3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Factors associated with the health and wellbeing of older people in a rural African setting(2015-03-27) Gomez-Olive, Francesc XavierBackground South Africa is experiencing a massive HIV epidemic that together with the new epidemic of non-communicable diseases is directly affecting the health and wellbeing of older people. For policy makers, there is a crucial need for information on how this dual epidemic is evolving and how this may affect older people's health, mortality and health care needs. 2. Aims To better understand factors that influence the health, wellbeing and survival of older people, and their need for care in rural South Africa at a time of a growing dual epidemic of chronic diseases (non-communicable and communicable). To provide information which may assist in the planning of health services for older people. 3. Methods Applying the WHO Study on Global Ageing and Adult Health (SAGE) and a study on HIV and non-communicable diseases (NCD), we investigated the health, wellbeing and mortality of the population 50 years and older in the Agincourt sub-district in north-east South Africa which is underpinned by health and demographic surveillance. A random sample of the population 50 years and older was selected for the SAGE survey. A random sample of the population 15 years and older was selected for the HIV and NCD study. All available adults 50 plus were invited to participate in the SAGE module in the 2006 census round. We assessed self-reported health, anthropometric measures, blood pressure and HIV status using dried blood spots. Statistical analysis included simple frequencies, univariate and multivariate analysis and Cox proportional hazard models. 4. Findings The usual pattern of mortality, of increasing death rates with age, is not observed in this population, where those in their 50s have higher mortality compared to older age groups. The high prevalence of HIV in this age group (50 to 59) appears to be the main explanation for the observed pattern. Hypertension affects two thirds of this older population and, although there are no differences by gender, women are more aware of their condition. This is reflected in more women attending primary health care services. Reporting lower quality of life and greater disability are associated with higher likelihood of death. We observed gender differences in the process of ageing with women reporting higher prevalence of mortality risk factors but living longer than men, a phenomenon known as the "survival paradox".Item Exploring the paradox: double burden of malnutrition in rural South Africa(2011-03-09) Kimani, Elizabeth WambuiBackground: In low- to middle-income countries, rising levels of overweight and obesity are a result of multiple transitions, in particular, a nutrition transition. Consequently, in these countries, metabolic diseases are contributing increasingly to disease burden, despite the persisting burden of undernutrition and infectious diseases. Understanding the patterns and factors associated with persistent undernutrition and emerging obesity in children and adolescents, and concomitant risk for metabolic disease, is therefore of criticial importance. This should contribute to public health policy on interventions to prevent adult disease. Aims: To better understand the double burden of malnutrition in a poor, high HIV prevalent, transitional society in a middle-income country; In so doing, to inform policies and interventions to address the double burden of malnutrition. Methods: A cross-sectional growth survey was conducted in 2007 targeting 4000 children and adolescents 1-20 years of age living in rural South Africa. The survey was nested within the ongoing Agincourt Health and Socio-demographic Surveillance System, which acted as the sampling frame and also provided data for explanatory variables. Anthropometric measurements were performed on all participants using standard procedures. In addition, HIV testing was done on children aged 1 to 5 years and Tanner pubertal assessment was conducted among adolescents 9-20 years. A one-year follow-up of HIV positive children included a matched control group of HIV negative counterparts. Data collection involved both quantitative and qualitative methods. Growth z-scores were used to determine stunting, underweight and wasting and were generated using the 2006 WHO growth standards for children up to five years and the 1977 NCHS/WHO reference for older children. Overweight and obesity were determined using the International Obesity Task Force cut-offs for BMI for children aged up to 17 years and adult cut offs of BMI =25 and =30 kg/m2 for overweight and obesity respectively for adolescents 18 to 20 years. Waist circumference cut-offs of =94cm for males and =80cm for females, and waist-to-height ratio of 0.5 for both sexes, were used to determine central obesity and hence metabolic disease risk in ix adolescents. Descriptive analysis described patterns of nutritional status by age, sex, pubertal stage and HIV status. Linear and logistic regression was done to determine predictors of nutrional outcomes. A p-value of <0.05 was considered statistically significant. Results: Prevalence of undernutrition, particularly stunting, was substantial: 18% among children aged 1-4 years, with a peak of 32% in children at one year of age. Stunting and underweight were also substantial in adolescent boys, with underweight reaching a peak of 19% at 14 years of age. Concurrently, the prevalence of combined overweight and obesity, almost non-existent in boys, was prominent among adolescent girls, increasing with age, and reaching a peak of 25% at 18 years. Risk for metabolic disease using waist circumference cut-offs was substantial among adolescents, particularly girls, increasing with sexual maturation, and reaching a peak of 35% at Tanner stage 5. Prevalence of HIV in children aged 1-4 years was 4.4%. HIV positive children had poorer nutritional outcomes than that of HIV negative children in 2007. The impact of paediatric HIV on nutritional status at community level was, however, not significant. Significant predictors of undernutrition in children aged 1-4 years, documented at child, maternal, household and community levels, included child’s HIV status, age and birth weight; maternal age; age of household head; and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease in adolescents aged 10-20 years, documented at individual/child and household levels included child’s age, sex and pubertal development; and household-level food security, socio-economic status, and household head’s highest education level. There was a high acceptance rate for the HIV test (95%). One year following the test, almost all caregivers had accepted and valued knowing their child’s HIV status, indicating that it enhanced their competency in caregiving. Additionally, nutritional status of HIV positive children had improved significantly within a year of follow-up. Conclusions: The study describes co-existing child stunting and adolescent overweight/obesity and risk for metabolic disease in a society undergoing nutrition transition. While likely that this profile reflects changes in nutrition and diet, variation in infectious disease burden, physical activity patterns, and social influences need to be investigated. The findings are critical in the wake of the rising public health importance of metabolic diseases in low- to middle-income countries, despite the unfinished agenda of undernutrition and infectious diseases. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged. In addition, gender-biased nutritional patterns call for gender-sensitive policies and interventions. The study further documents a significant role of paediatric HIV on nutritional status, and the potential for community-based paediatic HIV testing to ameliorate this. Targeted early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival.Item Spatial clustering of HIV/AIDS mortality events in rural South Africa population between 2000-2006(2010-04-16T11:58:31Z) Namosha, Elias EBackground: Cluster detection analysis could be an appropriate approach to identify critical AIDS mortality locations for public health intervention. Methods: GIS and Kulldorff’s spatial scan statistic was used to investigate statistically significant AIDS mortality clusters (p 0.05). SaTScan was used to perform the spatial analysis scanning while MapInfo was used as a visualizing tool. Mortality data between 2000- 2006 were analyzed. Results: AIDS exhibit strong spatial clustering tendencies as measured by the Kulldorff’s spatial scan statistic method. Conclusion: Further work is needed to understand the underlying mechanisms responsible for the spatial clustering.Item The dynamics of rural water supply in South Africa: the planning response(2010-02-19T07:49:24Z) Ntshwane, Walter PhalaItem Children left behind: the effects of temporary labour migration on child care and residence patterns in rural South Africa(2010-01-22T11:43:34Z) Kautzky, Keegan Joseph MichaelBackground: The rural South African population is characterised by high and stable levels of male temporary migration and rapidly rising levels of female temporary migration, with approximately 60% of men and 20% of women between the ages of 20 and 60 years absent from the home for more than 6 months of the year. Despite the magnitude of this social phenomenon, limited research exists analysing its effect on child care and children’s residence patterns. Objectives: The purpose of this study is to examine temporary labour migration patterns as a household coping strategy in rural northeast South Africa in 2002 and 2007, describe characteristics of the children left behind, and to assess the effect of temporary migration on child care patterns, specifically analysing household variation in child care and residence by sex and refugee status of the migrant. Methods: An analytic cross-sectional study was conducted on approximately 83,000 individuals in 14,000 households in 25 villages of the Agincourt sub-district of the Bushbuckridge region of Limpopo Province. Data was collected in a special module on temporary migration incorporated into the annual Agincourt Health and Demographic Surveillance System census update in 2002 and 2007. Secondary analysis of the data utilised descriptive statistics and Pearson Chi2 tests of association. Results: The proportion of temporary migrants in the population rose between 2002 and 2007 and now constitutes nearly one-fifth of the population. Nearly three-quarters – 13% of the total population – are labour migrants. A slight increase in the proportion of female and Mozambican descent migrants is observed. Today, three-quarters of temporary labour migrants are male and one-quarter female, three-quarters are South African descent and more than one-quarter are Mozambican descent. Temporary labour migrants with children constitute nearly 6% of the total population. Temporary labour migrants overwhelmingly rely on a single care strategy. Complex care arrangements are far less common, constituting the response of only 5% of migrants. Highly complex care arrangements are rare, but do exist. Child care strategies are becoming increasingly complex over time for all migrants. Female migrants and migrants of South African descent are more likely than male and Mozambican descent migrants to rely on complex care arrangements. The overwhelming majority of migrants keep all children in the same household, maintaining relative stability in care and residence, 10% move children with them, 2% move children elsewhere for care and less than 1% move a childcarer into the household while they are away for work. Less stable child care arrangements are increasingly utilised over time. If the migrant is male, children are more likely to remain in the same household; if the migrant is female, children are more likely to move with the migrant. Approximately one-fifth of children in the population are effectively left behind by temporary labour migrants today, a decline from nearly one-third in 2002. There is significant variation in child care, residence and decision-making authority among relatives: mothers and stepmothers provide the majority of care in the absence of a migrant, with grandmothers a secondary and female siblings and aunts a tertiary source of child care.Item Assessing the determinants of sexual risk-behaviour amongst young men in rural South Africa to inform male-oriented HIV prevention programming(2009-05-04T11:20:33Z) Anifowoshe-Kehinde, Adebimpe WasilatNo abstract or preliminary pages submitted on diskItem Migration, sexual behaviour, and human immunodeficiency virus infection in rural South Africa(2008-03-11T10:52:37Z) Lumfwa, Louis Adolf MuzingaABSTRACT HIV has been linked to many risk factors such as sexual behaviour, gender, gender based violence, poverty, migration, conflicts, sexually transmitted diseases and circumcision. In this project, the role played by migration was particularly underscored. The aim of the study was to estimate and to compare the prevalence of HIV infection among migrants and non-migrants and to investigate whether migration leads to increased high risk sexual behaviour among migrant workers aged between 14 and 35 years from Limpopo Province. This study was based on a secondary data analysis from a large community intervention study. A random sample of 2860 participants were selected in a cross sectional study after pair matching a community of villages set for an intervention. Data were collected using a questionnaire in English with a version in Sotho. HIV test was performed on oral fluid using Vironostika HIV Uniform oral fluid. The study was approved by Wits University and Informed consent was previously obtained by the original study. Stata was used for the statistical analyses of the data. This study found that the HIV prevalence among migrants was not statistically different from the prevalence among non-migrants (10.04% versus 10.97%; p = 0.662), that the slight association between migration and HIV infection was not significant (Adjusted OR = 1.19; 95% CI: 0.7 – 2.01) (p = 0.520). There was no association between migration and sexual behaviour such as sexual experience, age at first sexual relationship, have ever had sexual relationship and used a condom. However the study showed an association between migration and the number of sexual partners. These striking findings suggest that migration does not always lead to an increased risk of HIV infection even though it can lead to an increase of number of sexual partners. The study concludes that migration did not prove to be a risk factor for HIV infection. However, other underlying structural factors need to be examined for a better understanding of the conditions that lead to HIV infection. It recommends interventions that cover information (Knowledge, attitude and belief), risk perception and change of sexual behaviour.