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Internal migration and sexual partnerships and practices: Findings from a South African Cohort
(University of the Witwatersrand, Johannesburg, 2024) Nyanisa , Yandisa; Ginsburg, Carren; Levin, Jonathan
Introduction There are high levels of geographic movement of people within South Africa’s borders, especially from rural to urban areas of the country. Such movements have an impact on sexual partnerships and practices. The aim of this study is to determine the relationship between internal migration and sexual partnerships and practices in a cohort of migrants and residents of the Agincourt study site (non-migrants) in South Africa’s rural northeast over two survey waves from 2018 to 2019. Methods This study used data from the Migrant Health Follow-Up Study (MHFUS) which commenced in 2017. The MHFUS is a 5-year cohort study that is nested within the Agincourt Health and Demographic Surveillance System (HDSS) longitudinal research platform. The cohort is based on a simple random sample of 3800 Agincourt HDSS residents and migrants aged 18 – 40. The Agincourt HDSS is located in a 420 square kilometre area of the Bushbuckridge district, Mpumalanga Province. Descriptive statistics, logistic and ordinal regression models were used to describe the characteristics of migrants and non-migrants in the cohort as well as sociodemographic factors associated with the number of sexual partners reported by participants, their type of recent sexual partners (whether a partner was regular or casual) and their calculated risk score (based on condom use and HIV testing). Results Sexual partnerships and practices differed by migration status and gender. A larger proportion of migrants than non-migrants had more than one partner in the last 12 months in both study waves. Of those migrants who had sexual partners in the last 12 months (n=1265), 11.2% had partners in both their place of origin and their current place of residence (migrant destination) in Wave 1. Nine or more total sexual life partners were reported more frequently by migrants (16.8%) compared to non-migrants (8.9%) in Wave 1. More males (31.6%) than females (5.3%) had two or more partners in Wave 1 and there were more males (15.6%) who reported having partners in iii both the origin and current locations compared to females (4.9%). Not using a condom was more common among non-migrants than migrants in both waves, with females being less likely to have used a condom in their last sexual intercourse compared to males. Ordinal logistic regression analysis indicated that the number of sexual partners in the last 12 months was associated with migration status, age, gender and employment status in Wave 1, while in Wave 2 it was also associated with level of education. Most recent partner (whether a partner was regular or casual) was associated with gender, education and employment in Wave 1 while associated with age, gender and employment in Wave 2. Risk score was associated with age and education in Wave 1 while associated with migration status, age, gender and education in Wave 2. Conclusion The study showed that sexual partnerships and practices differed by migration status and gender with non-migrants and females reporting more risky sexual practices compared to migrants and males. Internal migration can introduce risky behaviors that are related to sexual partnerships and practices. The study shows that the effect of migration can vary widely depending on factors such as gender dynamics, employment and education. A study of the relationship between internal migration and sexual relationships sheds light on this population's possible susceptibility to HIV/STIs. The evidence in this study also adds to the knowledge base needed for guidance in areas of prevention of STI, while future South African research focused on sexual partnerships and practices should incorporate measures of migration. Understanding these factors is essential for researchers, policymakers and health organizations involved in managing and providing support to migrants.
The association between substance use and HIV in two Sub-Saharan African countries, 2014 - 2016
(University of the Witwatersrand, Johannesburg, 2024) Jack, Samantha Louise; Mall, Sumaya
Background People Living With HIV/AIDS (PLWHA) are recognized to have an increased risk of substance abuse - alcohol heavy episodic drinking (HED), tobacco smoking, and illicit drugs. Substance use amongst PLWHA is associated with poorer antiretroviral treatment (ART) adherence, increased risk of cancers, and worse morbidity and mortality. Substance use is also associated with an increased risk of HIV infection amongst those who are HIV negative. The majority of this research is focused outside of the African continent and in high-income countries; thus, this study aims to contribute towards research in low-middle income African countries such as South Africa and Kenya. Aim This study aims to investigate the association between HIV and substance use in South Africa and Kenya, and the possible associated covariates. Methods The study population for this secondary data analysis included n=7919 men and women participants drawn between the ages of 40 and 60 recruited between August 2013 and August 2016. The Mann-Whitney test was used for continuous variables and all other categorical variables were analysed using a chi squared test or Fisher’s exact test. Predictive factors for the logistic regression models were informed by the literature review and conceptually modelled using a Direct Acyclic Graph. An overall logistic regression model was run which included both countries, and then separate logistic regression models were run for Kenya and South Africa. Results The prevalence of substance use in the overall sample was 54.30%. In Kenya it was 51.33% and in South Africa (SA) 55.60%. The prevalence of HIV in the overall sample was 20.94%. In Kenya HIV prevalence was 13.66%, and in SA 23.35%. PLWHA had a 1.22 greater odds of substance use than those who were HIV negative in the overall sample (p=0.012, 95%CI 1.04 - 1.43). In Kenya, PLWHA had a 1.49 higher odds of substance use (p=0.013, 95%CI 1.09 - 2.03). In SA, there was no significant association found between HIV status and substance use. In the Kenyan logistic model HIV status, sex, marital status and employment status were found to be associated with substance use. Full-time employment and marriage presented as protective factors against substance use in Kenya. In the SA logistic model age, sex, marital status and employment status were associated with substance use. Marriage was also a protective factor for the SA model. Self-employment and informal employment increased the odds of substance use by more than two-fold in the SA model (aOR=2.27, p<0.001, 95%CI 1.63-3.16; aOR= 1.50, p=0.0008, 95%CI 1.19-1.91 respectively). The factor with the largest odds for substance use across all three models was being male, with increased odds of 15.5 in the overall model (p<0.0001, 95%CI 13.4-17.9), 11.6 in Kenya (p<0.0001, 95%CI 8.65-15.5) and 17.7 in South Africa (p<0.0001, 95%CI 14.9-21.1). Conclusion Treatment of substance use disorders should become a staple in integrated routine ART care as the prevalence of substance use in PLWHA in this study and across the literature is high, especially in men The implementation of the substance use treatment should be tailored to the unique gendered and socioeconomic factors that are present in each country.
HIV-exposure as a risk factor for mortality among neonates with culture- confirmed bloodstream infection and meningitis in South Africa, 2019- 2020
(University of the Witwatersrand, Johannesburg, 2024) Marumo, Andani Ronel; Musenge , Eustasius; Mashau, Rudzani
Background: HIV-exposed but uninfected neonates (HEU) are a growing population. Exposure to HIV has been associated with increased mortality and morbidity. We aimed to determine the effect of HIV-exposure as a risk factor for mortality in neonates admitted with bloodstream infections (BSIs) and/or meningitis at non-academic hospitals in South Africa. Methods: We conducted a retrospective cohort study using data from the Baby GERMS-SA surveillance project of hospitalised neonates with culture-confirmed BSI and meningitis at six non-academic hospitals in South Africa from October 2019 to September 2020. A multivariable Cox proportional hazards regression was used to determine the effect of HIV- exposure regardless of HIV-status as a risk factor for mortality. We further examined the effect of HIV-exposure using a multivariable logistics regression. Results: Of 697 neonates with a known maternal HIV status and in-hospital outcome, 34% (239/697) were exposed to HIV and 1% (4/239) were HIV PCR-positive. The HEU neonates had significant low gestational age (77% (184/239) vs. 66% (296/458), p=0.001) and very low birth weight (48% (115/239) vs. 40% (184/458), p=0.016) compared to HIV-unexposed uninfected (HUU) neonates. Exclusive breastfeeding was more common in HUU neonates (44% (202/458) vs. 32% (77/239)). We did not observe significant differences in age at the time of infection (median age 6 vs. 6 days p=0.14), and duration of hospitalisation (median length of 17 vs. 15 days p=0.12) between the HEU and HUU neonates. The crude in-hospital mortality among HIV-exposed neonates and HUU neonates was 26% (63/239) and 23% (104/458), respectively. After adjusting for relevant confounders such as birth weight, timing of infection, use of invasive devices, breastfeeding, and maternal age, there was no difference in the risk for mortality between HEU neonates and those who were HUU (HR 1.12, 95% CI: 0.76-1.67, p=0.549) at 28-days. The odds of mortality were 1.21 (95% CI 0.72–2.05, v p=0.467) times more among HEU neonates than among HUU neonates in the exploratory analysis. Conclusions: We did not find a difference in mortality between HEU and HUU neonates with culture-confirmed invasive infections in our study. Regardless of their HIV exposure status, approximately a quarter of these neonates died in hospital.
Factors Associated with Uptake of HIV Testing Services among Men in South Africa
(University of the Witwatersrand, Johannesburg, 2024) Khoza, Samson S.; Christofides, Nicola
Background: In 2016, the overall Human immunodeficiency virus (HIV) prevalence rate was estimated at 12,7% and the total number of people living with HIV was estimated at approximately 7,03 million in the South African population in 2016. The World Health Organization recommends that people know their HIV status by getting tested and those who are found to be HIV positive get initiated on treatment early. However, HIV testing rates are below the 90% target and reportedly lower among males in South Africa. Aim: The study aimed to investigate factors associated with HIV Counselling and Testing (HCT) among men aged 18-34 years in South Africa. Methods: The study is a cross-sectional study using secondary data from Testa Boy study conducted by the Centre for Communication Impact in collaboration with Genesis Analytics between April and May 2017. The primary study employed a three multistage sampling approach, where at the first, the country was stratified into nine provinces, with sample size proportional to the population size of each province. After that an initial sub-place (district) was selected randomly from each province. Households were then randomly selected from the enumeration area (EA) or Primary Sampling Unit (PSU) in each sub-place (township/village). Finally, following the household selection, one eligible respondent from each household was selected randomly to participate in the study using a KISH grid that was used to draw a sample of PSUs. Data was collected using a self-administered questionnaire. The primary study constituted of a total of 3,000 male and female participants across all provinces in South Africa. We restricted our study to 1, 388 male participants. The outcome variable of this study was “uptake of HIV Counselling and Testing in the past 12 months”. The data was analysed using Stata SE version 14. Both univariable and multivariable analyses were employed. Results: About 52% of total of 1,388 men had HCT uptake in the past 12 months. Rates of HCT uptake at the provincial level ranged from 41% and 60% with Western Cape recording the high levels and North-west recording the lowest levels. In the multivariable analyses, men residing in provinces outside of the Western Cape demonstrated significantly lower odds of HCT uptake. The odds of HCT uptake was significantly lower among men in the Eastern Cape (AOR0.33, 95%CI 0.33-0.94), Limpopo (AOR0.54, 95%CI 0.30-0.99) and North-west (AOR 0.43, 95%CI 0.22-0.83) compared to the men in Western Cape. Employed men were 1.34 times significantly more likely to receive HCT compared to unemployed men (AOR1.34, 95% CI 1.01-1.77, p=0.039). Middle income (AOR 1.51, 95% CI 1.01-2.27) and low-income men (OR 1.60, 95% CI 1.16-2.21) had significantly increased odds of HCT uptake than rich-income men. With regards to sexual history, men who did not report condom use at first (AOR 0.71, 95% CI 0.53-0.93) and at last sex (AOR 0.68, 95% CI 0.52-0.90) exhibited significantly reduced odds of HCT uptake compared to those who reported condom use. Knowing someone who is HIV positive (AOR 1.40, 95% CI 1.09-1.82) was significantly associated with increased HCT uptake among men. iii Conclusion: The study provides important insights into the patterns and determinants of HCT uptake among men in South Africa. Geographic residence emerged as a key factor, with men from most provinces outside Western Cape exhibiting substantially lower odds of HCT uptake compared to those in Western Cape. Risky sexual behaviours such as not using condoms during sexual intercourse were correlated with low HCT uptake. Targeted interventions, such as expanding community-based HCT initiatives, strengthening health system infrastructure in underserved areas and tailor-made combinations of prevention interventions such as HCT and condom prevention strategies could contribute to increased HCT uptake and better control of the HIV epidemic in the country.
Engaging the public in priority setting for health in rural South Africa
(University of the Witwatersrand, Johannesburg, 2023-10) Tugendhaft, Aviva Chana; Hofman, Karen; Kahn, Kathleen; Christofides, Nicola
Introduction: The importance of public engagement in health priority setting is widely recognised as a means to promote more inclusive, fair, and legitimate decision-making processes. This is particularly critical in the context of Universal Health Coverage, where there is often an imbalance between the demands for and the available health resources. In South Africa, public engagement is protected in the Constitution and entrenched in policy documents; yet context specific tools and applications to enable this are lacking. Where public engagement initiatives do occur, marginalised voices are frequently excluded, and the process and outcomes of these initiatives are not fully evaluated. This hampers our understanding of public engagement approaches and how to meaningfully include important voices in the priority setting agenda. The aim of this doctoral (PhD) research was to investigate the feasibility and practicality of including the public in resource allocation and priority setting for health in a rural setting in South Africa using an adapted deliberative engagement tool called CHAT (Choosing All Together). Methods: The PhD involved the modification and implementation of the CHAT tool with seven groups in a rural community in South Africa to determine priorities for a health services package. For the modification of CHAT, desktop review of published literature and policy documents was conducted, as well as three focus group discussions, with policy makers and implementers at national and local levels of the health system and the community, and modified Delphi method to identify health topics/issues and related interventions appropriate for a rural setting in South Africa. Cost information was drawn from various national sources and an existing actuarial model used in previous CHAT exercises was employed to create the board. The iterative participatory modification process was documented in detail. The implementation process was analysed in terms of the negotiations that took place within the groups and what types of deliberations and engagement with trade-offs the participants faced when resources were constrained. In terms of the outcomes, the study focused on what priorities were most important to the rural community within a constrained budget and the values driving these priorities, but also how priorities might differ amongst individuals within the same community and the characteristics associated with these choices. Qualitative data were analysed from the seven group deliberations using the engagement tool. Content analysis was conducted, and inductive and deductive coding was used. Descriptive statistics was used to describe the study participants using the data from a demographic questionnaire and to show the group choices from the stickers allocated on the boards from the groups rounds. The investment level (sticker allocation) of all study participants was recorded at each stage of the study. From these the number of stickers allocated to each topic by the participants was calculated by adding up the number of stickers across interventions selected by the participant by topic. The median and interquartile range across study participants was calculated for the topic totals. To examine differences in sticker allocations, Wilcoxon rank sum tests were performed for differences across participant categories and sticker allocations in the final round of CHAT. Findings: Based on the outcomes, seven areas of health need and related interventions specific for a rural community context were identified and costed for inclusion in the CHAT board. These include maternal, new-born and reproductive health; child health; woman and child abuse; HIV/AIDS and TB; lifestyle diseases; quality/access; and malaria. The CHAT SA board reflects both priority options of policymakers/ experts and of community members and demonstrates some of the context specific coverage decisions that will need to be made under NHI. The CHAT implementation shows that the rural communities mostly prioritised curative services over primary prevention due to perceived inefficacy of existing health education and prevention programmes. The exercise fostered strong debates and deliberations. Specifically, the groups engaged deeply with trade-offs between costly treatment for HIV/AIDS and those for non-communicable disease. Barriers to healthcare access were of particular concern and some priorities included investing in more mobile clinic. The individual level priorities were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics such as age. The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and enhance the legitimacy and acceptability of the decision-making process. In terms of reconciling plurality in priority setting for health, group deliberative approaches help to identify social values and reconcile some of the differences, but additional individual voices may also need to be considered alongside group processes, especially among the most vulnerable. Conclusion: This research marks the first instance of modifying and implementing a deliberative tool for priority setting in a South African rural context. The findings shed light on the process and some of the outcomes of this approach within a vulnerable community, offering insights into public engagement in priority setting more broadly. The study demonstrates that participatory methods are feasible in modifying public engagement tools such as CHAT and can be adapted to different country contexts, potentially enhancing the priority setting process. Regarding the implementation of CHAT, the study provides an example of how a rural community grappled with resource allocation decisions, considered different perspectives and societal implications, and set priorities together. The research also highlights the priorities of this rural community, the social values driving their choices, and individual characteristics that are important to consider when setting priorities. The work demonstrates that meaningful public engagement includes various factors that interrelate and impact one another and that could inform a dynamic and cyclical approach going forward, as well as the importance of transparency during all stages of the process.
Adolescent health in rural South Africa: building an evidence-base to inform a health promotion intervention supporting healthier lifestyles
(University of the Witwatersrand, Johannesburg, 2024) Seabi, Tshegofatso Martha; Kahn, Kathleen; Wagner, Ryan G
Background Low- and middle-income countries (LMICs), including South Africa, face the persisting double burden of malnutrition, with undernutrition and overnutrition coexisting within the population. This issue is particularly pronounced among rural adolescents, who experience limited access to healthcare services, inadequate infrastructure, poverty, and a scarcity of nutritious foods. Addressing this double burden of malnutrition is essential for improving the health outcomes of rural adolescents and breaking the intergenerational cycle of malnutrition. Community health worker-led interventions have shown promise in promoting healthier lifestyles in this population, making it crucial to understand the feasibility and acceptability of such interventions. Aim This thesis aims to provide context-specific information on the changing distribution of Body Mass Index (BMI) and views on obesity among rural South African adolescents to inform the development of a targeted behaviour change intervention. Furthermore, it seeks to determine the feasibility, acceptability, and overall experience of implementing a complex intervention aimed at promoting healthier lifestyles in this population. Methods Using a mixed methods approach focusing on adolescents 12-20 years of age living in rural South Africa. This work is nested within the MRC/Wits rural public health and health transitions research unit (Agincourt) Health and Demographic Surveillance System, which is where the sample was drawn and provided explanatory variables such as SES. This work includes data from two studies with comparable measures, conducted in 2007 (n= 1309) and in 2018 (n=518), this study analysed comprehensive data on the prevalence and trends of BMI, including both undernutrition and overweight/obesity, among rural adolescents in 2007 and 2018. This was done through weight and height measures. Growth z-scores were used to determine stunting, underweight and overweight and overweight/obesity was generated using the 2007 WHO growth standards for adolescents aged up to 17 years and adult cut-offs of BMI of <=18.5 for underweight and =>30 kg/m2 for overweight and obese respectively for adolescents 18 to 20 years. Qualitative data was collected in the form of focus group discussions and in-depth interviews. Pre-intervention, three focus group discussions were held with male (n = 16) and female adolescents (n = 15) focusing on obesity to capture views, attitudes and perceptions surrounding obesity. Post-interventions, six focus group discussions were held with male and female adolescents. In-depth interviews were conducted with adolescents (n=20), parents (n=5) and CHWs (n=3), focusing on the feasibility and acceptability of the health promotion intervention. All qualitative data were analysed using inductive thematic analysis. Results This study found that there is a persistent double burden of malnutrition amongst rural adolescents. The pattern of underweight and overweight/obesity remains similar between 2007 and 2018, with an increase in overweight and obesity, and a decrease in underweight observed across different age and gender groups throughout this period. The prevalence of stunting and underweight, particularly in males in both 2007 and 2018 was substantial although lower in the later year. Adolescents expressed conflicting views of obesity, highlighting their knowledge of the cause and long-term consequences of obesity. In regard to the intervention, participants expressed support for the CHWs and the community-based intervention guided by them. The findings demonstrated the feasibility of providing the intervention to adolescents in a rural context, with modifications needed to ensure participant uptake, such as changes to the time and location. Responses from participants show how the intervention, which included dietary and quantity modifications, was acceptable to adolescents. The gathered information in this study serves as a foundation for developing a health promotion intervention tailored to the specific needs and circumstances of rural adolescents, considering both undernutrition and overweight and obesity. Conclusion This research provides valuable context-specific insights into the burden of malnutrition and perceptions of obesity among rural South African adolescents, considering the complexities of the double burden of malnutrition. The findings contribute to the development of tailored health promotion interventions that address both undernutrition and overweight/obesity in this population. Understanding the feasibility and acceptability of such interventions is vital for successful implementation and sustainability in rural communities.
Attrition in the dental therapy profession: an exploration of the contributing factors
(University of the Witwatersrand, Johannesburg, 2024) Sodo, Pumla Pamella; Jewett, Sara
Background: A new type of oral health profession called dental therapy was introduced to address the growing need for affordable and accessible oral healthcare services, especially among marginalised communities. Extensive global research has demonstrated that dental therapists provide cost-effective and high-quality services, effectively addressing the issue of limited access to basic oral health services. The introduction of dental therapy into the South African healthcare system took place in 1977, however, disparities in accessing basic oral healthcare persist, particularly among some population groups where the highest prevalence of oral diseases has been reported. Despite being established over four decades ago, the number of registered dental therapists remains low, and there have been reports of attrition within this professional group. This PhD aimed to explore the factors contributing to attrition in the dental therapy profession. The first objective was to determine South African dental therapists' attrition rate and demographic profile over 42 years (1977-2019). The second objective explored factors contributing to attrition, while the third objective explored the applicability of the Hertzberg Two-Factor Theory in the context of dental therapy attrition in South Africa. Methods: This was a concurrent mixed methods study, involving registered graduate dental therapists, former dental therapists, and key stakeholders. The conceptual framework that guided the study was derived from Hertzberg's Two-Factor Theory. Data sources included the HPCSA registry and primary data collected using a quantitative survey investigating job satisfaction and intention to leave among registered graduate dental therapists and qualitative in-depth interviews with former dental therapists and key stakeholders to gain insights into their perspectives on attrition in the dental therapy profession. The attrition rate was determined by using the formula (Attrition Rate = Number of dental therapists who left the profession divided by the total number of dental therapists registered during the period of interest, multiplied by 100). Quantitative data was analysed in STATA version 15 using descriptive and inferential statistics, and qualitative data was analysed using thematic analysis. Findings: A total of 1232 dental therapists were registered with HPCSA over 42 years, with only 714 registered in 2019, two-thirds of whom were Africans. The attrition rate over the 42 years was 40%, while it reduced to 9% during the 10 years from 2010 to 2019. Of the 200 registered dental therapists who took part in the survey, 74.5% being Africans, approximately 51.5% expressed their intention to leave the profession and a notable 69.5% reported job dissatisfaction. In logistic regression analysis, job satisfaction correlated positively with several factors, including qualification from UKZN (AOR= 2.28, CI: 1.06-4.91), post-graduation job availability (AOR=3.87, CI: 1.73-8.69), awareness of postgraduate opportunities (AOR=2.28, CI: 1.05-4.96), and feeling valued (AOR= 6.91, CI: 1.45-26.36). Conversely, job satisfaction was negatively associated with becoming aware of the scope of work only after enrolment (AOR= 0.31, CI: 0.21-0.81). Job satisfaction was inversely correlated with the intention to leave; satisfied individuals had significantly lower odds of intending to leave (AOR= 0.25, CI: 0.11-0.57). In-depth interviews with 14 former dental therapists identified diverse reasons for enrolling in dental therapy and a shared enthusiasm for the dental therapy profession. Most reasons they cited for attrition, such as inadequate remuneration, job scarcity, poor working conditions, lack of career advancement opportunities, and policy implementation gaps aligned with Herzberg's Two-Factor Theory. One novel factor contributing to attrition not covered by the theory was a lack of professional identity. The 12 key stakeholders who were interviewed echoed similar factors contributing to the attrition of dental therapists. To address limitations in moving from a description of factors to recommendations on how to address system-level challenges, I adapted a framework that is a combination of Herzberg's Two-Factor Theory and the Human Resources for Health System Development framework. This new framework addresses multifaceted issues affecting dental therapists, covering production, deployment, and retention. Conclusion: This study sheds light on challenges within South Africa's dental therapy profession, highlighting their profound implications for both the profession and the broader healthcare system. Despite comparable attrition rates to other mid-level health professionals, there were alarmingly high job dissatisfaction levels and intentions to leave the profession, demanding immediate attention and intervention. Identifying key factors contributing to attrition and the novel insight into the lack of professional identity collectively highlight the multifaceted nature of the issue. To address these challenges, embracing a comprehensive human resource retention framework is imperative. This study emphasizes the urgent need for proactive measures to ensure the sustainability and contentment of dental therapists, ultimately benefiting the healthcare system and the communities it serves. Addressing these factors will lead to increased retention rates and improved access to basic oral health services nationwide
Occupational characteristics and economic activities of health workers in the quarterly labour force survey: 2008-2017
(University of the Witwatersrand, Johannesburg, 2024) Dinga, Aphiwe; Blaauw, Duane
ackground There is global emphasis on the importance of research and analyses of health labour markets. The latter is defined as dynamic systems consisting of the demand and supply of health workers, influenced by a country’s regulations and institutions. However, there is limited national data to inform a health labour market analysis. Aim The aim of the study was to analyse the demographic, occupational characteristics and the economic activities of health workers who were surveyed in the Quarterly Labour Force Survey (QLFS) from 1 January 2008 to 31 December 2017. Methodology This study was a cross-sectional secondary data analysis of the health workers captured in the QLFS, a household survey that is conducted every three months by Statistics South Africa. The survey focuses on the labour market activities of individuals aged 15 to 64 years who live in South Africa. The sample analysed for this study was all health workers surveyed in the QLFS during the study period. Both the South African Standard Classification of Occupations (SASCO) and the Standard Industry Classification (SIC) codes were used to extract data on all health occupations to ensure that the entire health workforce in the QLFS was included in the current study. To identify predictors of employment a multiple logistic regression was carried out. STATA ® 15 was used for the statistical analysis. Results The study sample comprised a total of 5 502 health workers. Nurses constituted the highest proportion of health workers in the survey (60.1%) while medical doctors and dentists represented 10.0%. Nurses were older than the other categories of health workers with a mean age of 43.6 years (SD±10.3), compared to the mean age of 41.8 (SD±10.8) for doctors, 38.6 (SD±10.4) for mid-level health workers and 37.8 (±10.8) for allied health workers. The majority (59.0%) of health workers were employed in the public sector, and in urban areas (83.8%). Only 4.6% of doctors and 7.0% of allied health workers were employed in rural areas. Overall, the study found that fewer than 1% of health workers reported more than one job during the 10-year period. The results of the logistic regression showed that the odds of employment were approximately two times higher for health workers between the ages of 36-45 and 46-55 years old and 1.8 times higher for health workers between the ages of 26-35. There were 0.5 odds of employment for health workers aged 56-64 years compared to the reference age group of 18–25-year-olds. Females were less (0R=0.56) likely to be employed as compared to males. Compared to health workers in urban areas, those in rural areas were less (0.47) likely to be employed. Health workers were 0.53 times less likely to be employed outside the health industry as compared to being employed in the health industry. Conclusion Although the QLFS provides useful information on the health workforce in South Africa, the results highlight the need for investment in a robust human resources for health information system
The effects of COVID-19 on paediatric therapeutic services at Chris Hani Baragwanath Academic Hospital
(University of the Witwatersrand, Johannesburg, 2024) McGrath, Robyn Lesley; Slemming, Wiedaad
Background: The COVID-19 pandemic has affected child health services worldwide, including in South Africa, where prioritisation of paediatric therapeutic services was lacking despite their vital role in health promotion and disease management. Aim: This study aimed to assess the impact of the COVID-19 pandemic on paediatric therapeutic services at a tertiary level hospital in Johannesburg, South Africa, focusing on service outputs, challenges, and innovations during 2020 and 2021. Methods: This study used a concurrent triangulation mixed methods approach. Quantitative analysis of service output data was combined with qualitative analysis of healthcare worker interviews. Integration was facilitated through a convergent design joint display during interpretation. Results: In 2020, patient contact sessions significantly decreased, particularly during lockdown phases, leading to missed diagnoses and adverse patient outcomes. Ineffective hospital management contributed to a lack of communication and direction for managers and clinicians which was worsened by the absence of national guidelines. Persistent trends of low service utilisation during the pandemic drove healthcare worker innovation, forcing healthcare workers to adopt a systems approach to decision making. Innovations centred on inter-professional communication and coordination, service re-evaluation and restructuring, new service delivery models, technology use, patient education and prioritisation, and adapting the duration and frequency of care. Conclusion: Paediatric services healthcare workers responded innovatively to pandemic challenges, with some solutions improving long-term service delivery efficiency. Insights from this study can enhance health system preparedness and inform planning for paediatric therapeutic services in South Africa, especially in anticipation of future events and the National Health Insurance scheme

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