ETD Collection

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Subject: search.filters.subject.Socioeconomic Factors

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Now showing 1 - 4 of 4
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    Good to great: strategies to improve the detection of TB amongst household contacts in South Africa
    (2018) Velen, Kavindhran
    Background: In South Africa, TB household contact tracing provides an opportunity for increased TB and HIV case finding. We aimed to determine the effect of two new potential interventions for TB contact tracing programmes: Point of Care CD4 (PoC CD4) on HIV linkage to care and household Isoniazid Preventive Therapy (IPT) provision on uptake and retention of IPT. Methods: A pragmatic, three-arm, cluster-randomized trial was undertaken. TB Household contacts were randomised to 3 arms: 1) Standard of Care TB and HIV testing (SOC); 2) SOC with POC CD4 for those testing HIV positive; 3) SOC with POC CD4 and IPT for eligible household members. Linkage to care within 90 days was assessed either through patient visits (at 10 weeks and 6 months) or via telephonic contact. Results: 2,243 index TB patients and 3,012 contacts (64,3% female, median age 30 years) were enrolled. On self-report, 26(1.2%) were currently receiving TB treatment and 1816 (60.3%) reported a prior HIV test. HIV testing uptake was 34.7% in the SoC arm, 40.2% in the PoC CD4 arm (RR1.16, CI 0.99–1.36, p-value = 0.060) and 39.9% in the PoC CD4 + HH-IPT arm (RR = 1.15, CI 0.99–1.35, p-value = 0.075). Linkage to care within 3 months was 30.8% in the SoC arm and 42.1% in the POC CD4 arms (RR 1.37; CI: 0.68–2.76, p-value = 0.382). 20/21 contacts (95.2%) initiated IPT in the PoC CD4 + HH-IPT arm, compared to 3/20 (15.0%) in the PoC CD4 arm (p = 0.004; p-value from Fisher’s exact test<0.001). Among3,008 contacts screened for tuberculosis, 15 (3.4%) had bacteriologically confirmed TB with an overall yield of TB of 0.5% (95% CI: 0.3%, 0.8%). Conclusions: Household PoC CD4 testing and IPT initiation is feasible. There was only weak evidence that PoCCD4 led to a small increase in HCT uptake and no evidence for an increase in linkage-to-care. IPT initiation and completion was increased by the household intervention. Although feasible, these interventions had low impact due to the low uptake of HIV testing in households.
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    Effect of household socioeconomic status on household dyanamics in a high HIV prevalence area of the KwaZulu-Natal province from 2003 - 2012
    (2016) Gweliwo, Patricia
    Socio-economic status (SES) disparities do not only exist between racial groups in South Africa but also exists within the vulnerable black population with the devastating impacts of the HIV epidemic. Households are important determinants of human welfare. However, little is known about the effect of household socio-economic status on the establishment and break-up of households within a low-resource setting and a severe HIV epidemic. It is in the midst of these challenges in rural South Africa that this study examined the effect of household SES on household formation and dissolution among the black population in rural northern KwaZulu-Natal. METHODS Using longitudinal data from the period 2003-2012 from the Africa Centre for Health and Population Studies, the study used a cross-sectional study design approach to examine the effect of household SES on household formation. It also examined the effect of household SES change (i.e. either positive, negative change or stable SES) between the start and end of observation of a household within the study period. Household formation was defined as when an individual or individuals come from different households to form a new social unit with a new household head. Dissolution occurred when all individuals in a household end their membership to a household due to death, out-migration or by joining other households. Separate regression models for the two outcomes, household formation and dissolution were explored with household SES covariates while adjusting for other household variables. RESULTS Household formation and dissolution trends both decreased over the study period. Out of a total of 18,249 households, newly formed households had a relatively higher percentage of tertiary educated household heads (10.7% versus 2.5%), unemployed household members (41.6% versus 28.5%), grant recipient household members (37.1% versus 8.5 %) and households within the average to richest wealth quintiles (44.1% versus 36.4 %) than pre-existing households. Multivariate analysis showed that tertiary educated household heads (aOR=2.96, 95% (CI) 2.26-3.89) and households within the average to richest wealth quintiles most especially the 4th quintile (aOR=3.29, 95% (CI) 2.69-4.04) were associated with a higher odds of households being newly formed. However, the lesser the employed members (aOR=0.31, 95% (CI) 0.21-0.45) and grant recipients per household size in a household (aOR=0.15, 95% (CI) 0.12-0.18) the lower the odds of formation. Furthermore, small size households (aOR=0.68, 95% (CI) 0.56-0.80) and unmarried household heads (aOR =0.47, 95% (CI) 0.40-0.55) were associated with lower odds of being newly formed. Whereas female headed households (aOR=2.23, 95% (CI) 1.93-2.57) were associated with a higher odds of household formation. With regards to household dissolution, close to a quarter of households had an increase in SES over the study period compared to households with a decreased SES (24.6% versus 8.6 %). Similar to household formation, male headed households dominated the study population with the highest proportion in dissolved households (63.8% and 61.5% at start and end of household observation respectively). Also unmarried household heads were the majority in dissolved households (62.7% and 64.1% at start and end of household observation respectively). Approximately 65.6% of households that never dissolved had an extended family type of composition compared to 36.6% of dissolved households. The area was predominantly rural with about 47.2% households in rural segment of the study area. The study has shown that households had lower odds of dissolving if there is a positive change (i.e. an increase) in household SES compared with households with an unchanged SES over the period. In exact terms, an increment in the number of employed household members over the study period was associated 49% lower odds of a household being a dissolved (aOR=0.51 95% (CI) 0.42-0.61). Also, an increment in the number of household grant recipients over the period of observation was associated with a 69% lower odds to result in the dissolution (aOR=0.31 95% (CI) 0.25-0.39). Households with an improved wealth index over the period of study were associated with 55% lower odds of dissolution (aOR =0.45, 95% (CI) 0.38-0.54). However, households with both male and female death (multiple sex) were more likely to dissolve. Similarly, peri-urban (aOR=0.71; 95% (CI) 0.58-0.86) households were more likely to dissolve compared to urban households. Surprisingly divorced, widowed and separated couples were not significantly associated with household dissolution. CONCLUSION SES is an important determinant of household existence and stability. This study has shown a complex relationship between household SES and household formation. Although education and improved household wealth index were more likely to result in household formation, an increase in the number of employed household members and household grant recipients did not necessary have an effect on household formation. Government cash transfers, education, employment of household members are valuable cushioning mechanisms necessary for household stability. There is need for government and non-governmental organisations to set up interventions to improve the socio-economic conditions of poor households prioritising rural and female headed households. This is especially critical in a high HIV prevalence area where these interventions will also mitigate against the burden of the HIV epidemic on the population.
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    Prevalence and predictors of psychosocial outcomes amongst socioeconomically deprived primary school children in a rural setting in South Africa: the role of ecological factors
    (2015) Hlungwani, Tintswalo Mercy
    South Africa is passing through a phase of transition and children living in the country are still subject to many social and financial problems. They face high levels of social adversity, socio-economic deprivation, migration, displacement and morbidity. Rural South African children’s right to education and physical and mental health remains unfulfilled because of exposure to on-going adversity including poverty, family disruption through labour migration, malnutrition, inter-personal violence, chronic illness and death of family members due to HIV/AIDS. Although numerous studies highlight psychosocial problems amongst these children in South Africa and even document risk factors, there is paucity of studies that have focused on rural children’s mental health with consideration to both protective and risk factors. The study is focused on primary school children aged 8-12 in grades 5 and 6. It examines the prevalence of psychosocial problems among these children and determines the socio-demographic factors which can serve as predictors of psychological outcomes in these children. The study looks at both risk factors and protective factors as predictors of said psychological outcomes.
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    The socio demographic profile and other characteristics of adult burns patients treated at Johannesburg tertiary hospitals
    (2014) Ncedani, Andiswa
    Introduction: This is the descriptive study of the socio demographic profile and other characteristics such as the burn injury details and socio economic characteristics of adult burn injury patients treated at Johannesburg Tertiary Hospitals (JTH) during the study period. Relevant stakeholders can use this information in the efforts to reduce preventable burn injuries. Method: Prospective study where all adult burn patients in the burns unit, trauma/surgical wards during the study period were eligible to participate in the study. The information was extracted from the medical files (such as hospital classification, date of birth (DOB), type of burn, type of management done to date etc), this was followed by an interview done by principal investigator only, using a questionnaire to gather the information on patients’ demographic details, socio economic information, income details and burn injury details. Descriptive statistics were used to define the profile of burn patients and other characteristics. Results: The results revealed the description and the profile of adult burn patients: a male (71%), African (94%), unmarried (70%), mean age of 35.6 years. He was most likely to have a secondary school qualification (62%), full time employed possible (51%) in the industrial sector, stays with 2-5 people in his household. He was likely to be originally from outside the Gauteng Province (58%). He sustained burns injuries of 10-29% TBSA, while at home (94%), from flames (68%). He remembered (92%), his activity prior to the burn incident and thought that the burn could have been prevented (82%). Conclusion: Burns injuries were reported to be preventable. The burn injury-prevention program should be targeted to males, in the working age groups, residing in one roomed dwelling or informal settlements. Patients with poor judgement, predisposing medical conditions such as epileptics, those that have modified their electricity supply and heat sources should be prioritised for burn injury-prevention programs.