Browsing Research Articles (SOPH) by Title
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Puoane, Thandi; Tsolekile, Lungiswa (Kamla-Raj Enterprises, 2008)[more][less]
Abstract: This paper was conducted to describe some of the circumstances that increases the risk factors for non-communicable diseases amongst the previously disadvantaged South African population. The work presented here is based on an action research in an urban black township of Cape Town. The goal was to develop a Non- Communicable Disease model, which can be used to benefit an urban township community. Using a participatory process data was collected during each stage of the development and implenting interventions. Interviews, observations and situational assessment of resources available for promoting healthy lifestyle in the township were used to collect data. Although urbanisation seems to be a driving force in nutrition transition, there are underlying factors that influence lifestyle changes. These includes the environment in which people find themselves. The city provides variety of cheap unhealthy food at a lower price. Due to poverty and lack of knowledge, healthy foods become of less important. People tend to indulge in food rich in fat and sugars due to the belief that they have missed opportunities of enjoying these foods due to deprivation. This has lead to the increase in the prevalence of NCDs among poor South Africans. In conclusion, this work provided important information regarding the challenges faced by the urbanised poor population in South Africa. Although Khayelitsha was used to illustrate these challenges, the situation is similar to other urban townships of in South Africa. URI: http://hdl.handle.net/10566/242 Files in this item: 1
PuoaneChallenges2008.pdf (28.29Kb) -
Meyers, Tammy; Dramowski, Angela; Schneider, Helen; Gardiner, Nicolene; Kuhn, Louise; Moore, David (Lippincott Williams & Wilkins, 2012)[more][less]
Abstract: Background: With widespread availability of pediatric antiretro- viral therapy and improved access to prevention of mother-to-child transmission (PMTCT), it is important to monitor the impact on pediatric HIV-related hospital admissions and in-hospital mortality in South Africa. Methods: Over a 15-year period, 4 independent surveillance studies were conducted in the pediatric wards at Chris Hani Baragwanath Hospital in Soweto, South Africa (1996, 2005, 2007, and late 2010 to early 2011). Trends in HIV prevalence and HIV-related mortality were evaluated. Results: HIV prevalence was similar during the first 3 periods: 26.2% (1996), 31.7% (2005), and 29.5% (2007) P > 0.10, but was lower in 2010-2011 (19.3%; P = 0.0005). Median age of the children admitted with HIV increased in the latter periods from 9.13 (interquartile range 3.6-28.8) months to 10.0 (3.0-44.5) months (P > 0.10) and 18.0 (6.2-69.8) months (P = 0.048). Median admis¬sion weight-for-age z-scores were similar (< -3 SD) for the latter 3 periods. Admission CD4 percentage increased from 0.0% (0.0-9.4) in 2005 to 15.0% (8.2-22.8) in 2007 (P < 0.0001) and was 18.7% (9.6-24.7) in 2010-2011 (P > 0.10). Mortality among all vs. HIV- infected admissions was 63 of 565 (11.2%) and 43 of 179 (24.0%) in 2005, 91 of 1510 (6.0%) and 53 of 440 (12.0%) in 2007, and 18 of 429 (4.2%) and 9 of 73 (12.3%) in 2010-2011. Conclusions: HIV prevalence and mortality among pediatric admissions is decreasing. This is likely a result of improved PMTCT and wider antiretroviral therapy coverage. Continued effort to improve PMTCT coverage and identify and treat younger and older HIV-infected children is required to further reduce HIV-related morbidity and mortality. URI: http://hdl.handle.net/10566/507 Files in this item: 1
MeyersPediatricHIV2012.pdf (1.017Mb) -
Puoane, Thandi; Tsolekile, Lungiswa; Sanders, David; Parker, Whadiah (Health Systems Trust, 2008)[more][less]
Abstract: This chapter will examine the current actions, including lifestyle measures, for the prevention and management of non-communicable diseases within a South African context. It will also focus on the biological, behavioural and social determinants of health. Interventions and initiatives directed at primary, secondary and tertiary prevention of chronic non-communicable diseases are also discussed. This chapter ends with recommended lifestyle changes, which can be taken to influence the adoption of healthy lifestyles, and therefore reduce the risks for chronic non-communicable diseases. URI: http://hdl.handle.net/10566/255 Files in this item: 1
PuoaneChronic2008.pdf (621.8Kb) -
Igumbor, Ehimario U.; Puoane, Thandi; Gansky, Stuart A.; Plesh, Octavia (Medpharm Publications, 2011)[more][less]
Abstract: Background: Comprehensive information is needed on the epidemiology and burden of chronic pain in the population for the development of appropriate health interventions. This study aimed to determine the prevalence, severity, risk indicators and responses of chronic pain among adults in Ngangelizwe, Mthatha, South Africa. Method: A cross-sectional survey utilising structured interviews of a sample of adult residents was used. Interviews elicited information on socio-demographic characteristics, general health status, and the prevalence, duration, frequency, severity, activity limitation and impact of chronic pain. Results: More than 95% (n = 473) of the sampled adults participated in the study. Of these, 182 [38.5%, 95% confidence interval (CI): 36.3-42.5%] reported chronic pain in at least one anatomical site. The most common pain sites were the back and head. The median pain score was 5 on a scale of 0 to 10 [interquartile range (IQR) = 4-7] and the median number of sites of pain was 1 (IQR = 1-2). Female gender [odds ratio (OR) = 2.6, 95% CI: 1.7-3.9] and being older than 50 years of age (OR = 3.5, 95% CI: 2.6-4.1) were identified as risk indicators for chronic pain in the sample. Over 65% of respondents reported that they self-treated; 92.1% had consulted with a doctor or nurse, 13.6% consulted a traditional healer, and 34.5% consulted a pharmacist because of their pain. Despite this, over 50% reported that relief of their pain was transient. Conclusion: Chronic pain is a common general complaint in this community, but there is a need for focused attention on women and the elderly. URI: http://hdl.handle.net/10566/432 Files in this item: 1
IgumborChronicPainMthatha2011.pdf (228.2Kb) -
Puoane, Thandi; Bradley, Hazel A. (MedPharm Publications, 2006)[more][less]
Abstract: BACKGROUND: Community health workers (CHWs) are lay people trained to assist with health care in their communities. This study took place at two sites in Khayelitsha, a township in the Cape Peninsula, from 2000 to 2002. OBJECTIVES: To describe the process of developing an intervention programme for primary prevention of noncommunicable diseases (NCDs) in general and cardiovascular disease in particular, targeting CHWs. METHOD: Forty-four CHWs were assigned to either an intervention or a control group. The intervention group, living in Site C, received training on lifestyle modification with emphasis on healthy eating and physical activity, while the control group, living in Site B, did not receive any training until a year later. The process was undertaken in four stages. Stage 1 involved assessment of the CHWs’ risk factors by obtaining anthropometric measurements. CHWs were interviewed and focus group discussions were held on the socio-cultural factors associated with body weight and body image, and barriers to physical activity. Stage 2 involved developing and implementing a training programme for primary prevention of NCDs among CHWs. Stage 3, conducted at Site C, involved a situational assessment of available resources in the community for promoting healthy lifestyles. The fourth and final stage involved the implementation of community interventions by the CHWs. RESULTS: A large percentage of CHWs were overweight and obese, and therefore at risk for NCDs. They had misconceptions about causes and treatment of these diseases, and also lacked knowledge on nutrition and the risk of high fat intake. Easy access to cheap unhealthy food, rather than fresh fruit and vegetables, limited their ability to make healthy food choices. The findings from stage 1 led to a community participatory intervention. CONCLUSIONS: Developing community-targeted interventions for NCDs can be achieved by involving CHWs at the initial stage and utilising a multifaceted approach. Education of community members and CHWs does not guarantee behaviour modification. Unless the environment encourages healthy living, NCDs will continue to be a burden in the poor populations of South Africa. URI: http://hdl.handle.net/10566/236 Files in this item: 1
PuoaneCommunityIntervention2006.pdf (301.1Kb) -
Puoane, Thandi (MedPharm Publications, 2008)[more][less]
Abstract: OBJECTIVE: To estimate the prevalence of overweight and obesity, and identify factors associated with Body Mass Index (BMI) and waist circumference (WC) among adults residing in an urban township in South Africa. DESIGN: Cross-sectional study. SETTING: Khayelitsha, a large black township located in Cape Town. SUBJECTS: 107 males and 530 females, aged ≥ 18 years. METHODS: The prevalence of overweight/obesity (BMI ³ 25 kg/m2) and abdominal obesity (WC ≥ 94 cm for men and ≥ 80 cm for women), and their relationship with factors previously found to increase the risk of obesity, such as age, gender, marital status, educational level, employment status, immigrant status from rural to urban, and physical activity level, were assessed using logistic regression analyses. RESULTS: The prevalence of obesity (BMI ³ 30 kg/m2) was 53.4% and 18.7%, and that of abdominal obesity was 71.5% and 23.4%, among women and men respectively. However, more women (21.3%) than men (11.2%) reported walking more than 45 minutes per day. Female gender and being married were associated with a high BMI and large WC. Recent migration was associated with a smaller WC. The level of physical activity was not associated with BMI or WC. CONCLUSIONS: These findings suggest that physical activity may play less of a role in obesity control, or that more than 45 minutes of physical activity per day is required to reduce the risk of obesity, especially in women. At least among South African women, obesity control focused on nutritional interventions may be more beneficial than increasing the intensity or duration of physical activity. URI: http://hdl.handle.net/10566/233 Files in this item: 1
MalhotraPuoaneSAJCN2008.pdf (303.1Kb) -
Igbinosa, Isoken H.; Igumbor, Ehimario U.; Aghdasi, Farhad; Tom, Mvuyo; Okoh, Anthony I (Hindawi Publishers Corporation, 2012)[more][less]
Abstract: Aeromonas species are ubiquitous bacteria in terrestrial and aquatic milieus. They are becoming renowned as enteric pathogens of serious public health concern as they acquire a number of virulence determinants that are linked with human diseases, such as gastroenteritis, soft-tissue, muscle infections, septicemia, and skin diseases. Proper sanitary procedures are essential in the prevention of the spread of Aeromonas infections. Oral fluid electrolyte substitution is employed in the prevention of dehydration, and broad-spectrum antibiotics are used in severe Aeromonas outbreaks. This review presents an overview of emerging Aeromonas infections and proposes the need for actions necessary for establishing adequate prevention measures against the infections. URI: http://hdl.handle.net/10566/434 Files in this item: 1
IgbinosaAeromonas2012.pdf (571.7Kb) -
Joubert, Jane; Puoane, Thandi (South African Medical Association, 2007)[more][less]
Abstract: OBJECTIVE: To estimate the burden of disease attributable to excess body weight using the body mass index (BMI), by age and sex, in South Africa in 2000. DESIGN: World Health Organization comparative risk assessment (CRA) methodology was followed. Re-analysis of the 1998 South Africa Demographic and Health Survey data provided mean BMI estimates by age and sex. Population attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. SETTING: South Africa. SUBJECTS. Adults ≥ 30 years of age. OUTCOME MEASURES. Deaths and disability-adjusted life years (DALYs) from ischaemic heart disease, ischaemic stroke, hypertensive disease, osteoarthritis, type 2 diabetes mellitus, and selected cancers. RESULTS: Overall, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke, 38% of ischaemic heart disease, 31% of kidney cancer, 24% of osteoarthritis, 17% of colon cancer, and 13% of postmenopausal breast cancer were attributable to a BMI ≥ 21 kg/m2. Excess body weight is estimated to have caused 36 504 deaths (95% uncertainty interval 31 018 - 38 637) or 7% (95% uncertainty interval 6.0 - 7.4%) of all deaths in 2000, and 462 338 DALYs (95% uncertainty interval 396 512 - 478 847) or 2.9% of all DALYs (95% uncertainty interval 2.4 - 3.0%). The burden in females was approximately double that in males. CONCLUSIONS: This study shows the importance of recognising excess body weight as a major risk to health, particularly among females, highlighting the need to develop, implement and evaluate comprehensive interventions to achieve lasting change in the determinants and impact of excess body weight. URI: http://hdl.handle.net/10566/284 Files in this item: 1
PuoaneEstimating2007.pdf (412.1Kb) -
Goga, Ameena; Dinh, Thu-Ha; Jackson, Debra (South African Medical Research Council, National Department of Health South Africa and PEPFAR/US Centers for Disease Control & Prevention, 2012)[more][less]
Abstract: Aims and Objectives: The overall aim of this evaluation was to conduct a national facility-based survey to monitor the effectiveness of the South African National PMTCT programme. The primary objective was to measure rates of early MTCT of HIV at six weeks postpartum. The secondary objective was to periodically estimate coverage of key PMTCT interventions and services (e.g., HIV testing, CD4 cell count testing, infant antiretroviral (ARV) prophylaxis, infant feeding counselling). URI: http://hdl.handle.net/10566/462 Files in this item: 1
GogaPMTCT2012.pdf (5.124Mb) -
Tylleskar, Thorkild; Jackson, Debra; Meda, Nicolas; Ingrebetsen, Ingunn Marie S; Chopra, Mickey; Diallo, Abdoulaye Hama; Doherty, Tanya M.; Ekström, Eva-Charlotte; Fadnes, Lars T; Goga, Ameena; Kankasa, Chipepo; Klungsøyr, Jørn I; Lombard, Carl; Nankabirwa, Victoria; Nankunda, Jolly K; Van de Perre, Philippe; Sanders, David; Shanmugam, Rebecca; Sommerfelt, Halvor; Wamani, Henry; Tumwine, James K; PROMISE-EBF Study Group (Elsevier, 2011)[more][less]
Abstract: Background: Exclusive breastfeeding (EBF) is reported to be a life-saving intervention in low-income settings. The effect of breastfeeding counselling by peer counsellors was assessed in Africa. Methods:24 communities in Burkina Faso, 24 in Uganda, and 34 in South Africa were assigned in a 1:1 ratio, by use of a computer-generated randomisation sequence, to the control or intervention clusters. In the intervention group, we scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers. The data gathering team were masked to the intervention allocation. The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks. Country-specific prevalence ratios were adjusted for cluster effects and sites. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00397150. Findings 2579 mother–infant pairs were assigned to the intervention or control clusters in Burkina Faso (n=392 and n=402, respectively), Uganda (n=396 and n=369, respectively), and South Africa (n=535 and 485, respectively). The EBF prevalences based on 24-h recall at 12 weeks in the intervention and control clusters were 310 (79%) of 392 and 139 (35%) of 402, respectively, in Burkina Faso (prevalence ratio 2·29, 95% CI 1·33–3·92); 323 (82%) of 396 and 161 (44%) of 369, respectively, in Uganda (1·89, 1·70–2·11); and 56 (10%) of 535 and 30 (6%) of 485, respectively, in South Africa (1·72, 1·12–2·63). The EBF prevalences based on 7-day recall in the intervention and control clusters were 300 (77%) and 94 (23%), respectively, in Burkina Faso (3·27, 2·13–5·03); 305 (77%) and 125 (34%), respectively, in Uganda (2·30, 2·00–2·65); and 41 (8%) and 19 (4%), respectively, in South Africa (1·98, 1·30–3·02). At 24 weeks, the prevalences based on 24-h recall were 286 (73%) in the intervention cluster and 88 (22%) in the control cluster in Burkina Faso (3·33, 1·74–6·38); 232 (59%) and 57 (15%), respectively, in Uganda (3·83, 2·97–4·95); and 12 (2%) and two (<1%), respectively, in South Africa (5·70, 1·33–24·26). The prevalences based on 7-day recall were 279 (71%) in the intervention cluster and 38 (9%) in the control cluster in Burkina Faso (7·53, 4·42–12·82); 203 (51%) and 41 (11%), respectively, in Uganda (4·66, 3·35–6·49); and ten (2%) and one (<1%), respectively, in South Africa (9·83, 1·40–69·14). Diarrhoea prevalence at age 12 weeks in the intervention and control clusters was 20 (5%) and 36 (9%), respectively, in Burkina Faso (0·57, 0·27–1·22); 39 (10%) and 32 (9%), respectively, in Uganda (1·13, 0·81–1·59); and 45 (8%) and 33 (7%), respectively, in South Africa (1·16, 0·78–1·75). The prevalence at age 24 weeks in the intervention and control clusters was 26 (7%) and 32 (8%), respectively, in Burkina Faso (0·83, 0·45–1·54); 52 (13%) and 59 (16%), respectively, in Uganda (0·82, 0·58–1·15); and 54 (10%) and 33 (7%), respectively, in South Africa (1·31, 0·89–1·93). Interpretation: Low-intensity individual breastfeeding peer counselling is achievable and, although it does not affect the diarrhoea prevalence, can be used to effectively increase EBF prevalence in many sub-Saharan African settings. URI: http://hdl.handle.net/10566/516 Files in this item: 2
TylleskarExclusiveBreastfeeding2011.pdf (1.030Mb) -
Stern, Ruth; Puoane, Thandi; Tsolekile, Lungiswa (Centers for Disease Control and Prevention, 2010)[more][less]
Abstract: Introduction Noncommunicable diseases are increasing in developing countries, exacerbated by growing urbanization. We examined the experiences and perceptions about noncommunicable diseases of people who migrated from rural areas to urban Cape Town, South Africa. Methods We conducted a qualitative study in an impoverished periurban township that has a noncommunicable disease prevention program, including health clubs. We used in-depth interviews, participatory reflection and action groups, and focus group discussions. Results Participants described changes in eating patterns and levels of physical activity. These changes were a result of socioeconomic and environmental constraints. However, respondents were not concerned about these changes. Despite hardships, they were pleased with their urban lifestyle. Furthermore, they approved of their weight gain because it signified dignity and respect. Participants who attended health clubs found them informative and socially and emotionally supportive. Conclusion The study highlighted the complexity of the risk factors for noncommunicable diseases and the need to develop prevention strategies that extend beyond the traditional focus on diet and exercise. URI: http://hdl.handle.net/10566/292 Files in this item: 1
PuoaneExplorationNCD2010.pdf (381.1Kb) -
Moshabela, Mosa; Schneider, Helen; Silal, Sheetal; Cleary, Susan (BioMed Central, 2012)[more][less]
Abstract: Background: In low-resource settings, patients’ use of multiple healthcare sources may complicate chronic care and clinical outcomes as antiretroviral therapy (ART) continues to expand. However, little is known regarding patterns, drivers and consequences of using multiple healthcare sources. We therefore investigated factors associated with patterns of plural healthcare usage among patients taking ART in diverse South African settings. Methods: A cross-sectional study of patients taking ART was conducted in two rural and two urban sub-districts, involving 13 accredited facilities and 1266 participants selected through systematic random sampling. Structured questionnaires were used in interviews, and participant’s clinic records were reviewed. Data collected included household assets, healthcare access dimensions (availability, affordability and acceptability), healthcare utilization and pluralism, and laboratory-based outcomes. Multiple logistic regression models were fitted to identify predictors of healthcare pluralism and associations with treatment outcomes. Prior ethical approval and informed consent were obtained. Results: Nineteen percent of respondents reported use of additional healthcare providers over and above their regular ART visits in the prior month. A further 15% of respondents reported additional expenditure on self-care (e.g. special foods). Access to health insurance (Adjusted odds ratio [aOR] 6.15) and disability grants (aOR 1.35) increased plural healthcare use. However, plural healthcare users were more likely to borrow money to finance healthcare (aOR 2.68), and incur catastrophic levels of healthcare expenditure (27%) than non-plural users (7%). Quality of care factors, such as perceived disrespect by staff (aOR 2.07) and lack of privacy (aOR 1.50) increased plural healthcare utilization. Plural healthcare utilization was associated with rural residence (aOR 1.97). Healthcare pluralism was not associated with missed visits or biological outcomes. Conclusion: Increased plural healthcare utilization, inequitably distributed between rural and urban areas, is largely a function of higher socioeconomic status, better ability to finance healthcare and factors related to poor quality of care in ART clinics. Plural healthcare utilization may be an indication of patients’ dissatisfaction with perceived quality of ART care provided. Healthcare expenditure of a catastrophic nature remained a persistent complication. Plural healthcare utilization did not appear to influence clinical outcomes. However, there were potential negative impacts on the livelihoods of patients and their households. URI: http://hdl.handle.net/10566/547 Files in this item: 1
MoshabelaAntiretroviralTherapy2012.pdf (419.5Kb) -
Mabunda, Jabu; Bradley, Hazel A. (LAM Publications Ltd, 2011)[more][less]
Abstract: The purpose of the study was to assess factors contributing to poor performance of Directly Observed Treatment Short-Course (DOTS) in Mopani district of Limpopo Province, South Africa. An exploratory qualitative approach was used to investigate the factors that contribute to poor performance of the DOTS Strategy. Four focus group discussions were conducted, two with Directly Observed Therapy (DOT) Supporters and two with patients on treatment for more than 6 months. The focus groups (4) discussions were tape-recorded. Data collected were descriptively analyzed using thematic methods. The patients generally found supervision of TB treatment helpful as they were motivated and encouraged to continue treatment. Some of the aspects identified as being unhelpful were the inconvenient times for treatment support and stigma due TB supporters’ visit to patients home. Patients often preferred family members as supporters, whereas health workers favoured trained volunteers as DOT supporters. Other factors affecting DOTS were poverty, food shortage, cultural beliefs, and side-effects of the medication. Patients receiving disability grants prefer to remain uncured so as to continue receiving the grant. Behavioural factors seem to play a major role in noncompliance with TB treatment. The findings of the study support the importance of initial counseling and motivation of patients in improving adherence in the programme. Self-motivation was mentioned rather than the motivation from the DOT supporters. Further exploration of alternative DOTS supporters other than trained volunteer demands further investigation. URI: http://hdl.handle.net/10566/315 Files in this item: 1
MabundaTBDOTS2011.pdf (108.3Kb) -
Hughes, Gail; Hoyo, Catherine; Puoane, Thandi (South African Medical Association, 2006)[more][less]
Abstract: BACKGROUND: In South Africa, former apartheid laws encouraged rural males seeking employment to migrate to urban areas, moving weekly, monthly or annually between their rural families and urban workplaces. The combination of the migrant labour system and long family separations caused an explosion of serious health consequences, among others sexually transmitted infections (STIs) in the migrant population. OBJECTIVE: To describe some correlates of male migration patterns for the rural women left behind, especially the fear of STIs that this engendered in them and their risk-avoidance behaviour. Setting and subjects. In KwaZulu-Natal, 208 prenatal patients who were partners of oscillating male migrant workers were interviewed to determine their demographic and behavioural characteristics, and their fear of STIs. RESULTS: Thirty-six per cent of the rural women said that they were afraid of contracting STIs from their returning migrant partners. Women who saw their partners infrequently were more fearful of STI transmission, and were less able to have sexual communication. However, almost none of the women protected themselves, while only 8% used condoms, primarily for contraceptive purposes. CONCLUSIONS: These results reflect the gender-based power relationships of South African male migrants and their rural partners, the social and economic dependency of the women on their migrant partners, and the women’s social responsibility to bear children. The results point to the need to go beyond interventions that simply seek to modify behaviour without altering the forces that promote risk taking and discourage risk reduction, and the need to develop appropriate interventions to curb STIs and decrease HIV. URI: http://hdl.handle.net/10566/260 Files in this item: 1
PuoaneSTIs2006.pdf (563.5Kb) -
Dewing, Sarah; Matthews, Catherine; Schaay, Nikki; Cloete, Allanise; Simbayi, Leickness; Chopra, Mickey (Springer, 2011)[more][less]
Abstract: This case study with one lay adherence counsellor assessed the implementation of Options for Health, a sexual risk-reduction intervention based on Motivational Interviewing (MI), in an antiretroviral clinic in Cape Town, South Africa. In most cases Options was not delivered with fidelity and less than one-third of intended recipients received it; the counsellor often forgot to do Options, was unsure how to deal with particular cases and felt that there was not always time to do Options. Options was not implemented in a way that was consistent with MI. Revisions to the implementation plan and training programme are required. URI: http://hdl.handle.net/10566/473 Files in this item: 1
DewingAntiretroviralClinic2011.pdf (162.5Kb) -
Schneider, Helen; Govender, Veloshnee; Harris, Bronwyn; Cleary, Susan; Moshabela, Mosa; Birch, Stephen (Blackwell Publishing Ltd, 2012)[more][less]
Abstract: Objectives: A mixed methods study exploring gender differences in patient profiles and experiences of ART services, along the access dimensions of availability, affordability and acceptability, in two rural and two urban areas of South Africa. methods Structured exit interviews (n = 1266) combined with in-depth interviews (n = 20) of women and men enrolled in ART care. results Men attending ART services were more likely to be employed (29% vs. 20%, P = 0.001) and were twice as likely to be married ⁄ co-habiting as women (42% vs. 22% P = 0.001). Men had known their HIV status for a shorter time (mean 32 vs. 36 months, P = 0.021) and were also less likely to disclose their status to non-family members (17% vs. 26%, P = 0.001). From both forms of data collection, a key finding was the role of female partners in providing social support and facilitating use of services by men. The converse was true for women who relied more on extended families and friends than on partners for support. Young, unmarried and unemployed men faced the greatest social isolation and difficulty. There were no major gender differences in the health system (supply side) dimensions of access. conclusions Gender differences in experiences of HIV services relate more to social than health system factors. However, the health system could be more responsive by designing services in ways that enable earlier and easier use by men. URI: http://hdl.handle.net/10566/474 Files in this item: 1
SchneiderART-Services2012.pdf (66.55Kb) -
Zarowsky, Christina (BioMed Central, 2011)[more][less]
Abstract: The papers in this important collection reflect a mature and confident way of doing global health research which is anything but business-as-usual. In the context of increasing competition for individual or institutional “leadership” of the field (and business) of gobal health, these contributors instead speak of active and sustained collaboration -- listening, responsiveness, flexibility, willingness and capacity to follow as well as to lead -- in learning what to transform or sustain, and how, in order to move towards greater equity in both health and health research. Each paper and the collection as a whole is an important contribution to the evidence base for a range of issues from maternal health, HIV and access to services, to chronic disease, health system strengthening, occupational health, ecosystemic approaches to health, and social inclusion, exclusion, and neglect. In addition, they challenge conventional models of research focused on narrowly defined research questions and a narrow range of pre-specified research methods, documenting instead how both the research questions and the methods most appropriate to address them change over time. Finally, they challenge both the idea of “pure” science undertaken by independent researchers on behalf of science and specific communities, and the conventional wisdom that North-South and research-research user-community partnerships are necessarily either North and researcher-driven, or scientifically dubious. URI: http://hdl.handle.net/10566/460 Files in this item: 1
ZarowskyGlobalHealthPartnership2011.pdf (155.1Kb) -
London, Leslie; Schneider, Helen (Elsevier Ltd, 2012)[more][less]
Abstract: While neoliberal globalisation is associated with increasing inequalities, global integration has simultaneously strengthened the dissemination of human rights discourse across the world. This paper explores the seeming contradiction that globalisation is conceived as disempowering nations states' ability to act in their population's interests, yet implementation of human rights obligations requires effective states to deliver socio-economic entitlements, such as health. Central to the actions required of the state to build a health system based on a human rights approach is the notion of accountability. Two case studies are used to explore the constraints on states meeting their human rights obligations regarding health, the first drawing on data from interviews with parliamentarians responsible for health in East and Southern Africa, and the second reflecting on the response to the HIV/AIDS epidemic in South Africa. The case studies illustrate the importance of a human rights paradigm in strengthening parliamentary oversight over the executive in ways that prioritise pro-poor protections and in increasing leverage for resources for the health sector within parliamentary processes. Further, a rights framework creates the space for civil society action to engage with the legislature to hold public officials accountable and confirms the importance of rights as enabling civil society mobilization, reinforcing community agency to advance health rights for poor communities. In this context, critical assessment of state incapacity to meet claims to health rights raises questions as to the diffusion of accountability rife under modern international aid systems. Such diffusion of accountability opens the door to 'cunning' states to deflect rights claims of their populations. We argue that human rights, as both a normative framework for legal challenges and as a means to create room for active civil society engagement provide a means to contest both the real and the purported constraints imposed by globalisation. URI: http://hdl.handle.net/10566/475 Files in this item: 1
LondonGlobalInequalities2012.pdf (178.5Kb) -
Uwimana, Jeannine; Jackson, Debra; Hausler, Harry; Zarowsky, Christina (Wiley-Blackwell, 2012)[more][less]
Abstract: In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers’ and community care workers’ (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB⁄ HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility- and communitybased organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB⁄ HIV activities including PMTCT will require political will and leadership to address these health systems barriers. URI: http://hdl.handle.net/10566/457 Files in this item: 1
UwimanaHealthSystemBarriers2012.pdf (205.7Kb) -
Scott, Vera; Chopra, Mickey; Conrad, Liz; Ntuli, Antoinette (Health and Medical Publishing Group, 2005)[more][less]
Abstract: OBJECTIVES. To assess the extent of inequalities in availability and utilisation of HIV services across South Africa. DESIGN. Cross-sectional descriptive study. Setting. Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled. Outcome measures. Availability and utilisation of HIV services and management and support structures for programmes were assessed through the collection of secondary data supplemented by site visits. RESULTS. There were marked inequalities in service delivery between the three sites. Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing (100% v. 52% and 24% respectively), better uptake of this service (59 v. 9 and 5.5 clients per 1 000 adults respectively) and greater distribution of condoms (15.6 v. 8.2 condoms per adult male per year). Extra counsellors had also been employed at the urban site in contrast to the other 2 sites. The urban site also had far more intensive management support and monitoring, with 1 manager per 12 health facilities compared with 1 manager per more than 90 health facilities at the other 2 sites. CONCLUSION. The process of scaling up of HIV services seems to be accentuating inequalities. The urban site in this study was better able to utilise the extra resources. In contrast, the poorer sites have thus far been unable to scale up the response to HIV even with the availability of extra resources. Unless policy makers pay more attention to equity, efficacious interventions may prove to be of limited effectiveness. URI: http://hdl.handle.net/10566/172 Files in this item: 1
ScottHowEquitable2005.pdf (307.4Kb)