Experiences of intimate partner violence (IPV) among females with same-sex partners in South Africa: what is the role of age-disparity?

BACKGROUND: South African women have been exposed to epidemic proportions of intimate partner violence (IPV) amongst heterosexual relationships but not much is known about same-sex partnerships. Sexual minorities are excluded from research but are subject to intimate partner violence as much as heteronormative persons. The purpose of this study is to determine the association between age-disparity and IPV outcomes among females with same-sex partners in South Africa. METHODS: A cross-sectional study of the nationally representative South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM 2017) is used. A weighted sample of 63,567 female respondents identified as having a same-sex partner are analysed. IPV is measured as ever been physically and/ or sexually abused. Any experience of IPV is included in the dependent variable of this study. Descriptive and inferential statistics are used to estimate the relationship between demographic, socioeconomic, age-disparity and IPV. RESULTS: Almost 16% of females in same-sex relationships experienced IPV and about 22% from younger partners. In female same-sex partnerships, partner age-disparity (OR: 1.30, CI: 1.18 - 1.51), type of place of residence (OR: 2.27, CI: 1.79 - 3.79), highest level of education (OR: 1.07, CI: 0.97 - 1.17), marital status (OR: 1.60, CI: 1.37 - 1.88), and race (OR: 1.47, CI: 1.41 - 1.54) are associated with an increased likelihood of violence. CONCLUSION: IPV programs that are specifically targeted for non-heteronormative orientations are needed. These programs should promote health equity and safety for non-confirmative sexual identities in the country.

Perpetuation of household food insecurity during COVID-19 in South Africa.

BACKGROUND: Perpetual food insecurity has long-term health and development effects on populations. The global pandemic created sub-populations that were newly food insecure, but there exists sub-populations were food insecure, and COVID-19 held that situation. This study seeks to identify the demographic and socioeconomic characteristics of the perpetually food insecure in South Africa in order to obtain specific evidence of populations to be prioritised in the post-pandemic era. METHODS: Secondary data from the South African National Income Dynamics CRAM Survey for rounds (Waves) 1 and 5 are analysed. The study population are those respondents who reported a household member not having enough food to eat in the early stages of the pandemic (1st round) and remained without sufficient food a year later (5th round). The study controls for the demographic and socioeconomic characteristics of the population but also changes to employment status, social grant access and willingness to be vaccinated. Descriptive and analytical statistical tests are used. RESULTS: A total of 26.15% of respondents were food insecure at the start of the pandemic. Of these, 41.09% remained food insecure a year later. The drivers of perpetual food insecurity during the pandemic include unemployment (OR = 2.09; CI 1.335293-3.265678), still being unemployed (OR = 1.86; CI 1.308032-2.636252), seven or more (≥ 7) household members (OR = 1.24; CI 1.1611329-1.610126), those with only a primary education (OR = 1.11; CI 1.5051066-2.434695), participants between the ages of 45 and 64 years old (ORs = 1.03 and 1.20; CIs 1.0171956-1.0171956 and 1.1733304-2.144875, respectively) and women (OR = 1.09; CI 1.0745444-1.406035). CONCLUSIONS: South Africa needs to address socioeconomic challenges and inequalities to assist the perpetually food insecure and to ensure that, should there be a pandemic resurgence, or a new pandemic, individuals and households in the country are in a better financial situation and appropriately supported to avoid food insecurity at all costs.

School attendance among refugee children with disabilities residing in South Africa: A cross-sectional, descriptive study.

Refugee children with disabilities are entitled to an education under South African law. These children face the challenges of living in a different country and having to manage their disabilities. However, without providing a quality education to refugee children with disabilities, they face lifelong challenges including poverty and exploitation. This nationally representative cross-sectional study, examines the prevalence of school attendance of refugee children with disabilities in South Africa. Using the Community Survey of 2016, 5,205 refugee children with disabilities are identified and studied. Descriptive statistics are used and results show that less than 5% of refugee children with disabilities are in school. Further there are differences across province of residence, sex and other sociodemographic characteristics. This study is a starting point for more quantitative analysis and further qualitative analysis on the barriers to education for refugee children with disabilities in the country.

The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study.

BACKGROUND: Despite the progress in reducing under-five mortality (U-5 M) in recent years, these deaths remain considerably high in Nigeria. This could be attributed to poor health policies including inequality of health insurance coverage and access to adequate healthcare services utilisations which has remained inimical to achieving sustainable development goals (SDGs). Therefore, this study examined the impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of U-5 M in Nigeria. METHODS: The data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 127,545 birth histories of childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using Cox proportional regression. The results were presented as hazard ratios (HR) with 95% confidence intervals (CIs). Data were analyzed using Stata software version 15.1. RESULTS: The results showed that 14.3% of the sampled birth histories of the childbearing women were children who died before age 5. The results further showed that 97.7% of the children were of mothers who have health insurance and over one-half (56.5%) were children whose mothers had adequate healthcare services utilisation. The risk of under-five death was significantly lower among the children of mothers who were covered by health insurance (HR: 0.66, CI: 0.42-1.02) and those whose mothers utilised adequate healthcare services (HR: 0.78, CI: 0.68-0.90). A similar result was observed among children whose mothers reported that distance to the health facility was not a problem (HR: 0.81, CI: 0.72-0.86). Some mothers' characteristics including educational attainment, wealth quintile and region of residence significantly influenced the risk of U-5 M. CONCLUSIONS: The study established that maternal health insurance coverage and adequate healthcare services utilisation were found to be protective factors against the risk of U-5 M. Also, the revealed low health insurance coverage of mothers calls for more pragmatic policy and intervention programmes through health insurance to achieve SDGs targets of ending preventable deaths of children under 5 years of age and ensuring quality, as well as universal access to maternal and child healthcare services.

The prevalence and socio-demographic correlates of hypertension among women (15-49 years) in Lesotho: a descriptive analysis.

BACKGROUND: Hypertensive disorders are among the leading conditions for severe maternal morbidity across all regions and have a major impact on health care costs. This study aimed to identify the prevalence and its associated socio-demographic correlates of hypertension among women of the reproductive ages in Lesotho. METHODS: The study used the Lesotho Demographic and Health Survey (2014 LDHS) data set. A total of 3353 women of childbearing age (15-49 years) whose blood pressure was measured were used for analysis. The blood pressure readings were categorized according to the JNC7 cut-offs. The dependent variable of this study is hypertension. Both bivariate and binary logistic regressions were performed to determine socio-demographic correlates of hypertension. RESULTS: Results from this study revealed that one out of every five respondents of the study had hypertension compared to 23% who were in the prehypertension stage. The situation adds to the overall future risk of hypertension. About 30% percent who were at the hypertension stage were either living with a partner or widowed. The odds of being hypertensive were significantly 9.78 times higher among women aged 45-49 years [CI: 6.38-15.00]. Other factors associated with hypertension among women of the reproductive ages were "living with a partner" [OR 3.55:95% CI: 1.76-7.16], widowed [OR 2.61:95% CI: 1.89-3.60], and residing in the Maseru district [OR 2.12: 95% CI: 1.49-3.03]. CONCLUSION: Chances of being diagnosed with high blood pressure increased with an increase with the age of the respondents. Age was found to be the most definite positive significant socio-demographic correlate of hypertension among women in Lesotho. To control hypertension, primary prevention strategies should target the identified high-risk -older age groups, the ever-married as well as prehypertensive women.

Women's attitudes towards negotiating safe sexual practices in Nigeria: Do family structure and decision-making autonomy play a role?

BACKGROUND: The risk of contracting sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) is related to women's sexual attitudes, beliefs, and power dynamics within marriages in developing countries. Despite the interventions towards improving women's sexual health and well-being, women are disproportionately affected by the risk of STIs transmission compared with their male counterparts in most sub-Saharan African countries including Nigeria. This study examined the roles of family structure and decision-making autonomy on women's attitudes towards negotiating safe sexual practices in Nigeria. METHODS: The study involved analyses of data from a nationally representative and weighted sample size of 28,219 ever-married/cohabiting women aged 15-49 years from the 2018 Nigeria Demographic and Health Survey. Descriptive and statistical analyses were carried out, including frequency tables, Pearson's chi-square test, and multivariable binary logistic regression model. RESULTS: The overall prevalence of having positive attitudes towards negotiating safe sexual practices were 76.7% and 69.6% for a wife justified in asking the husband to use a condom if he has an STI and refusing to have sex with the husband if he had sex with other women, respectively. The results further showed that polygamous unions negatively influenced urban and rural women's attitudes towards negotiating safe sexual practices, but women's decision-making autonomy on how to spend their earnings was found to be a protective factor for having positive attitudes towards negotiating safe sexual practices with partners. Surprisingly, there were significant variations in attitudes towards negotiating safe sexual practices among urban and rural women who enjoyed decision-making autonomy on their healthcare (aOR 1.70; CI 1.32-2.18 and aOR 0.52; CI 0.44-0.62, respectively). Plausibly, such women might have constrained them to compromise their sexual relationships for fear of being neglected by partners. CONCLUSION: The outcomes of this study have some policy implications for both maternal and child health. There is the need to intensify programmes aimed at improving women's sexual health and rights towards achieving sustainable development goals of preventing deaths of newborns, ending STIs and creating gender in Nigeria.

Time to hypertension development among people living with HIV in South Africa: A longitudinal analysis of the National Income Dynamics Survey (NIDS).

INTRODUCTION: There is an increased risk of hypertension among people living with HIV (PLWH). Older age has been associated with a higher risk of chronic conditions. In this study, we assess the time taken before adults living with HIV develop hypertension and explore the factors associated with hypertension diagnosis among PLWH. METHODS: Retrospective analysis on (n = 95 701) HIV positive adults from the longitudinal survey data from the National Income Dynamics Survey (NIDS) in South Africa was performed. The adults (18-75 years) were followed in order to determine the age of hypertension risk. Kaplan Meier survival estimates were used to show time to diagnosis. Multivariate cox regression model was used to determine the factors associated with hypertension diagnosis. RESULTS: 10.5% had HIV and hypertension at the start of the NID survey (wave 1:2008). Of the remaining (n = 85 569), over 75% aged 30-46 were at risk of developing hypertension. Thereafter the risk of hypertension comorbidity begins to decrease after the age of 45. In other words, the risk of hypertension began to reduce once the adults living with HIV turned 45 years old. There was no significant association between the development of hypertension comorbidity and the other demographic, socio-economic and health characteristics assessed. CONCLUSION: Young adults living with HIV are also at risk of hypertension. HIV infected persons need to routinely screen for chronic diseases and started on treatment timeously.

The comorbidity of HIV, hypertension and diabetes: a qualitative study exploring the challenges faced by healthcare providers and patients in selected urban and rural health facilities where the ICDM model is implemented in South Africa.

BACKGROUND: PLWH are living longer as a result of advancement and adherence to antiretroviral therapy. As the life expectancy of PLWH increases, they are at increased risk of hypertension and diabetes. HIV chronic co-morbidities pose a serious public health concern as they are linked to increased use and need of health services, decreased overall quality of life and increased mortality. While research shows that integrated care approaches applied within primary care settings can significantly reduce hospital admissions and mortality levels among patients with comorbidities, the primary care system in South Africa continues to be challenged with issues about the delivery of quality care. METHODS: This study applied a phenomenological qualitative research design. IDIs were conducted with 24 HCPs and adults living with the comorbidity of HIV and either hypertension or diabetes across two provinces in South Africa. The objective of the research was to understand the challenges faced by HCPs and patients in health facilities where the ICDM model is implemented. The health facilities were purposively sampled. However, the HCPs were recruited through snowballing and the patients through reviewing the facilities' clinic records for participants who met the study criteria. All participants provided informed consent. The data was collected between March and May 2020. The findings were analysed inductively using thematic content analysis. RESULTS: The challenges experienced included lack of staff capacity, unclear guidelines on the delivery of integrated care for patients with HIV chronic comorbidities, pill burden, non-disclosure, financial burden, poor knowledge of treatments, relocation of patients and access to treatment. Lack of support and integrated chronic programmes including minimal information regarding the management of HIV chronic comorbidities were other concerns. CONCLUSION: The outcomes of the ICDM model need to be strengthened and scaled up to meet the unique health needs and challenges of people living with HIV and other chronic conditions. Strengthening these outcomes includes providing capacity building and training on the delivery of chronic care treatment under the ICDM model, assisted self-management to improve patient responsibility of chronic disease management and strengthening activities for comorbidity health promotion.

Healthcare beliefs and practices of kin caregivers in South Africa: implications for child survival.

BACKGROUND: Appropriate health-seeking practices may have a positive influence on child survival, particularly when practiced by kin caregivers of children who are below the age of 5 years. While literature has shown that children who are raised in kinship care often present with poor health outcomes and often have unmet healthcare needs, the health-seeking behaviours and practices of the children's kin caregivers that ultimately influence these health outcomes remain largely unknown. In this paper, we explored the healthcare beliefs and practices of kin caregivers in South Africa on child survival. METHODS: Overall, 12 structured interviews were conducted with all the participants. Six [6] interviews were conducted in the Eastern Cape province and 6 were conducted in the KwaZulu-Natal province. The sample of participants was obtained by seeking permission from the child welfare authorities in the KwaZulu-Natal and Eastern Cape Department of Social Development (DSD) to assist in identifying a sample of the kin-caregivers who have provided primary care to children below the age of 5. The structured interviews were transcribed and analysed using thematic content analysis. After thematic content analysis was carried out, transcripts were given case numbers and then imported into NViVo version 11 for analysis and interpretation of the findings. RESULTS: The healthcare seeking behaviours and poor use of healthcare services of the caregivers were largely influenced by their notions and perceptions of health and illness. The notions and perceptions that the caregivers hold about the health statuses of the children placed under their care and illness were found to be largely culturally determined and largely influenced by preconceptions and certain healthcare beliefs. Increased reliance on traditional herbs, Notion of witchcraft and Faith healing emerged as key factors that influence health-seeking practices and beliefs of kin caregivers, thus influencing under-five mortality. CONCLUSION: Kin caregivers should be equipped with the necessary guidance, resources and training that facilitate the successful fulfilment of the caregiving role, given the number of unmet needs and challenges that they face. This will in turn translate into positive child health outcomes.

Exposure to Intimate Partner Violence and Hypertension Outcomes among Young Women in South Africa.

Hypertension and intimate partner violence is affecting longevity and quality of life among women worldwide. In this study, intimate partner violence is identified as a risk factor for hypertension outcomes among young women in South Africa. Using a nationally representative sample of 216 (N) young women (15-34 years old) from the South African Demographic and Health Survey, this study uses cross-tabulations and logistic regression methods to identify the odds of hypertension outcomes. Results show that between 20 and 41% of 15-34-year-old women have hypertension. Further, 68% of women with hypertension experienced physical intimate partner violence. Finally, the odds of hypertension are increased if young women experience physical (OR: 4.07; CI: 1.04726-15.82438) or sexual (OR: 2.56; CI: 1.18198-5.55834) intimate partner violence. Efforts to reduce hypertension outcomes in the country should include intimate partner violence awareness and assistance.

The relationship between women's experience of intimate partner violence and other socio-demographic factors, and under-5 children's health in South Africa.

Women in South Africa experience high levels of Intimate Partner Violence (IPV). There are numerous health consequences experienced by victims. However, children of IPV victims often experience negative emotional and developmental outcomes as well. In South Africa, infant and child health outcomes are not optimal and IPV is high, and thus there is a need to determine whether a relationship between them exists. This study used the 2016 South African Demographic and Health Survey. Mothers aged 15 to 49 and who were included in the Domestic Violence module formed the study population. Frequency tables and graphs were done, and unadjusted and adjusted logistic regressions were performed with each of the three reported child health outcomes (birth weight, duration of breastfeeding and diarrhoea incidence), IPV and other socio-demographic factors. Thirteen percent of women have experienced IPV. Five percent of their children were low birth weight, 10% had experienced diarrhoea; but 87% had been breastfed for 6+ months. Mothers in the rich wealth category were 37% more likely to have a child born at low birth weight but those aged 20 to 39 had around a 60% less likelihood of breastfeeding for 6+ months than 15 to 19-year olds. Women who had experienced IPV had around 77% higher odds of having a child experience diarrhoea in the last 2 weeks. Wealthier mothers often have unhealthier lifestyle practices and behaviours, due to more disposable income which could account for lower birth weight children. Mothers in tertiary education and starting their professional careers are normally around 20 to 39 years and should be provided supportive structures to be allowed to breastfeed their children. The long-term emotional and developmental consequences to children of IPV victims are known, but we now know that there are also very immediate consequences to the health of these children as well.