Browsing by Author "Chola, Lumbwe"

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    Association of neighbourhood and individual social capital, neighourhood economic deprivation and self-rated health in South Africa - a multi-level analysis
    (Public Library of Science, 2013-07-29) Chola, Lumbwe; Alaba, Olufunke
    Introduction: Social capital is said to influence health, mostly in research undertaken in high income countries' settings. Because social capital may differ from one setting to another, it is suggested that its measurement be context specific. We examine the association of individual and neighbourhood level social capital, and neighbourhood deprivation to self-rated health using a multi-level analysis. Methods: Data are taken from the 2008 South Africa National Income Dynamic Survey. Health was self-reported on a scale from 1 (excellent) to 5 (poor). Two measures of social capital were used: individual, measured by two variables denoting trust and civic participation; and neighbourhood social capital, denoting support, association, behaviour and safety in a community. Results: Compared to males, females were less likely to report good health (Odds Ratio 0.82: Confidence Interval 0.73, 0.91). There were variations in association of individual social capital and self-rated health among the provinces. In Western Cape (1.37: 0.98, 1.91) and North West (1.39: 1.13, 1.71), trust was positively associated with reporting good health, while the reverse was true in Limpopo (0.56: 0.38, 0.84) and Free State (0.70: 0.48, 1.02). In Western Cape (0.60: 0.44, 0.82) and Mpumalanga (0.72: 0.55, 0.94), neighbourhood social capital was negatively associated with reporting good health. In North West (1.59: 1.27, 1.99) and Gauteng (1.90: 1.21, 2.97), increased neighbourhood social capital was positively associated with reporting good health. Conclusion: Our study demonstrated the importance of considering contextual factors when analysing the relationship between social capital and health. Analysis by province showed variations in the way in which social capital affected health in different contexts. Further studies should be undertaken to understand the mechanisms through which social capital impacts on health in South Africa.
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    Cost-effectiveness of peer counselling for the promotion of exclusive breastfeeding in Uganda
    (Public Library of Science, 2015) Chola, Lumbwe; Fadnes, Lars T.; Engebretsen, Ingunn M. S.; Nkonki, Lungiswa; Nankabirwa, Victoria; Sommerfelt, Halvor; Tumwine6, James K.; Tylleskar, Thorkild; Robberstad, Bjarne; PROMISE-EBF Study Group
    Background: Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children. Methods: Data were obtained from a community randomized trial conducted in Uganda between 2006–2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, two methods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis. Findings: Peer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analyses Conclusions: Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda’s GDP per capita (US$1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.
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    Costs of promoting exclusive breastfeeding at community level in three sites in South Africa
    (PLoS, 2014-01) Nkonki, Lungiswa Leonora; Daviaud, Emmanuelle; Jackson, Debra; Chola, Lumbwe; Doherty, Tanya; Chopra, Mickey; Robberstad, Bjarne
    Background: Community-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of settings. Methods: We conducted a cost analysis of a community cluster randomised-controlled trial (Promise-EBF), aimed at promoting exclusive infant feeding in three sites in South Africa. The costs were considered from the perspective of health service providers. Peer supporters in this trial visited women to support exclusive infant feeding, once antenatally and four times postpartum. Results: The total economic cost of the Promise-EBF intervention was US$393 656, with average costs per woman and per visit of US$228 and US$52, respectively. The average costs per woman and visit in an operational ‘non research’ scenario were US$137 and US$32 per woman and visit, respectively. Investing in the promotion of exclusive infant feeding requires substantial financial commitment from policy makers. Extending the tasks of multi-skilled community health workers (CHWs) to include promoting exclusive infant feeding is a potential option for reducing these costs. In order to avoid efficiency losses, we recommend that the time requirements for delivering the promotion of exclusive infant feeding are considered when integrating it within the existing activities of CHWs. Discussion: This paper focuses on interventions for exclusive infant feeding, but its findings more generally illustrate the importance of documenting and quantifying factors that affect the feasibility and sustainability of community-based interventions, which are receiving increased focus in low income settings.
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    Knowledge and attitudes of non-occupational HIV post-exposure prophylaxis amongst first- and second year medical students at Stellenbosch University in South Africa
    (AOSIS Publishing, 2014-11) Ncube, Nondumiso, B.Q.; Meintjes, Willem A.J.; Chola, Lumbwe
    Background: Human immunodeficiency virus (HIV) infection is a worldwide problem, with 68% of infected people residing in sub-Saharan Africa. Antiretroviral therapy is used as post-exposure prophylaxis (PEP) to prevent infection in cases of occupational exposure, and use has recently been expanded to nonoccupational exposure. Studies have demonstrated a lack of awareness of non-occupational PEP (NOPEP) in the general population. Aim: The aim of this study was to evaluate knowledge and attitudes towards availability of, access to and use of NO-PEP amongst first- and second-year medical students. Setting: Participants were medical undergraduates of Stellenbosch University in the Western Cape of South Africa who were registered in 2013. Methods: A descriptive cross-sectional study of 169 students was performed. Data were collected using self-administered questionnaires handed out in a classroom in August 2013. Self-reported knowledge and attitudes towards NO-PEP and barriers to access to and use of NO-PEP were analysed using frequency tables. Associations between self-reported and objective knowledge of NO-PEP were analysed by odds ratios. Results: Over 90% of students had good knowledge on HIV transmission, and about 75% knew how it can be prevented. Twenty eight per cent (n = 47) of students reported knowledge of NO-PEP; 67% reported hearing about it from lecturers, whilst 1% reported hearing about it from their partner. Students who knew the correct procedure to take when a dose is forgotten were 2.4 times more likely to report knowledge of NO-PEP than those who did not know what to do when a dose is forgotten (p = 0.029). No other associations were statistically significant. Conclusion: Students had positive attitudes towards the use of NO-PEP and also identified barriers to its use. Despite good knowledge of HIV prevention and transmission, knowledge on NO-PEP was poor.
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    Modelling the cost of community interventions to reduce child mortality in South Africa using the Lives Saved Tool (LiST)
    (BMJ Publishing Group, 2017-08) Nkonki, Lungiswa L.; Chola, Lumbwe; Tugendhaft, Aviva; Hofman, Karen
    Objective: To estimate the costs and impact on reducing child mortality of scaling up interventions that can be delivered by community health workers at community level from a provider’s perspective. Setting: In this study, we used the Lives Saved Tool (LiST), a module in the spectrum software. Within the spectrum software, LiST interacts with other modules, the AIDS Impact Module, Family Planning Module and Demography Projections Module (Dem Proj), to model the impact of more than 60 interventions that affect cause-specific mortality. Participants: DemProj Based on National South African Data. Interventions: A total of nine interventions namely, breastfeeding promotion, complementary feeding, vitamin supplementation, hand washing with soap, hygienic disposal of children’s stools, oral rehydration solution, oral antibiotics for the treatment of pneumonia, therapeutic feeding for wasting and treatment for moderate malnutrition. Primary and secondary outcome measures: Reducing child mortality. Results: A total of 9 interventions can prevent 8891 deaths by 2030. Hand washing with soap (21%) accounts for the highest number of deaths prevented, followed by therapeutic feeding (19%) and oral rehydration therapy (16%). The top 5 interventions account for 77% of all deaths prevented. At scale, an estimated cost of US$169.5 million (US$3 per capita) per year will be required in community health worker costs. Conclusion: The use of community health workers offers enormous opportunities for saving lives. These programmes require appropriate financial investments. Findings from this study show what can be achieved if concerted effort is channelled towards the identified set of life-saving interventions.
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    The social determinants of multimorbidity in South Africa
    (BioMed Central, 2013-08) Alaba, Olufunke; Chola, Lumbwe
    Introduction: Multimorbidity is a growing concern worldwide, with approximately 1 in 4 adults affected. Most of the evidence on multimorbidity, its prevalence and effects, comes from high income countries. Not much is known about multimorbidity in low income countries, particularly in sub-Saharan Africa. The aim of this study was to determine the prevalence of multimorbidity and examine its association with various social determinants of health in South Africa. Method: The data used in this study are taken from the South Africa National Income Dynamic Survey (SA-NIDS) of 2008. Multimorbidity was defined as the coexistence of two or more chronic diseases in an individual. Multinomial logistic regression models were constructed to analyse the relationship between multimorbidity and several indicators including socioeconomic status, area of residence and obesity. Results: The prevalence of multimorbidity in South Africa was 4% in the adult population. Over 70% of adults with multimorbidity were females. Factors associated with multimorbidity were social assistance (Odds ratio (OR) 2.35; Confidence Interval (CI) 1.59-3.49), residence (0.65; 0.46-0.93), smoking (0.61; 0.38-0.96); obesity (2.33; 1.60-3.39), depression (1.07; 1.02-1.11) and health facility visits (5.14; 3.75-7.05). Additionally, income was strongly positively associated with multimorbidity. The findings are similar to observations made in studies conducted in developed countries. Conclusion: The findings point to a potential difference in the factors associated with single chronic disease and multimorbidity. Income was consistently significantly associated with multimorbidity, but not single chronic diseases. This should be investigated further in future research on the factors affecting multimorbidity.
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    Training for health services and systems research in Sub-Saharan Africa : a case study at four East and Southern African Universities
    (BioMed Central, 2013-12) Guwatudde, David; Bwanga, Freddie; Dudley, Lilian; Chola, Lumbwe; Leyna, Germana Henry; Mmbaga, Elia John; Kumwenda, Newton; Protsiv, Myroslava; Atkins, Salla; Zwarenstein, Merrick; Obua, Celestino; Tumwine, James K.
    Abstract Background The need to develop capacity for health services and systems research (HSSR) in low and middle income countries has been highlighted in a number of international forums. However, little is known about the level of HSSR training in Sub-Saharan Africa (SSA). We conducted an assessment at four major East and Southern African universities to describe: a) the numbers of HSSR PhD trainees at these institutions, b) existing HSSR curricula and mode of delivery, and c) motivating and challenging factors for PhD training, from the trainees’ experience. Methods PhD training program managers completed a pre-designed form about trainees enrolled since 2006. A desk review of existing health curricula was also conducted to identify HSSR modules being offered; and PhD trainees completed a self-administered questionnaire on motivating and challenging factors they may have experienced during their PhD training. Results Of the 640 PhD trainees enrolled in the health sciences since 2006, only 24 (3.8%) were in an HSSR field. None of the universities had a PhD training program focusing on HSSR. The 24 HSSR PhD trainees had trained in partnership with a university outside Africa. Top motivating factors for PhD training were: commitment of supervisors (67%), availability of scholarships (63%), and training attached to a research grant (25%). Top challenging factors were: procurement delays (44%), family commitments (38%), and poor Internet connection (35%). Conclusion The number of HSSR PhD trainees is at the moment too small to enable a rapid accumulation of the required critical mass of locally trained HSSR professionals to drive the much needed health systems strengthening and innovations in this region. Curricula for advanced HSSR training are absent, exposing a serious training gap for HSSR in this region.