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.

Preparedness for self-isolation or quarantine and lockdown in South Africa: results from a rapid online survey.

BACKGROUND: The World Health Organization (WHO) declared the COVID-19 pandemic a public health emergency of international concern. South Africa, like many other countries, initiated a multifaceted national response to the pandemic. Self-isolation and quarantine are essential components of the public health response in the country. This paper examined perceptions and preparedness for self-isolation or quarantine during the initial phase of the pandemic in South Africa. METHODS: The analysis used data obtained from an online quantitative survey conducted in all nine provinces using a data-free platform. Descriptive statistics and multivariable logistic regression models were used to analyse the data. RESULTS: Of 55,823 respondents, 40.1% reported that they may end up in self-isolation or quarantine, 32.6% did not think that they would and 27.4% were unsure. Preparedness for self-isolation or quarantine was 59.0% for self, 53.8% for child and 59.9% for elderly. The odds of perceived possibility for self-isolation or quarantine were significantly higher among Coloureds, Whites, and Indians/Asians than Black Africans, and among those with moderate or high self-perceived risk of contracting COVID-19 than those with low risk perception. The odds were significantly lower among older age groups than those aged 18-29 years, and those unemployed than fully employed. The odds of preparedness for self-isolation or quarantine were significantly less likely among females than males. Preparedness for self, child and elderly isolation or quarantine was significantly more likely among other population groups than Black Africans and among older age groups than those aged 18-29 years. Preparedness for self, child and elderly isolation or quarantine was significantly less likely among those self-employed than fully employed and those residing in informal dwellings than formal dwellings. In addition, preparedness for self-isolation or quarantine was significantly less likely among those with moderate and high self-perceived risk of contracting COVID-19 than low risk perception. CONCLUSION: The findings highlight the challenge of implementing self-isolation or quarantine in a country with different and unique social contexts. There is a need for public awareness regarding the importance of self-isolation or quarantine as well as counter measures against contextual factors inhibiting this intervention, especially in impoverished communities.

Determinants of Parents Taking Their Children for Scheduled Vaccinations during COVID-19 Pandemic in South Africa.

Scheduled or routine childhood vaccinations are known for their effectiveness in eradicating fear for many life-threatening and disabling diseases and saving lives globally. This paper is aimed at assessing determinants of parents taking their children for scheduled vaccinations during the COVID-19 pandemic in South Africa. Data used for this paper were obtained from the Human Sciences Research Council's (HSRC) COVID-19 Online Survey titled "One Year Later Survey", which was conducted between 25 June and 11 October 2021 in South Africa. Multivariate logistic regression analysis was performed to achieve this study goal. Findings showed that just over half of parents (56.7%) reported taking their children for scheduled vaccinations across the country. Males were significantly less likely (aOR = 0.53 95% CI [0.45-0.61], p < 0.001) to have taken their children for scheduled vaccinations than females. Parents' experiences and views were among key determinants of parents having taken their children for scheduled vaccinations in South Africa. Parents who had never taken influenza (flu) vaccines were significantly less likely (aOR = 0.33 [0.28-039], p < 0.001) to have taken their children for scheduled vaccinations than those who had taken flu vaccines. Parents who did not know anyone who had personally experienced serious side effects to any vaccine were significantly less likely (aOR = 0.77 [0.66-0.90], p = 0.001) to have taken their children for scheduled vaccinations than those who knew anyone who had experienced them. Parents who did not think vaccines were a good way to protect communities from disease were significantly less likely (aOR = 0.50 [0.33-0.77], p = 0.001) to have taken their children for scheduled vaccinations than those who thought vaccines were a good way to protect communities from disease. These findings are of significance especially during the time when the country is still struggling to reach a substantial proportion of its population vaccinated for COVID-19. Thus, these findings may be relevant in determining parents' intentions to have their children receive the South African Department of Health recommended vaccines for their respective age group.

Factors Affecting Access to Public Healthcare Facilities in the City of Tshwane, South Africa.

Access to healthcare services is largely determined by socioeconomic factors, with economically well-off individuals obtaining healthcare services more efficiently than those who are disadvantaged. This paper aims to assess the effects of socioeconomic and other related factors on access to healthcare facilities in the City of Tshwane, South Africa, during the COVID-19 pandemic. Data were sourced from the Gauteng City-Region Observatory (GCRO) quality of life survey (2020/2021). Multivariate logistic regression was applied. Results showed that 66.3% of the respondents reported that they had access to public healthcare facilities within their area. Furthermore, results showed that those who lived in informal houses were significantly (OR = 0.55, 95% CI [0.37-0.80], p < 0.01) less likely to report that they had access to public healthcare facilities in their area compared to those who lived in formal houses. More efforts need to be undertaken to ensure that all citizens have access to public healthcare facilities, especially among those who are disadvantaged, such as informal dwellers. In addition, future research should encompass locality in relation to the factors that affect access to public healthcare facilities, especially during pandemics such as the COVID-19 pandemic, in order to have geographically targeted interventions.

Exploring Determinants of HIV/AIDS Self-Testing Uptake in South Africa Using Generalised Linear Poisson and Geographically Weighted Poisson Regression.

Increased HIV/AIDS testing is of paramount importance in controlling the HIV/AIDS pandemic and subsequently saving lives. Despite progress in HIV/AIDS testing programmes, most people are still reluctant to test and thus are still unaware of their status. Understanding the factors associated with uptake levels of HIV/AIDS self-testing requires knowledge of people's perceptions and attitudes, thus informing evidence-based decision making. Using the South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey of 2017 (SABSSM V), this study assessed the efficacy of Generalised Linear Poisson Regression (GLPR) and Geographically Weighted Poisson Regression (GWPR) in modelling the spatial dependence and non-stationary relationships of HIV/AIDS self-testing uptake and covariates. The models were calibrated at the district level across South Africa. Results showed a slightly better performance of GWPR (pseudo R2 = 0.91 and AICc = 390) compared to GLPR (pseudo R2 = 0.88 and AICc = 2552). Estimates of local intercepts derived from GWPR exhibited differences in HIV/AIDS self-testing uptake. Overall, the output of this study displays interesting findings on the levels of spatial heterogeneity of factors associated with HIV/AIDS self-testing uptake across South Africa, which calls for district-specific policies to increase awareness of the need for HIV/AIDS self-testing.

Determinants of Deteriorated Self-Perceived Health Status among Informal Settlement Dwellers in South Africa.

Self-perceived health (SPH) is a widely used measure of health amongst individuals that indicates an individual's overall subjective perception of their physical or mental health status. As rural to urban migration increases, the health of individuals within informal settlements becomes an increasing concern as these people are at high health and safety risk due to poor housing structures, overcrowding, poor sanitation and lack of services. This paper aimed to explore factors related to deteriorated SPH status among informal settlement dwellers in South Africa. This study used data from the first national representative Informal Settlements Survey in South Africa conducted by the Human Sciences Research Council (HSRC) in 2015. Stratified random sampling was applied to select informal settlements and households to participate in the study. Multivariate logistic regression and multinomial logistic regression analyses were performed to assess factors affecting deteriorated SPH among the informal settlement dwellers in South Africa. Informal settlement dwellers aged 30 to 39 years old (OR = 0.332 95%CI [0.131-0.840], p < 0.05), those with ZAR 5501 and more household income per month (OR = 0.365 95%CI [0.144-0.922], p < 0.05) and those who reported using drugs (OR = 0.069 95%CI [0.020-0.240], p < 0.001) were significantly less likely to believe that their SPH status had deteriorated compared to the year preceding the survey than their counterparts. Those who reported always running out of food (OR = 3.120 95%CI [1.258-7.737], p < 0.05) and those who reported having suffered from illness or injury in the past month preceding the survey (OR = 3.645 95%CI [2.147-6.186], p < 0.001) were significantly more likely to believe that their SPH status had deteriorated compared to the year preceding the survey than their counterparts. In addition, those who were employed were significantly (OR = 1.830 95%CI [1.001-3.347], p = 0.05) more likely to believe that their SPH status had deteriorated compared to the year preceding the survey than those who were unemployed with neutral SPH as a base category. Overall, the results from this study point to the importance of age, employment, income, lack of food, drug use and injury or illness as key determinants of SPH amongst informal settlement dwellers in South Africa. Given the rapid increasing number of informal settlements in the country, our findings do have implications for better understanding the drivers of deteriorating health in informal settlements. It is therefore recommended that these key factors be incorporated into future planning and policy development aimed at improving the standard of living and health of these vulnerable residents.

Vaccine hesitancy and related factors among South African adults in 2021: unpacking uncertainty versus unwillingness.

Background: Amidst widespread public health recommendations and availability of COVID-19 vaccinations, half of South African adults are vaccinated against COVID-19. This study investigated the socio-behavioral determinants of vaccine hesitancy in South Africa, where vaccine hesitancy was separated into unwilling ness and uncertainty to take a COVID-19 vaccine. Methods: Data was collected from a large-scale public survey during June-October 2021 that included online and telephonic surveys. Vaccination hesitancy was based on the question "When available, would you take the COVID 19 vaccine?," with responses categorized into those who were willing, unwilling, and uncertain about taking a COVID-19 vaccine. Multinomial regression examined the association between socio-behavioral variables and vaccine hesitancy. Results: Overall, 73.8% reported they would definitely or probably take the vaccine, 16.4% were uncertain and 9.9% reported they probably or definitely would not (n = 16,988). Younger age, White and Colored population groups, no influenza vaccination history, previous vaccination refusal, knowing someone who experienced a serious vaccination side-effect, misperceptions about vaccine benefits, cultural or religious discouragement from taking a COVID-19 vaccination, lack of governmental confidence, concerns about side-effects, perceived lack of safety information, and lack of trust in the pharmaceutical industry and in the information from health care providers were all associated with higher odds of being uncertain and unwilling to take a COVID-19 vaccination. Strengths of association for unwillingness and uncertainty varied by the explanatory variables. Concern about effectiveness due to fast development was associated with uncertainty to take the vaccine but not with unwillingness. Concerns about side-effects had stronger associations with uncertainty than with unwillingness, while previous vaccine refusal, misperceptions of the protective benefits of vaccines, White population group, religious/cultural discouragement, and lack of trust in the pharmaceutical industry and health care providers' information had stronger associations with unwillingness than uncertainty. Conclusion: The determinants of COVID-19 vaccine hesitancy should be addressed in interventions to improve vaccine uptake. Public health interventions and health communication can be prioritized and tailored to the different forms of vaccination hesitancy.

Structural violence in South African primary healthcare facilities: insights from discussions with adolescents and young people seeking sexual and reproductive health needs.

INTRODUCTION: South Africa has an enabling legislative and policy framework that promotes the protection of adolescents and young people's sexual and reproductive health and rights. Much of the literature in this field has identified discriminatory and hostile attitudes from healthcare workers as a major underlying factor to negative sexual and reproductive health outcomes for this age cohort. Not as well understood is the role of structural violence although this type of violence, through its structures of injustice and inequalities, is closely associated with stigma and discrimination. DATA AND SOURCES: To contribute to closing this research gap, this paper draws on the findings of a larger qualitative study, specifically focus group discussions with young people aged 15-24 years. RESULTS: The consequences of these attitudes within the structural violence framework are illuminated as are recommendations for enhancing access to sexual and reproductive health and services by adolescents and young people. DISCUSSION AND CONCLUSION: Key among the latter is that young people's sexual and reproductive health needs and wellbeing should be pursued through a multisectoral approach that encompasses stigma reduction interventions involving the young people, families, and communities collaborating with healthcare workers.

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.

Determinants of Confidence in Overall Knowledge About COVID-19 Among Healthcare Workers in South Africa: Results From an Online Survey.

Background: Adequate information and knowledge about COVID-19 has been shown to induce the confidence and positive performance among healthcare workers (HCWs). Therefore, assessing the relationship between confidence in knowledge and associated factors among HCWs is vital in the fight against COVID-19. This paper investigates factors associated with HCWs' confidence in their overall knowledge about COVID-19 in South Africa in the early stages of the epidemic. Methods: Data utilized in this paper were from an online survey conducted among HCWs using a structured questionnaire on a data free online platform. The study population were all the medical fraternity in South Africa including medical and nurse practitioners as well as other healthcare professionals. Bivariate and multivariate logistic regression models were performed to examine the factors associated with confidence in HCWs' overall knowledge about COVID-19. Results: Overall, just below half (47.4%) of respondents indicated that they had confidence in their overall knowledge about COVID-19. Increased odds of having confidence in the knowledge about COVID-19 were significantly associated with being male [aOR = 1.31 95% CI (1.03-1.65), p < 0.05], having a doctorate degree [aOR = 2.01 (1.23-3.28), p < 0.05], being satisfied with the information about COVID-19 guidelines [aOR = 6.01 (4.89-7.39), p < 0.001], having received training in 6-8 areas [aOR = 2.54 (1.89-3.43), p < 0.001] and having received training in 9-11 areas [aOR = 5.33 (3.81-7.47), p < 0.001], and having already treated COVID-19 patients [aOR = 1.43 (1.08-1.90), p < 0.001]. Those who were highly concerned with the levels of training of HCWs [aOR = 0.47 (0.24-0.92), p < 0.05] had decreased odds of having confidence in their overall knowledge about COVID-19. Conclusion: This study sheds light on the importance of capacitating HCWs with knowledge and adequate relevant training as part of infection prevention control measures during pandemics. Future training and information sharing should be sensitive to knowledge gaps by age, gender, qualifications, professional categories, and experience.

Access to and Satisfaction with Basic Services in Informal Settlements: Results from a Baseline Assessment Survey.

Subjective responses of satisfaction with basic services delivery is an indicator of service delivery performance. This study provides an overview of the status of basic service delivery and determines the factors associated with service delivery satisfaction within informal settlements targeted for upgrading in South Africa. A multinomial logistic regression was used to analyze the relationship between satisfaction with basic services of water, sanitation, refuse and electricity with several predictors including individual factors, household factors, community factors and service-related factors. The most common source of drinking water, toilet facility and refuse disposal method were communal tap (55%) pit latrine (53%) and local authorities (34%), respectively. Approximately 52% of the respondents in the study reported not having access to electricity. Results also show that satisfaction in basic services delivery varies and is influenced by service-related factors. Interventions targeted at improving the quality of basic service provided are essential to meet the targets set out in the sustainable development goals.