Doctoral Degrees (Public Health)
Permanent URI for this collection
Browse
Browsing Doctoral Degrees (Public Health) by Author "Hlongwana, Khumbulani Welcome."
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Item Barriers and facilitators to the implementation of the collaborative framework for the care and control of tuberculosis and diabetes in Ghana.(2021) Salifu, Rita Suhuyini.; Hlongwana, Khumbulani Welcome.Background: The rising tuberculosis -diabetes mellitus co-epidemic is threatening the advances made by global policy to reduce tuberculosis and diabetes mellitus prevalence. In 2011, the World Health Organization (WHO) and International Union Against Lung Disease (Union) launched the Collaborative Framework for Care and Control of Tuberculosis and Diabetes. The recommendations provided by the framework have been adopted by many countries, globally. The overall aim of this research was to explore the barriers and facilitators to the implementation of the WHO-Union collaborative framework in Ghana, from the perspectives of the policymakers, program managers, health facility managers, and front-line implementers (healthcare workers). Methods: Using an explorative qualitative study design, data was generated by employing a scoping review, documents review, in-depth interviews, and non-participant observation. In-depth interviews were conducted with 27 participants from Accra and Tamale in Ghana. All interviews were audio recorded (with participants’ permission) and transcribed verbatim, except for two interviews, whereby participants requested the interview not to be audio-recorded. Non-participant observation was guided by a checklist of sensitising concepts. Analysis was guided by the grounded theory to identify recurrent ideas which were coded and further grouped to develop themes. Results: This thesis presents key findings from research on the implementation of the framework in Ghana. The major outputs of this study included: 1) a scoping review to map evidence on the implementation of the framework, globally. 2) paper one examines the systems and structures in place for implementing the collaboration of TB-DM management in the selected health facilities. 3) paper two explores the mechanisms of collaboration between the National Tuberculosis Control Program and the Non-Communicable Disease Control Program at the national, regional, and local (health facility) levels of the health care system. 4) paper three addresses the experiences of frontline healthcare workers through the lens of Lipsky’s theoretical framework of street-level bureaucracy. Conclusion: The findings of this research support the implementation of the framework in Ghana. This has been enhanced by the increased staff capacity and institutionalization of screening. However, gaps still exist which require increased awareness about TB-DM comorbidity, and increased support for inservice training to curb the rising TB-DM comorbidity.Item Contraceptive use among adolescent girls in Zambia: a study on adolescents’ needs, preferences and perspectives on contraception methods=Ukusetshenziswa kwezivimbelakukhulelwa ngamantombazane angamatshitshi eZambia: Ucwaningo ngezidingo zamatshitshi, okukhethwayo nemibomo kwezindlela zezivimbelakukhulelwa.(2023) Chola, Mumbi.; Ginindza, Themba Geoffrey.; Hlongwana, Khumbulani Welcome.The fertility rate in Africa is among the highest in the world, and this trend is projected to continue unless drastic interventions are put in place to avert the situation. Contraceptive use among adolescents in sub-Saharan Africa remains very low despite various interventions to improve the uptake. The study aimed to examine the key determinants of contraceptive use among adolescent girls in Zambia; specifically, i) examining patterns, trends and factors that drive poor usage of contraceptives; ii) exploring the motivators and influencers of decision-making regarding contraceptive use among adolescent girls; and finally, iii) understanding their perspectives on existing contraceptive methods. The study examined patterns, trends and factors associated with contraceptive use among adolescents in Zambia, using data from 1996, 2001/2, 2007 and 2013/14 Zambia Demographic and Health Surveys. Qualitative data was collected through focus group discussions and analysed using thematic analysis. Permission to conduct the study was obtained from the Ministry of Health and the National Health Research Authority. Ethical approvals were provided by the Biomedical Research Ethics Committees (BRECs) of the University of Zambia and the University of KwaZulu-Natal in South Africa. Results revealed that contraceptive use among adolescent girls in Zambia remained low over the 18 years and increased by only 3%, particularly among younger, uneducated, and unmarried sexually active adolescent girls. Marriage or living with a partner contributed the most to the change in contraceptive use (44%), while living in a rural area accounted for approximately 20%. Adolescent girls' experience with contraceptives was affected by various factors such as knowledge of contraceptives, including sources of information and contraceptives, experience with using contraceptives, challenges with access to contraceptives, and misconceptions about contraceptives. The interaction of factors related to their personal experience, their community and the environment in which they access contraceptive services all contribute to the overall patient experience and influence the adolescent girls’ contraceptive decision. Most of the motivators for the use and/or non-use of contraceptives are intrapersonal and interpersonal. Contraceptive use among adolescent girls remains low and is determined by various factors. Key influencers and motivators for contraceptive use involve people in their lives, such as partners, family and community members. Interventions targeting increasing demand, access and use of contraceptives among adolescents must be innovative, participatory and implemented within the context of local cultural norms. IQOQA Izinga lokuvunda e-Afrika libalelwa kweliphezulu emhlabeni wonke, futhi le nkombamvama ihlelelwe ukuqhubeka ngaphandle uma kunokungenelela okunamandla okumele kufakwe ukuze kugwenywe isimo. Izimvimbelakukhulelwa ezisetshenziswa phakathi kwamatshitshi ase-Saharan Africa ziyohlala ziphansi ngale kokungenelela okwahlukene ukuze kuthuthukiswe lokho okukhona okuzosetshenziswa. Ucwaningo lwaluhlose ukuhlola izinkombamthelela ezisemqoka zokusetshenziswa kwezivimbelakukhulelwa phakathi kwamantombazane eZambia; ngokucacile i) ukuhlola izinhlelo, izinkombamvama noma izinto eziqhuba ukusetshenziswa kabi kwezivimbelakukhulelwa; ii) ukuhlola abagqugquzeli nabanomthelela ekuthathweni kwezinqumo ezimayelana nokusetshenziswa kwezivimbelakukhulelwa phakathi kwamantombazane angamatshitshi; ekugcineni, iii) ukuqonda imicabango yabo mayelana nezindlela ezikhona zezivimbelakukhulelwa. Ucwaningo lwahlola izinhlelo, izinkombamvama nezici ezihlobene nezivimbelakukhulelwa ezisetshenziswa phakathi kwamantombazane eZambia, lusebenzisa imininingo esukela onyakeni wowe-1996, 2001/2, 2007 kanye nowezi-2013/14 eZambia Demographic and Health Surveys. Kwaqoqwa imininingo yocwaningo lobunjalo botho kugxilwe ezingxoxweni zeqoqo okwakucwaningwa ngalo lahlaziywa kusetshenziswa uhlaziyongqikithi. Imvume yokwenza ucwaningo yatholakala kuNgqongqoshe WeZempilo kanye NeZiphathimandla Zocwaningo LweZempilo KuZwelonke. Isiqinisekiso SeNqubonhle sanikezelwa Amakomidi eBiomedical Research Ethics (BRECs) aseNyuvesi yaseZambia kanye neNyuvesi YakwaZulu-Natali eNingizimu Afrika. Imiphumela yocwaningo yaveza ukuthi ukusetshenziswa kwezivimbelakukhulelwa phakathi kwamantombazane angamatshitshi aseZambia kwahlala kuphansi esikhathini esingaphezu kweminyaka eyi-18 kwase kukhula ngama-3%, kwabancane, abangafundile kanye nakumantombazane abangamatshitshi angaganile kodwa alwenzayo ucansi. Umshado noma ukuhlala nomlingani wakho kube neqhaza elikhulu ezinguqukweni ezisetshenziswayo zokuvimbela ukukhulelwa (44%), ngenkathi ukuhlala endaweni yasemakhaya kubalelwa esilinganisweni esingama-20%. Lokho amantombazane asengamatshitshi aseke edlula kukho mayelana nokusetshenziswa kwezivimbelakukhulelwa kwaphazanyiswa yizinto eziningi njengolwazi lwezivimbelakukhulelwa kubandakanya nemithombo yolwazi nezivimbelakukhulelwa, odlula kukho uma usebenzisa izivikelakukhelwa, izingqinamaba zokusebenzisa izivimbelakukhulelwa kanye nemibono engemihle ngezivimbelakukhulelwa. Ukuxhumanakunikezelana kwezinto ezihlobene kulokho umuntu nomuntu adlule kukho, umphakathi wabantu kanye nendawo lapho abakwazi ukuthola khona izivimbelakukhulelwa konke kunomthelela kukho lokho isiguli esedlule kukho nalokho okuthinta izinqumo zokuvimbela ukukhulelwa ezithathwa ngamantombazane angamatshitshi. Abagqugquzeli abaningi bokusetshenziswa nokungasetshenziswa kwezivimbelakukhulelwa banobudlelwane bomuntu kanye nobudlelwane kubantu. Ukusetshenziswa kwezivimbelakukhulelwa amantombazane angamatshitshi kuhlale kuphansi futhi lokhu kudalwa yizinto ezahlukene. Abagqugquzeli nabakhuthaza ukusetshenziswa kwezivikelakukhulelwa basemqoka kufaka abantu ezimpilweni zabo, njengabalingani, umndeni namalunga omphakathi. Ukungenelela okuqonde ekukhuliseni isidingo, ukufinyelela nokusetshenziswa kwezivimbelakukhulelwa phakathi kwamatshitshi kumele kufake izindlela ezintsha, kubambe iqhaza futhi kuqaliswe engqikithini yenkambisonqubo yokuyisiko endaweni.Item Factors influencing contraceptive use and sexual behaviour among women of reproductive age in Umlazi township, KwaZulu-Natal province, South Africa.(2021) Hlongwa, Mbuzeleni Ndabayakhe.; Hlongwana, Khumbulani Welcome.Access to safe and effective contraceptive methods is one of the cornerstones of reproductive health, worldwide. However, the degree to which women manage various aspects of their sexual lives, including the prevention of unplanned or unwanted pregnancies, infant and maternal mortality, and exposure to HIV and AIDS, continues to raise questions relating to health promotion concerns. Despite the implementation of various government interventions, unplanned pregnancies, termination of pregnancies, and maternal mortality remain relatively high in South Africa. While HIV infection has been well documented in South Africa, the risky sexual behaviour of South Africans remains a concern. The aim of this study was to examine the factors that influence contraceptive use and sexual behaviour among women of reproductive age in Umlazi Township, KwaZulu-Natal Province, South Africa. The specific research objectives were as follows: 1. To map evidence on factors influencing contraceptive use and sexual behaviour in South Africa through a systematic scoping review. 2. To determine the proportion of women of reproductive age using contraceptives in Umlazi Township, KwaZulu-Natal, South Africa. 3. To examine women’s knowledge of different contraceptive methods in Umlazi Township, KwaZulu-Natal province, South Africa. 4. To determine contraceptive methods used by women in Umlazi Township, KwaZulu- Natal province, South Africa. 5. To identify factors influencing contraceptive use and sexual behaviour among women of reproductive age in Umlazi Township, both from a user and provider perspective. 6. To explore the experiences of women of reproductive age regarding contraceptive use and risky sexual behaviours in Umlazi Township, South Africa. Methods The was a mixed-methods study, which utilised primary level data to answer objectives two to six. A systematic scoping review was conducted to address the first study objective. The study was conducted in a clinic-based setting among women of reproductive age in Umlazi Township under eThekwini Municipality in KwaZulu-Natal. The healthcare providers from the selected clinics and women of reproductive age attending the selected facilities, participated in the study. For quantitative study, data were collected through a structured questionnaire, coded and entered into Epi data manager (version 4.6). Stata version 15 was used to conduct quantitative data analysis. Multivariable logistic regression model was used to assess the level of the association between the predictor and outcome variables and the p-value < 0.05 was considered statistically significant. For qualitative study, women from four primary health care facilities were recruited through a combination of convenience and criterion-based sampling techniques. Using NVivo version 11, two skilled researchers independently conducted thematic data analysis, as a mechanism for quality assurance, before the results were collated and reconciled. Results Overall, 471 eligible women and 35 healthcare workers participated in the quantitative study. Fifteen women participated in the qualitative study. The quantitative study found that more than half (51.8%) of the women were aged 18–24 years, and only a handful (18.3%) had a tertiary qualification. The majority were single (89.0%) and unemployed participants accounted for 54.0% of the total sample. This study found that women who had talked about condoms with their partner/s in the past 12 months were more likely (p=< 0.0001) to have used condoms during their last sexual intercourse. Older women (aged 35-49 years) were more likely (p=0.035) to have used a condom during their last sexual encounter, compared to their younger counterparts. However, women who were exposed to physical partner violence (hitting and/or slapping), those who had been diagnosed with HIV and those whose sexual partners were diagnosed with HIV, did not show a significant association with condom use at last sex. This study showed a high proportion (84.1%) of women using contraception in the sample. This study further indicated that women with a secondary level of education (p=0.053) or a tertiary level of education (p=0.040), were more likely to use contraceptive methods compared to women with a lower education status. Older women aged 25-49 years who experienced pregnancy, whether planned (p=0.038) or unplanned (p=0.001), were more likely to use a contraceptive method. Furthermore, more than a third of healthcare providers (37.1%) were unsure whether modern contraceptives cause users to become promiscuous, and more than half (57%) had negative attitudes toward adolescent girls exploring contraceptive methods. Poor working conditions, long queues, and contraceptive stock-outs were cited by health care providers as deterrents to providing quality sexual behaviour counselling and modern contraceptive education to users. The qualitative study found that women were concerned about unpleasant contraceptive side effects such as prolonged or irregular menstrual periods, bleeding, weight gain, and/or severe pains. Some women stopped using their preferred contraceptive method or opted for a different contraceptive method due to undesirable side effects and/or contraceptive stock outs. Women also raised concerns that they were not adequately counselled or informed on the use or potential negative effects of various contraceptive methods available at health care facilities. Furthermore, perceived negative attitudes towards young women by health care providers, long waiting times and concerns over contraceptive efficacy, contributed to reduced contraceptive uptake. Conclusion This study adds to our knowledge of women's concerns and issues related to contraception access and use in Umlazi Township, KwaZulu-Natal. This study found that numerous factors influence contraceptive use and sexual behaviour. The amount to which women engage in unprotected sexual activities highlights the urgent need for a comprehensive, integrative, and adaptive educational approach to altering women's sexual behaviours. It is vital to make concerted educational efforts to eliminate existing hurdles that prevent young women from using contraception. Family planning strategies tailored to the needs of different groups of women should be targeted, including prioritising education opportunities, given the many benefits associated with these. The availability of comprehensive counselling services to support women who are experiencing short-term side effects is critical in order to ensure that they are able to cope with side effects or switch to a different method rather than completely discontinuing contraceptive use in order to avoid unintended pregnancy.