2. Academic Wits University Research Outputs (All submissions)
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Item Eco-efficiency assessment of pork production through life-cycle assessment and product system value in South Africa(EDP Sciences, 2022-05-20) Qalase, C.; Harding, K.G.The consumption of pork as a source of animal protein has increased worldwide, especially in developing countries such as South Africa. The increase in pork demand is putting pressure on the natural environment, and the costs of production are increasing. This study sought to determine what is the eco-efficiency of pork production in a South African context. It also was meant to determine which processes in the value chain have low eco-efficiencies. Lastly, it sought to find what strategies could be recommended to improve overall eco-efficiency. Eco-efficiency was assessed by following the requirements of the International Standards Organisation ISO 14045 standard, which requires that the Life cycle assessment (LCA) method and product system value be combined. The environmental life cycle costing (LCC) method was used to determine the product system value (Value Added) of pork production. The functional unit was 1 kg of pork carcass, specifically from the cradle to the abattoir gate. The findings indicated that the pig farm and abattoir were the processes that had low eco-efficiencies and eco-efficient strategic improvements could be made. Mitigation strategies could be developed to concentrate on the production of animal feed and the use of renewable energy sources at the abattoir. The use of water could be improved by automation of the abattoir processes. Therefore, this study achieved its goal as economic and environmental areas of interest were identified in this specific case study for South Africa. This framework could be extended to study the eco-efficiency of other meat production chains and other sectors.Item The Inequality—Financial Markets Nexus: Implications for Developing Metrics for Voluntary Disclosures(Southern Centre for Inequality Studies (SCIS), 2024-01-21) Khan, Zoheb; Theobald, Stuart; Ewinyu, Arabo K.; Francis, David; Mogale, Etumeleng; Valodia, ImraanCan a disclosure framework reduce overall socio-economic inequality, or will it shift inequality somewhere else, for example, to other firms, other regions, or out of the firm and the private sector and into households? Are there material regional variations in the perceptions of the causes and effects of socio-economic inequality? What is the appropriate level of focus for an inequality disclosure framework? Surplus generated by workers accrues to the owners of capital and, at the most basic level, is a significant contributor to socio-economic inequality. There is also inequality in income between workers within firms and sectors. Furthermore, inequality is produced by access to and changes in asset prices, and by sovereign investing activities, among other factors. The correct unit of analysis for the proposed Taskforce on Inequality-related Financial Disclosures (TIFD – which since the original drafting of this paper has now converged efforts with new partners to form the Taskforce on Inequality and Social-related Financial Disclosures (TISFD)) deserves attention. The authors of this paper believe that regional variations mean that a one-size-fits-all disclosure framework is unlikely to be appropriate. For instance, the distribution of informal employment needs to be considered, with 61% of all global employment being informal and with as much as 90% of employment being informal in many countries in the global South. While disclosure frameworks matter for formal companies, what is often overlooked in the development of disclosure frameworks are the implications for the large number of people, particularly in the global South, who are informally employed or who work in informal enterprises. A second consideration is high unemployment given that the distribution of labour income is one of the great drivers of income inequality. Furthermore, the growth of precarious and non-standard employment, with the rise of platform work as an example, is an additional concern.Item Financial Directions and Budget Trends in Government Healthcare(Southern Centre for Inequality Studies (SCIS), 2023-11) Sachs, Michael; Abdullah, Fareed; Madonko, Thokozile; Jonas, Kim; Slingers, Nevilene; Zvawada, Tanaka; Ewinyu, Arabo; Shedi, OlwethuThis working paper provides evidence and analysis that can assist in taking forward the agenda of the Presidential Health Compact. It does so by reviewing the financial performance of the government healthcare system over the last decade. After assessing the financial management performance, it looks at the “financial health” challenges facing the system, including the problems of accruals and medico-legal claims. The report then examines the budget pressures faced by provincial healthcare departments, as well as the different allocation of resources and levels of care across provinces. It ends with a conclusion and tentative reflections informed by the evidence.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 Household structure, composition and child mortality in the unfolding antiretroviral therapy era in rural South Africa: comparative evidence from population surveillance, 2000–2015(2023-03-15) Brian Houle; Chodziwadziwa Kabudula; Dickman Gareta; Kobus Herbst; Samuel J ClarkObjectives The structure and composition of the household has important influences on child mortality. However, little is known about these factors in HIVendemic areas and how associations may change with the introduction and widespread availability of antiretroviral treatment (ART). We use comparative, longitudinal data from two demographic surveillance sites in rural South Africa (2000–2015) on mortality of children younger than 5 years (n=101 105). Design We use multilevel discrete time event history analysis to estimate children’s probability of dying by their matrilineal residential arrangements. We also test if associations have changed over time with ART availability. Setting Rural South Africa. Participants Children younger than 5 years (n=101 105). Results 3603 children died between 2000 and 2015. Mortality risks differed by co-residence patterns along with different types of kin present in the household. Children in nuclear households with both parents had the lowest risk of dying compared with all other household types. Associations with kin and child mortality were moderated by parental status. Having older siblings lowered the probability of dying only for children in a household with both parents (relative risk ratio (RRR)=0.736, 95%CI (0.633 to 0.855)). Only in the later ART period was there evidence that older adult kin lowered the probability of dying for children in single parent households (RRR=0.753, 95%CI (0.664 to 0.853)). Conclusions Our findings provide comparative evidence of how differential household profiles may place children at higher mortality risk. Formative research is needed to understand the role of other household kin in promoting child well-being, particularly in one-parent households that are increasingly prevalent.Item The impact of the Covid-19 pandemic on postnatal depression: analysis of three population-based national maternity surveys in England (2014–2020)(2023-05-15) Siân Harrison; Maria A. Quigley; Gracia Fellmeth; Alan Stein; Fiona AlderdiceBackground Few studies have evaluated postnatal depression before and during the Covid-19 pandemic using comparable data across time. We used data from three national maternity surveys in England to compare prevalence and risk factors for postnatal depression before and during the pandemic. Methods Analysis was conducted using population-based surveys carried out in 2014 (n = 4571), 2018 (n = 4509), and 2020 (n = 4611). Weighted prevalence estimates for postnatal depression (EPDS score ≥13) were compared across surveys. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the association between sociodemographic, pregnancy- and birth-related, and biopsychosocial factors, and postnatal depression. Findings Prevalence of postnatal depression increased from 10.3% in 2014 to 16.0% in 2018 (difference = +5.7% (95% CI: 4.0–7.4); RR = 1.55 (95% CI: 1.36–1.77)) and to 23.9% in 2020 (difference = +7.9% (95% CI: 5.9–9.9); RR = 1.49 (95% CI: 1.34–1.66)). Having a long-term mental health problem (aRR range = 1.48–2.02), antenatal anxiety (aRR range = 1.73–2.12) and antenatal depression (aRR range = 1.44–2.24) were associated with increased risk of postnatal depression, whereas satisfaction with birth (aRR range = 0.89–0.92) and social support (aRR range = 0.73–0.78) were associated with decreased risk before and during the pandemic. Interpretation This analysis indicates that Covid-19 had an important negative impact on postnatal women’s mental health and may have accelerated an existing trend of increasing prevalence of postnatal depression. Risk factors for postnatal depression were consistent before and during the pandemic. Timely identification, intervention and followup are key to supporting women at risk, and it is essential that mechanisms to support women are strengthened during times of heightened risk such as the pandemic.Item Community Health Worker Use of Smart Devices for Health Promotion: Scoping Review(2023-02-25) Merlin Greuel1 , BA, MGH, MD; Frithjof Sy1 , BSc, MD; Till Bärnighausen1,2,3 , MSc, MD, SCD; Maya Adam1,4 , BA, MD; Alain Vandormael1 , MSc, PhD; Jennifer Gates5 , BA; Guy Harling2,6,7,8,9 , BSc, MA, MPH, SCDBackground: Community health workers (CHWs) have become essential to the promotion of healthy behaviors, yet their work is complicated by challenges both within and beyond their control. These challenges include resistance to the change of existing behaviors, disbelief of health messages, limited community health literacy, insufficient CHW communication skills and knowledge, lack of community interest and respect for CHWs, and CHWs’ lack of adequate supplies. The rising penetration of “smart” technology (eg, smartphones and tablets) in low- and middle-income countries facilitates the use of portable electronic devices in the field. Objective: This scoping review examines to what extent mobile health in the form of smart devices may enhance the delivery of public health messages in CHW-client interactions, thereby addressing the aforementioned challenges and inducing client behavior change. Methods: We conducted a structured search of the PubMed and LILACS databases using subject heading terms in 4 categories: technology user, technology device, use of technology, and outcome. Eligibility criteria included publication since January 2007, CHWs delivering a health message aided by a smart device, and face-to-face communication between CHWs and clients. Eligible studies were analyzed qualitatively using a modified version of the Partners in Health conceptual framework. Results: We identified 12 eligible studies, 10 (83%) of which used qualitative or mixed methods approaches. We found that smart devices mitigate challenges encountered by CHWs by improving their knowledge, motivation, and creativity (eg, through self-made videos); their status within the community; and the credibility of their health messages. The technology stimulated interest in both CHWs and clients—and sometimes even in bystanders and neighbors. Media content produced locally or reflecting local customs was strongly embraced. Yet, the effect of smart devices on the quality of CHW-client interactions was inconclusive. Interactions suffered as CHWs were tempted to replace educational conversations with clients by passively watching video content. Furthermore, a series of technical difficulties experienced especially by older and less educated CHWs compromised some of the advantages brought about by mobile devices. Adequate CHW training ameliorated these difficulties. Only 1 study (8%) considered client health behavior change as an end point, thus revealing a major research gap. Conclusions: Smart mobile devices may augment CHWs’field performance and enhance face-to-face interactions with clients, yet they also generate new challenges. The available evidence is scarce, mostly qualitative, and focused on a limited range of health outcomes. Future research should include larger-scale interventions across a wide range of health outcomes and feature client health behavior change as an end point.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 Prevalence and risk factors for postnatal mental health problems in mothers of infants admitted to neonatal care: analysis of two population-based surveys in England(2023) Jenny Gong; Gracia Fellmeth; Maria A. Quigley; Chris Gale; Alan Stein; Fiona Alderdice; Siân HarrisonBackground Previous research suggests that mothers whose infants are admitted to neonatal units (NNU) experience higher rates of mental health problems compared to the general perinatal population. This study examined the prevalence and factors associated with postnatal depression, anxiety, post-traumatic stress (PTS), and comorbidity of these mental health problems for mothers of infants admitted to NNU, six months after childbirth. Methods This was a secondary analysis of two cross-sectional, population-based National Maternity Surveys in England in 2018 and 2020. Postnatal depression, anxiety, and PTS were assessed using standardised measures. Associations between sociodemographic, pregnancy- and birth-related factors and postnatal depression, anxiety, PTS, and comorbidity of these mental health problems were explored using modifed Poisson regression and multinomial logistic regression. Results Eight thousand fve hundred thirty-nine women were included in the analysis, of whom 935 were mothers of infants admitted to NNU. Prevalence of postnatal mental health problems among mothers of infants admitted to NNU was 23.7% (95%CI: 20.6–27.2) for depression, 16.0% (95%CI: 13.4–19.0) for anxiety, 14.6% (95%CI: 12.2–17.5) for PTS, 8.2% (95%CI: 6.5–10.3) for two comorbid mental health problems, and 7.5% (95%CI: 5.7–10.0) for three comorbid mental health problems six months after giving birth. These rates were consistently higher compared to mothers whose infants were not admitted to NNU (19.3% (95%CI: 18.3–20.4) for depression, 14.0% (95%CI: 13.1–15.0) for anxiety, 10.3% (95%CI: 9.5–11.1) for PTS, 8.5% (95%CI: 7.8–9.3) for two comorbid mental health problems, and 4.2% (95%CI: 3.6–4.8) for three comorbid mental health problems six months after giving birth. Among mothers of infants admitted to NNU (N=935), the strongest risk factors for mental health problems were having a long-term mental health problem and antenatal anxiety, while social support and satisfaction with birth were protective. Conclusions Prevalence of postnatal mental health problems was higher in mothers of infants admitted to NNU, compared to mothers of infants not admitted to NNU six months after giving birth. Experiencing previous mental health problems increased the risk of postnatal depression, anxiety, and PTS whereas social support and satisfaction with birth were protective. The fndings highlight the importance of routine and repeated mental health assessments and ongoing support for mothers of infants admitted to NNU.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.