1. Academic Wits Research Outputs/Journal articles
Permanent URI for this communityhttps://hdl.handle.net/10539/37774
For queries relating to content and technical issues, please contact IR specialists via this email address : openscholarship.library@wits.ac.za, Tel: 011 717 4652 or 011 717 1954
Browse
65 results
Search Results
Item Parenting in place: young children's living arrangement and migrants' sleep health in South Africa(Wiley, 2023-06) Madhavan, Sangeetha; Kim, Seung Wan; White, Michael; Gomez‐Olive, XavierMigration research tends to treat childrearing as a secondary role for migrants. By prioritising the economic objectives of migration, most models present migrants as either delaying childbearing or, if they have young children, not living with them. However, migration has become increasingly feminised, the types of mobility more varied, while the returns to migration remain uncertain at best. At the same time, norms around childrearing are shifting, and the capacity of kin to take care of children may be weakening. In such contexts, migrants may not want to or be able to be separated from their children. Confronting such difficult decisions and their consequences may be reflected in poor sleep health for the migrant parent. We draw on data from the Migration and Health Follow‐Up Study (MHFUS) in South Africa to examine the following questions: (i) To what extent is children's coresidence associated with sleep health for migrant parents? (ii) Do effects vary by sex of migrant? and (iii) Do effects vary by location of migrant? Results from propensity score matching confirm that migrants who coreside with all their young children are more likely to experience healthy sleep compared to those who have nonresident or no young children. However, stratified analysis shows that these effects are only significant for women and those not living in Gauteng province. The value of these findings is underscored by the need for research on the well‐being of migrant parents who are negotiating multiple agendas in economically precarious and physically insecure destinations.Item A qualitative study to explore strategies to improve the Road to Health Application for maternal and child health outcomes in South Africa(Frontiers Media, 2023-03) Dietrich, Janan Janine; Tsotetsi, Lerato; Dubazane, Thenjiwe; Tshabalala, Gugulethu; Maimela, Boitumelo; Weiss, Martin; Mulaudzi, MamakiriBackground: The Road to Health Application (RTHA) is essentially a digitalized version of the National Department of Health’s Road to Health book, and a hand-printed booklet given to mothers at the birth of each baby. The RTHA, like the booklet, provides guidelines for maternal and child health outcomes, with the goal of creating a database of children and caregivers in South Africa and teaching them how to raise a healthy child. This paper explored potential barriers and enablers to using the RTHA in the South African context based on user experiences. Methods: Using a qualitative design, we conducted 50 serial interviews (two separate interviews, 1 month apart). Through convenience, sampling eligible participants were 18 years or older women who were pregnant and/or had a child under the age of 5 years. Participants included 25 existing users and 25 new users of the RTHA, who owned android smart phones at enrollment. Existing users were recruited telephonically through the National Department of Health database, and new users were approached at the antenatal care unit and wellness baby clinic (women with children under 5 years) at the Chris Hani Baragwaneth Academic Hospital. Upon enrollment, participants completed a brief survey on sociodemographics and mobile phone use, and thereafter, they had a baseline interview followed by a telephonic interview 1 month later. A semistructured interview guide was used to explore barriers, enablers, and the usability of the RTHA. Using thematic data analysis, we identified enablers and barriers to the use of the RTHA. Results: A third (33%) of all participants reported IsiZulu as their main language of communication, and 6% of the participants reported English as their main language of communication. The RTHA was an important addition to the booklet that helped keep new mothers informed about child immunization and provided important information about healthy child rearing practices. However, multiple barriers were cited to using the RTHA; these included the fact that the app was only available in two languages, high data costs, lack of access to smart phones, and app functionalities. The enablers to using the RTHA included the accessibility of important information regarding prenatal and postnatal childcare. Conclusion: This study gives insight into the barriers and enablers from the end-user perspective to improve the RTHA for future use in South Africa and offers guidance on how to improve the RTHA to be more user-friendly, which could increase its usability among mothers. It further emphasizes the need to consider the challenges experienced by users in South Africa when developing future mobile health interventions to increase uptake.Item The political economy of social ownership in South Africa: Opportunities to address inequality in transition(AFD- French Development Agency, 2025-03) Lehmann-Grube, Katrina; Mabasa, Khwezi; Taylor, JuliaSouth Africa has high levels of persistent, structural inequality. Social ownership has remerged in recent years as an opportu-nity to address inequality, particularly in the context of the just transition. The just transition refers to the manner in which the transition to a low-carbon economy is achieved. Social ownership is proposed as a means to reduce the concentration of wealth, improve access to resources and labour opportunities for a more equitable society. This research paper examines how models of social ownership in different sectors can be used to address inequality in post-apartheid South Africa to support a just transition. We draw from the literature on social ownership, expert interviews, and case studies in energy, agriculture, mining and finance sectors, with a specific focus on the following ownership models: coope-ratives, public entities, and trade union-led socio-economic development projects. The research findings provide a definition for social ownership, pull out key features of successful social ownership models, and unpacks the ways in which they contribute to reducing inequality. The paper aims to support policymaking and contribute to ongoing debates over economic restructuring and inequality.Item Debating South Africa's approach to a lower inflation target(University of the Witwatersrand, Joahnnesburg, 2025) Willcox, OwenThis policy brief argues against lowering of the inflation target. A lower inflation target will worsen South Africa’s fiscal dynamics, leading to deeper and longer fiscal austerity, which will result in lower economic growth and employment. The arguments of the South African Reserve Bank (SARB) for a lower target are cogent but ignore the impact on government debt, and hence the negative impact on the macroeconomy at large.Item The burden of cancers associated with HIV in the South African public health sector, 2004–2014: a record linkage study(2019-05) Dhokotera, Tafadzwa; Bohlius, Julia; Spoerr, Adrian; Egger, Matthias; Ncayiyana, Jabulani; Olago, Victor; Singh, Elvira; Sengayi, MazvitaIntroduction: The impact of South Africa’s high human immunodeficiency virus (HIV) burden on cancer risk is not fully understood, particularly in the context of antiretroviral treatment (ART) availability. We examined national cancer trends and excess cancer risk in people living with HIV (PLHIV) compared to those who are HIV-negative. Methods: We used probabilistic record linkage to match cancer records provided by the National Cancer Registry to HIV data provided by the National Health Laboratory Service (NHLS). We also used text search of specific HIV terms from the clinical section of pathology reports to determine HIV status of cancer patients. We used logistic and Joinpoint regression models to evaluate the risk and trends in cancers in PLHIV compared to HIV-negative patients from 2004 to 2014. In sensitivity analysis, we used inverse probability weighting (IPW) to correct for possible selection bias. Results: A total of 329,208 cancer cases from public sector laboratories were reported to the NCR from 2004 to 2014 with the HIV status known for 95,279 (28.9%) cancer cases. About 50% of all the female cancer cases (n = 30,486) with a known status were HIV-positive. PLHIV were at higher risk of AIDS-defining cancers (Kaposi sarcoma [adjusted OR:134, 95% CI:111–162], non-Hodgkin lymphoma [adjusted OR:2.73, 95% CI:2.56–2.91] and, cervix [adjusted OR:1.70, 95% CI:1.63–1.77], conjunctival cancer [adjusted OR:21.5, 95% CI:16.3–28.4] and human papilloma virus (HPV) related cancers (including; penis [adjusted OR:2.35, 95% CI:1.85–2.99], and vulva [adjusted OR:1.94, 95% CI:1.67–2.25]) compared to HIV-negative patients. Analysis using the IPW population yielded comparable results. Conclusion: There is need for improved awareness and screening of conjunctival cancer and HPV-associated cancers at HIV care centres. Further research and discussion is warranted on inclusive HPV vaccination in PLHIV.Item The prevalence of malnutrition and growth percentiles for urban South African children(BMC Public Health, 2019-05) Nyati, Lukhanyo H.; Pettifor, John M.; Norris, Shane A.Background: Low- and middle-income countries (LMIC) are experiencing a double-burden of malnutrition characterised by high prevalence of both under- and over-nutrition. We set out using data from the mixedlongitudinal Birth-to-Twenty Plus (Bt20+) birth cohort, to evaluate the patterns of malnutrition and growth in a large South African (SA) city by; (i) assessing the prevalence of undernutrition from birth to 5 years of age and overweight and obesity from ages 2 to 21 years in black and white, male and female children, and (ii) determining percentiles for height, weight, BMI, waist and hip circumferences and comparing the centiles to American and Dutch references. Methods: Height, weight, waist and hip circumferences were measured on urban black and white SA children from the Bt20+. A total of 3273 children born between April and June 1990 in the Greater Johannesburg Metropolitan area were included in the cohort. Z-scores were derived using the WHO 2006 child growth standards (0–5 years), for defining stunting, underweight and wasting. The International Obesity Task Force (IOTF) references were used to define overweight and obesity. Percentiles were developed using the lambda mu sigma (LMS) method and compared to American and Dutch references. Results: Black children were consistently shorter and black males lighter than white children and American references. The prevalence of stunting peaked at 2 years and was significantly higher in males than females and in black than white children. Black females had a greater prevalence of overweight and obesity than black males from 10 to 17 years. The percentiles for black females for weight and BMI were similar to those of South African white and American references but both black and white South African females had lower waist circumferences than American references. Conclusion: The growth percentiles show that young South African urban black females are experiencing general but not central obesity due to a secular change which is faster in weight than height. High levels of undernutrition persist alongside high levels of over-nutrition with adolescence being a critical period for the upsurge in obesity in females. Early intervention is needed to combat the rise in obesity.Item Hypertension in a rural community in South Africa: what they know, what they think they know and what they recommend(BioMed Central, 2019-03) Klipstein-Grobusch, Kerstin; Jongen, Vita W.; Lalla-Edward, Samanta T.; Vos, Alinda G.; Godijk, Noortje G.; Tempelman, Hugo; Grobbee, Diederick E.; Devillé, WalterBackground: Hypertension is one of the most important risk factors for cardiovascular disease and has a high prevalence in South Africa and other low- and middle-income countries. However, awareness of hypertension has been reported to be low. Health programmes can increase awareness of hypertension and its causes, but hinge on the knowledge and perception of the targeted community. Therefore, this study investigated knowledge on and perceptions about hypertension of community members in a rural area in Limpopo, South Africa with the aim to increase awareness of hypertension and cardiovascular disease in the local population. Methods: Using a mixed methods study approach, 451 participants of the Ndlovu Cohort Study, attending a follow-up visit between August 2017 and January 2018, completed a questionnaire on cardiovascular risk perception. A knowledge score was calculated for all participants. Sixty participants were invited to participate in six focus group discussions, of which 56 participated. Audio recordings were transcribed verbatim, transcripts coded, and thematic analysis of the data undertaken to obtain an understanding of knowledge and perception of hypertension in the community. Results: Most members of the community seemed to have intermediate (74.3%) or good (14.0%) knowledge of hypertension based on the knowledge score, and only 11.8% of the population had poor knowledge. The risk factors of hypertension seemed to be well known in the community. Poverty was identified as a major vulnerability in this community limiting choices for healthy lifestyles such as nutritious foods, recreational physical activity and accessing health care timely. Participants proposed community-based activities as an effective way to reach out to community members for prevention and management of hypertension. Conclusion: This study highlights the need for improved health promotion efforts to increase knowledge of hypertension in rural communities, and to address poverty as a major obstacle to healthy life-style choices.Item Lipid levels, insulin resistance and cardiovascular risk over 96 weeks of antiretroviral therapy: a randomised controlled trial comparing low-dose stavudine and tenofovir(BioMed Central, 2018-12) Vos, Alinda G.; Chersich, Matthew F.; Klipstein‑Grobusch, Kerstin; Zuithof, Peter; Moorhouse, Michelle A.; Lalla‑Edward, Samanta T.; Kambugu, Andrew; Kumarasamy, N.; Grobbee, Diederick E.; Barth, Roos E.; Venter, Willem D.Background: HIV infection and antiretroviral treatment are associated with changes in lipid levels, insulin resistance and risk of cardiovascular disease (CVD). We investigated these changes in the first 96 weeks of treatment with lowdose stavudine or tenofovir regimens. Methods: This is a secondary analysis of a double blind, randomised controlled trial performed in South-Africa, Uganda and India comparing low-dose stavudine (20 mg twice daily) with tenofovir in combination with efavirenz and lamivudine in antiretroviral-naïve adults (n = 1067) (Clinicaltrials.gov, NCT02670772). Over 96 weeks, data were collected on fasting lipids, glucose and insulin. Insulin resistance was assessed with the HOMA-IR index and 10-year CVD risk with the Framingham risk score (FRS). A generalized linear mixed model was used to estimate trends over time. Results: Participants were on average 35.3 years old, 57.6% female and 91.8% Black African. All lipid levels increased following treatment initiation, with the sharpest increase in the first 24 weeks of treatment. The increase in all lipid subcomponents over 96 weeks was higher among those in the stavudine than the tenofovir group. Insulin resistance increased steadily with no difference detected between study groups. FRS rose from 1.90% (1.84–1.98%) at baseline to 2.06 (1.98–2.15%) at week 96 for the total group, with no difference between treatment arms (p = 0.144). Lipid changes were more marked in Indian than African participants. Conclusion: Lipid levels increased in both groups, with low-dose stavudine resulting in a worse lipid profile compared to tenofovir. Insulin resistance increased, with no difference between regimens. CVD risk increased over time and tended to increase more in the group on stavudine. The low CVD risk across both arms argues against routine lipid and glucose monitoring in the absence of other CVD risk factors. In high risk patients, monitoring may only be appropriate at least a year after treatment initiation.Item Developing a model for integrating sexual and reproductive health services with HIV prevention and care in KwaZulu-Natal, South Africa(BioMed Central, 2018-11) Milford, Cecilia; Scorgie, Fiona; Greener, Letitia Rambally; Mabude, Zonke; Beksinska, Mags; Harrison, Abigail; Smit, JenniferBackground: There are few rigorous studies evaluating the benefits of vertical versus integrated delivery of healthcare services, and limited published studies describing conceptual models of integration at service-delivery level in public healthcare facilities. This article seeks to fill this gap, by describing the development of a district-based model for integrating sexual and reproductive health (SRH) and HIV services in KwaZulu-Natal, South Africa. Methods: Baseline data were collected from seven urban public healthcare facilities through client and provider interviews, and a facility inventory was completed to assess current service integration practices. Feedback sessions were held with health providers from participating facilities to share data collected and explore appropriate integration scenarios. A conceptual model of potential service integration was then designed, and subsequently implemented and evaluated in the research sites. Results: Key principles of the model included a focus on health system strengthening and strong community input and involvement. The model was designed primarily to support the integration of family planning into HIV services, and included measures to improve client and commodity monitoring; capacity building through training and mentorship; and a ‘health navigation’ strategy to strengthen referrals within and between public healthcare facilities. Endline evaluation data were collected in the same facilities following implementation of the model. Conclusions: This manuscript demonstrates the utility of the conceptual model. It shows that service integration can be accomplished in a phased manner with support of community and healthcare providers. In addition, local context must be taken into account and the components of the model should be flexible to suit the needs of the health system.Item Assessment of adolescent and youth friendly services in primary healthcare facilities in two provinces in South Africa(BioMed Central, 2018) James, Shamagonam; Pisa, Pedro T.; Imrie, John; Beery, Moira P.; Martin, Catherine; Skosana, Catherine; Delany-Moretlwe, SineadBackground: Health services for adolescents are increasingly recognised as a priority in low- and middle-income countries (LMICs). The Adolescent and Youth Friendly Service (AYFS) approach has been promoted in South Africa by the National Department of Health and partners, as a means of standardising the quality of adolescent health services in the country. The objective of this paper is to detail the evaluation of AYFS against defined standards to inform initiatives for strengthening these services. Methods: A cross-sectional assessment of AYFS was carried out in 14 healthcare facilities in a sub-district of Gauteng Province and 16 in a sub-district in North West Province, South Africa. Data on adolescent care and service management systems were collected through interviews with healthcare providers, non-clinical staff and document review. Responses were scored using a tool based on national and World Health Organisation criteria for ten AYFS standards. Results: Mean scores for the ten standards showed substantial variation across facilities in the two sub-Districts, with Gauteng Province scoring lower than the North West for 9 standards. The sub-district median for Gauteng was 38% and the North West 48%. In both provinces standards related to the general service delivery, such as Standards 4 and 5, scored above 75%. Assessment of services specifically addressing sexual, reproductive and mental health (Standard 3) showed that almost all these services were scored above 50%. Exploration of services related to psycho-social and physical assessments (Standard 8) demonstrated differences in the healthcare facilities’ management of adolescents’ presenting complaints and their comprehensive management including psycho-social status and risk profile. Additionally, none of the facilities in either sub-district was able to meet the minimum criteria for the five standards required for AYFS recognition. Conclusion: Facilities had the essential components for general service delivery in place, but adolescent-specific service provision was lacking. AYFS is a government priority, but additional support for facilities is needed to achieve the agreed standards. Meeting these standards could make a major contribution to securing adolescents’ health, especially in preventing unintended pregnancies and HIV as well as improving psycho-social management