Browsing by Author "Burger, R."

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Effects and determinants of tuberculosis drug stockouts in South Africa
    (BMC (part of Springer Nature), 2019) Koomen, L. E. M.; Burger, R.; Van Doorslaer, E. K. A.
    Background: The frequent occurrence of medicine stockouts represents a significant obstacle to tuberculosis control in South Africa. Stockouts can lead to treatment alterations or interruptions, which can impact treatment outcomes. This study investigates the determinants and effects of TB drug stockouts and whether poorer districts are disproportionately affected. Methods: TB stockout data, health system indicators and TB treatment outcomes at the district level were extracted from the District Health Barometer for the years 2011, 2012 and 2013. Poverty terciles were constructed using the Census 2011 data to investigate whether stockouts and poor treatment outcomes were more prevalent in more impoverished districts. Fixed-effects regressions were used to estimate the effects of TB stockouts on TB treatment outcomes. Results: TB stockouts occurred in all provinces but varied across provinces and years. Regression analysis showed a significant association between district per capita income and stockouts: a 10% rise in income was associated with an 8.50% decline in stockout proportions. In terms of consequences, after controlling for unobserved time invariant heterogeneity between districts, a 10% rise in TB drug stockouts was found to lower the cure rate by 2.10% (p < 0.01) and the success rate by 1.42% (p < 0.01). These effects were found to be larger in poorer districts. Conclusions: The unequal spread of TB drug stockouts adds to the socioeconomic inequality in TB outcomes. Not only are stockouts more prevalent in poorer parts of South Africa, they also have a more severe impact on TB treatment outcomes in poorer districts. This suggests that efforts to cut back TB drug stockouts would not only improve TB treatment outcomes on average, they are also likely to improve equity because a disproportionate share of this burden is currently borne by the poorer districts.
  • Thumbnail Image
    Item
    Temporal case study of household behavioural response to Cape Town's Day Zero using smart meter data
    (Elsevier, 2018-11-13) Booysen, M. J.; Visser, M.; Burger, R.
    ENGLISH ABSTRACT: Faced with the threat of "Day Zero", when it was feared that Cape Town's taps could run dry, consumers reduced household water usage from 540 to 280 litres per household per day over the 36 months between January 2015 and January 2018. This paper describes the events that prompted this reduction. We look at how changes in water use were a ected by o cial announcements and by public engagement with this news via the social media activity and internet searches. We analysed the water usage of a subset of middle to high income households where smart hot and cold water meters were installed. For hot water usage patterns we compared meter readings with that in another area una ected by the drought. We further map our cold water smart meter readings against that of the City of Cape Town's municipal data for domestic freestanding households | a sample of more than 400,000 households. We found that the introduction of Level 5 restrictions had a perverse e ect on consumption, possibly due to confusing messages. The most dramatic change in behaviour appears to have been instigated by a media storm and consequent user panic after the release of the City's CriticalWater Shortages Disaster Plan in October 2017. However, contradictory communication from national and provincial government eroded some of this gain. The paper concludes with recommendations for demand management in a similar future scenario.