Understanding the differential impacts of COVID-19 among hospitalised patients in South Africa for equitable response

Background. There are limited in-depth analyses of COVID-19 differential impacts, especially in resource-limited settings such as South Africa (SA).Objectives. To explore context-specific sociodemographic heterogeneities in order to understand the differential impacts of COVID-19. Methods. Descriptive epidemiological COVID-19 hospitalisation and mortality data were drawn from daily hospital surveillance data, National Institute for Communicable Diseases (NICD) update reports (6 March 2020 - 24 January 2021) and the Eastern Cape Daily Epidemiological Report (as of 24 March 2021). We examined hospitalisations and mortality by sociodemographics (age using 10-year age bands, sex and race) using absolute numbers, proportions and ratios. The data are presented using tables received from the NICD, and charts were created to show trends and patterns. Mortality rates (per 100 000 population) were calculated using population estimates as a denominator for standardisation. Associations were determined through relative risks (RRs), 95% confidence intervals (CIs) and p-values <0.001. Results. Black African females had a significantly higher rate of hospitalisation (8.7% (95% CI 8.5 - 8.9)) compared with coloureds, Indians and whites (6.7% (95% CI 6.0 - 7.4), 6.3% (95% CI 5.5 - 7.2) and 4% (95% CI 3.5 - 4.5), respectively). Similarly, black African females had the highest hospitalisation rates at a younger age category of 30 - 39 years (16.1%) compared with other race groups. Whites were hospitalised at older ages than other races, with a median age of 63 years. Black Africans were hospitalised at younger ages than other race groups, with a median age of 52 years. Whites were significantly more likely to die at older ages compared with black Africans (RR 1.07; 95% CI 1.06 - 1.08) or coloureds (RR 1.44; 95% CI 1.33 - 1.54); a similar pattern was found between Indians and whites (RR 1.59; 95% CI 1.47 - 1.73). Women died at older ages than men, although they were admitted to hospital at younger ages. Among black Africans and coloureds, females (50.9 deaths per 100 000 and 37 per 100 000, respectively) had a higher COVID-19 death rate than males (41.2 per 100 000 and 41.5 per 100 000, respectively). However, among Indians and whites, males had higher rates of deaths than females. The ratio of deaths to hospitalisations by race and gender increased with increasing age. In each age group, this ratio was highest among black Africans and lowest among whites.Conclusions. The study revealed the heterogeneous nature of COVID-19 impacts in SA. Existing socioeconomic inequalities appear to shape COVID-19 impacts, with a disproportionate effect on black Africans and marginalised and low socioeconomic groups. These differential impacts call for considered attention to mitigating the health disparities among black Africans.

New Approaches; New activities and New Outcomes in International Conferences on HIV/AIDS in Africa: Report of the 3rd African Conference on the Social Aspects of HIV/AIDS; Dakar; 10-14 October 2005

Africa's HIV/AIDS situation remains cause for concern. The impact of HIV is considerable and threatens the survival and development of African societies. Although much has been attempted; the results still leave much to be desired. AIDS is an epidemic that needs to be addressed with much creativity and spirit of initiative. It is against this background that the 3rd African conference on the social aspects of HIV/AIDS brought innovations in the way international conferences are designed; activities implemented and results obtained. The innovations concerned the approach to international conferences and take into account reconceptualising HIV/AIDS so as to encourage holistic approaches and better visibility of vulnerable groups.The activities of the conference were organised in such a way as to get people living with HIV/AIDS (PLWHA); grassroots communities and marginalised groups to play a focal role.The conference offered an opportunity for developing cultural activities that would translate the African cultural concepts that had been identified as important in the HIV situation and response analysis. Interaction at the conference created an opportunity to analyse the various dimensions of the political; cultural and economic determinants. The conference offered food for thought around response construction while singling out the themes of urgency and acceleration of response; synergy construction; and coordination and conception of political responses

Translating Research into Policy: The case of Orphans and Vulnerable Children in South Africa

Policies are often developed without taking into account social science research findings and recommendations; despite the plethora of such research studies. This is largely because researchers and policy makers often work in isolation; yet if they worked synergistically they could have a significant impact on implementing interventions known to work to improve the lives of populations. Several approaches have been advanced to encourage policy makers to take heed of scientific findings and to urge scientists to take into account the needs of policy makers in designing their research agenda.This paper aims to illustrate how policy has been informed using the case study of the Orphans and Vulnerable Children project in South Africa. It further highlights the successes and challenges encountered thus far with this project. In some countries; particularly those of the north; there has been major progress in bridging this gap between research and policy; however; in developing countries much remains to be done

Factors Influencing the Utilisation of Prevention of Mother-to-Child-Transmission (PMTCT) Services by Pregnant Women in the Eastern Cape; South Africa

"The aim of the study was to identify factors influencing the utilisation of Prevention of Mother-to-Child Transmission (PMTCT) in a resource poor setting in South Africa. A sample of 186 pregnant women (29.6HIV positive and 70.4HIV negative) in four clinics in a rural district in the Eastern Cape were interviewed as part of the PMTCT programme after they had received their HIV test results. Regarding infrastructure; most women lacked transport to and communication with a health facility. More than 90felt that they had received adequate information on most of the components of the PMTCT programme. About 90of the women were satisfied with the HIV counselling they had received. Most women (54) felt they would receive support during their pregnancy mainly from their mothers; and/or husband/partner (50). Most pregnant women (92) preferred to give birth in hospital; while 8prefer to deliver at home; mostly with the assistance of a traditional birth attendant (TBA). Two-thirds of the HIV positive women stated they would feed their babies with formula milk only. Community attitudes towards people living with HIV/AIDS were mostly perceived as negative. Factors influencing the utilisation of PMTCT (that is the acceptance of antiretroviral therapy to HIV positive women; facility-based delivery; and adherence to ""take-home"" ART identified for mother and newborn); included: (1) HIV counselling by health care staff; (2) physical access to a health facility; (3) family and community support; (4) stigma; (5) delivery preference; and (6) infant feeding preferences."