Household preferences to water policy interventions in rural South Africa

Water Policy ◽  
2004 ◽  
Vol 6 (6) ◽  
pp. 487-499 ◽  
Author(s):  
R. A. Hope ◽  
G. D. Garrod

Water policy is often designed and implemented without negotiation with or participation from the intended beneficiaries. This is often the case in the implementation of global water policy initiatives that aim to benefit rural households in the developing world. Evidence of water policy responding to the locally defined preferences of the rural majority without improved water services is weak. Significant efforts have made to unpack quantity, quality and source attributes of domestic water supply to the least well-served populations in sub-Saharan Africa and Asia. This effort has been limited to evaluating individual attributes in relation to health, productivity and usage criteria rather than a ‘user evaluation’ of these attributes together. The advantage of the latter approach is that trade-offs between attributes can be estimated to provide parameters for each attribute and marginal rates of substitution between attributes. A choice experiment in rural South Africa examines the preferences of households to changes in domestic water sources, water quantity, water quality, stream-flow failure and productive uses of domestic water. Trade-offs in rural household domestic water preferences estimate welfare coefficients that provide a ‘user evaluation’ of water policy interventions. The findings provide defensible estimates of the magnitude and direction of the utility gain/loss from water attributes that allows a more evidenced-based understanding of rural households' preferences to water policy interventions.

2018 ◽  
Vol 3 (6) ◽  
pp. e000955 ◽  
Author(s):  
Guy Harling ◽  
Dumile Gumede ◽  
Maryam Shahmanesh ◽  
Deenan Pillay ◽  
Till W Bärnighausen ◽  
...  

IntroductionWhile young people in sub-Saharan Africa (SSA) are at greatest risk of HIV acquisition, uptake of HIV prevention interventions among them has been limited. Interventions delivered through social connections have changed behaviour in many settings, but not to date in SSA. There is little systematic evidence on whom young SSA adults turn to for advice. We therefore conducted an exploratory cross-sectional study from whom young rural South Africans received support and sexual behaviour-specific advice.MethodsWe asked 119 18–34  year olds in rural KwaZulu-Natal about the important people in their lives who provided emotional, informational, financial, physical, social or other support. We also asked whether they had discussed sex or HIV prevention with each contact named. We used descriptive statistics and logistic regression to analyse support and advice provision patterns.ResultsRespondents named 394 important contacts, each providing a mean of 1.7 types of support. Most contacts were relatives, same-gender friends or romantic partners. Relatives provided most informational, financial and physical support; friends and partners more social support and sexual advice. Respondents reported discussing sexual matters with 60% of contacts. Sources of support changed with age, from friends and parents, towards siblings and partners.DiscussionSexual health interventions for young adults in rural South Africa may be able to harness friend and same-generation kin social ties through which sex is already discussed, and parental ties through which other forms of support are transmitted. The gender-segregated nature of social connections may require separate interventions for men and women.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S13-S14 ◽  
Author(s):  
Itai M`yambo Magodoro ◽  
Stephen Oliver ◽  
Dickman Gareta ◽  
Tshwaraganang H Modise ◽  
Olivier Koole ◽  
...  

Abstract Background The healthcare infrastructure developed in response to the HIV epidemic in sub-Saharan Africa has been proposed as a model to respond to the emerging noncommunicable disease (NCD) burden in the region. However, the evidence for the effectiveness of such a strategy is equivocal. Methods We conducted a population-wide health screening among adults ≥15 years within a demographic and health surveillance site (DHSS) in rural South Africa. We collected blood pressure (BP), glycated hemoglobin (HbA1c), HIV disease indicators, and healthcare utilization data. We defined hypertension (HTN) as BP ≥140/90mmHg or use of antihypertensive medication in the past 2 weeks, and diabetes (DM) as HbA1c ≥6.5% or use of hypoglycemic medication in the past two weeks. Cascade of care indicators included: (1) awareness of NCD diagnosis, (2) seeing a provider within the past 6 months; (3) reported use of medication; and (4) disease control, defined as BP <140/90 mmHg or HbA1c <6.5%. We fit regression models to NCD care indicators between people with HIV on ART (PWHA) and HIV negatives. To make population-level estimates, we used inverse probability sampling weights derived from sex- and age-adjusted regression models drawn from the entire DHSS population. Results Of 7,992 individuals, 5,911 (74.2%) were HIV-negative and 2,080 (25.8%) were PWHA (Table 1). PWHA had lower prevalence of both DM (6.8% vs. 10.4%) and HTN (18.0% vs. 24.8%). In multivariable models, linkage to HIV care was associated with improved HTN care cascade indicators, but not DM indicators (Figure 1). PWHA had lower systolic BP and HbA1c than HIV negatives (Figures 2 and 3). Conclusion Linkage to ART programs may be associated with better HTN but not DM care in rural South Africa. Future work should explore how to translate success in ART programs to other NCDs, and for HIV-negative individuals. Disclosures All Authors: No reported Disclosures.


SAGE Open ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 215824401880634 ◽  
Author(s):  
Johannes N. Mampane

The “blesser and blessee” phenomenon has been prominent in South African media since the year 2016. This is a form of transactional sex in which older rich men (“blessers”) tend to entice young women (“blessees”) with money and expensive gifts in exchange for sexual favors. In most cases, these older men are married men who secretly engage in extramarital affairs with these young women. In this light, there have been many debates on whether transactional sex should be equated to prostitution or sex work. However, many researchers argue that both practices at the end of the day are proven to be equally high-risk sexual behaviors for HIV infection in sub-Saharan Africa. In this regard, the purpose of this study was to explore and describe perceptions and experiences of young women regarding factors that influence their susceptibility to transactional sex and the risk of HIV infection in rural South Africa. Twelve young women aged 18 to 30 years participated in two focus group discussions and 12 individual in-depth interviews. The findings of the study revealed that there are sociobehavioral, sociocultural, and socioeconomic factors that influence the susceptibility of young women to transactional sex and HIV risk. The study concluded that it was imperative for researchers to explore the context and motivation for transactional sex among young women in sub-Saharan Africa to be able to develop and implement appropriate and relevant HIV prevention interventions for this vulnerable population.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049621
Author(s):  
Brian Houle ◽  
Thomas A Gaziano ◽  
Nicole Angotti ◽  
Sanyu A Mojola ◽  
Chodziwadziwa W Kabudula ◽  
...  

ObjectivesThere is a scarcity of longitudinal cohort studies in sub-Saharan Africa to understand the epidemiology of cardiovascular disease as a basis for intervention. We estimated incident hypertension and associated sociodemographic, health and behavioural risk factors in a population aged 40 years and older over a 5-year period.DesignWe assessed the association between incident hypertension and sociodemographic, health and behavioural factors using Poisson regression. We adjusted for non-response in 2015 using inverse probability sampling weights from a logistic regression including sex and age at baseline.SettingRural South Africa.ParticipantsWe used a population-based cohort of normotensive adults in 2010 who were aged 40 years and older at retest in 2015.ResultsOf 676 individuals completing baseline and 5-year follow-up, there were 193 incident cases of hypertension. The overall hypertension incidence rate was 8.374/100 person-years. In multivariable analyses, those who became hypertensive were more likely to be older, have a high waist circumference (incidence rate ratio (IRR): 1.557, 95% CI: 1.074 to 2.259) and be employed (IRR: 1.579, 95% CI: 1.071 to 2.329) at baseline. Being HIV positive and not on antiretroviral therapy at baseline was associated with lower risk of incident hypertension.ConclusionsOver a 5-year period, 29% of respondents developed hypertension. Given the high burden of hypertension in South Africa, continued longitudinal follow-up is needed to understand the complex interplay of non-communicable and infectious diseases and their underlying and modifiable risk factors to inform public health prevention strategies and programmes.


2021 ◽  
pp. 1-9
Author(s):  
Lindsay C. Kobayashi ◽  
Meagan T. Farrell ◽  
Kenneth M. Langa ◽  
Nomsa Mahlalela ◽  
Ryan G. Wagner ◽  
...  

Introduction: Despite rapid population aging, there are currently limited data on the incidence of aging-related cognitive impairment in sub-Saharan Africa. We aimed to determine the incidence of cognitive impairment and its distribution across key demographic, social, and health-related factors among older adults in rural South Africa. Methods: Data were from in-person interviews with 3,856 adults aged ≥40 who were free from cognitive impairment at baseline in the population-representative cohort, “Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI), in Agincourt sub-district, Mpumalanga province, South Africa (2014–19). Cognitive impairment was defined as scoring <1.5 standard deviations below the mean of the baseline distribution of orientation and episodic memory scores. Incidence rates and rate ratios for cognitive impairment were estimated according to key demographic, social, and health-related factors, adjusted for age, sex/gender, and country of birth. Results: The incidence of cognitive impairment was 25.7/1,000 person-years (PY; 95% confidence interval [CI]: 23.0–28.8), weighted for mortality (12%) and attrition (6%) over the 3.5-year mean follow-up (range: 1.5–4.8 years). Incidence increased with age, from 8.9/1,000 PY (95% CI: 5.2–16.8) among those aged 40–44 to 93.5/1,000 PY (95% CI: 75.9–116.3) among those aged 80+, and age-specific risks were similar by sex/gender. Incidence was strongly associated with formal education and literacy, as well as marital status, household assets, employment, and alcohol consumption but not with history of smoking, hypertension, stroke, angina, heart attack, diabetes, or prevalent HIV. Conclusions: This study presents some of the first incidence rate estimates for aging-related cognitive impairment in rural South Africa. Social disparities in incident cognitive impairment rates were apparent in patterns similar to those observed in many high-income countries.


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