Research Outputs (Public Health)
Permanent URI for this collectionhttps://hdl.handle.net/10539/36984
This collection includes content from the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) which has been operating the Agincourt health and demographic surveillance system since 1992. Work has evolved since then into a robust research infrastructure supporting advanced community-based research with studies ranging from the biomedical to the ethnographic, making rural voices heard.
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Item The global cost of epilepsy: A systematic review and extropolation(Wiley Online LIbrary, 2022-02-22) Begley, Charles; Wagner, Ryan G; Abraham, Annette; Beghi, Ettore; Newton, Charles; Kwon, Churl-Su; Labiner, David; Winkler, Andrea S"Objective Global action for epilepsy requires information on the cost of epilepsy, which is currently unknown for most countries and regions of the world. To address this knowledge gap, the International League Against Epilepsy Commission on Epidemiology formed the Global Cost of Epilepsy Task Force. Methods We completed a systematic search of the epilepsy cost-of-illness literature and identified studies that provided a comprehensive set of direct health care and/or indirect costs, followed standard methods of case identification and cost estimation, and used data on a representative population or subpopulation of people with epilepsy. Country-specific costs per person with epilepsy were extracted and adjusted to generate an average cost per person in 2019 US dollars. For countries with no cost data, estimates were imputed based on average costs per person of similar income countries with data. Per person costs for each country were then applied to data on the prevalence of epilepsy from the Global Burden of Disease collaboration adjusted for the treatment gap. Results One hundred one cost-of-illness studies were included in the direct health care cost database, 74 from North America or Western Europe. Thirteen studies were used in the indirect cost database, eight from North America or Western Europe. The average annual cost per person with epilepsy in 2019 ranged from $204 in low-income countries to $11 432 in high-income countries based on this highly skewed database. The total cost of epilepsy, applying per person costs to the estimated 52.51 million people in the world with epilepsy and adjusting for the treatment gap, was $119.27 billion. Significance Based on a summary and extrapolations of this limited database, the global cost of epilepsy is substantial and highly concentrated in countries with well-developed health care systems, higher wages and income, limited treatment gaps, and a relatively small percentage of the epilepsy population."Item Associations of father and adult male presence with first pregnancy and HIV infection: Longitudinal evidence from adolescent girls and young women in rural South Africa (HPTN 068)(Springer, 2021-01) Albert, Lisa M; Edwards, Jess; Pence, Brian; Hills, Susan; Kahn, Kathleen; Gómez‑Olivé, F. Xavier; Wagner, Ryan G; Twine, Rhian; Pettifor, AudreyThis study, a secondary analysis of the HPTN 068 randomized control trial, aimed to quantify the association of father and male presence with HIV incidence and first pregnancy among 2533 school-going adolescent girls and young women (AGYW) in rural South Africa participating in the trial between March 2011 and April 2017. Participants’ ages ranged from 13–20 years at study enrollment and 17–25 at the post-intervention visit. HIV and pregnancy incidence rates were calculated for each level of the exposure variables using Poisson regression, adjusted for age using restricted quadratic spline variables, and, in the case of pregnancy, also adjusted for whether the household received a social grant. Our study found that AGYW whose fathers were deceased and adult males were absent from the household were most at risk for incidence of first pregnancy and HIV (pregnancy: aIRR = 1.30, Wald 95% CI 1.05, 1.61, Wald chi-square p = 0.016; HIV: aIRR = 1.27, Wald 95% CI 0.84, 1.91, Wald chi-square p = 0.263) as compared to AGYW whose biological fathers resided with them. For AGYW whose fathers were deceased, having other adult males present as household members seemed to attenuate the incidence (pregnancy: aIRR = 0.92, Wald 95% CI 0.74, 1.15, Wald chi-square p = 0.462; HIV: aIRR = 0.90, Wald 95% CI 0.58, 1.39, Wald chi-square p = 0.623) such that it was similar, and therefore not statistically significantly different, to AGYW whose fathers were present in the household.Item Validation of Oxford Cognitive Screen: Executive Function(OCS-EF), a tablet-based executive function assessmenttool amongst adolescent females in rural South Africa(Wiley Online, 2021) Rowe, Kirsten; Duta, MihaelaShort, reliable, easily administered executive function (EF) assessment tools are needed to measure EF in low- andmiddle-income countries, particularly in sub-Saharan Africa given the prevalence of human immunodeficiency virus(HIV)-associated neurocognitive disorder. We administered Oxford Cognitive Screen — Executive Function (OCS-EF)to 932 rural South African females (mean age 19.7 years).Item Exploring the perception of and attitude towards preconception care service provision and utilisation in a South Western Nigerian community – a qualitative study(School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, 2021-02) Ojifinni, Oludoyinmola O.; Munyewende, Pascalia O.; Ibisomi, LatifatBackground: Hospital-based, quantitative studies in Nigeria show low levels of knowledge and use of preconception care (PCC) services. This study explored the perception of and attitude towards PCC in a southwestern Nigerian community qualitatively. Data Source and Methods: Focus group discussions (FGDs) were held with 57 purposively selected adult women and men and key informant interviews (KIIs) with one female and one male community leader in Ibadan North Local Government Area, Oyo State, Nigeria in 2018. The FGDs and KIIs held within the community were digitally recorded, transcribed verbatim and analysed thematically. Results: Participants placed PCC in the context of marriage, describing its importance for addressing effects of adverse exposures on pregnancy and ensuring positive pregnancy outcomes. Conclusion: Barriers to PCC uptake mentioned included lack of awareness and prohibitive service costs. Expressing their willingness to use and promote PCC use, they stated the need to ensure PCC uptake through improved awareness at the community level.Item Classical Cardiovascular Risk Factors and HIV are Associated With Carotid IntimaMedia Thickness in Adults From SubSaharan Africa Findings From H3Africa AWIGen Study(2019-06-07) Boua P; Ali S; Soo CBackground-—Studies on the determinants of carotid intima-media thickness (CIMT), a marker of sub-clinical atherosclerosis, mostly come from white, Asian, and diasporan black populations. We present CIMT data from sub-Saharan Africa, which is experiencing a rising burden of cardiovascular diseases and infectious diseases. Methods and Results-—The H3 (Human Hereditary and Health) in Africa’s AWI-Gen (African-Wits-INDEPTH partnership for Genomic) study is a cross-sectional study conducted in adults aged 40 to 60 years from Burkina Faso, Kenya, Ghana, and South Africa. Cardiovascular disease risk and ultrasonography of the CIMT of right and left common carotids were measured. Multivariable linear and mixed-effect multilevel regression modeling was applied to determine factors related to CIMT. Data included 8872 adults (50.8% men), mean age of 50 6 years with age- and sex-adjusted mean ( SE) CIMT of 640 123lm. Participants from Ghana and Burkina Faso had higher CIMT compared with other sites. Age (b = 6.77, 95%CI [6.34–7.19]), body mass index (17.6[12.5–22.8]), systolic blood pressure (7.52[6.21–8.83]), low-density lipoprotein cholesterol (5.08[2.10–8.06]) and men (10.3[4.75– 15.9]) were associated with higher CIMT. Smoking was associated with higher CIMT in men. High-density lipoprotein cholesterol (12.2 [17.9– 6.41]), alcohol consumption (–13.5 [19.1–7.91]) and HIV (8.86 [15.7–2.03]) were inversely associated with CIMT. Conclusions-—Given the rising prevalence of cardiovascular diseases risk factors in sub-Saharan Africa, atherosclerotic diseases may become a major pan-African epidemic unless preventive measures are taken particularly for prevention of hypertension, obesity, and smoking. HIV-specific studies are needed to fully understand the association between HIV and CIMT in sub-Saharan AfricaItem Variation by Geographic Scale in the Migration-Environment Association: Evidence from Rural South Africa(Federal Institute for Population Research, 2017) Hunter, L.M.; Leyk, S.; Maclaurin, G.J.; Nawrotzki, R.; Twine, W.; Erasmus, B.F.N.; Collinson, M.Scholarly understanding of human migration’s environmental dimensions has greatly advanced in the past several years, motivated in large part by public and policy dialogue around “climate migrants”. The research presented here advances current demographic scholarship both through its substantive interpretations and conclusions, as well as its methodological approach. We examine temporary rural South African outmigration as related to household-level availability of proximate natural resources. Such “natural capital” is central to livelihoods in the region, both for sustenance and as materials for market-bound products. The results demonstrate that the association between local environmental resource availability and outmigration is, in general, positive: households with higher levels of proximate natural capital are more likely to engage in temporary migration. In this way, the general findings support the “environmental surplus” hypothesis that resource security provides a foundation from which households can invest in migration as a livelihood strategy. Such insight stands in contrast to popular dialogue, which tends to view migration as a last resort undertaken only by the most vulnerable households. As another important insight, our findings demonstrate important spatial variation, complicating attempts to generalize migration-environment findings across spatial scales. In our rural South African study site, the positive association between migration and proximate resources is actually highly localized, varying from strongly positive in some villages to strongly negative in others. We explore the socio-demographic factors underlying this “operational scale sensitivity”. The cross-scale methodologies applied here offer nuance unavailable within more commonly used global regression models, although also introducing complexity that complicates story-telling and inhibits generalizability.Item Social accountability and nursing education in South Africa(2015) Armstrong, S.J; Rispel, L.CBACKGROUND: There is global emphasis on transforming health workforce education in support of universal health coverage. OBJECTIVE: This paper uses a social accountability framework, specifically the World Health Organization's six building blocks for transformative education, to explore key informants' perspectives on nursing education in South Africa. METHODS: Using a snowballing sampling technique, 44 key informants were selected purposively on the basis of their expertise or knowledge of the research area. Semi-structured interviews were conducted with the key informants after informed consent had been obtained. The interviews were analysed using template analysis. RESULTS: South Africa has strategic plans on human resources for health and nursing education, training, and practice and has a well-established system of regulation and accreditation of nursing education through the South African Nursing Council (SANC). Key informants criticised the following: the lack of national staffing norms; sub-optimal governance by both the SANC and the Department of Health; outdated curricula that are unresponsive to population and health system needs; lack of preparedness of nurse educators; and the unsuitability of the majority of nursing students. These problems are exacerbated by a perceived lack of prioritisation of nursing, resource constraints in both the nursing education institutions and the health training facilities, and general implementation inertia. CONCLUSION: Social accountability, which is an essential component of transformative education, necessitates that attention be paid to the issues of governance, responsive curricula, educator preparedness, and appropriate student recruitment and selection.Item Predictors of health care use by adults 50 years and over in a rural South African setting(2014) Ameh, S; Kahn, K; Tollman, S.M; et alBACKGROUND: South Africa's epidemiological transition is characterised by an increasing burden of chronic communicable and non-communicable diseases. However, little is known about predictors of health care use (HCU) for the prevention and control of chronic diseases among older adults. OBJECTIVE: To describe reported health problems and determine predictors of HCU by adults aged 50+ living in a rural sub-district of South Africa. DESIGN: A cross-sectional study to measure HCU was conducted in 2010 in the Agincourt sub-district of Mpumalanga Province, an area underpinned by a robust health and demographic surveillance system. HCU, socio-demographic variables, reception of social grants, and type of medical aid were measured, and compared between responders who used health care services with those who did not. Predictors of HCU were determined by binary logistic regression adjusted for socio-demographic variables. RESULTS: Seventy-five percent of the eligible adults aged 50+ responded to the survey. Average age of the targeted 7,870 older adults was 66 years (95% CI: 65.3, 65.8), and there were more women than men (70% vs. 30%, p<0.001). All 5,795 responders reported health problems, of which 96% used health care, predominantly at public health facilities (82%). Reported health problems were: chronic non-communicable diseases (41% - e.g. hypertension), acute conditions (27% - e.g. flu and fever), other conditions (26% - e.g. musculoskeletal pain), chronic communicable diseases (3% - e.g. HIV and TB), and injuries (3%). In multivariate logistic regression, responders with chronic communicable disease (OR=5.91, 95% CI: 1.44, 24.32) and non-communicable disease (OR=2.85, 95% CI: 1.96, 4.14) had significantly higher odds of using health care compared with those with acute conditions. Responders with six or more years of education had a two-fold increased odds of using health care (OR=2.49, 95% CI: 1.27, 4.86) compared with those with no formal education. CONCLUSION: Chronic communicable and non-communicable diseases were the most prevalent and main predictors of HCU in this population, suggesting prioritisation of public health care services for chronic diseases among older people in this rural setting.Item Barriers to accessing health care in Nigeria: implications for child survival(2014) Adedini, S A; Odimegwu, C; Bamiwuye, S A; et alBackground: Existing studies indicate that about one in every six children dies before age five in Nigeria. While evidence suggests that improved access to adequate health care holds great potential for improved child survival, previous studies indicate that there are substantial barriers to accessing health care in Nigeria. There has not been a systematic attempt to examine the effects of barriers to health care on under-five mortality in Nigeria. This study is designed to address this knowledge gap. Data and method: Data came from a nationally representative sample of 18,028 women (aged 15 49) who had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and Health Survey. The risk of death in children below age five was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI). Results: Results indicate higher under-five mortality risks for children whose mothers had cultural barriers and children whose mothers had resource-related barriers to health care (HR: 1.44, CI: 1.32 1.57, pB0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04 1.24, pB0.001), relative to children whose mothers reported no barriers. Barriers to health care remained an important predictor of child survival even after adjusting for the effects of possible confounders. Conclusion: Findings of this study stressed the need for improved access to adequate health care in Nigeria through the elimination of barriers to access. This would enable the country to achieve a significant reduction in childhood mortality.Item 'Practice what you preach': Nurses' perspectives on the Code of Ethics and Service Pledge in five South African hospitals.(2015) White, J; Phakoe, M; Rispel, L.CBACKGROUND: A recent focus of the global discourse on the health workforce has been on its quality, including the existence of codes of ethics. In South Africa, the importance of ethics and value systems in nursing was emphasised in the 2011 National Nursing Summit. OBJECTIVE: The study explored hospital nurses' perceptions of the International Code of Ethics for Nurses; their perceptions of the South African Nurses' Pledge of Service; and their views on contemporary ethical practice. METHODS: Following university ethics approval, the study was done at a convenience sample of five hospitals in two South African provinces. In each hospital, all day duty nurses in paediatric, maternity, adult medical, and adult surgical units were requested to complete a self-administered questionnaire. The questionnaire focused on their perceptions of the Code of Ethics and the Pledge, using a seven-point Likert scale. STATA(®) 13 and NVIVO 10 were used to analyse survey data and open-ended responses, respectively. RESULTS: The mean age of survey participants (n=69) was 39 years (SD=9.2), and the majority were female (96%). The majority agreed with a statement that they will promote the human rights of individuals (98%) and that they have a duty to meet the health and social needs of the public (96%). More nuanced responses were obtained for some questions, with 60% agreeing with a statement that too much emphasis is placed on patients' rights as opposed to nurses' rights and 32% agreeing with a statement that they would take part in strike action to improve nurses' salaries and working conditions. The dilemmas of nurses to uphold the Code of Ethics and the Pledge in face of workplace constraints or poor working conditions were revealed in nurses' responses to open-ended questions. CONCLUSION: Continuing education in ethics and addressing health system deficiencies will enhance nurses' professional development and their ethical decision-making and practice.