and residency. Weibull regression methods were used to investigate factor associated with homicide deaths. Kulldorff spatial scan statistics was used to describe homicide clustering. Results: With 536 homicide-related deaths, and 814, 715 total Person Years of contribution, the study found an overall incidence rate of 66 (95% CI= (60, 72) per 100, 000 Person Years of v Observation (PYOs) for the period studied. Death due to firearm was reported the leading cause of mortality (65%). Most deaths occurred over the weekends (43%), followed by Friday (16.2%).The highest homicide incidence rates were recorded in 2001 (90; 95% CI= (71, 111) per 100,000 person years at risk and 2004 (86; 95% CI= (68, 108) per 100,000 person years at risk. Males had a rate that was about six times more than females 115 (95% CI=105,127) per 100,000 PYOs. Age-specific homicide rate were highest among males aged 25-29 years (209.90 per 100,000 PYOs) and females aged 50-54 years (78 per 100,000 PYOs). Resident, age, sex, education, socioeconomic status, and employment independently predicted homicide risk. The study identified two geographical clusters with significantly elevated homicide risk. Conclusion: A significant six fold difference in homicide rate existed between males and females. Sex differential increases with age, with males aged 15-54 years the most likely to be killed, and females aged 55 years and above having the highest homicide rate. Increase in wealth status and level of education increases one‘s risk of homicide. Employment per se was protective from homicide risk. Firearm was the leading cause of mortality. Most deaths occur over the weekend. Two geographical areas with elevated homicide risk were observed. These findings underscore the need to have timely information and strategies for effective violence prevention program to subgroups and areas at risk.
The relationship between awareness of violence against women prevention campaigns and gender attitudes and talking about violence among women in Gauteng
(2016-10-12) Mataba, Rumbidzayi B.
Introduction: Gender based violence (GBV) is a public health problem with as many as 35% of women having been subjected to either physical and or sexual violence globally. Gender attitudes and silence around gender based violence, are factors that exacerbate GBV. Global and local awareness campaigns are means for preventing violence against women. Campaigns have the potential to challenge women and men’s underlying gender beliefs and attitudes that contribute to unequal power relations between women and men. The overall objective of this study was to examine the association between awareness campaigns and gender attitudes or talking about domestic violence among women in Gauteng, South Africa. Materials and Methods: This study is a secondary analysis of data from a cross-sectional study conducted in Gauteng, South Africa from April to July 2010. The study aimed to describe the prevalence and patterns of experiences of GBV, HIV risk, gender attitude and awareness of GBV prevention campaigns in Gauteng. The main exposure variable in this study is having heard about 16 Days of Activism for No Violence Against Women and Children campaign and the 365 Days National Action Plan to End Gender Based Violence. The two primary outcomes are gender attitudes and discussing about domestic violence. Gender attitudes were measured using three scales: the Gender Equitable Women’s Scale, the Ideas about Gender Relations Scale and the Ideas about Rape Scale. Univariate analysis was conducted to describe the socio-demographic characteristics, awareness of campaigns, gender attitudes and talking about domestic violence among the participants. Multivariate analysis was conducted to examine the associations between awareness of campaigns and the outcomes while adjusting for age, education, employment, nationality, race and relationship status. Results: The results show that only a minority of the participants had heard of the 16 Days of Activism for No Violence Against Women and Children campaign (32.6%) and the 365 Days National Action Plan to End Gender Based Violence (9.2%) campaigns. Most of the participants had progressive gender attitudes; GEWS (71.7%), IGRS (82.1%) and the IRS (88.1%) while less than half (48.7%) had spoken about domestic violence to someone else. Women who were exposed to the 16 Days of Activism for No Violence Against Women and Children campaign were twice as likely to have progressive gender attitudes measured by the Gender Equitable Women’s Scale (aOR 2.2, 95% CI 1.2-3.8) compared to those who had not been exposed. Education, relationship status and nationality were found to be significantly associated with gender attitudes on the same scale. No association was found between awareness of 16 Days of Activism for No Violence Against Women and Children campaign and gender attitudes measured through the Ideas about Gender Relations Scale and the Ideas about Rape Scale. Awareness of 16 Days of Activism for No Violence Against Women and Children campaign was also associated with talking about domestic violence (aOR 1.9, 95% CI 1.2 - 3.0). Age and education were also significantly associated with talking about domestic violence. Gender attitudes were also significantly associated with talking about domestic violence (aOR 1.2 95% CI 1.1 – 3.6). No association was found between exposure to the 365 Days National Action Plan to End Gender Based Violence and gender attitudes or talking about domestic violence. Conclusions: From this study, the majority of the women interviewed had progressive gender attitudes. However, the majority of the women had never spoken about domestic violence to someone else. Women exposed to GBV campaigns had more progressive gender attitudes and spoke about domestic violence more than those who were not exposed. These findings are evidence to the need for wider coverage and different messaging approaches in the implementation of GBV campaigns in South Africa. Wider coverage of campaigns is only possible with more funding for national, provincial and local GBV programmes. Key messages in GBV campaigns need to include a priority focus on addressing the underlying social and cultural norms that contribute to the imbalances of power due to gender difference.
The psychosocial work environment of women construction workers: an integrative literature review
(2022) Williams, Thato Leslie-Ann
Background: There is an increase in the number of women in the construction industry, which was considered as a masculine trade for decades. This is prone to have a bearing on the psychosocial work environment of women employed in this male dominated field of work. Women face unique challenges as opposed to their male counterparts who are employed in the same trade. These challenges include discrimination, sexual harassment, overlooked for promotions and being office bound regardless of education. These challenges can impact the psychosocial work environment of women in the workplace, which can result in them opting to exit the industry. Aims and objectives: To gather and critically analyse scientific literature to describe the psychosocial work environment of women employees in the construction industry. Design: An integrative literature review using the Whittemore and Knafl (2005) framework’s stages was used. These stages included problem identification, literature search, data evaluation, data analysis and presentation of findings. Methods: A comprehensive literature search was performed using Asce Library, Emerald, Science Direct electronic databases and from reference list of included articles. The studies were in English, published between January 1993 to November 2018. A total of 3764 studies were retrieved from the search. The inclusion and exclusion criteria were applied, and 57 studies were eligible for abstract reading, which yielded 7 eligible studies that were used in the study. Results: Four themes that emerged include, less representation of women in the construction industry due to inability of retaining women. Discussion and conclusion: Discrimination due to the benevolent sexism that women face. Stressful work environment which is amplified for women as it affects work-life balance. Labour laws, they are implemented and hardly reviewed. Women are an un-tapped resource and by eradicating these challenges by interventions the industry can be inclusive.
Evaluation of implementation fidelity to national guidelines on management of tuberculosis in paediatric patients in Homa-Bay County, Kenya
(2022) Kiptoon, Sharon Cherono
Background: Tuberculosis (TB) has been a major public health concern for a long time. Infection in children has not been given a lot of focus as in adults despite children being a vulnerable population with weaker immunity. Prognosis is worse when there is HIV/TB coinfection. The WHO rolled out guidelines for the management of TB in pediatric patients which were adopted by the Kenya Government. Health care workers then implement the guidelines. The Objectives of this study were to measure adherence to national guidelines on the management of Tuberculosis in Pediatric patients (up to 14 years) and to identify moderators affecting implementation fidelity. Methods: A convergent parallel mixed method design was used to collect information from TB treatment sites in Homa bay County. The study was conducted during the months of August, September and October 2018.Quantitative data collected focused on Pediatric patients between ages zero and 14. A checklist based on the guidelines was designed to review 442 records in the clinics for a four-year period (2014 to 2018). Qualitative data was collected through in-depth interviews with eight Sub-County TB coordinators. Interview moderators were based on Carrol et al Implementation Fidelity framework. Summation of "yes" and "No" responses were tallied to get an adherence score for the County as a whole and for the sub-counties individually. The qualitative analysis used the thematic method in excel spreadsheets. Results: Results showed high adherence for the County with a median of 80% (IQR 66.66-93.33%). Four of the sub-counties with normally distributed scored had a mean score of 79% and while the other four had a median score of 80% (66.66 – 93.33). Guidelines which had low implementation fidelity scores were those involving follow up tests i.e., sputum, gene X-pert and X-ray during duration of treatment. In the qualitative aspect good facilitation strategies were found to be in place from both the County and national TB programs. An attitude of fear, lack of knowledge on infection prevention, lack of skills to produce specimens for TB testing and staff shortages affected quality of treatment delivery. The health care workers reported ease in following the guidelines especially with the roll out of new guidelines which simplified diagnosis of TB in children, drugs which are dispersible and in fixed dose combination. Participant’s response to the intervention was poor with both health care workers and patients expressing difficulties with direct observed therapy schedule which required frequent visits and frequent follow up tests. Conclusion and recommendations: In conclusion, implementation fidelity to guidelines on management of tuberculosis is high. Good facilitation strategies is a positive moderator towards achieving high implementation fidelity. The national TB program in Kenya is doing well so far in monitoring the process of guideline implementation once rolled out, however, to be able to achieve the sustainable development goal eradicating TB, further follow up is needed in the facilities to improve the levels of adherence from 80% to 100%. Use of the conceptual framework by Carroll has proved to be a good guide in evaluating healthcare worker’s performance in implementing treatment guidelines It is recommended that health workers should undergo more sensitization on why certain guidelines have been put in place e.g., repeating sputum samples at different phases of treatment in order to improve quality of care. More training on vital procedures e.g., gastric aspirate should also be done to improve health workers' confidence and ease diagnosis of TB at younger age. Further research on implementation fidelity on other evidence based interventions would go a long way to improve service delivery and ensure other program goals are met.
Exposure and risk assessment of benzene, toluene, ethyl benzene and xylene (btex) in a petrochemical depot at Heidelberg, South Africa
(2022) Mdlalose, Richard John
Background: The International Labour Organization estimated 2.2 million workers are dying yearly from work-related accidents and occupational diseases, whilst about 270 million suffer serious injuries, and 160 million become ill due to their work. It is further estimated that work-related accidents and diseases cause 4% of annual Global Gross Domestic Product or US $1.25 trillion due to lost working time, workers’ compensation, the interruption of production, and medical expenses. In 2005, the ILO estimated that 440 000 people died throughout the world because of exposure to hazardous chemicals. In 2018 chemicals production was the second largest production sector in the world. Chemicals are indispensable and critical part of life. Their visible positive outcomes are quite palpable. They are well recognized for instance pesticides improve the quality of food production, pharmaceuticals cure illness, cleaning products help to establish hygienic living conditions. Chemicals are key development of final products that make life little easy for human beings, etc. Controlling employees ‘exposure to chemicals and preventing or minimizing emissions remains a significant challenge in workplaces throughout the world. The production, storage, and handling of petrochemical products particularly BTEX emissions are known and associated with potential harm to human and aquatic organisms. Some of the health effects associated with exposure to BTEX are the health effects on hematopoietic system, including pancytopenia. The benzene exposure leads to an acute myelogenous leukemia. The exposure to toluene, ethylbenzene, and xylene have been linked to the damaging the central nervous system and irritation of the respiratory system. Benzene and ethylbenzene are confirmed carcinogens (Benzene is classified as a Group 1 and ethylbenzene is a Group 2 B carcinogens). Purpose: To characterize, assess exposure and health risk assessment to benzene, toluene, ethylbenzene, and xylene (BTEX) at the petrochemical depot at Heidelberg in Gauteng, South Africa. Methods: Exposure sampling was done using a MiniRAE 3000 Photoionization detector (PID). The PID (equipment) was calibrated before the commencement of the monitoring program following the manufacturer’s operating manual. The PID equipment was used to collect the BTEX samples. The PID was mounted on a marked tripod stand at 1.5 m above ground and approximately 0.2 m to 0.5 m in the microenvironment (Exposure scenario) of the depot workers (Controllers and/or laboratory assistant) with the probe extended or placed within 30cm of the breathing zone of the depot workers. Sampling was conducted at three different exposure scenarios (workstations) i.e., density huts, laboratory, and during plant equipment cleaning in the plant (strainer removal) over three days period. The sampling started from 08h00 to 17h00. One workstation was sampled per day. The sampling of BTEX per workstation took 30 minutes per hour over ten hours, every hour BTEX was sampled for a duration of 30 minutes and in totality ten samples were collected per 12- hour shift, a total of 30 BTEX samples were collected over the 3 days period. Additionally, the measured BTEX concentrations were used to obtain dose estimates. Data from the equipment was exported to a Microsoft Excel spreadsheet. All outliners were removed from the data and a correction factor was applied to derive the final concentration. Thereafter, statistical tests using student F-test and Test were performed to evaluate for significant differences amongst paired comparisons. Results : The highest average BTEX concentrations were measured in the laboratory, followed by density huts and the least was measured during the removal of the strainer (plant equipment cleaning). The activity areas (exposure scenarios) served as direct sources for the BTEX vapours. The average benzene concentrations measured in three activity areas ranged from 469 ppm to 542 ppm. The highest benzene concentration was found to be 542 times higher than the current South African Occupational Exposure Limits of 1ppm. The average toluene concentrations measured ranged from 1335 pm to 1542 pm; the highest toluene concentration was found to be more than 30 times above the South African Occupational Exposure Limits of 50 ppm. The average ethylbenzene concentrations measured ranged from 433 ppm to 500 ppm; the highest concentration was found to be 5 times above the South African Occupational Exposure Limits of 100 ppm. The average xylene concentrations measured ranged from 1372 ppm to 1584 ppm, the highest concentration was found to be more than 15 times above the South African Occupational Exposure Limits of 100 ppm. All the measured BTEX compounds were found to be above their respective South African Occupational Exposure Limits. The cancer risk was determined to be 13 x 10-2 (male) and 10 x 10-2 (female), 14 x 10-2 (male) and 11x 10-2 (female), 16 x 10-2 (male) and 13 x 10-2 (female), 12 x 10-3 (male) and 10 x 10-3 (female) for the workers in the density huts, laboratory, strain remover (plant equipment cleaning), respectively. In all exposure scenarios (male and female) the cancer risk was found to be higher than the acceptable risk levels of 1E-4 . There were 13 males and 10 females in the population of 100 controllers who were likely to develop cancer when working density huts environment. In the laboratory work environment, 14 males and 11 females in a population of 100 controllers were likely to develop cancer, whereas 16 males and 13 female laboratory workers were likely to develop cancer in a population of 100 laboratory workers, and during plant equipment cleaning 12 males and 10 female controllers were likely to develop cancer in a population of 1000. Therefore, the potential of developing cancer was heightened by working in the laboratory and density huts. The risk of the number of employees who were likely to develop cancer was reduced when doing plant equipment cleaning. In all three activity areas, cancer risk for males was higher than for their female counterparts. This finding denotes that male were more vulnerable than females even though the exposure concentration is the same. The higher number of males who were likely to develop cancer in all the activity areas were influenced by two factors i.e., males have a shorter average life expectancy and higher average body weight versus their females’ counterparts. A hazard quotient was used to determine the non-carcinogenic health effects, a hazard quotient of greater than 1 was used as a reference value. A value greater than 1 denoted a higher possibility that depot workers will get health effects from exposure to the Toluene, ethylbenzene, and xylene (TEX). The hazard quotient for males ranged from 4.6 to 577.5, the highest hazard quotient was more than 577 times above the HQ reference value. The lowest was at density huts for xylene and the highest was at the laboratory for a chemist for xylene. The hazard quotient for females ranged from 3.15 to 399.00, the highest hazard quotient was more than 399 times above the HQ reference value. The lowest was at density for xylene and the highest was at the laboratory for laboratory assistant. From the results, both males and females had a hazard quotient far above 1 which means health effects arising from TEX exposure were anticipated. Conclusion: The results showed highest constant BTEX concentrations in the three exposure scenarios over the 12 hours shift. The BTEX emissions were generated by activities that were performed by the depot workers. Highest BTEX concentrations were measured at laboratory, followed by density huts and the least was measured during the removal of the strainer (plant equipment cleaning). The lack of effective vapour recovery system and natural ventilation in the laboratory and in density huts also contributed to the high BTEX concentrations measured in these areas. Individual BTEX component results measured in the three activity areas indicated concentrations that were far above the South African Occupational Exposure Limits for individual BTEX. The cancer risk score was found to be far above the reference USEPA cancer risk value and denoting that depot workers were likely to develop cancer. The hazard quotient for the three exposure scenarios was also found to be greater than the reference value of 1 which indicates the potential to develop non-carcinogenic health effects due to exposure in three exposure scenarios. Recommendations: The following recommendations are made to assist management of the depot to control employees’ exposure to BTEX emissions per activity area: Density huts: The practicality of introducing a vapour recovery system on workbenches to extract the VOCs generated during sample collection and from density measuring jugs should be investigated or alternatively, the introduction of an online fuels and density analysis should be investigated or the practicality of introducing sample bombs to collect fuel samples should be investigated. Keep the windows opened to promote an ingress of fresh air and allow BTEX emissions to escape. A practicality of introducing a controlled mechanical ventilation to blow vapours away from the breathing zone of the depot workers should be investigated. Laboratory: The practicality of automating or modifying the GC equipment in the laboratory to be able to conduct an online petrochemical analysis to control employees’ exposure should be investigated. The tasks that require rinsing of testing tubes with fuels, refilling of the testing tubes, and discarding of superfluous samples should be performed under controlled conditions, the practicality of introducing a vapour recovering system to control vapours emissions should be investigated. The current practice of keeping the decanting drum open should be discontinued to prevent the accumulation of vapours in the laboratory or alternatively, it should be kept under a vapour recovery system. The practicality of keeping the retained fuel samples under the vapour recovery system in the laboratory storage should also be investigated. The fume hood and two extraction units should be serviced on a regular basis. Cleaning of plant equipment (strainer removal): The practicality of automating the removal and lifting the strainer to be cleaned to increase the distance between the strainer and receptors (controllers) should be investigated. The practicality of putting the clogged-up strainer in degreaser bath to remove and clean the strainer with the view of automating the task to prevent employees ‘exposure to VOC emissions. Recommendations applicable to all activity areas: Employees exposed to BTEX including the other petrochemicals should undergo a risk-based medical surveillance program including biological monitoring to evaluate the efficacy of the existing controls and as part of a preventative medical surveillance program. Provide information, instruction, and training at regular interval about: - petrochemicals (BTEX) that employees are potentially exposed to at workplace and duties of persons who are likely to be exposed to VOCs vapour. The names and potential harmfulness of the BTEX at the workplace and the employees who are likely to be exposed. Significant findings of the BTEX exposure assessment (an occupational health risk assessment survey). Information on how to access the relevant safety data sheets and information that each part of an SDS provides. The work practices and procedures that must be followed for the use, handling, storage, transportation, spillage, and disposal of samples, in emergency situations, as well as for good housekeeping and personal hygiene. The necessity of personal exposure air sampling, biological monitoring, and medical surveillance; The need for engineering controls and how to use and maintain them. The need for personal protective equipment, including respiratory protective equipment, and its use and maintenance. The precautions that must be taken by an employee to protect themselves against health risks associated with exposure, including wearing and using protective clothing and respiratory protective equipment. The necessity, correct use equipment, maintenance and potential of safety facilities and engineering control measures provided. Supervisor/Line Manager must give written instructions of the procedures to be followed in the event of spillages, leakages, or any similar emergency situations to employees. Once the aforementioned information, instruction and training have been provided, enforce the wearing of the prescribed PPE including ABEK respirator and no employee should be allowed to enter and remain in respiratory zone without the prescribed PPE and respiratory protection equipment (ABEK respirator).
The burden of severe Hepatitis A disease in South Africa’s public sector: A cross sectional study using routine laboratory data from 2016 to 2021
(University of the Witwatersrand, Johannesburg, 2023) Khoza, Mariana Makhanani; Mazanderani, Ahmad Haeri; Somaroo, Harsha
Background Hepatitis A virus (HAV) is a common cause of acute viral hepatitis in South Africa, however, there is limited data on the burden of severe HAV disease in the South African population. Objective To describe the burden of severe HAV disease in South Africa’s public sector by describing the prevalence of laboratory diagnosed acute liver failure (ALF) in patients with HAV infection, during the period January 2016 to December 2021. Methods This was a cross-sectional study using retrospective secondary data from the National Health Laboratory Service (NHLS), from January 2016 to December 2021. Laboratory patient records that were positive for HAV IgM were extracted and merged with International Normalised Ratio (INR) test records, using the NHLS Corporate Data Warehouse (CDW) record linking algorithm. All patients with a positive HAV IgM result linked to an INR result >1.5 were reported as having laboratory diagnosed ALF. Descriptive statistics and regression analyses were conducted using STATA 17 SE. Results A total of 15 261 laboratory patient records were positive for HAV infection. Of the patients with HAV infection a total of 7 824 (51.27%) were linked with an INR test result, and of those a total of 1 420 (18.15%) patients had ALF. The average annual burden of patients with ALF was 237 patients per year (range: 136–333). Children <10 years had the highest number of HAV infections (n= 6 227, 40.80%) and ALF (n=576, 40.56%) for the study period. Patients 50-59 years with HAV infection were most likely to have ALF compared to children <10 years (OR 2.95, 95% CI 2.207 - 3.935, p<0.000). Conclusion Whereas adults with acute HAV infection are more likely to develop ALF, severe HAV disease is predominantly a childhood disease in South Africa. This study emphasises the need to strengthen HAV prevention strategies to limit the incidence and burden of severe HAV disease
Determinants of sub-optimal glycaemic control among patients enrolled in a medicine dispensing programme in Kwazulu-Natal: A cohort study, 2018 – 2021
(University of the Witwatersrand, Johannesburg, 2023) Johnston, Leigh Clare
Background: In South Africa, type 2 diabetes mellitus (T2DM) is a growing public health problem, thus, by 2030, 50% of T2DM patients, receiving treatment, must achieve optimal glycaemic control (haemoglobin A1c (HbA1c) ≤7%). The CCMDD (Central Chronic Medicines Dispensing and Distribution) programme allows glycaemically-stable patients to collect their medication from community-based pick-up points. While the CCMDD is a large public health programme, there is a paucity in stakeholder’s knowledge of T2DM patients glycaemic control over time. We determined glycaemic control for CCMDD-enrolled T2DM patients in eThekwini, South Africa from 2018-2021, as well as the rate and predictors of becoming sub-optimally controlled. Methods: We performed a cohort study, linking HbA1c data from the National Health Laboratory Service to CCMDD-enrolled patients in eThekwini, South Africa from 2018–2021. We included patients optimally controlled at their baseline HbA1c, and having ≥1 repeat test available. We used Kaplan Meier analysis to assess survival rates and Cox regression to determine associations between time to sub-optimal control (HbA1c > 7%) and several factors. Adjusted hazard ratios (aHR), 95% confidence interval (95% CI), and p-values are reported. Results: Of 41145 T2DM patients enrolled in the CCMDD, 7960 (19%) had an available HbA1c result over the study period. A quarter of patients (2147/7960; 27%) were optimally controlled at their baseline HbA1c. Of those controlled at baseline, 695 (32%) patients had a repeat test available, with 35% (242/695) changing their status to sub-optimal control. Patients prescribed dual-therapy had a higher risk of sub-optimal glycaemic control (aHR: 1.503; 95% CI: 1.16–1.95; p-value=0.002) compared to those on monotherapy. HbA1c testing frequency per national guidelines (aHR: 0.46; 95% CI: 0.24–0.91; p-value=0.024) was associated with a lower hazard of sub-optimal glycaemic control. Conclusions: HbA1c monitoring, in line with testing frequency guidelines, is needed to flag sub- optimally controlled patients who become ineligible for CCMDD enrolment. Patients receiving dual-therapy may require special consideration. Addressing these shortfalls can assist planning and implementation to achieve 2030 targets.
The relationship between mental distress and somatization in hospital based health care workers in Gauteng during covid-19 pandemic in 2020
(University of the Witwatersrand, Johannesburg, 2023) Ramuedi, Ntsako Khosa; Kerry Wilson, Nioh
Background Mental distress among Health Care Workers (HCWs) is an urgent health concern, and somatization is a known outcome of mental distress. The Covid-19 pandemic increased stress for HCWs globally due to working with Covid-19 patients and resource limitations. Although there was already a lot of mental distress in HCWs in prior years, the coronavirus pandemic made matters worse, with 45% of people reporting that the pandemic had a significant negative impact on their lives. Somatization can lead to increased use of health services, sick leave and poor health. Service delivery is also impacted negatively if the service providers are not well or are suffering from the mental distress and are also showing symptoms. Aim To identify if a relationship exists between mental distress and somatization symptoms in Gauteng hospital-based health care workers in 2020. Objectives. To describe the prevalence of mental distress and somatization among health care workers by socio demographic status. To identify the somatization symptoms associated with high GHQ-12 scores in health care workers during Covid-19. To describe the association between mental distress and somatization among health care workers during covid-19 adjusting for demographic variables. Methods Health care workers can be described as anyone working in the health sector or at a health facility. All staff in the three selected hospital facilities in Johannesburg, were given the opportunity participate in the study. The PHQ-15 and GHQ-12 tools were used to collect information on HCWs somatization and mental distress after the first wave of the Covid-19 pandemic in South Africa. The anonymous questionnaire consisted of the two tools and demographic questions was used. The responses to each question on the tools were summed in order to determine severity of mental distress and somatization in HCWs, a higher score indicating more stress and or more somatization. Logistic regression was used to determine the adjusted relationship between somatization and mental distress. Results The study had a sample size of 295. A large proportion of participants (52%) reported suffering somatic symptoms. Males mean somatization score was significantly lower than the females. The majority (62%) of HCWs were troubled indicating a high burden of mental distress in the health care sector. The most commonly reported symptoms were back pain, headaches and being tired or low energy, all three were significantly associated with mental distress among others. There was a positive moderate correlation between PHQ-15 and GHQ-12 scores (0.30592) (p < 0.0001). Logistic regression indicated somatization was significantly associated with mental distress with a significant OR 2.14 (p = 0.0029) adjusted for demographic factors in these workers. Conclusions There was a statistically significant positive relationship between somatization and poor mental health. Health care workers with mental distress may be at risk of somatization, particularly specific symptoms such as back pain, headache and having low energy. Females were more bothered by most of the somatoform symptoms as compared to their male counterparts. Support for health care worker’s mental health is required as well as increased awareness of somatization linked to mental distress. Policies and services need to be developed to protect and support HCWs mental health during times of stress in the sector
Occupational noise exposure among groundskeepers at a public university in Gauteng, South Africa
(2024) Mokone, Moses
Background- There is sufficient scientific evidence indicating that excessive and prolonged exposure to noise causes noise-induced hearing loss (NIHL), also known as permanent hearing loss and other non-auditory effects such as sleep disturbance, hypertension, and interference with the nervous and cardiovascular systems. The World Health Organization (WHO) estimated that NIHL costs approximately 0.2% to 2% of the gross domestic product (GDP) of the developed nations in terms of compensation and economic burden on society. It also estimated that more than 16% of the NIHL in adults is attributable to occupational noise exposure. Although preventable, NIHL is one of the most widespread irreversible occupational disease worldwide and thus was declared as a serious occupational hazard. Worldwide, occupational noise exposure is widely regulated and most countries, including South Africa, use 85 dBA as the occupational exposure limit for noise exposure and has adopted the 3-dB exchange rate, with the exception of the US and Brazil, amongst others, which use the 5-dB exchange rate rule. Exchange Rate is the increase in noise level that corresponds to a doubling of the noise level. A few countries around the world such as the US, Japan and India use 90 dBA as a regulated limit for noise exposure. Acute hearing loss can also occur suddenly if a person is exposed to very high impact noise (above 140 dBC) for a short duration such as explosion and gun shots. Research shows that 8-hour average daily noise exposure levels between 75 dBA and 80 dBA are unlikely to cause hearing loss. The International Organization for Standardization (ISO 1999) “Acoustics - Determination of Occupational Noise Exposure and Estimation of Noise-Induced Hearing Impairment” provides damage risk criterion information that enable the prediction of NIHL at various audiometric frequencies and for varying exposure durations. Attempts to limit human exposure to noise are based on damage risk criterion. For example, the National Institute for Occupational Safety and Health (NIOSH) estimates a risk of NIHL after a 40-year working lifetime of 1% at 80 dBA, 8% at 85 dBA, and 25% at 90 dBA. This shows that the 85 dBA limit does not guarantee safety, since 85 dBA is already indication 8% excess risk. The WHO has indicated that workers employed in sectors such as manufacturing, transportation, construction, mining, utility, agriculture and military have the highest risk of 2 | P a g e NIHL. In the Services sector, which include Garden and Landscaping services, the extensive use of powered lawn maintenance machines results in widespread exposure to high levels of noise. The employees employed in the garden and landscaping sector such as groundskeepers, are in charge of maintaining general landscape of public and private areas such as sporting grounds, community parks and learning institutions grounds. Their main tasks involve a variety of outdoor activities such as clearing leaves, mowing lawns, cutting trees, trimming hedges, applying fertilizer, removing dead or unwanted plants and other general garden maintenance work. Noise exposure, which is one of the main health hazards that severely affect the health of these employees during operation of powered lawn maintenance machines such as leaf blowers, riding and push lawnmowers, brush-cutters and chainsaws can be a significant source of workplace noise exposure among groundskeepers. Although the literature on occupational noise exposure has concentrated on large industrial sectors (mining, construction, manufacturing and transportation), the problem extends to smaller operations such as lawn maintenance. Recent literature suggests that noise generating activities in small-scale operations, such as lawn maintenance, use high noise emitting machinery. Purpose- The purpose of this study was to evaluate occupational noise exposure levels of groundskeepers who operate different types of powered lawn maintenance machines at three campuses of a public university in Gauteng and estimate their risk of NIHL. Methods- A quantitative, cross-sectional study design conducted among groundskeepers following a nonprobability convenience sampling strategy was used. Personal and area noise exposure levels were evaluated in accordance with the South African National Standard (SANS) Code of Practice 10083:2013. The measurements for personal noise were conducted using a type 2 Casella dBbadges (personal noise dosimeters), which were placed on the groundskeepers’ shoulders, close to the ear adjudged as receiving the highest noise levels covering sufficient time representative of daily (task-based) exposure. Area noise measurements were performed using a type 1 Quest integrating sound level meter (SLM), which was mounted on a tripod stand and placed at approximately 1.5 meters above the floor and 1 m from the noise generating machine. In each measurement position, one-minute measurements were completed, and Aweighted equivalent noise levels (LAeq) were recorded. To ensure accuracy of measurements, the noise measuring instruments were calibrated before and after each series of measurements v using a calibrated portable acoustic calibrator as per the manufacturer’s instructions. The SLM and personal noise dosimeters (PNDs) were calibrated using a type 1 acoustic calibrator (Model QC-10, Quest Technologies, USA) and type 2 acoustic calibrator (Casella CEL 110/2, Regent House, Bedford, U.K) respectively. No significant shift in calibration was detected for any individual measurement. All the noise measuring instruments were externally calibrated by a South African National Accreditation System (SANAS) 17025 accredited laboratory. A questionnaire constructed by the primary researcher was utilized to record groundskeepers’ demographic information, work processes pertaining to tasks performed and noise exposure levels, including certain elements of hearing conservation practices such as information and training, audiometric testing, and use of hearing protective devices (HPDs). A total of 18 PND measurements and 17 area noise measurements were conducted at three university campuses i.e. Campus A, Campus B and Campus C. The noise measurements were conducted over a period of five (5) days (1-3 September 2021 and 3-4 November 2021). Data/ readings from the noise monitoring instruments were manually recorded on predesigned field sheets and manually entered onto Microsoft Excel spreadsheet. Thereafter, a statistical analysis using a one-way analysis of variance (ANOVA) was carried out to determine whether a significant difference existed between the mean personal and area noise exposure levels measured at three university campuses. Formulas from the SANS 10083 standard were used to calculate measured noise levels for comparison with the regulated noise rating limit of 85 dBA using Microsoft Excel spreadsheet Results- The results of this study showed that majority, 78% (14 out 18), of groundskeepers’ personal noise exposure levels (task-based) in the three campuses exceeded the legislated noise rating limit of 85 dBA, thus increasing groundskeepers’ risk to NIHL. Groundskeepers in campus A were exposed to the highest eight-hour equivalent continuous A-weighted sound pressure level (LAeq, 8h) with mean noise levels of 91.5 dBA ±4.7, followed by campus B and C with mean noise levels of 89.1 dBA ±4.0 and 86.9 dBA ±2.9 respectively. Peak noise exposure levels (LCpeak) measured as part of personal noise exposure in the three campuses ranged from 115.6 dB to 140.0 dB. These excessive peak noise exposures are attributed to the types of machines used during lawn maintenance activities. The overall statistical difference in the mean personal noise exposure levels (LAeq, 8h) and peak levels (LCpeak) between the three campuses were found to be not significant for both the LAeq, 8h (P = 0.304) and LCpeak (P = 0.607). vi Furthermore, majority, 71% (12 out 17), of area noise levels measured on specific lawn maintenance machines had equivalent continous A-weigted sound pressure level (LAeq) above the noise rating limit of 85 dBA. Machines measured in campus A had the highest area noise levels (LAeq) with mean noise levels of 98.8 dBA ±6.9, followed by campus B and C with mean noise levels of 92.9 dBA ±8.3 and 91.6 dBA ±5.1 respectively. The overall statistical difference in the mean area noise levels (LAeq) between the three campuses were found to be not significant (P = 0.135). The findings of this study demonstrated that the study participants comprised a total of 18 males across the 3 campuses, with mean working experience in the current job of five (5) years (ranging 2 – 11 years). Majority (9 out of 18 or 50%) of the participants were aged between 36–45, while only 16% (3 out of 18) were above the age of 56. The distribution of the participants according to their education was 100% secondary school. This may have positive implications for understanding of information and training material used for noise exposure awareness. The results of groundskeepers’ awareness to certain elements of hearing conservation program, with specific focus to information and training, audiometric testing, and use of hearing protection devices (HPDs) revealed that majority (95%) of groundskeepers were not trained about the noise rating limit and its meaning as required by Regulation 4 of the NIHL Regulations. Furthermore, it was found that, 50% of groundskeepers indicated that they never received information and training on the health effects of noise exposure while working at the university. In terms of audiometric testing, 78% of groundskeepers indicated that they were given audiometric testing while employed at the university. The study further indicated that majority (63%) of groundskeepers reported that, they use hearing protection devices (HPDs) while operating noisy machines. Notably, 90% of groundskeepers reported that, there is no one who is checking and supervising if they wore HPDs while operating lawn maintenance machines. The analysis further shows that, 47% of groundskeepers reported that, their HDPs were not comfortable when worn. Conclusion- The findings of this study have highlighted that, although the university had hearing conservation programs in place, there were shortcomings in the implementation of some elements of the program, in particular with regard to information and training, noise exposure monitoring and use of hearing protection devices. Most groundskeepers were exposed to noise vii levels exceeding the noise rating limit of 85 dBA and were at risk of acquiring NIHL. When considering the peak noise levels, the results of the study showed that there was only one groundskeeper from campus A who was exposed to noise levels exceeding the peak limit of 140 dBC. In all cases, employees should never be exposed to peak noise levels in excess of 140 dBC. Prevention, by reducing the noise exposure via engineering measures should be prioritized. The peak noise exposure limit of 140 dBC is regulated in the European Union Physical Agents (noise) Directive 2003/10/EC (2003) as an upper exposure action value. This EU noise directive is adopted by most European countries. Currently in the South African NIHL Regulations and SANS 10083 standard, peak noise exposure levels are not regulated. No significant differences were found in the mean area and personal noise levels measured in the three campuses. However, the use of certain machines such as backpack leaf blower and chainsaw were shown to be associated high noise exposure levels. Therefore, it is essential to ensure that noise levels on the lawn maintanance machines are significantly reduced by implementing good maintenance practices and buy quiet program. Information and training interventions should be aligned to target potentially exposed groundskeepers to modify their perceptions, noise control adherence approaches and continual motivation to sustain and improve an implemented hearing conservation program. This is the first study in South Africa to evalaute occupational noise exposure among groundskeepers in a public univeristy. Findings from this study may contribute to existing knowledge on occupational noise exposure among groundskeepers and may be investigated by other universities where lawn mainteance machines are used. However, the findings of this study may not be generalized to other universities because the study was only conducted in one university. Lessons drawn from this study are that there is a greater need to enhance hearing conservation measures in gardening and landscaping services within the universities.
A survey of the professional quality of life of pharmacists and rehabilitation therapists at three public sector hospitals in Gauteng, South Africa
(2024) Moyo, Nonkazimulo
Background- The global goal of Universal Health Coverage (UHC) cannot be achieved without a wellmotivated and productive health workforce. Central to their motivation and productivity is the notion of professional quality of life (ProQOL) that captures both the positive and negative emotions of caring work. However, there is a dearth of empirical studies on the ProQOL of pharmacists and rehabilitation therapists, especially in an African setting. Study aim -The aim of the study was to examine the self-reported ProQOL of pharmacists and rehabilitation therapists at three public sector hospitals in the Gauteng Province of South Africa. Methodology- During 2021, a cross-sectional analytical study was conducted at three public sector hospitals in the Gauteng Province of South Africa. Following informed consent, all eligible pharmacists, pharmacist assistants, occupational therapists, physiotherapists and speech therapists and audiologists completed a self-administered questionnaire electronically. In addition to sociodemographic information, the questionnaire obtained information on compassion satisfaction, burnout, and secondary traumatic stress using the ProQOL scale (version 5) and work-related experiences during the COVID-19 pandemic. STATA® 17 was used for descriptive and multivariate analysis of the survey data. Results- A total of 118 pharmacists and rehabilitation therapists completed the survey. The majority were female (83.00%), single (63.46%), with mean age 30.77 years (SD=9.08). The results revealed moderate mean scores for compassion satisfaction (39.62; SD=5.48), burnout (24.26; SD=5.12) and secondary traumatic stress (23.03; SD=6.31). The predictors of compassion satisfaction were moderate positive COVID-19 experiences score (β=+2.61;95% CI 0.54; 4.68; p=0.014) and high positive COVID-19 experiences score (β =+ 2.68; 95%CI 0.40; 4.96; p=0.021); moderate overall job satisfaction score (β =+ 3.17; 95% CI 0.16; 6.18; p=0.039) and high overall job satisfaction score (β =+ 7.26; 95% CI 4.06; 10.47; p<0.001). The predictors of burnout were being single (β=+2.02 95% CI 0.07; 3.97; p=0.042), full professional registration (β=+4.23; 95% CI 1.79; 6.67; p=0.001), direct involvement in patient care (β=+3.24; 95% CI 0.22; 6.26; p=0.036) and reporting a heavy workload (β=+ 2.61; 95% CI 0.75; 4.48; p=0.007). The predictors of secondary traumatic stress were being male (β=+ 3.26; 95% CI 0.36; 6.15; p=0.028), and full registration (β=+ 5.72; 95% CI 2.41; 9.03; p<0.001). Conclusion- The ProQOL of pharmacists and rehabilitation therapists is influenced by a combination of individual, workplace, and health system factors, suggesting the need for a multifaceted approach to optimise their contribution to the achievement of UHC. Such approach should include provincial health, hospital management, and peer support as well as self-care activities.
The impact of the covid-19 pandemic on essential public healthcare services in Gauteng province, South Africa
(2024) Fonka, Cyril Bernsah
Background: The Covid-19 pandemic like previous outbreaks has the potential to adversely impact essential healthcare services. Even though the Gauteng province was considered the epicentre of the Covid19 outbreak in South Africa, there is no comprehensive assessment of the effect of Covid-19 on the service utilisation, delivery and health outcomes of routine healthcare services in Gauteng province. Aim: To assess the impact of the Covid-19 pandemic on the utilisation, delivery and health outcomes of essential maternal, neonatal and child health (MNCH) services in Gauteng province, South Africa. Methods: This was a mixed methods study. A longitudinal study design was used to analyse data from the District Health Information Software (DHIS). We compared key MNCH indicators in the pre-Covid-19 period (March 2019-February 2020) to corresponding periods during the Covid-19 outbreak (March 2020- February 2021). The differences were analysed using time plots, linear regression, and Interrupted Time Series Analysis (ITSA) in Stata 17.0, at a 5% level of alpha for statistical significance. In-depth interviews were conducted with senior managers in the Gauteng Department of Health (GDoH) using MS Teams, to explore their perspectives on the impact of Covid-19 on routine healthcare services in the province and their recommendations for dealing with future pandemics. The interviews were recorded, transcribed, coded and analysed thematically using MS word 2016. Results: The Covid-19 pandemic disrupted the utilisation of essential MNCH services in the Gauteng province. The disruption was observed in the time trend plots, and then quantified by comparing the indicator means for the 12-month periods before and during Covid-19. The impact was a statistically significant decline in the mean of three indicators: PHC headcount <5 years declined by 77 103.9 visits (p<0.001), ANC 1st visits before 20 weeks decreased by 3.0% (p=0.002) and PNC visits within 6 days decreased by 10.2% (p<0.001) (Error! Reference source not found.). The ITS regression provided a more nuanced analysis. The decrease in PHC headcount t <5 years and PNC visits within 6 days were due to the immediate effect of the March 2020 Covid-19 lockdown which led to a drop in utilisation services. However, the effect on ANC 1st visits before 20 weeks was a continuous decline in utilisation throughout the Covid-19 period (Error! Reference source not found.). Service delivery and outcome indicators were negatively affected though not significantly. There were no significant recoveries and some indicators rather became worse post-lockdown. The nature of the adverse impact of Covid-19 on MNCH indicators was similar across all five districts, although the degree of disruption varied among the districts and services. The decline in service utilisation for PHC headcount <5 years ANC 1st visits before 20 weeks and PNC visits within 6 days was statistically significant in all districts, except for ANC 1st visits in Johannesburg (Error! Reference source not found.). The decline in PHC headcount <5 years was significantly larger in the three metropolitan districts (Johannesburg, Ekurhuleni and Tshwane) compared to the two non-metropolitan districts (Sedibeng and West Rand) (Table 5). ANC 1st visits before 20 weeks significantly declined in the Ekurhuleni, Sedibeng and West Rand districts compared to Johannesburg. While the decrease in PNC visits within 6 days significantly deteriorated in Johannesburg compared to the other four districts (Error! Reference source not found.). Pneumonia fatality <5 years significantly declined in the pooled analysis, in the Tshwane district alone. The majority of the respondents agreed that the Covid-19 pandemic disrupted essential healthcare services but a few disagreed. Several reasons were advanced for the disruption. On the supply side, they included: (i) the reallocation of resources to fighting Covid-19; (ii) healthcare worker shortages due to Covid-19 illness; (iii) healthcare facilities turning away non-Covid-19 patients; and (iv) Covid-19 screening that increased waiting times. On the demand side are; (i) restrictions on movement and limited public transport during the lockdown; (ii) fears of being infected by Covid-19 at health facilities; and (iii) misinterpretation of health information about the availability of non-Covid services. According to the respondents, the disruption of essential healthcare services had significant consequences, particularly for chronic patients, including treatment interruption, loss of follow-up, and death. The ‘catch-up’ plan and technology were used to improve service delivery during Covid-19. Conclusion: The Covid-19 pandemic disrupted the utilisation of essential healthcare services for MNCH. Although service delivery and health outcomes were less impacted, some outcome indicators at district levels went worst. While there were recovery attempts for service delivery like immunisation, some services rather deteriorated post-Covid-19 lockdown. However, there were mixed findings, fewer routine services were not affected by Covid-19. It is important to continuously assess and redress the unintended impacts of outbreaks even while they are occurring. This requires an understanding of the reasons and mechanisms of service disruption from demand and supply perspectives. Critical policies like lockdowns should be a collective decision, implemented without undermining routine services. High-level policymakers must consider addressing geographical variations of an outbreak’s impact on essential healthcare services. Covid19 may have more complex long-term effects, especially for individuals with adverse social determinants. And it may take longer for some healthcare services to fully recover hence, the need for health systems interventions to prioritise the affected services.
Nurses’ experiences in implementing Nurse Initiated Management of Anti-Retroviral Therapy (NIMART) in primary health care facilities in Dr Ruth Segomotsi Mompati District, North West Province
(2024) Sibisi, Nthabiseng
Aim of study- This study aimed to explore the nurses’ experiences in the implementation of NIMART in Dr Ruth Segomotsi Mompati District since its inception in 2010 to 2017. Methods This study employed an exploratory qualitative research design. The study setting included nine PHC facilities in three sub-districts. The study included only those nurses who had been trained to implement the NIMART in the district PHC facilities from 2010-2017. The final sample included Sixteen (16) nurses, comprising of three males and thirteen females from the three eight-hour operational clinics and six 24-hour Community Health Centres (CHCs). Data were therefore collected using in-depth interviews lasting thirty-five minutes (minimum) one and half hours 1h30 minutes (maximum). These interviews were guided by a semistructured interview guide. Data were later transcribed verbatim using an electronic software O’ Transcribe, and then analysed using MAXQDA 2018v, where inductive coding was applied. Thematic analysis was employed to interpret and represent data, which was finally presented as themes based on participants’ dominant narratives. Results- There were five key themes that emerged from this study. These included: perceptions about the NIMART programme mostly related to it being a task-shifting strategy when managing HIV and Aids and the programme benefits; contextual elements affecting access and adherence to NIMART, and challenges such as socio-cultural factors, social norms, socio-political and governance factors; facilitators of NIMART implementation in terms of functional health information management system and clinical guidelines, multidisciplinary team and skilled personnel, impactful counselling services, and intrinsic nurse motivators. Challenges of NIMART implementation included insufficient human resources for health, services integration, poor management and health-service support systems, lack of capacity building, ART unavailability and poor patient compliance to ART, and nurse demotivation. The proposed interventions by the nurses included provision of training, increasing staff to curb workload, management support, and debriefing, health service support resources and patient support improvement. Conclusion Task-shifting and successful NIMART implementation are complex notions, which can be successful if accompanied by training, reorganisation of services, mentoring, supervision, and ongoing support from existing health-service system structures. The rural health context must be considered as unique, and policies should be tailored to suit the needs of rural healthcare workers and patients. Dr RSM case-study has shows the plight of farm labourers and the need for a multisectoral approach to address patient related issues in this context. The challenges to successful NIMART implementation suggest a need for reorientation of health-services to fit rural contexts.
Predictors of resilience among adolescents living in rural Mpumalanga in 2018: a cross sectional study
(2024) Snijder, Michelle
Literature suggests that resilience can be reached by practicing behaviours, thoughts and attitudes that promote resilience. To understand which behaviours, thoughts and attitudes foster resilience, predictors of resilience should be studied. This study aimed to examine predictors of resilience among adolescents living in the rural Mpumalanga Province, South Africa. Data were collected using a questionnaire from a sample of 245 adolescents between 13.1 and 15.2 years (median age 14.1 (13.1- 15.2); sex 52.7% female and 47.4% male). The questionnaire included questions from depression, stress and resilience scales as well as additional questions relating to communication with parents, and socio-demographic characteristics. The 20 question Centre for Epidemiological Studies Depression Scale (CES-D) measured depression, the 10-item Perceived Stress Scale (PPS-10) measured stress while the 25-item Connor Davidson Resilience Scale (CD-RISC-25) measured resilience. The prevalence of resilience was estimated at 46.1%. The findings suggest that perceptions of stress did not significantly predict resilience. Experiencing depressive symptoms and healthy interpersonal relationships significantly predicted high resilience. Although healthy relationships with parents predicted high resilience, adolescents relied more on relationships with friends to build resilience. However, regularly meeting with friends predicted low resilience, while always meeting with friends decreased the chances of low resilience. Thus, the study suggests that healthy relationships with both parents and friends may predict high resilience. However, when relationships with friends replaces that of parents, low resilience results. Finally, this study supports the need for further studies on the validity and acceptability of the PPS-10 and CES-D scales in the South African context.
Bayesian spatio-temporal analysis of malaria prevalence in children aged 2-10 years between 2000-2015 in Gabon
(2024) Mougeni, Fabrice Lotola
Abstract Background: In Gabon malaria still threatens the health of children and the country’s economy. In order to contribute in the estimation of malaria burden, in the endemic risk classification, and help in the design of the effective intervention, it is necessary to identify hot spots and cold spots, and to provide policy makers with good estimates of malaria prevalence at the national level with appropriate methods. It is also important, to understand, at a small spatial scale, how some factors are affecting the variation of malaria prevalence. This includes mainly geo-climatic factors, since malaria is related the meteorological conditions. This study focused on the effect of space and time in the distribution of malaria prevalence, and the effect of ecological variables in its variation for children between 2-10 years of age living in Gabon. Method: This study used successive cross-sectional data carried out in four time points: 2000, 2005, 2010, and 2015, using a stratified two-stage sampling method. The survey data provided information on malaria prevalence for children aged 2-10 years, and cluster-level ecological variables. Descriptive analysis such as the mean of the prevalence and the covariates with their standard deviation, on average, overtime, by province and type of residence was carried out, followed by more advanced models for the estimation of the prevalence. Considering the weighting scheme, the prevalence was obtained via the space and time Horvitz and Thompson estimator. This was then smoothed using the Besage York Mollié (BYM) model with space-time interaction, to reduce uncertainty due to the small area. The spatial autocorrelation was determined using the Moran’s I index, and hot spots with the local statistic Getis-Ord General Gi. The relationship between malaria prevalence and predictors was analyzed nationally. Ordinary Least squared (OLS) was used to see if the covariates can explain the spatial autocorrelation observed in the prevalence, Geographically Weighted Regression (GWR) or Spatial Varying Coefficient (SVC) to evaluate if the relationship between prevalence-covariates was not varying by location. Spatio-temporal model for OLS (SPTOLS) was used to account for the effect of time and space, and Geo-Additive Model (GAM) for considering the non-linear relationships. Lastly, Spatial Lag Model (SLM), Spatial Durbin Error Model (SDEM) or Spatial Error Model (SEM), were used for identifying the spillover effects. These were implemented in the Integrated Nested Laplace Approximation (INLA) using Stochastic Partial Differential Equation approach (SPDE). The different methods were compared to find the best one fitting well the data by using the DIC. Results: In total, 336 clusters were used, with 153 (46%), and 183 (54%) in rural and urban areas, respectively. On average, Estuaire province has the highest prevalence, followed by Moyen-Ogooue and Woleu-Ntem, 29% (±16%), 22% (±13%), 21% (±10%), respectively before the estimation using the smooth space-time model with sampling design. On average, after using the space-time smoothing model and the sample design, it was found that the prevalence decreased with year, and then showed a rebound from 2010. The highest value of the prevalence overtime was 46% in the Estuaire province in the year 2000 and the lowest value overtime was 6% in Ogooue-Maritime province in the year 2010. However, the effect of year was not significant. When the weight scheme was introduced, the variance of the estimate was reduced, and the contribution of the space in the variation of malaria prevalence was 46% during 2015. A strong spatial autocorrelation of the prevalence was found. Hot spots changed in magnitude by space and time, often in the north-west and the western part of the country. Cold spots were found mostly in the southern part. The spatial effect became almost null after 290 km (95% Credible Interval (CI): 230;360). The model including only the ecological variables was better in reducing the spatial variation. Using the SDEM, it was clearly seen how the prevalence can be influenced by the change of some risk factors in the nearby clusters or in the same cluster. The increase of malaria prevalence in a cluster was slightly and significantly associated with one-unit increase of: wet days (3%, 95% CI: [1%, 5%]) in the same cluster, and mean temperature (2%, 95% CI: [1%, 3%]) in the nearby clusters. It decreased slightly and significantly with a one-unit increase of day land surface (-2%, 95% CI: [-2%, -1%]) in the same cluster, but only slightly in the nearby clusters (< 1%). For a particular cluster, malaria prevalence decreased (-21%, 95% CI: [-40%, -5%]) greatly with the Insecticide Treated Bed Nets (ITNs) coverage increases in the nearby clusters. In contrast to GAM using SDEM for ITNs coverage only, the relationship between malaria revalence and ITNs coverage was clearly non-linear decreasing after 20% of coverage. Overall, malaria prevalence had non-linear relationship with mean temperature, night land surface temperature, enhanced vegetation index and rainfall. Conclusion: Substantial progress has been made to slow down the spread of malaria in Gabon. However, malaria prevalence is still high, with important spatial variation and hotspots in its distribution. The distribution of hot spots was showing some changes overtime in the cluster of households. Including the spatial effect allowed to obtain more accurate estimate of the prevalence, hence a better estimation of the clinical burden of P.falciparum. This can allow a better allocation of resources. From our findings, results may apply in two aspects: Firstly, in research focused on estimation in malaria. Such research trying to obtain an estimation of malaria outcomes, such as incidence, in different areas are encouraged to check on the spatial or spatio-temporal component in their estimation based on small area estimation with Bayesian approach due to the small level of unit to obtain more accurate estimate. Secondly, in strategies to reduce the prevalence. It is necessary to find strategies to increase, at the cluster of households level, the ITNs coverage to at least 20%, by taking into account some ecological variables implied in the decrease of the prevalence and to improve access to all health care interventions in the rural areas throughout the country. Monitoring the vector control intervention and those ecological variables can contribute to strengthen the action of interventions in public health, because of the spillover effect, which can spread the benefit of intervention over long distance to reach several areas not targeted in the neighborhood. This effect contributes in the cost-effectiveness of the interventions. The national direction of meteorology (DGM) and the NMCP need to work together to mitigate or control adverse climatic change effect on malaria if possible by developing early warning system for malaria. These results can be considered as a baseline for future surveys investigating the malaria distribution in Gabon and elsewhere.
The relationship between mental health and work stress in healthcare workers during COVID-19 in Gauteng, South Africa (2020)
(2024) Butao, Themba Archiford
Background: Research into the 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto, by Maunder et al (2006), revealed that health care workers (HCWs) experienced high “levels of burnout (p=0.019), psychological distress (p<0.001) and posttraumatic stress (p<0.001)” compared to HCWs that were working in Hamilton at hospitals that were not treating SARS infected patients. In June 2012, the Middle East Respiratory syndrome (MERS) had high nosocomial transmissions, and this led to increased distress among HCWs. Coronavirus Disease 2019 (COVID-19) is the most recent global pandemic, and it is has led to a negative impact on the healthcare sector and its employees. The impact of pandemics such as COVID-19 on the mental health of HCWs in low-middle income countries like South Africa is not fully known. Previous studies have shown that low-middle income countries, such as South Africa experience higher stress and burnout levels due to their limited resources such as access to personal protective equipment. High stress during patient care in high income countries has resulted in HCWs experiencing fear, exhaustion and stress in the past. Aim: To investigate the relationship between work stress and mental health in HCWs working in public hospitals and CHCs during COVID-19 in Gauteng in 2020. Methods: The study was a cross-sectional study using secondary data from a longitudinal study that was conducted in Gauteng, South Africa in 2020. The primary study was conducted by sending a questionnaire to HCWs working in large hospitals and some clinics in Gauteng, South Africa in 2020. The questionnaire consisted of the General Health Questionnaire-12 (GHQ-12), Job-Related Tension Index (JRTI) and COVID-19 related questions. A sample size of 223 was required for the study and was analysed using STATA® 16 software. Regression analysis was conducted to analyse the different relationships and odds ratios were obtained at the end of the study. Results: A total of 336 HCWs participated from 6 facilities. Of the occupations that could be identified, Professional nurses made up the highest percentage of HCWs (19.11%). A majority 55.22% and 54.33% of HCWs experienced mental distress and work stress respectively. The prevalence of both mental health disorders and work stress in HCWs in Gauteng during the COVID-19 pandemic was 39.10%. The odds of developing mental health disorders among HCWs who were experiencing work-stress in Gauteng, 2020, were 7.51 times the odds of developing mental health disorders among HCWs not experiencing workstress in Gauteng, 2020 (p <.001, CI: 2.99, 18.85). The study also showed that a unit increase in the JRTI score was associated with a 19% increase in the GHQ-12 score (p < .001, CI: 0.14, 0.25). Discussion and conclusion: Work-stress significantly affected mental health among HCWs working in public hospitals and community health centres (CHCs) in Gauteng during the early COVID-19 pandemic. The study also shows that pandemics such as the COVID-19 pandemic can lead to a high proportion of work-stress as well as mental health disorders in HCWs. Negative perceptions of risk during COVID-19 also played a significant role in the work stress and the mental wellbeing of HCWs. Recommendations: Decision makers at the district and provincial level should aim to provide constant counselling services even during periods of less work-stress. Sufficient outbreak response training should be provided as part of HCWs Continual Professional Development (CPD) courses so that there is better readiness for future pandemics. There should permanent policy changes that reduce the number of hours worked by HCWs, and more effort staff retention in the public sector as this is what majority of the country uses for seeking healthcare services. Smaller healthcare facilities should also be better equipped with not just only professional HCWs but equipment, including training and storage of such equipment, and regularly checked as preparation for future outbreaks.
Efficacy of water suppression method for controlling the emissions of submicron particles at a quarry, Boksburg, South Africa
(2024) Mkwanazi, D. D.
Background: Respiratory diseases has contributed 70% to worldwide occupational disease mortality in all industrial sectors since over a decade ago. Pneumoconioses occur as a result of accumulation of dust in the lungs. Silicosis, one of the most common forms of pneumoconioses, presents in three different forms namely acute, accelerated, and chronic silicosis. Quarrying and open cast mining are responsible for different workplace hazards including noise, trauma, vibration, ultraviolet radiation, and dust exposure, which may cause silicosis. Lung deposition of particulate matter depend on the particulate matter surface characteristics, aerodynamic size, and weight. Quarrying and stone crushing activities are associated with high levels of crystalline silica release. Water suppression has been proven to effectively control dust in mining and construction industries, but not enough attention has been paid on effects of water suppression on fine particulate matter. Purpose: To evaluate efficacy of water suppression as a dust control measure for submicron particles for the primary, secondary and tertiary treatment processes during the production of stone aggregates in a quarry. Methods: In this cross-sectional study data was collected using a Nanozen dust sampling device to monitor dust emissions in 0.300µm to 10.658µm bin sizes across 4 different sampling points namely primary, secondary, tertiary treatment area, and office complex at a quarry in Boksburg, South Africa. In the primary treatment area big rocks are crushed into 150mm smaller rock without dust suppression, the secondary area breaks them further into 57mm stones with water supperssion applied, and tertiary breaks them into 19mm and smaller stone products under further water suppression conditions. Primary treatment area and office complex were sampled as dry areas, while secondary and tertiary treatment areas were sampled as water suppression areas. Data was analysed based on mass and number concentrations for different bin sizes, and comparisons were made between dry and wet areas. The effect of water treatment (suppression) on submicron bin ranges (0.300-0.915µm) in terms of mass concentration and number concentration was analysed to determine its efficacy in reducing dust emissions in this range. Results: The total average mass concentration of 460.2 µg/m3 (±486.3) was emitted from the primary area without dust suppression with average of 2.22E+08 (±136958.7) number concentration. This was reduced to 6.02µg/m3 and 60.9 million (±552879) mass and number concentration respectively in secondary treatment area with water suppression. In tertiary area emissions were 10.52µg/m3 and 54.8 million particles/cm3 (±828126) respectively for mass and number concentrations following further water suppression, while in office area (no water suppression) 6.07µg/m3 and 44.4 million/cm3 mass and number concentrations were recorded respectively. Conclusions & Recommendations: Data showed reduction of emissions between primary and secondary area by 98.7% (mass concentration) and 72.5% (number concentration). Further treatment in tertiary treatment showed a further decrease in total average number concentration compared to secondary treatment. Emissions at the office block as a control site were consistent with emissions from secondary and tertiary treatment areas, demonstrating possible dispersion by wind. Water suppression was demonstrated to be effective against particle bin sizes larger than 1 micron, with progressively less effect on submicron particles as they became smaller. More research is recommended on suppression of submicron dust particulate matter emission and consideration of number concentration as a key dose matrix to determine exposure.
The use of machine learning techniques in identifying gender differentials in COVID-19 hospitalizations, probabilities of hospitalization outcomes and hidden correlations with demographic and clinical factors
(2024) Malaatjie, Meghan Abigail
Background: Sex-differentiated data on hospitalisation frequency, case severity, pre-existing medical conditions, and mortality outcomes amongst Covid-19 hospitalised patients is needed but limited in Gauteng province, the epicentre of the Covid-19 pandemic in South Africa. This study aims to investigate whether Machine Learning techniques can provide insight into gender differentials in COVID-19 hospitalizations throughout the four waves of the pandemic, in the Gauteng province of South Africa. Method: A weak supervision learning algorithm was used to perform binary classification. The training of a DNN was performed on 14 features of patient characteristics (Demographic variables, presence of comorbidity, care received upon admission and setting of care), to separate the two classes of data sets: a) severe disease class (a proxy measure of higher severity, which included those who died during admission or were admitted into an intensive care (ICU) or high care unit (HCU)), and b) less severe disease class. Results: The number of Covid-19 hospitalisations was highest in wave 3 for both males and females, and higher in females than males across all 4 waves. The observed difference in COVID-19 hospitalization frequency between men and women was the highest in the 20 - 40-year age group with a ratio of 1:3. There was a higher frequency of COVID-19 hospitalization for hypertension, diabetes, and HIV frequencies across all age groups. Conclusion: This study demonstrated the utility of machine learning for analysing multidimensional sexdisaggregated data to provide accurate, real-time information for public health monitoring of sexdifferences in the Gauteng province.
Revalence and factors associated with virological nonsuppression amongst HIV positive pregnant and lactating adult women in the Kingdom of Eswatini in 2016-2017
(2024) Ndlangamandla, Mpumelelo
Antiretroviral treatment (ART) is the primary intervention for preventing mother to child transmission of HIV service package. The likelihood of vertical transmission of HIV can be drastically reduced by using ART. The World Health Organization (WHO) recommends ART initiation in pregnant and lactating women living with HIV regardless of WHO clinical staging and thereafter to continue combination Antiretroviral Therapy (cART) for life. There are some challenges in implementing the WHO recommendations in settings where many women cannot attend antenatal care services due to social or economic barriers or structural barriers and even fewer women attend postnatal care services. The objectives of this study are to determine the prevalence of virological non-suppression among pregnant and lactating women living with HIV, to quantify the association between self-reported ART use and virological non-suppression and determine socio-demographic, clinical and behavioural characteristics associated with virological non-suppression among pregnant and lactating women living with HIV. This is a cross-sectional study using secondary data from the Swaziland HIV Incidence Survey. The primary study was a population-based survey which was nationally representative, using a cross-sectional study design conducted in 2016-2017 in the Kingdom of Eswatini employing a two-stage stratified cluster sample design. This study sample included adult women living with HIV who were either pregnant or lactating at the time of the survey. Data analysis was conducted using Stata 17. The data analysis made use of sampling weights and clustering of individuals within each enumeration area using weighted clustered logistic regression survey analysis commands in Stata. A total of 195 adult women living with HIV were included in the survey with a median age of 28 years old. Among the women, 104 (54.4%) were either married or cohabiting with someone, and 151 (71.9%) were living in a rural setting. Only 77 (38.8%) had attained primary education as their highest level of education while 122 (63.8%) were lactating. A total of 120 (62%) reported being on ARVs and 158 (81.8%) being virally suppressed. The overall virological non-suppression prevalence of 36.8% was higher than the UNAIDS target of 10% by 2020 to speed up HIV elimination. In a multivariable analysis, two risk factors remained statistically significant. Women who were aged 17 to 24 years old were almost five times more likely to be virologically non-suppressed (aOR=4.7, 95% CI 1.8 - 11.8, p=0.001) while women who did not report ARV use during pregnancy were eight times more likely to have virological non- RESEARCH REPORT (COMH7060) 320775 IV suppression (aOR=8.1, 95% CI 3.0 - 21.8, p<0.001). Maternal age was dichotomised with the younger group compared to the older group (17-24 years, vs 25+ years). An additional analysis excluding self-reported ARV use at pregnancy found that virological non-suppression was associated with maternal age (OR=5.5, 95% CI 2.3 – 13.7, p<0.001) and number of sexual partners in the previous 12 months (OR=7.9, 95% CI 1.6 – 40.5, p=0.013). Maternal age was dichotomised with the younger group compared to the older group (17-24 years, vs 25+ years) The study found that virological non-suppression was associated with maternal age and ARV use at pregnancy. The additional analysis also found a strong association with maternal age and number of sexual partners the women reported having in the previoustwelve months. However, the primary study was not powered to detect differences in virological non-suppression among our population of interest. The sample size was also small, which limited the ability to investigate other possible risk factors. To help the country address the identified gaps, I would recommend the scale up of the DREAMS program and strict following of HIV guidelines to actively monitor viral load and ART uptake during pregnancy and lactation. In addition, messaging around avoidance of multiple sexual partners should be strengthened
Risk assessment of exposure to indoor particulate matter (PM2.5) near a Ferro-manganese smelter - Meyerton, Gauteng Province
(2024) Khoza, Goodwill Jopa Zimakazi
Background- Globally, over 90% of the populace have no access to clean air. Exposure to airborne contaminants is associated with adverse health risks. Studies have reported on direct correlation between industrialised settings with increased incidence of air pollution associated illnesses. Chronic exposure to PM2.5 is linked to cardiovascular and respiratory illnesses. Exposure to particulate matter (PM) in residential settings has been studied in many big mega-cities globally. However, fewer studies were achieved in low-income settings and South Africa is no exception. Exposure and risk assessments research emanate from occupational settings with less emphasis on residential settings. Studies assessing the risk of exposure to PM2.5 in residential settings are quite limited. This provides understanding a research knowledge gap in South African low-income societies. Purpose- The purpose of the study is to determine indoor PM2.5 chronic daily intake to estimate the non-carcinogenic risk in communities living adjacent industrial PM emitting sources. Methods- Secondary data from the main study titled “Motor and cognitive health outcomes in a manganese-exposed African community” (HREC clearance certificate no. M121117), which was conducted during the period of 2019/20 was used to assess the risk of exposure to indoor PM2.5. The secondary data used in this study was collected during winter season, and PM2.5 was sampled using a gravimetric technique over a period of seven days. Particles were drawn into the sampling head by a Gillian Gil-Air 300plus pump (Sensidyne, St Petersburg FL, USA) which was connected using a teflon tubing. A PM2.5 Cyclone D32 with a cut-off point of PM2.5 attached to the sampling head to isolate larger particles from entering the inlet of the cassette. The pump was calibrated and operated at a continuous flow rate of 2.75 L/minute over a seven-days period. Pre-and-post-weighing of filters was performed to derive the final mass in a controlled laboratory environment using a micro-balance scale (modelCPA225D, Sartorius, AG, Göttingen, Germany). The pre-weight (mass) consisted only of the mass of a filter while the post mass consisted of particulate and filters. Results- The particulate matter (PM) mass concentration for New Sicelo, Old Sicelo and Noldick was found to be 0.0125 mg/m³, 0.0115 mg/m³ and 0.0061 mg/m³ respectively. The indoor PM mass concentrations for both New and Old Sicelo was found to be doubled as compared to that of Noldick’s. An increased PM mass concentrations for the New and Old Sicelo areas implied an unavoidable risk of PM exposure to the population of New and Old Sicelo, respectively. Flowing from the identified risk; sustainable mitigation plans are fundamental to curb the risk of generational poisonous exposures which will rampantly lower the populace life expectancy tremendously if not proactively addressed especially at source. Daily intake (DI) fractions for females and males were 22.98 m3 /kg/day and 17 m3 /kg/day for all three locations, respectively. Higher DI for females corroborate and support preceding studies’ findings that women spent 80% of their instances indoors. The chronic daily intake (CDI) for males at New Sicelo, Old Sicelo and Noldick were 0.21 mg/kg/day, 0.20 mg/kg/day and 0.10 mg/kg/day and females at New Sicelo, Old Sicelo and Noldick had been 0.29 mg/kg/day, 0.26 mg/kg/day and 0.14 mg/kg/day, respectively. The difference in CDI values for females and males tells how women are over exposed compared to men. Hazard quotients (HQ) for females throughout the three locations were 261, 240 and 127 respectively while males were 193, 178 and 94. A hazard quotients (HQ) measurement means women are over exposed compared to men. H>1 for women means that non-carcinogenic impact has been surpassed and cancer is high while men with H>1 for women means that non-carcinogenic impact has been surpassed and cancer is high while men with H>1 have a negligible cancer risk in the tree areas (Old and New Sicelo, Noldick). The findings from the study positively affirm the following aspects; i) characterization of the PM mass concentration from the three locations and, ii) how impactful is the PM exposure levels to the population health status which in turn influence the concept of exposure assessment. To support the exposure assessment process; a systematic review was conducted on time-activity patterns, the demographic data for risk assessment input variables were noted and the estimation non-carcinogenic health risk of exposure to indoor PM concentration especially for the community of Meyerton. Conclusion -The study determined indoor PM2.5 chronic daily intake to estimate the non-carcinogenic risk in communities living adjacent to industrial PM emitting sources. The study may want to aid in perception of exposure and development of abatement measures to decrease exposure to PM2.5 sources and assists in performing exposure assessments.
Factors associated with pre-exposure prophylaxis (PrEP) uptake and continuation among adolescent girls and young women in the uMhlathuze Municipality, KwaZuluNatal South Africa
(2024) Methazia, Jewelle Joanna Sardis
Background Despite the notable advancements in preventing human immunodeficiency-virus (HIV) globally, South Africa (SA) continues to report the largest epidemic of HIV in the world. Furthermore, adolescent girls and young women AGYW) in SA carry the unequal burden of infection in SA. Studies have reported that AGYWs find it difficult to negotiate condom use placing them at a direct risk of contracting HIV. Pre-exposure prophylaxis (PrEP) was identified as a novel preventative intervention with uptake and continued use offering the potential to decrease HIV incidence. In SA, guidelines, and strategies to provide of PrEP to high-risk groups, which include AGYW have been developed. This study aimed to describe the characteristics of the AGYW initiating PrEP services and determine the factors associated with PrEP uptake and continued use among AGYW enrolled in an HIV prevention combination program in the uMhlathuze Municipality in KwaZulu-Natal South Africa. Methods This is a retrospective cohort study involving secondary data analysis of programmatic data from an HIV combination prevention program for AGYW in 5 Department of Health community primary health clinics the uMhlathuze Municipality in KwaZulu-Natal. We sampled participants from a population of HIV uninfected AGYW between the ages 15 -24 that initiated the program between the 1st of June 2020 and the 31st of June 2021. Our primary outcome of interest was PrEP initiation at baseline defined as the number of AGYW who were offered PrEP and initiate its use during at their first visit. Our secondary outcome of interest was PrEP continuation at follow-up visit defined as having at least 1 record of follow up after PrEP initiation. Categorical variables were expressed as frequencies and proportions. Bivariable analysis was carried out to determine associations between PrEP initiation and the categorical variables using the Chi-squared (χ2) test. Log-binomial regression was utilised to evaluate risk factors associated with our primary outcome (PrEP initiation) and our secondary outcome (PrEP continuation). Risk ratios (RRs) and their 95% CI were used as the measure of effect. Variables with p<0.1 were included in the multivariable analysis for both PrEP initiation and PrEP continuation to ascertain factors associated with each outcome. A cut off p<0.05 was used in the multivariable model to identify factors associated with both the primary (PrEP initiation) and secondary outcome (PrEP continuation). All statistical analyses were performed using Stata (V.15) statistical software and RStudio. Results Between the 1st of June 2020 and the 31st of June 2021, 3324 AGYW were enrolled in the HIV prevention combination program and were offered PrEP services. Overall, 1609 (48%) initiated PrEP services. Majority (71%) were aged 19 - 24 and 6.5% of PrEP initiates reported having an STI in the 6 months prior to initiating PrEP pills. Among those that initiated PrEP only 8% (N=125) had at least 1 record of follow-up post initiation. Factors that remained significantly associated with PrEP initiation in the multivariable analysis were had STI in the last 6 months (RR:2, CI: 1.5-2.8, p<0.001); currently on STI treatment (RR:1.6, CI: 1.2-2.3, p=0.004); used condom at last sexual encounter (RR:1.8, CI: 1.2-2.8, p=0.007). For our secondary outcome of interest PrEP continuation, factors associated with continued use of PrEP in our univariable analysis were age category 19-24 (RR:0.7, CI:0.5-1.0, p=0.036); used condom at last sex (RR: 1.7, CI:0.9-3.2, p=0.092). However, none of these factors remained statistically significant predictors of PrEP continuation in the multivariable model. Conclusion This study had moderate uptake of PrEP and poorer continuation than other studies. It is possible that lockdown restrictions implemented to curb the transmission of COVID-19 at the time of the study may have hampered the success of the PrEP intervention for AGYW enrolled in the HIV combination prevention program. This finding calls for more innovative PrEP service delivery models for programs and interventions in real clinic settings to ensure AGYW have uninterrupted access to PrEP when access to clinics is restricted. Our findings demonstrate important differences between PrEP uptake and key sexual and HIV risk behaviours. Our unadjusted analysis showed positive associations between PrEP uptake and the use of condoms at last sexual encounter, current STI diagnosis and STI diagnosis in the last 6 months, pregnancy, HIV discordant relationships, and having heterosexual anal sex. We continued to observe positive associations between the PrEP uptake and the use of condoms at last sexual encounter, current STI diagnosis and STI diagnosis in the last 6 months in our adjusted analysis. Condom use at last sexual encounter was common among PrEP initiates, and many AGYW currently taking STI treatment and those who had an STI in the last 6 months also elected to use PrEP pills. Our findings indicate programs offering PrEP should also integrate STI services with appropriate testing approaches and targeted vaccination for AGYW.

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