Academic Wits Research Outputs (All submissions)
Permanent URI for this collectionhttps://hdl.handle.net/10539/36827
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Item Participatory action research to address lack of safe water, a community-nominated health priority in rural South Africa(2023-07-27) Jennifer Hove; Denny Mabetha; Maria van der Merwe; Rhian Twine; Kathleen Kahn; Sophie Witter; Lucia D’AmbruosoBackground Despite international evidence supporting community participation in health for improved health outcomes and more responsive and equitable health systems there is little practical evidence on how to do this. This work sought to understand the process involved in collective implementation of a health-related local action plan developed by multiple stakeholders. Methods Communities, government departments and non-government stakeholders convened in three iterative phases of a participatory action research (PAR) learning cycle. Stakeholders were involved in problem identification, development, and implementation of a local action plan, reflection on action, and reiteration of the process. Participants engaged in reflective exercises, exploring how factors such as power and interest impacted success or failure. Conclusion The process offered new ways of thinking and stakeholders were supported to generate local evidence for action and learning. The process also enabled exploration of how different stakeholders with different levels of power and interest coalesce to design, plan, and act on evidence. Creation of safe spaces was achievable, meanwhile changing stakeholders’ level of power and interest was possible but challenging. This study suggests that when researchers, service providers and communities are connected as legitimate participants in a learning platform with access to information and decision-making, a shift in power and interest may be feasible. Results The local action plan was partially successful, with three out of seven action items achieved. High levels of both power and interest were key factors in the achievement of action items. For the achieved items, stakeholders reported that continuous interactions with one another created a shift in both power and interest through ownership of implementation processes. Participants who possessed significant power and influence were able to leverage resources and connections to overcome obstacles and barriers to progress the plan. Lack of financial support, shifting priorities and insufficient buy-in from stakeholders hindered implementation.Item We Should Not Be Quiet but We Should Talk’: Qualitative Accounts of CommunityBased Communication of HIV PreExposure Prophylaxis(2023) Hannah Goymann1; Mxolisi Mavuso; Shannon A. McMahon; Anita Hettema; Allison B. Hughey; Sindy Matse; Phiwa Dlamini; Kathleen Kahn; Till Barnighausen; Albrecht Jahn; Kate BarnighausenCommunity leaders play an important role in the acceptance of public health services, but little is known about their willingness to facilitate HIV pre-exposure prophylaxis (PrEP) roll-out in Eswatini. We conducted in-depth interviews (n = 25) with purposefully selected male and female community leaders in Eswatini. We analysed our data inductively using a thematic analysis approach. Community leaders feel they are important communicators of culturally appropriate PrEP messaging. Our participants described a complex social space within their communities influenced by religion, tradition, values, and HIV stigma. Community leaders use their position to provide leverage for unique, effective, and easily accessible messages and platforms to reach the community in a manner that ensures trust, relatability, familiarity, and shared faith. Community leaders feel that they are trusted and see trust manifesting in the conversations they are able to engage in, and have a reach that extends beyond formal health services. Existing PrEP programming should embed community leader participation in PrEP programming and engage the trust, knowledge, and potential of community leaders to support PrEP uptake and acceptance.Item Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa: an analysis of verbal autopsy data from six countries(2023-06-25) Ursula Gazeley; Georges Reniers; Julio E. Romero-Prieto; Clara Calvert; Momodou Jasseh; Kobus Herbst; Sammy Khagayi; David Obor; Daniel Kwaro; Albert Dube; Merga Dheresa; Chodziwadziwa W. Kabudula; Kathleen Kahn; Mark Urassa; Amek Nyaguara; Marleen Temmerman; Laura A. Magee; Peter von Dadelszen; Veronique FilippiObjective: To compare the causes of death for women who died during pregnancy and within the first 42days postpartum with those of women who died between >42days and within 1 year postpartum. Design: Open population cohort (Health and Demographic Surveillance Systems). Setting: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. Population: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. Methods: InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42days versus 43–365days postpartum adjusting for HDSS and time period (2000– 2009 and 2010–2019). Main outcome measures: Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). Results: Of 2114 deaths, 1212 deaths occurred within 42days postpartum and 902 between 43 and 365days postpartum. Compared with deaths within 42days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42days postpartum did not change significantly between 2000–2009 and 2010–2019. Conclusions: Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration of non-obstetric care with ante-, intra- and postpartum care in high-burden settings.Item Consensus study on factors influencing the academic entrepreneur in a middle-income country’s university enterprise(2023-05-20) Alfred Austin Farrell; James Ashton; WitnessMapanga; Maureen Joffe; Nombulelo Chitha; Mags Beksinska; Wezile Chitha; Ashraf Coovadia; Clare L. Cutland; RobinL. Drennan; Kathleen Kahn; Lizette L. Koekemoer; Lisa K.Micklesfield; JacquiMiot; Julian Naidoo; Maria Papathanasopoulos; Warrick Sive; Jenni Smit; StephenM. Tollman; Martin G. Veller; Lisa J.Ware; Jeffrey Wing; Shane A. NorrisPurpose – This study aims to ascertain the personal characteristics of a group of successful academic entrepreneurs in a South African university enterprise and the prevalent barriers and enablers to their entrepreneurial endeavour. Design/methodology/approach – The authors used a Delphi process to identify and rank the characteristics, enablers, barriers and behaviours of entrepreneurial academics, with a Nominal Group Technique applied to establish challenges they encounter managing their enterprise and to propose solutions. Findings – Perseverance, resilience and innovation are critical personal characteristics, while collaborative networks, efficient research infrastructure and established research competence are essential for success. The university’s support for entrepreneurship is a significant enabler, with unnecessary bureaucracy and poor access to project and general enterprise funding an impediment. Successful academic entrepreneurs have strong leadership, and effective management and communication skills. Research limitations/implications – The main limitation is the small study participant group drawn from a single university enterprise, which complicates generalisability. The study supported the use of Krueger’s (2009) entrepreneurial intentions model for low- and middle-income country (LMIC) academic entrepreneur investigation but proposed the inclusion of mitigators to entrepreneurial activation to recognize contextual deficiencies and challenges.Item Obstacles and facilitators to communicating with children about their parents’ mental illness: a qualitative study in a sub‑district of Mpumalanga, South Africa(2023) Lucy Dean; Hadassah Buechner; Bianca Moffett; Meriam Maritze; Louise J. Dalton; Jeffrey R. Hanna; Elizabeth Rapa; Alan Stein; Stephen Tollman; Kathleen KahnBackground Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents’ symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts. Methods A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis. Results Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals’ concerns for the wellbeing and future mental health of patients’ children, as well as their hopes for increased mental health awareness amongst future generations. Conclusions This study provides insight into healthcare professionals’ attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent’s mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducationalItem Executive function and pre-academic skills in preschoolers from South Africa(2023-08-25) Caylee J. Cook; Steven Howard; Gaia Scerif; Rhian Twine; Kathleen Kahn; Shane Norris; Catherine DraperBackground: While there is now considerable evidence in support of a relationship between executive function (EF) and academic success, these findings almost uniformly derive from Western and high-income countries. Yet, recent findings from low- to middle- income countries have suggested that patterns of EF and academic skills differ in these contexts, but there is little clarity on the extent, direction and nature of their association. Aim: This study aimed to investigate the contribution of EF to pre-academic skills in a sample of preschool children (N = 124; Mage = 50.91 months; 45% female). Setting: Two preschools were recruited from an urban setting in a community with both formal and informal housing, overcrowding, high levels of crime and violence, and poor service delivery. Three preschools were recruited from rural communities with household plots, a slow rate of infrastructure development, reliance on open fires for cooking, limited access to running water and rudimentary sanitation. Methods: Pre-academic skills were assessed using the Herbst Early Childhood Development Criteria test, and EF was assessed using the Early Years Toolbox. Results: Although EF scores appeared high and pre-academic skills were low (in norm comparisons), EF inhibition (ß = 0.23, p = 0.001) and working memory (ß = 0.25, p < 0.001) nevertheless showed strong prediction of pre-academic skills while shifting was not significant. Conclusion: While EF is an important predictor of pre-academic skills even in this low- and middle-income country context, factors in addition to EF may be equally important targets to foster school readiness in these settings. Contribution: The current study represents a first step towards an understanding of the current strengths that can be leveraged, and opportunities for additional development, in the service of preparing all children for the demands of school.Item Unmasking Pneumococcal Carriage in a High Human Immunodeficiency Virus (HIV) Prevalence Population in two Community Cohorts in South Africa, 2016–2018: The PHIRST Study(2022-07-19) Maimuna Carrim; Stefano Tempia; Deus Thindwa; Neil A Martinson; Kathleen Kahn; Stefan Flasche; Orienka Hellferscee; Florette K Treurnicht; Meredith L McMorrow; Jocelyn Moyes; Thulisa Mkhencele; Azwifarwi Mathunjwa; Jackie Kleynhans; Limakatso Lebina; Katlego Mothlaoleng; Floidy Wafawanaka; Francesc Xavier Gómez-Olivé; Cheryl Cohen; Anne von Gottberg; Nicole WolterBackground Longitudinal pneumococcus colonization data in high human immunodeficiency virus (HIV) prevalence settings following pneumococcal conjugate vaccine introduction are limited. Methods In 327 randomly selected households, 1684 individuals were enrolled and followed-up for 6 to 10 months during 2016 through 2018 from 2 communities. Nasopharyngeal swabs were collected twice weekly and tested for pneumococcus using quantitative lytA real-time polymerase chain reaction. A Markov model was fitted to the data to define the start and end of an episode of colonization. We assessed factors associated with colonization using logistic regression. Results During the study period, 98% (1655/1684) of participants were colonized with pneumococcus at least once. Younger age (<5 years: adjusted odds ratio [aOR], 14.1; 95% confidence [CI], 1.8–111.3, and 5–24 years: aOR, 4.8, 95% CI, 1.9–11.9, compared with 25–44 years) and HIV infection (aOR, 10.1; 95% CI, 1.3–77.1) were associated with increased odds of colonization. Children aged <5 years had fewer colonization episodes (median, 9) than individuals ≥5 years (median, 18; P < .001) but had a longer episode duration (<5 years: 35.5 days; interquartile range, 17–88) vs. ≥5 years: 5.5 days (4–12). High pneumococcal loads were associated with age (<1 year: aOR 25.4; 95% CI, 7.4–87.6; 1–4 years: aOR 13.5, 95% CI 8.3–22.9; 5–14 years: aOR 3.1, 95% CI, 2.1–4.4 vs. 45–65 year old patients) and HIV infection (aOR 1.7; 95% CI 1.2–2.4). Conclusions We observed high levels of pneumococcus colonization across all age groups. Children and people with HIV were more likely to be colonized and had higher pneumococcal loads. Carriage duration decreased with age highlighting that children remain important in pneumococcal transmission.Item Cohort Profile: Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI).(2018) F Xavier Go´ mez-Olive´; Livia Montana; Ryan G Wagner; Chodziwadziwa W Kabudula; Julia K Rohr; Kathleen Kahn; Till Ba¨rnighausen; Mark Collinson; David Canning; Thomas Gaziano; Joshua A Salomon; Collin F Payne; Alisha Wad; Stephen M Tollman; Lisa BerkmanItem Rapidly shifting immunologic landscape and severity of SARS-CoV-2 in the Omicron era in South Africa(2022-08-19) Kaiyuan Sun; Stefano Tempia; Jackie Kleynhans; Anne von Gottberg; Meredith L McMorrow; Nicole Wolter; Jinal N. Bhiman; Jocelyn Moyes; Maimuna Carrim; Neil A Martinson; Kathleen Kahn; Limakatso Lebina; Jacques D. du Toit; Thulisa Mkhencele; Cécile Viboud; Cheryl Cohen; PHIRST groupSouth Africa was among the first countries to detect the SARS-CoV-2 Omicron variant. Propelled by increased transmissibility and immune escape properties, Omicron displaced other globally circulating variants within 3 months of its emergence. Due to limited testing, Omicron’s attenuated clinical severity, and an increased risk of reinfection, the size of the Omicron BA.1 and BA.2 subvariants (BA.1/2) wave remains poorly understood in South Africa and in many other countries. Using South African data from urban and rural cohorts closely monitored since the beginning of the pandemic, we analyzed sequential serum samples collected before, during, and after the Omicron BA.1/2 wave to infer infection rates and monitor changes in the immune histories of participants over time. Omicron BA.1/2 infection attack rates reached 65% (95% CI, 60% – 69%) in the rural cohort and 58% (95% CI, 61% – 74%) in the urban cohort, with repeat infections and vaccine breakthroughs accounting for >60% of all infections at both sites. Combined with previously collected data on pre-Omicron variant infections within the same cohorts, we identified 14 distinct categories of SARS-CoV-2 antigen exposure histories in the aftermath of the Omicron BA.1/2 wave, indicating a particularly fragmented immunologic landscape. Few individuals (<6%) remained naïve to SARS-CoV-2 and no exposure history category represented over 25% of the population at either cohort site. Further, cohort participants were more than twice as likely to get infected during the Omicron BA.1/2 wave, compared to the Delta wave. Prior infection with the ancestral strain (with D614G mutation), Beta, and Delta variants provided 13% (95% CI, -21% – 37%) , 34% (95% CI, 17% – 48%), and 51% (95% CI, 39% – 60%) protection against Omicron BA.1/2 infection, respectively. Hybrid immunity (prior infection and vaccination) and repeated prior infections (without vaccination) reduced the risks of Omicron BA.1/2 infection by 60% (95% CI, 42% – 72%) and 85% (95% CI, 76% – 92%) respectively. Reinfections and vaccine breakthroughs had 41% (95% CI, 26% – 53%) lower risk of onward transmission than primary infections. Our study sheds light on a rapidly shifting landscape of population immunity, along with the changing characteristics of SARS-CoV-2, and how these factors interact to shape the success of emerging variants. Our findings are especially relevant to populations similar to South Africa with low SARS-CoV-2 vaccine coverage and a dominant contribution of immunity from prior infection. Looking forward, the study provides context for anticipating the long-term circulation of SARS-CoV-2 in populations no longer naïve to the virus.Item Genomic and environmental risk factors for cardiometabolic diseases in Africa: methods used for Phase 1 of the AWI-Gen population cross-sectional study(2018-07-12) Stuart A. Al; Cassandra Soo; Godfred Agongo; Marianne Alberts; Lucas Amenga-Etego; Romuald P. Boua; Ananyo Choudhury; Nigel J. Crowther; Cornelius Depuur; F. Xavier GómezOlivé; Issa Guiraud; Tilahun N. Haregu; Scott Hazelhurst; Kathleen Kahn; Christopher Khayeka-Wandabwa; Catherine Kyobutung; Zané Lombard; Felistas Mashinya; Lisa Micklesfield; Shukri F. Mohamed; Freedom Mukomana; Seydou Nakanabo-Diallo; Hamtandi M. Natama; Nicholas Ngomi; Engelbert A. Nonterah; Shane A. Norris; Abraham R. Oduro; Athanase M. Somé; Hermann Sorgho; Paulina Tindana; Halidou Tinto; Stephen Tollman; Rhian Twine; Alisha Wade; Osman Sankoh; Michèle RamsayThere is an alarming tide of cardiovascular and metabolic disease (CMD) sweeping across Africa. This may be a result of an increasingly urbanized lifestyle characterized by the growing consumption of processed and calorie-dense food, combined with physical inactivity and more sedentary behaviour. While the link between lifestyle and public health has been extensively studied in Caucasian and African American populations, few studies have been conducted in Africa. This paper describes the detailed methods for Phase 1 of the AWI-Gen study that were used to capture phenotype data and assess the associated risk factors and end points for CMD in persons over the age of 40 years in sub-Saharan Africa (SSA). We developed a population-based cross-sectional study of disease burden and phenotype in Africans, across six centres in SSA. These centres are in West Africa (Nanoro, Burkina Faso, and Navrongo, Ghana), in East Africa (Nairobi, Kenya) and in South Africa (Agincourt, Dikgale and Soweto). A total of 10,702 individuals between the ages of 40 and 60 years were recruited into the study across the six centres, plus an additional 1021 participants over the age of 60 years from the Agincourt centre. We collected socio-demographic, anthropometric, medical history, diet, physical activity, fat distribution and alcohol/tobacco consumption data from participants. Blood samples were collected for disease-related biomarker assays, and genomic DNA extraction for genome-wide association studies. Urine samples were collected to assess kidney function. The study provides base-line data for the development of a series of cohorts with a second wave of data collection in Phase 2 of the study. These data will provide valuable insights into the genetic and environmental influences on CMD on the African continent
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