Doctoral Degrees (Population Studies)
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Browsing Doctoral Degrees (Population Studies) by Author "Vermaak, Kerry."
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Item The determinants of childhood diarrhea and acute respiratory infection: testing the importance of community-level determinants in Eswatini.(2020) Simelane, Maswati Sonboy.; Vermaak, Kerry.Background: It has been noted that regardless of the observed decline in childhood mortality in developing countries, the mortality rate is still extremely high. Approximately 30 countries in Africa and Asia need to triple their current standard of reduction of childhood mortality to realise the sustainable development goal (SDG) number 3 of ensuring healthy lives and wellbeing for all age groups. The study investigated the following research questions: 1. what is the prevalence of childhood diarrhoea and ARIs? 2. What are the individual, household and community-level factors associated with childhood diarrhoea and ARIs? 3. To what extent do community-level factors explain variations in childhood diarrhoea and ARIs? 4. Which clusters or communities have a higher burden of childhood diarrhoea and ARIs? Methodology: The study used a pooled secondary data analysis approach utilising data from the 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys (MICS) that were cross-sectional. The study utilised 5340 children aged below five years as the unit of analysis. The outcome variables of the study were child diarrhoea and acute respiratory infection. The single-level multivariate logistic regression, multilevel multivariate logistic regression and Quantum GIS were used to answer the study questions. STATA 13 was used for the analyses. Results: The study found that the magnitude of diarrhoea in Eswatini was 16.2% among underfive children. In the multilevel model, child age, current height for age, toilet facility region of residence overall community diarrhoea, were found to be important variables. For instance, children aged 6-11 months and 12-23 months were 434% and 290% respectively, more likely to have diarrhoea relative to those aged less than 6 months. Children with a normal and above normal current height for age had 91% and 93% respectively increased odds of having diarrhoea compared to those with a growth deficit. Children from households with no toilet facility were 283% more likely to have diarrhoea compared to those from households with a flush toilet. Residents in the Hohho region were 159% more likely to have diarrhoea compared to children who resided in the Lubombo region. Children from communities that had medium and high overall community diarrhoea were 26% and 877% more likely to have diarrhoea compared to children from communities with low overall community diarrhoea. The results showed a substantial variation of diarrhoea across communities. The individual-level factors explained 5.6% of diarrhoea across communities; household factors explained 65.3% of the variation while community-level factors explained 85% of the variation even though it was not significant. The Mapping analysis revealed that the severity of diarrhoea was most pronounced in the Manzini region and the Shiselweni region when compared to the Hhohho region. A total of 31% of the constituencies had a high prevalence of diarrhoea between 18.4-28.1% in the Manzini region. A consideration of the Shiselweni region revealed that 50% of the communities had a high prevalence of diarrhoea of between 18.4-28.1% The study found that the magnitude of ARI in Eswatini was 20.9% among under-five children. In the multilevel model, maternal age, household wealth index, shared toilet with neighbours, and region of residence were important factors that explained the variation of ARI across communities. Individual factors explained about 76.05 % as shown by the PVC; household level factors explained about 94% of the variance, and community-level factors explained about 93.6% of the variation of child ARI across communities. The study mapped the prevalence of ARI across communities (clusters) and found that the Hhohho region had four constituencies with a high prevalence of ARI, Motshane, Mbabane South, Mbabane East, Nkhaba and Tiphisini. In the Manzini region, five constituencies had a higher burden of ARI, namely Lamgabhi, Kwaluseni, Ntontozi, Mafutseni and Ludzeludze. In the Shiswelweni region, the burden of diarrhoea was higher among five constituencies, namely Zombodze, Mbangweni, Kubuta, Ngudzeni and Sigwe. In the Lubombo region, the burden of ARI was higher at Lubulini, Hlane, and Mhlume. Conclusion: The study demonstrated that the prevalence of diarrhoea and ARI are still very high and a persistent public health problem in Eswatini. The causes of the high magnitude of diarrhoea and ARI vary by individual, household and community factors. Policies that aim to ensure reduction in child morbidity from diarrhoea and ARI in Eswatini include strategies and programmes that rectify characteristics of the community contexts which mainly in the socially and economically disadvantaged communities and regions of Eswatini.Item Understanding modifiable risk factors for non-communicable diseases among adult men in Maseru, Lesotho.(2018) Tseole, Nkeka Peter.; Vermaak, Kerry.Background A large body of scholarship describes escalating mortality caused by Non-Communicable Diseases (NCDs) is in Africa. Disease forecasts also anticipate further increases in the prevalence of NCDs in the region. However, there is little work focusing on NCDs in some African countries such as Lesotho. Studies on gender differences in mortality caused by NCDs (linked to NCDs modifiable risk factors) have observed higher death rates in men than in women. There are fewer investigations directed to gendered effects of modifiable risk factors for NCDs in Lesotho. Objectives In order to bridge the existing knowledge gap, this study explores the prevalence and effects of modifiable risk factors for NCDs on adult men’s health. Men are the only subjects in the study owing to reports that mortality caused by NCDs is high in men compared to women, yet men are generally the least researched gender in Lesotho. The study objectives comprised an investigation of the relationship between demographic and socioeconomic factors and lifestyle risk behaviours for NCDs. The study further explored men’s perceptions and attitudes to modifiable risk factors for NCDs. Given the effect that masculinity has on health, the current study has also studied how adult men in Maseru define masculinity. It has also evaluated masculinity’s effects on modifiable risk factors for NCDs. Lastly, the study investigated gender norms in order to better understand how dominant notions of masculinity influence the prevalence of modifiable risk factors for NCDs in men. Methods The study used sequential explanatory mixed methods research design which prioritises and begins with collecting and analysing quantitative and then qualitative data. The methodology process was guided by the Health Belief Model (HBM) and the Health, Illness, Men and Masculinity Model (HIMM) to provide different perspectives on the study. The study went through three phases. The first phase was a pilot study that provided a background understanding of the masculinity scales and prevalence of NCDs risks in a small population sample of 227 respondents. The second phase involved the analysis of the 2014 Lesotho Demographic Health Survey’s secondary data. This phase was meant to provide a larger picture of the prevalence of the NCD’s risk factors among adult men in Lesotho. The third phase involved collection of qualitative data using eight focus group discussions with a total of 54 adult men. This stage was informed by the second stage and this qualitative research assisted the researcher to deep-dive into the reasons behind the estimates and patterns seen from the pilot and the LDHS data analysis, and the potential health preventative measures. Results The prevalence of smoking The final analysis of the data collected by and large shows a low but increasing prevalence of smoking, especially among younger adult men in Maseru, Lesotho. Between 2009 and 2014, there was about seven percent increase in the prevalence of smoking in men. The prevalence of smoking fluctuates among middle age men and eventually declines as men grow older. The prevalence of smoking decreases as the men’s level of education increases. A positive change in marital status, e.g. getting married, and/ cohabiting with a woman leads to increased smoking cessation, while a negative change, e.g. death, divorce and separation leads to an increased prevalence of smoking among adult men. Men who did not practice any religious practices reported higher prevalence of smoking than men who practiced any religion. Stressful occupations led to higher prevalence of smoking. Unskilled labour also reported higher prevalence of smoking. Increases in wealth was found to lead to declines in the prevalence of smoking. Harmful use of alcohol The study findings shows harmful alcohol use as the most prevalent NCDs risk factor in Maseru, Lesotho. Binge alcohol consumption is the most prevalent especially among younger adult men compared to older adult men. Similar to the prevalence of smoking, the prevalence of harmful alcohol use declines as men get older. Binge drinking prevails mostly during men’s leisure time, which is commonly on weekends and at social gatherings. The study shows that excessive and harmful use of alcohol is associated with manliness. Men who do not consume alcohol excessively are perceived as weak and feminine. Men who had the highest level of education showed the highest prevalence of harmful use of alcohol compared to men who reported lower levels of education. Again, similar to smoking, the prevalence of harmful use of alcohol varies across different marital statuses. The married men and men cohabiting with women have lower prevalence of harmful use of alcohol compared to men who are widowers, divorced and separated. Poor dietary The prevalence of poor dietary patterns contribute greatly to the high prevalence of NCDs. Men’s reported behaviours and rationales shows that men commonly abdicated responsibility for their health to women, particularly for healthy eating. The study findings indicate high prevalence of poor dietary patterns among adult men in Lesotho mainly owing to men’s dependency on women for healthy food preparation. Most men reported buying convenient meals as a common practice especially when their wives/partners are not around. In addition to men’s dependency on women for healthy meals preparation, a high prevalence of poor reported higher prevalence of smoking. Increases in wealth was found to lead to declines in the prevalence of smoking. Harmful use of alcohol. The study findings shows harmful alcohol use as the most prevalent NCDs risk factor in Maseru, Lesotho. Binge alcohol consumption is the most prevalent especially among younger adult men compared to older adult men. Similar to the prevalence of smoking, the prevalence of harmful alcohol use declines as men get older. Binge drinking prevails mostly during men’s leisure time, which is commonly on weekends and at social gatherings. The study shows that excessive and harmful use of alcohol is associated with manliness. Men who do not consume alcohol excessively are perceived as weak and feminine. Men who had the highest level of education showed the highest prevalence of harmful use of alcohol compared to men who reported lower levels of education. Again, similar to smoking, the prevalence of harmful use of alcohol varies across different marital statuses. The married men and men cohabiting with women have lower prevalence of harmful use of alcohol compared to men who are widowers, divorced and separated. Poor dietary The prevalence of poor dietary patterns contribute greatly to the high prevalence of NCDs. Men’s reported behaviours and rationales shows that men commonly abdicated responsibility for their health to women, particularly for healthy eating. The study findings indicate high prevalence of poor dietary patterns among adult men in Lesotho mainly owing to men’s dependency on women for healthy food preparation. Most men reported buying convenient meals as a common practice especially when their wives/partners are not around. In addition to men’s dependency on women for healthy meals preparation, a high prevalence of poor dietary patterns in men exists because the negative effects of poor diet seem to develop over a ‘long’ period of time. Physical inactivity Physical inactivity, especially leisure time physical inactivity is reportedly prevalent in Maseru, Lesotho. Reasons for the high prevalence of leisure time physical inactivity include modernisation, which has resulted in sedentary jobs, especially in urban areas like Maseru. Ignorance is another reason described in the study for physical inactivity. This stems from undermining some activities and not perceiving them as physical activities. Another finding of interest is that some adult men perceive leisure time physical inactivity as an activity for the working class members of society. Conclusion Masculinity is one of the principal health determinants that contribute greatly to the risky lifestyle practiced by men. This avoidable risky lifestyle increases men’s exposure to NCDs. It is of critical importance that high-risk members of society, e.g. men, to commit to and adopt lifestyle changes that mitigate the negative effect associated with modifiable risk factors for NCDs.