Social distancing behaviour: avoidance of physical contact and related determinants among South Africans: twelve days into the COVID-19 lockdown.

Social distancing behaviour is a primary preventive measure for reducing COVID-19 transmission. Improved understanding of factors associated with adherence to social distancing is vital for mitigating the impact of COVID-19 in South Africa. The study assessed adherence to social distancing and its associated factors during the state-implemented lockdown in South Africa. Data was analysed from a large-scale public survey conducted in South Africa from 8 to 29 April 2020, which was administered online and telephonically. Invitations to participate were distributed widely on local websites and social media networks, including on a data-free platform. Adherence to social distancing was measured by self-report of having engaged in close physical contact with someone outside the home. Simple and multiple logistic regression models examined the association between social distancing and potential explanatory variables. Of the 17,586 participants, 9.2% came into close physical contact with a person outside their home by hugging, kissing, or shaking hands during the past 7 days. The odds of coming into close physical contact with other people were significantly higher for males, students, and those with incorrect knowledge on physical distancing, angry attitudes about the lockdown, lack of confidence in the government response, high-risk perception, movement out of the local area, travelling to shops using public transport, households with communal water facilities and higher household size. The 25-59-year olds compared to 18-24-year olds, and the White and Indian/Asian compared to the African population groups had significantly lower odds of close physical contact with others outside the home. The study identifies subgroups of individuals for whom public health interventions to improve adherence to social distancing should be prioritised and tailored. Interventions and policies should take cognisance of the social determinants of health as well as culturally accepted greeting practices like hand shaking.

Adverse event reporting practices in drug-resistant tuberculosis facilities across South Africa.

Background: The reporting of adverse drug reactions associated with drug-resistant tuberculosis (DR-TB) medication is important for pharmacovigilance, especially in high-burden countries such as South Africa. With DR-TB treatment being so dynamic, it is important to understand adverse event reporting practices at specialised facilities. Objectives: The study aimed to understand the adverse drug reaction (ADR) reporting practices at DR-TB treatment facilities in South Africa. Method: Interviews were conducted with healthcare workers at specialised DR-TB facilities. This was to collect data on demographics, pharmacovigilance training, and determine attitudes and practices towards reporting adverse events. A checklist was developed to review the most recent adverse event forms captured at the facility. Results: Most participants did not have adverse event reporting training since their initial training but were confident that they could complete a form themselves. Most participants could correctly identify the major adverse events associated with DR-TB medication, but some deemed non-adverse events as plausible. Adverse event report forms were not standardised with most participants deeming further training and regular feedback as reasons to report ADRs. Conclusion: Standardisation of adverse event report forms used and the establishment of regular reporting will increase adverse event reporting at DR-TB facilities. Continuous training, empowerment and expansion of staff categories eligible to report adverse events will enhance and sustain such practice. Contribution: The study highlights challenges faced by healthcare professionals in reporting adverse events.

Determinants of Social Distancing Among South Africans From 12 Days Into the COVID-19 Lockdown: A Cross Sectional Study.

Introduction: Social or physical distancing has been an effective measure for reducing the spread of COVID-19 infections. Investigating the determinants of adherence to social distancing can inform public health strategies to improve the behaviour. However, there is a lack of data in various populations. This study investigates the degree to which South Africans complied with social distancing during the country's COVID-19 lockdown and identifies the determinants associated with being in close contact with large numbers of people. Materials and Methods: Data was collected from a South African national online survey on a data free platform, supplemented with telephone interviews. The survey was conducted from 8 to 29 April 2020. The primary outcome was the number of people that participants came into close contact with (within a 2-metre distance) the last time they were outside their home during the COVID-19 lockdown. Multivariate multinomial regression investigated the socio-demographic, psychosocial and household environmental determinants associated with being in contact with 1-10, 11-50 and more than 50 people. Results: Of the 17,563 adult participants, 20.3% reported having not left home, 50.6% were in close physical distance with 1-10 people, 21.1% with 11-50 people, and 8.0% with >50 people. Larger household size and incorrect knowledge about the importance of social distancing were associated with being in contact with >50 people. Male gender, younger age and being in the White and Coloured population groups were significantly associated with being in contact with 1-10 people but not with larger numbers of people. Employment, at least secondary school education, lack of self-efficacy in being able to protect oneself from infection, and moderate or high risk perception of becoming infected, were all associated with increased odds of close contact with 1-10, 11-50, and >50 people relative to remaining at home. Conclusion: The findings identify subgroups of individuals that are less likely to comply with social distancing regulations. Public health communication, interventions and policy can be tailored to address these determinants of social distancing.

Mapping the Burden of Hypertension in South Africa: A Comparative Analysis of the National 2012 SANHANES and the 2016 Demographic and Health Survey.

This study investigates the provincial variation in hypertension prevalence in South Africa in 2012 and 2016, adjusting for individual level demographic, behavioural and socio-economic variables, while allowing for spatial autocorrelation and adjusting simultaneously for the hierarchical data structure and risk factors. Data were analysed from participants aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES) 2012 and the South African Demographic and Health Survey (DHS) 2016. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported health professional diagnosis or on antihypertensive medication. Bayesian geo-additive regression modelling investigated the association of various socio-economic factors on the prevalence of hypertension across South Africa's nine provinces while controlling for the latent effects of geographical location. Hypertension prevalence was 38.4% in the SANHANES in 2012 and 48.2% in the DHS in 2016. The risk of hypertension was significantly high in KwaZulu-Natal and Mpumalanga in the 2016 DHS, despite being previously nonsignificant in the SANHANES 2012. In both survey years, hypertension was significantly higher among males, the coloured population group, urban participants and those with self-reported high blood cholesterol. The odds of hypertension increased non-linearly with age, body mass index (BMI), waist circumference. The findings can inform decision making regarding the allocation of public resources to the most affected areas of the population.

Myths, misconceptions, othering and stigmatizing responses to Covid-19 in South Africa: A rapid qualitative assessment.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new strain of virus in the Coronavirus family that has not been previously identified. Since SARS-CoV-2 is a new virus, everyone is at risk of catching the Coronavirus disease 2019 (Covid-19). No one has immunity to the virus. Despite this, misconceptions about specific groups of people who are immune to Covid-19 emerged with the onset of the pandemic. This paper explores South African communities' misconceptions about who is most vulnerable to Covid-19. A rapid qualitative assessment was conducted remotely in Gauteng, KwaZulu-Natal and the Western Cape provinces of South Africa. Recruitment of study participants took place through established relationships with civil society organizations and contacts made by researchers. In total, 60 key informant interviews and one focus group discussion was conducted. Atlas.ti.8 Windows was used to facilitate qualitative data analysis. The qualitative data was coded, and thematic analysis used to identify themes. The results show a high level of awareness and knowledge of the transmission and prevention of SARS-CoV-2. Qualitative data revealed that there is awareness of elderly people and those with immunocompromised conditions being more vulnerable to catching Covid-19. However, misconceptions of being protected against the virus or having low or no risk were also evident in the data. We found that false information circulated on social media not only instigated confusion, fear and panic, but also contributed to the construction of misconceptions, othering and stigmatizing responses to Covid-19. The study findings bring attention to the importance of developing communication materials adapted to specific communities to help reduce misconceptions, othering and stigmatization around Covid-19.

Alcohol Outlet Density and Deprivation in Six Towns in Bergrivier Municipality before and after Legislative Restrictions.

Introduction. In 2016, after the Western Cape Liquor Act was enacted, alcohol outlets were mapped in the six towns from a previous 2008 study to determine: (1) alcohol outlet density; (2) the association between deprivation and alcohol outlet density; (3) geospatial trends of alcohol outlet densities; and (4) the impact of alcohol legislation. Methods. Latitude and longitude coordinates were collected of legal and illegal alcohol outlets, and alcohol outlet density was calculated for legal, illegal and total alcohol outlets by km2 and per 1000 persons. To determine the impact of legislation, t-tests and hot spot analyses were calculated for both 2008 and 2016 studies. Spearman coefficients estimated the relationship between alcohol outlet density and deprivation. Results. Although not statistically significant, the number of alcohol outlets and the density per 1000 population declined by about 12% and 34%, respectively. Illegal outlets were still more likely to be located in more deprived areas, and legal outlets in less deprived areas; and a reduction or addition of a few outlets can change a town's hot spot status. Conclusions. Further studies with larger sample sizes might help to clarify the impacts of the Liquor Act, and the more recent 2017 Alcohol-Related Harms Reduction Policy on alcohol outlet density in the province.

HIV self-testing could "revolutionize testing in South Africa, but it has got to be done properly": perceptions of key stakeholders.

South Africa bears the world's largest burden of HIV with over 6.4 million people living with the virus. The South African government's response to HIV has yielded remarkable results in recent years; over 13 million South Africans tested in a 2012 campaign and over 2 million people are on antiretroviral treatment. However, with an HIV & AIDS and STI National Strategic Plan aiming to get 80 percent of the population to know their HIV status by 2016, activists and public health policy makers argue that non-invasive HIV self-testing should be incorporated into the country HIV Counseling and Testing [HCT] portfolios. In-depth qualitative interviews (N = 12) with key stakeholders were conducted from June to July 2013 in South Africa. These included two government officials, four non-governmental stakeholders, two donors, three academic researchers, and one international stakeholder. All stakeholders were involved in HIV prevention and treatment and influenced HCT policy and research in South Africa and beyond. The interviews explored: interest in HIV self-testing; potential distribution channels for HIV self-tests to target groups; perception of requirements for diagnostic technologies that would be most amenable to HIV self-testing and opinions on barriers and opportunities for HIV-linkage to care after receiving positive test results. While there is currently no HIV self-testing policy in South Africa, and several barriers exist, participants in the study expressed enthusiasm and willingness for scale-up and urgent need for further research, planning, establishment of HIV Self-testing policy and programming to complement existing facility-based and community-based HIV testing systems. Introduction of HIV self-testing could have far-reaching positive effects on holistic HIV testing uptake, giving people autonomy to decide which approach they want to use for HIV testing, early diagnosis, treatment and care for HIV particularly among hard-to reach groups, including men.

Perceptions of sugar mommy practices in South Africa.

The study sought to explore sugar mommy practices regarding their occurrence, acceptability as well as perceived reasons why older women and younger men enter into sugar mommy relationships. An exploratory qualitative study involving 135 participants from 11 diverse focus groups in terms of age, gender (females=27%) and geotype throughout the nine South African provinces was conducted. Data on the participants' views, opinions and experiences of sugar mommy practices were collected using focus group interviews. The data were thematically analyzed. The study found that sugar mommy practices were prevalent in South Africa. The perceived reasons for acceptability were: love, survival, and correctness. Perceived reasons why older women have sexual relationships with younger men included: sexual fulfilment, domination, reduction of stress, physical attraction, procreation, lack of self-control, youthful feeling, migrancy, difficulty in finding partners of compatible age and young men being seen as not demanding. Perceived reasons why younger men have sexual relationships with older women included: material gain, reduction of stress, being enticed, rejection by women of compatible age, peer influence and belief that older women are purer. Given the increase in sugar mommy practices, which may have significant implications for the prevalence of HIV/AIDS, it is necessary to understand the underlying perceptions of these practices, in order to develop culturally relevant and socially acceptable intervention programmes.

Self-reported prevalence of chronic non-communicable diseases and associated factors among older adults in South Africa.

INTRODUCTION: Little is known about the prevalence and predictors of chronic non-communicable diseases (NCDs) of older adults in South Africa. This study aims to investigate the self-reported prevalences of major chronic NCDs and their predictors among older South Africans. METHODS: We conducted a national population-based cross-sectional survey with a sample of 3,840 individuals aged 50 years or above in South Africa in 2008. The outcome variable was the self-reported presence of chronic NCDs suffered, namely, arthritis, stroke, angina, diabetes, chronic lung disease, asthma, depression, and hypertension. The exposure variables were sociodemographic characteristics: age, gender, education, wealth status, race, marital status, and residence. Multivariate logistic regression was used to determine sociodemographic factors predictive of the presence of chronic NCDs. RESULTS: The prevalence of chronic NCDs was 51.8%. The prevalence of multimorbidity (≥2 chronic conditions) was 22.5%. Multivariate logistic regression analysis showed that being female, being in age groups 60-79 and 70-79, being Coloured or Asian, having no schooling, having greater wealth, and residing in an urban area were associated with the presence of NCDs. CONCLUSION: The rising burden of chronic NCDs affecting older people places a heavy burden on the healthcare system as a result of increased demand and access to healthcare services. Concerted effort is needed to develop strategies for the prevention and management of NCDs, especially among economically disadvantaged individuals who need these services the most.

Self-rated health and associated factors among older South Africans: evidence from the study on global ageing and adult health.

BACKGROUND: Population ageing has become significant in South African society, increasing the need to improve understandings of health and well-being among the aged. OBJECTIVE: To describe the self-reported ratings of overall health and functioning, and to identify factors associated with self-rated health among older South Africans. DESIGN: A national population-based cross-sectional survey, with a sample of 3,840 individuals aged 50 years and older, was completed in South Africa in 2008. Self-reported ratings of overall health and functioning were measured using a single self-reported health state covering nine health domains (used to generate the Study on Global Ageing and Adult Health (SAGE) composite health state score). Disability was measured using the World Health Organization Disability Assessment Schedule II (WHODAS-II) activities of daily living (ADLs), instrumental activities of daily living (IADLs), perceptions of well-being, and the World Health Organization Quality of Life index/metric (WHOQoL). RESULTS: Overall, more than three quarters (76.8%) of adults rated their health as moderate or good. On balance, men reported very good or good health more often than women (p<0.001). Older people (aged 70 years and above) reported significantly poorer health status than those aged 50-59 (adjusted odds ratio (AOR) 1.52; 95% confidence interval (CI) 1.00-2.30). Indians and Blacks were significantly more likely to report poorer health status at (AOR = 4.01; 95% CI 1.27-12.70) and (AOR = 0.42; 95% CI 0.18_0.98; 30 p < 0.045), respectively, compared to Whites. Respondents with primary education (AOR = 1.83; 95% CI 1.19-2.80) and less than primary education (AOR = 1.94; 95% CI 1.37-2.76) were more likely to report poorer health compared to those with secondary education. In terms of wealth status, those in low wealth quintile (AOR = 2.02; 95% CI 1.14-3.57) and medium wealth quintile (AOR = 1.47; 95% CI 1.01-2.13) were more likely to report poorer health status than those in high wealth quintile. Overall, the mean WHODAS-II score was 20%, suggesting a low level of disability. The mean WHOQoL score for females (Mean = 51.5; SD = 12.2) was comparable to that of males (Mean = 49.1; SD = 12.6). CONCLUSION: The depreciation in health and daily functioning with increasing age is likely to increase demand for health care and other services as people grow older. There is a need for regular monitoring of the health status of older people to provide public health agencies with the data they need to assess, protect, and promote the health and well-being of older people.

Pre- and post-intervention assessment of a PMTCT-programme-strengthening initiative in a rural area of the Eastern Cape, South Africa.

The research assesses prevention-of-mother-to-child-transmission-of-HIV (PMTCT) services following implementation of programme-strengthening activities in a municipality in the Eastern Cape Province, South Africa. A pre-intervention and post-intervention design was used to conduct facility assessments and client exit interviews at baseline and after 28 months. For the facility assessments, unstructured interviews were conducted with the heads of maternity wards at each delivery facility (n = 4), nurses (n = 9) and lay counsellors (n = 18). District Health Information System (DHIS) records were used to assess changes on PMTCT-programme indicators. Observations were conducted at the fixed clinics and hospitals to determine compliance to the national criteria for PMTCT-services delivery. For the exit interviews with clients, the pre- and post-assessment samples, respectively, included women attending for antenatal care (n = 296; n = 239) as well as HIV-positive women attending for postnatal care (n = 70; n = 142). The personnel generally perceived the PMTCT services as having been strengthened as a result of the initiative and the DHIS records showed positive changes. Client exit interviews revealed significant increases in the numbers of women who: were aware of the PMTCT programme; were tested for HIV during their pregnancy; were aware of VCT before coming to the facility; knew their HIV-test result; and, had helpful pre-HIV-test and/or post-HIV-test counselling experiences. The long waiting periods at the facilities and the relatively short length of the counselling sessions remained a serious concern. Lessons learnt may help with designing strategies to expand the national programme in South Africa as well as PMTCT programmes elsewhere.

Factors associated with female high-risk drinking in a rural and an urban South African site.

OBJECTIVE: To assess and compare the extent of high-risk drinking and factors associated with high-risk drinking in the adult female population of a rural and an urban region in South Africa. DESIGN: Cross-sectional household survey using multistage sampling methods. Setting. A rural wine farming area of the Western Cape and an urban site in Gauteng. Subjects. Women of reproductive age (18 - 44 years). Outcome measures. The extent of risky alcohol consumption measured using the Alcohol Use Disorders Identification Test (AUDIT) scale which categorises current drinkers into high- and low-risk drinkers. RESULTS: Twenty-seven per cent (166/606) and 46% (188/412) of the women interviewed in Gauteng and the Western Cape respectively were current drinkers. In turn, 20% (33/166) of the Gauteng current drinkers and 68% (128/188) of the Western Cape current drinkers were classified as high-risk drinkers. Multivariate analysis indicated that employed people in Gauteng were less likely to be high-risk drinkers (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1 - 0.8). Living in a household that never/seldom went hungry was inversely associated with risky drinking for both sites (OR 0.3, 95% CI 0.1 - 0.9 for Gauteng and OR 0.2, 95% CI 0.3 - 1.2 for the Western Cape). Current smokers (Western Cape) (OR 7.6, 95% CI 3.1 - 18.9) and respondents with an alcohol problem in one or more family members (both sites) (OR 6.0, 95% CI 2.3 - 15.7 and OR 3.1, 95% CI 1.5 - 6.4) were more likely to be high-risk drinkers. CONCLUSIONS: High-risk drinking by women is a major problem, especially in the Western Cape. Targeted interventions are needed for women with alcohol problems in the family setting, lower socio-economic status, and concurrent substance abuse.

Predictors of risk of alcohol-exposed pregnancies among women in an urban and a rural area of South Africa.

The study sought to determine the prevalence and predictors of being at risk of an alcohol-exposed pregnancy (AEP) among women of child-bearing age in an urban and rural location in South Africa. We conducted a cross-sectional household survey of 1018 women aged 18-44 years in one urban (n=606) and one rural (n=412) site. The women were interviewed using a structured questionnaire. We defined the primary dependent variable, being at risk of having an AEP, as current alcohol use, not being pregnant, being fertile, and no effective use of contraceptives. The independent variables included demographic, substance use, health perceptions, psycho-social, and partner characteristics. The rural women (21.84%) were more likely than their urban counterparts (11.22%) to be at risk of an AEP. In multiple logistic regression analyses, significant predictors of being in the "at risk" group for the urban women were (a) being 'white' as opposed to 'black/African', and being 'coloured' as opposed to 'black/African'; and (b) current smoking. For the rural women, significant risk factors were (a) current smoking and (b) early onset of alcohol use. The significant protective factors were (a) education; (b) knowledge about Fetal Alcohol Syndrome; (c) parity. Use of stricter alcohol use criteria (i.e., three or more drinks and five or more drinks per sitting) in the definition of risk of an AEP yielded slightly different patterns of significant predictors. The results revealed high levels of risk of an alcohol-exposed pregnancy, especially amongst the rural women, and a need for location-specific prevention programmes. The high burden of AEP in South Africa calls for the establishment of national AEP prevention strategies and programmes as a matter of urgency.

Barriers to accessing PMTCT services in a rural area of South Africa.

Despite good intentions and commitment from providers, prevention-of-mother-to-child-transmission of HIV (PMTCT) services can be difficult for pregnant women to access, despite the provision of free health services for women and children. We examined the introduction of PMTCT services in a very poor rural area of the Eastern Cape, South Africa, to assess the context's impact on the provision of this service. Our approach involved 13 individual in-depth interviews and 26 focus group discussions, spread over six clinics in a single district, supplemented by situational observations. Our goal was to suggest how access to PMTCT services at the clinics may be improved. Poor roads, an underdeveloped transport system and poor telecommunications typify the pervasive poverty in the study area. Families have few resources for travel and most live a long distance from a clinic. Accessing emergency transport is especially difficult and expensive. Poor infrastructure also means that many families do not have access to clean water, which complicates the use of infant formula. PMTCT services had been recently added to several clinics that provide general services to the local population, but that were already understaffed and over-pressured. Since the PMTCT services were new, some elements of the intervention and staff training were delayed, thus inhibiting full implementation. New staff had not been added to ease accumulated pressures. Thus, socio-economic context can present a formidable barrier to the provision of PMTCT services. Improvement in services to rural areas will require creative thinking, perhaps including the use of mobile services and the development of community structures, such as contributions to community health education by traditional birth attendants and local volunteer groups.