Mental distress, COVID19 vaccine distrust and vaccine hesitancy in South Africa: A causal mediation regression analysis.

AIM: Within the context of increasing mental distress noted since the beginning of the COVID19 pandemic, the study aims at analysing the relationship between mental health, vaccine distrust and vaccine hesitancy in South Africa. SUBJECT AND METHODS: The study uses nationally representative panel data of 3241 individuals interviewed prior to and during the COVID19 pandemic. The study uses a range of regression techniques including logit, mediation and gradient-boosted causal mediation models to identify the causal relationship while accounting for selection bias. RESULTS: The results of multivariate logit regression reveal that vaccine distrust is the most important predictor of vaccine hesitancy [Coeff: 3.420, CI 3.122, 3.717]. Mental distress is not found to be a significant driver in a fully specified logit model, pointing to the need to analyse the pathways through which mental distress impacts vaccine hesitancy. The mediation regression undertaken for this purpose finds that the mental distress has a positive and significant association with vaccine distrust [Coeff: 0.027, CI: 0.0029, 0.052]. The increased vaccine distrust in turn results in increased vaccine hesitancy [Coeff: 0.661, CI: 0.611, 0.711]. The results of mediation regression therefore indicate strong and significant mediation effects, whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. These results are robust to the gradient boosted causal mediation model which establishes strong and significant indirect effects [Coeff: 0.015, CI: 0.01, 0.019], whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. CONCLUSION: The study concludes that mental health impacts on vaccine intention through the mediating role of vaccine distrust. The findings indicate that individuals at high risk of depression are more concerned regarding the safety of vaccines, which in turn feeds into vaccine hesitancy. Therefore, depressive symptoms impact on vaccine hesitancy through the mediating factor of vaccine distrust.

Food insecurity and health outcomes during the coronavirus pandemic in South Africa: a longitudinal study.

BACKGROUND: Given that South Africa experienced significant food insecurity even before the COVID-19 pandemic, it is not surprising that the pandemic would result in even greater food insecurity in the country. This paper provides additional evidence on the relationship between food insecurity and health. METHODS: Data came from the National Income Dynamics Study-Coronavirus Rapid Mobile Survey, a longitudinal survey of adult South Africans. Health was a self-reported indicator of general health, while food insecurity was measured by household hunger, the frequency of household hunger, and households running out of money to buy food. We performed descriptive and econometric analyses. RESULTS: Food insecurity has remained high even in the face of greater re-opening of the economy. Moreover, among hunger-affected households, between a quarter and a third struggled with hunger almost daily or daily. Belonging to a hunger-affected household was associated with a 7-percentage point higher probability of worse health compared to not experiencing hunger. Compared to being unaffected by hunger, being hungry everyday was associated with a 15-percentage point higher probability of worse health in wave 1, an effect that became statistically insignificant by wave 4. CONCLUSIONS: These results show the enormity of the hunger problem in South Africa and its adverse effects on health. In the face of economic uncertainty and the removal of COVID-19 palliatives like the grant top-ups, we enjoin policy makers to protect the vulnerable from food insecurity by continuing the implementation of anti-hunger policies and other measures that enhance food security in the country.

Health indicators and poor health dynamics during COVID-19 pandemic.

It is expected that the coronavirus pandemic will exacerbate inequality in wellbeing compared to the pre-pandemic situation. However, there are theories (e.g., the Conservation of Resource (COR) theory) that acknowledge situation-specific lower wellbeing for individuals who typically have more resources. The argument is that perception of loss might occur differently across the socioeconomic spectrum such that individuals with higher socioeconomic status perceive that they experience more loss. Therefore, given the pandemic situation, it is possible that indicators of poor wellbeing (e.g., depression) becoming less concentrated among the poor, contrary to expectation. Given the above, we examine income-related inequality in self-assessed health and depressive symptoms in South Africa. This is done using both pre-pandemic data (i.e. National Income Dynamic Study) and data collected during the pandemic (National Income Dynamic Study-Coronavirus Rapid Mobile Survey). Consistent with expectation, we find that poor self-assessed health is not only disproportionately concentrated amongst the poor, but this concentration has increased compared to the pre-pandemic period. However, contrary to expectation, depressive symptoms have become less concentrated amongst the poor compared to the pre-pandemic period. We note that while there may be an alternative explanation for this change in trend, it may also be due to situation-specific lower wellbeing for individuals who typically have more resources. We argue that this has implication for tracking population health in a crisis.

Socio-economic inequalities in ability to work from home during the coronavirus pandemic

The coronavirus pandemic has changed the nature of work, with physical distancing regulations aimed at preventing infections necessitating work-from-home (WFH) arrangements. Studies indicate that many individuals prefer working from home due to fear of contracting the virus at work. However, not all work can be performed from home. Moreover, jobs that are amenable to be performed from home generally pay more, while the ability to WFH will likely increase income inequality. Therefore, we ascertained socio-economic inequalities in ability to WFH among South African employees during the pandemic. We used data from the National Income Dynamics Study-Coronavirus Rapid Mobile Survey, a nationally representative longitudinal survey of South Africans conducted during the pandemic. We found that the ability to WFH was pro-rich (i.e. concentrated on workers in higher socio-economic classes) in all study periods. The results were robust to the use of different ranking variables and varying the age cut-off. There was no gender difference in these inequalities. Casual employment, urban residence, being married/cohabiting, age and household size dampened the degree to which ability to WFH favoured those in higher socio-economic classes. Conversely, being non-African, living in a house/flat and having more education increased the pro-richness of the ability to WFH. This study highlights the significant inequalities associated with ability to WFH, a likely important positive determinant of welfare in the pandemic and post-pandemic periods. Interventions targeted at inequality-enhancing factors such as race, housing and education may be important in lowering these inequalities.JEL Codes: D63, J22

COVID19 vaccine intentions in South Africa: health communication strategy to address vaccine hesitancy.

BACKGROUND: Vaccine hesitancy is emerging as a significant challenge in many parts of the world in the fight against the COVID19 pandemic. The continued infection amongst the unvaccinated can lead to a heightened risk of further virus mutation, exposing even those vaccinated to new virus strains. Therefore, there are social benefits in minimising vaccine hesitancy. The objective of this study is to assess the level of COVID19 vaccine hesitancy in South Africa, identify the socio-economic patterns in vaccine hesitancy and highlight insights from the national survey that can inform the development of a COVID-19 vaccination acceptance communication campaign. METHODS: The study uses the nationally representative National Income Dynamics Study - Coronavirus Rapid Mobile Survey (NIDS-CRAM) survey. The analysis combines univariate and bivariate statistics, as well as multivariate regression models like binomial/ordinal and multinomial logit. RESULTS: The study finds that vaccine acceptance is lower than that of non-pharmaceutical intervention like face-mask use. Only 55% fully accept the vaccine, while a further 16% are moderately accepting of vaccines. Together, vaccine acceptance is estimated at 70.8%, and vaccine hesitancy against COVID19 is estimated at 29.2% amongst the adult South African population. The study has identified the perceived risk of infection with the mediating role of efficacy as a key predictor of vaccine intention. Higher awareness of COVID19 related information and higher household income are correlated with lower vaccine hesitancy. The non-black African population group has significantly high vaccine hesitancy compared to black Africans. CONCLUSIONS: There are other significant differences across socio-economic and demographic variables in vaccine hesitancy. From a communication perspective, it is imperative to continue risk messaging, hand in hand with clearer information on the efficacy of the vaccines.

Childcare and depression during the coronavirus pandemic in South Africa: A gendered analysis.

BACKGROUND: The 2019 coronavirus disease (COVID-19) pandemic resulted in the closure of businesses and schools, the remote provision of services and the disruption of the services of professional childminders. These disruptions resulted in a significant increase in parental responsibility for childcare. Such a substantial increase in time requirements for childcare domestically has potential mental health consequences. We therefore ascertained the relationship between childcare and depression in South Africa during the pandemic. METHODS: Data came from the National Income Dynamics Study-Coronavirus Rapid Mobile Survey, a longitudinal telephonic survey conducted during the COVID-19 pandemic in South Africa. The outcome was a depression index obtained from the two-item Patient Health Questionnaire while the main covariate was the average number of hours spent in taking care of children per weekday. We employed the ordered logit model. FINDINGS: We found a positive relationship between spending more hours on childcare and worse depressive health for caregivers in both periods analyzed. Childcare responsibilities preventing/mitigating the ability of caregivers to work as well as preventing caregivers from searching for jobs moderated the depression-childcare relationship. CONCLUSION: These findings highlight the need to carefully consider policy responses aimed at containing the pandemic. We advocate a multi-stakeholder approach to mitigating the mental health impact of COVID-19 by encouraging more collaboration between government, school authorities, employers and parents/guardians.

Income-related health inequalities associated with the coronavirus pandemic in South Africa: A decomposition analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has resulted in an enormous dislocation of society especially in South Africa. The South African government has imposed a number of measures aimed at controlling the pandemic, chief being a nationwide lockdown. This has resulted in income loss for individuals and firms, with vulnerable populations (low earners, those in informal and precarious employment, etc.) more likely to be adversely affected through job losses and the resulting income loss. Income loss will likely result in reduced ability to access healthcare and a nutritious diet, thus adversely affecting health outcomes. Given the foregoing, we hypothesize that the economic dislocation caused by the coronavirus will disproportionately affect the health of the poor. METHODS: Using the fifth wave of the National Income Dynamics Study (NIDS) dataset conducted in 2017 and the first wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) dataset conducted in May/June 2020, this paper estimated income-related health inequalities in South Africa before and during the COVID-19 pandemic. Health was a dichotomized self-assessed health measure, with fair and poor health categorized as "poor" health, while excellent, very good and good health were categorized as "better" health. Household per capita income was used as the ranking variable. Concentration curves and indices were used to depict the income-related health inequalities. Furthermore, we decomposed the COVID-19 era income-related health inequality in order to ascertain the significant predictors of such inequality. RESULTS: The results indicate that poor health was pro-poor in the pre-COVID-19 and COVID-19 periods, with the latter six times the value of the former. Being African (relative to white), per capita household income and household experience of hunger significantly predicted income-related health inequalities in the COVID-19 era (contributing 130%, 46% and 9% respectively to the inequalities), while being in paid employment had a nontrivial but statistically insignificant contribution (13%) to health inequality. CONCLUSIONS: Given the significance and magnitude of race, hunger, income and employment in determining socioeconomic inequalities in poor health, addressing racial disparities and hunger, income inequality and unemployment will likely mitigate income-related health inequalities in South Africa during the COVID-19 pandemic.