Perceptions of the COVID-19 pandemic: a qualitative study with South African adults.

INTRODUCTION: In South Africa, public perceptions of the COVID-19 pandemic and risk mitigation measures remain mixed. To better understand health behaviours in the context of COVID-19, a qualitative study was conducted, which aimed to investigate perceptions relating to the COVID-19 pandemic among the South African adult population. METHODS: Twelve online focus groups were conducted across the following age groups: 18-34, 35-54, 55 + years old (total n = 70) in December 2021. Diversity across socioeconomic status, geographical areas, and urban and rural settings was maximised, with an equal representation of men and women. Focus groups were conducted, and audio recorded using an online platform, transcribed verbatim and thematically analysed using MAXQDA. RESULTS: There were mixed perceptions around the pandemic, however, the majority of participants appreciated government actions at the onset of the pandemic and as a result government trust was reported to have initially been high. Nevertheless, as the pandemic progressed, challenges relating to government communication around the pandemic, the inconsistent application of preventative measures by government, the use of soldiers to enforce preventative measures, the banning of alcohol and cigarettes, government corruption and the pervasiveness of social media were reported to have eroded government trust, negatively impacting the uptake of preventative measures. Economic and psychological impacts were experienced differently across income groups. Low-income earners, who already had pre-existing economic challenges reported increased psychological and financial strain. While the once cushioned middle class reported an increase in job insecurity accompanied by psychological challenges. High income earners did not report economic challenges but reported being affected psychologically. Though, low-income earners reported an appreciation of the government financial relief afforded to them middle income earners appeared to not have received adequate financial support. CONCLUSION: With the existing mistrust of government, there is need for government to leverage existing trusted sources in communities to aid in the implementation of preventative measures. These findings support the development of context specific solutions to address challenges faced at different socioeconomic levels.

Determinants of anaemia among women of reproductive age in South Africa: A Healthy Life Trajectories Initiative (HeLTI).

Anaemia continues to be a persistent concern among South African women of reproductive age (WRA), yet population specific information on its determinants remains sparse. We used baseline data from the Healthy Lives Trajectory Initiative a randomised trial (n = 480) to quantify factors associated with anaemia in Soweto, South Africa aged 18-25 years. We used multivariable logistic regression to describe associations with anaemia and used structural equation modelling to assess a theoretical model, which tested three categories socioeconomic status (household asset score, education level), nutritional factors (food security, leafy green vegetable and chicken and beef consumption, iron status and vitamin A status) and biodemographic factors (parity, age at start of menarche, HIV status, contraception use, anthropometry, and inflammation status). The multiple logistic regression showed that ID (OR: 2.62, 95% CI: 1.72, 3.98), iron deficiency erythropoiesis (IDE) (OR: 1.62, 95% CI: 1.07, 2.46), and elevated CRP (OR: 1.69, 95% CI: 1.04, 2.76), increased the odds of being anaemic. SEM analysis revealed Hb was directly and positively associated with adjusted ferritin (0.0031 per mg/dL; p≤0.001), and CRP (0.015 per mg/dL; p≤0.05), and directly and negatively associated with soluble transferrin receptor sTfR (-0.042 per mg/dL; p≤0.001). While contraception use had both a direct (0.34; p≤0.05) and indirect (0.11; p≤0.01) positive association with Hb. Additionally, chicken and beef consumption had a positive indirect association with Hb concentrations (0.15; p≤0.05) through adjusted ferritin. Iron deficiency was the main anaemia risk factor in this low resource setting. However, anaemia of inflammation is present. Therefore, we suggest that in our setting, WRA anaemia control programs that include interventions to reduce ID and inflammation should be tested.

Perceptions of the South African 24-Hour Movement Guidelines for Birth to 5 Years: A Qualitative Study.

BACKGROUND: South Africa launched 24-hour movement guidelines for birth to 5 years in 2018. Perceptions of these guidelines were assessed as part of the dissemination process with community-based organizations in 2019. METHODS: Fifteen dissemination workshops were held with community-based organization representatives and a range of stakeholders. Discussions were held with workshop attendees (n = 281) to obtain qualitative feedback on the guidelines and workshop. Six follow-up focus groups (n = 28) were conducted to obtain additional feedback on the guidelines and their dissemination. Discussions and focus groups were thematically analyzed. RESULTS: Participants recognized the importance of the guidelines for the health and development of young South African children. Participants' perceptions of the guidelines were consistently positive. The participants acknowledged the alignment of the guidelines with other South African programs and initiatives, and that they addressed gaps. Screen time and sleep were identified as the behaviors needing particular attention among young South African children. The negative impact of COVID-19 on young children's movement behaviors was acknowledged, especially regarding screen time. CONCLUSION: These findings provide evidence of stakeholders' positive perceptions of the South African guidelines and support the dissemination and implementation of these guidelines for the promotion of early childhood health and development in South Africa.

Barriers and facilitators of micronutrient supplementation among non-pregnant women of reproductive age in Johannesburg, South Africa.

The prevalence of anaemia among South African women of reproductive age (WRA) remains high at 39%. Multiple micronutrient supplementation (MMS) may be an effective strategy in the prevention and management of anaemia. Our aim was to understand facilitators and barriers to preconception MMS adherence and to explore perceptions and beliefs of MMS in the prevention and treatment of anaemia among non-pregnant WRA. This qualitative study was embedded in a preconception MMS intervention trial of WRA and was conducted in two phases. Phase one assessed the barriers and facilitators of MMS adherence. Individual interviews were conducted with the community health workers (n = 7) administering MMS, and with non-pregnant WRA (n = 25) participating in the trial. Phase two included four focus groups with participating WRA (n = 26), which further explored participants' perceptions and beliefs of MMS provision and adherence, and strategies to improve adherence. The reported facilitators to supplementation were family support, interaction with the community health workers, easy access to MMS, and experienced benefits of MMS. Barriers to preconception supplementation included the lack of family support, the link of supplements to antenatal care, and the perceived lack of benefits of MMS. Participants reported negative associations of supplements with medication, individual and societal stigma around medication and challenges around the supplementation schedule. For successful preconception MMS interventions, young women, their families, and communities need to be convinced of the value of supplementation. Public health interventions utilising preconception supplementation will require specialised training for health care providers, targeted counselling materials and community household support.

Evaluation of the Dissemination of the South African 24-Hour Movement Guidelines for Birth to 5 Years.

South Africa (SA) launched their 24-h movement guidelines for birth to five years in December 2018. The guideline dissemination plan adopted a "train-the-trainer" strategy through dissemination workshops with community-based organisations (CBOs) working in early childhood development. The aim of this paper is to: (1) document this dissemination process; and (2) report on the feasibility of implementing the dissemination workshops, the acceptability of the workshops (and guidelines) for different end-user groups, and the extent to which CBO representatives disseminated the guidelines to end-users. Fifteen workshops were held in seven of SA's nine provinces with a total of 323 attendees. Quantitative and qualitative findings (n = 281) indicate that these workshops were feasible for community-based dissemination of the guidelines and that this method of dissemination was acceptable to CBOs and end-users. Findings from follow-up focus groups (6 groups, n = 28 participants) indicate that the guidelines were shared with end-users of CBOs who participated in the focus groups. An additional musical storytelling resource, the "Woza, Mntwana" song, was well-received by participants; sharing via WhatsApp was believed to be the most effective way to disseminate this song. These findings confirm the feasibility and acceptability of culturally appropriate and context-specific community-based dissemination of behavioural guidelines in low-income settings.