Doctoral Degrees (Population Studies)
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Item Unpacking the social constructions of motherhood: exploring mother presence among young African women.(2022) Majola, Thobelani Nompilo.; Maharaj, Pranitha.The experience of pregnancy and childbirth are life changing for women. In most African societies, childcare is often a woman’s responsibility. The motherhood journey of a young woman may be significantly impacted by the presence and/or absence of a biological mother. The presence of a biological mother is regarded as important in all stages of development, particularly for female children. However, mothers are absent for a number of reasons including their death. The absence of a biological mother exposes children to various challenges, including poverty, poor educational attainments and health issues. A growing body of research in South Africa has focused on father absence; however, few has explored mother absence and the implications this has on children. Therefore, this study aimed to unpack the meaning of motherhood as socially constructed by young African women in a township of KwaZulu-Natal province. The study sought to explore the perspectives and experiences of young women, taking into consideration the presence and/or absence of a biological mother. A qualitative research methodology was employed and data was obtained through telephonic interviews with 20 young women who grew up living with the presence of their biological mothers as well as 20 young women who grew up in the absence of their biological mothers. Young women were recruited using purposive and snowball sampling. The findings of the study suggest that the presence of a biological mother was significant for women who fell pregnant at a young age. Even though grandmothers and extended family members were actively supporting young women who had absent mothers, the presence of a biological mother was deemed essential for women. The transition from girlhood to motherhood was accompanied by numerous implications for young women. Financial challenges stemming from unemployment, poor economic backgrounds and father absence affected young mothers. This negatively impacted education and career aspiration of certain young women. The study recommends the involvement of families, government and private stakeholders in supporting young mothers. This can be achieved by enhancing family support programmes within communities. Furthermore, the promotion of Small, Medium and Micro Enterprises (SMMEs) is deemed important for the reduction of high rates of unemployment among young women in South Africa.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 social support and determinants of health in old age in South Africa using a mixed method approach.(2019) Kosse, Alpha Kapinga Mukenge.; Maharaj, Pranitha.The study attempted to understand social support and determinants of health of people aged 60 years and older living in South Africa and provide a comprehensive definition of the concept of old. This research was motivated by the fact that South Africa has witnessed an increase in the proportion of older people. They have to live with threats inherent in the demise of the extended family, their traditional support networks as well as the risk of being marginalised as a result of modernisation and urbanisation. In the absence of alternative social support, the elderly are left to fend for themselves. For decades, population aging has been overlooked and there is nearly no empirical evidence on factors that affect health in old age in Africa, let alone South Africa. Furthermore, there is no consensus on the concept of old among scholars. The study made use of both qualitative and quantitative methods to explore the issue at hand. For this study, both descriptive and explanatory research designs were used, drawing on 18 in-depth interviews from a primary study among participants in an old age home and a nationally representative quantitative sample of publicly available data. The motivation for this methodological approach was to improve the outcome of this study since strengths of one data source will compensate for the weaknesses in the other source. A total of 3545 respondents aged 60 years and older who took part in NIDS wave 5, conducted in 2017, were included in this study. The findings from the in-depth interviews seem to suggest that the current concept of old was flawed and irrelevant. Old age cannot be described using a one-size-fits-all approach, instead, it is heterogeneous and depends on some factors including lifestyle. Old age was well explained according to others and health played an important role in this regard. An older person was regarded as a sickly individual who depended on others for performing activities of daily living. In terms of gender, men and women were believed to age differently. Moreover, from a cultural standpoint, the elderly were those who have procreated and lived long enough to see their children becoming mature and independent members of the community. The elderly reported having at least one monthly medical appointment. The frequency of visits to health care facilities was dependent on the number of medical conditions. It was found that older people were affected by several conditions uncommon at younger ages and some have been on medication for more than a decade. Despite the multiplicity of these medical conditions, many older people were not living healthy. Old age pension was found to be the main source of income of the households headed up by the elderly. In becoming recipients of old age pensions, the elderly were able to keep their medical appointments as they were able to afford taxi fare. The likelihood of receiving emotional and instrumental support was higher than gifts and other donations. Adult children, notably daughters and sons were the main source of support for their parents. It turned out that childless older parents were less likely to receive gifts. Working adult children or family members were more supportive than their unemployed counterparts. Social support was associated with improved well-being and better health. This study could not confirm the abandonment of the elderly highlighted by the modernisation and aging theory. A great deal of ill-health in old age can be prevented by raising awareness about the positive impact of a healthy lifestyle. Providing health care workers with adequate training and making them knowledge about health challenges in old age is likely to change their perception and care of older patients.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.Item Male circumcision as an HIV reduction strategy : implications for men and women in Zimbabwe.(2016) Chikutsa, Antony.; Maharaj, Pranitha.Male circumcision is not a common practice in Zimbabwe except among a few ethnic groups who circumcise as a rite of passage or for religious reasons. Recent scientific research has shown evidence that male circumcision is efficacious in preventing the transmission of HIV from women to men. In response to this, Zimbabwe introduced voluntary medical male circumcision as an additional HIV prevention strategy in 2009. Prior to this, HIV prevention strategies in Zimbabwe focused on the promotion of abstinence, faithfulness and correct and consistent condom use, popularly known as the ABC approach. The purpose of this study was to evaluate the acceptability of medical male circumcision as an additional approach to preventing the acquisition of HIV. The study also intended to understand the factors which may influence the uptake of medical male circumcision for HIV reduction. In addition, the study also sought to find out the role of women in the promotion of circumcision and the implications on men’s sexual behaviour. The study adopted a mixed methods approach using the convergent parallel design in which both qualitative and quantitative data were collected simultaneously and were then merged during analysis and interpretation. A sample of 681 respondents was determined using a statistical formula and selected using random sampling. One hundred and eighty two female respondents were included in the sample because it was felt that women have a significant role to play in the promotion of medical male circumcision. Thus, it was felt important to assess their knowledge, attitudes and beliefs about circumcision in the study. In addition to the 681 individual interviews, five key informants drawn from the Ministry of Health and Child Care and other stakeholders were interviewed. Furthermore, five focus group discussions were also done to complement the data collected using individual and key informant interviews. Participants in focus group discussions were aged between 18 and 49 years. The prevalence of male circumcision among men in the study sample was found to be 15.8 percent. Of these, 40 percent were circumcised as part of the on-going HIV prevention campaign while 33 percent were circumcised for religious or cultural reasons. A further 12 percent were circumcised for medical reasons. The study also established that about 97 percent of both men and women had heard about male circumcision for HIV prevention. The findings show that men were generally more knowledgeable about voluntary medical male circumcision than women. Also, circumcised men had significantly better understanding of vi circumcision than uncircumcised men. Fifty-seven percent of men compared to 54 percent of women reported that they believe that circumcision works for HIV prevention. The study also established that there is general acceptability of the promotion of medical male circumcision for HIV prevention (76 percent for men and 84 percent for women). However, 43 percent of uncircumcised men reported that they are willing to get circumcised for HIV reduction. On risky behaviour after circumcision, 84 percent of respondents reported that they are willing to abstain for 6 weeks to allow complete healing of the wound while 75 percent reported willingness to use condoms after getting circumcised. The study concluded that knowledge and acceptability about medical male circumcision are generally high. The study also concluded that the level of willingness to get circumcised is not corresponding to the levels of knowledge and acceptability. The study attributed this gap to the embedded fear and uncertainties that people have about circumcision. The study thus recommends that there is a need to continue with promotional campaigns that target increasing knowledge in the population. There is also a need to design specific campaigns that target women in order to address the knowledge gap between men and women.Item Women's experiences of induced abortion in Mombasa city and the Kilifi district, Kenya.(2013) Ndunyu, Louisa Njeri.; Covan, Eleanor Krassen.The primary objectives in this study were to gain a deep level of understanding of Kenyan women’s experiences of seeking abortion, both safe and unsafe, and to explore how social and legal issues impact their choices and the routes they take to obtain abortion. I explored the contexts and interpreted 49 in-depth narratives of women’s emic experiences of abortion in Mombasa city and the Kilifi district, Kenya, using a qualitative form of inquiry conducted between April and July 2005. Ethical Review Committees granted ethical clearance to this study. This emic work revealed gender inequity consistent with developing feminist theory and thus how women conceive gendered relationships is introduced in this analysis of women's narratives. The findings provide new insights as well as useful confirmatory knowledge, gleaned from detailed empirical evidence within Kenyan women’s social contexts. The women have revealed the evidence through their narratives; such an approach is largely missing in existing abortion literature. The prominent finding is that women do not abort motherhood, but they do abort particular pregnancies to protect motherhood; to avoid a difficult motherhood likely to compromise the quality of care they envisage for their potential and existing children. This includes ensuring the best nurturing environment, paternal and religious identity, social legitimacy. The abortion decision is difficult to make and thoroughly considered. The married women make a consultative decision with their ‘breadwinners’ having the upper hand. Legal barriers cannot bar abortion but entrench inequities in abortion care access, heighten secrecy, stigma, and hamper prompt comprehensive post abortion care seeking. Thus, financial resources, peers, geographical remoteness, and knowledge significantly influence the type of abortion accessed. Consequently, unsafe abortion threatens motherhood of the most vulnerable groups of women. The foremost recommendation is that public health law must ensure healthy, enjoyable, dignified motherhood for the women; hence safe early abortion (first trimester) must become accessible to alleviate existing health care inequities.Item Church-based social spaces and HIV/AIDS in rural South Africa.(2013) Atujuna, Millicent.; Denis, Philippe Marie Berthe Raoul.; Preston-Whyte, Eleanor.Primarily, this dissertation examined the extent to which churches have potential in preventing HIV/AIDS. Set in rural KwaZulu-Natal an area marked with both high levels of HIV prevalence and high religious participation, the study used the concept of social space as a framework within which the contribution of churches towards the prevention of further spread of the HIV infection can be understood. Unlike recent studies which have consistently shown that the contribution of churches in the prevention of further spread of HIV infection is likely to emanate from the churches‘ teaching on morality, this study has argued that the contribution of churches in minimizing risky sexual behaviours is likely to emanate from how churches balance their teachings on moral issues and the subsequent practice of social control on the one hand and the provision of social support on the other. This is particularly so because in African settings where behaviour is largely influenced by the prevailing circumstances within society, and where churches are significantly entrenched in the lives of individuals providing a variety of social support services, there is a strong likelihood that churches will have an impact on their adherents‘ behaviour as well. The social space concept, therefore, defines churches not only as institutions enforcing the moral code which churches emphasise but also as caring and integrating forces, providing social support for their members in time of need. The study investigated four churches representing three Christian religious denominations: the Mainline, the Pentecostal and the African Independent churches. In investigating these churches, it used two types of data: The Africa Centre Demographic surveillance Systems (ACDIS) data collected between 2002 and 2004 and the Ethnographic data collected in 2006 consisting of a total of 96 in-depth interviews, 11-13 services of each church type selected, 6-8 church- related activities (or groups in each church), 3 informal discussions with community members and a set of 2 conversational data from each church. The analysis is done in two parts. The first part of the analysis (Chapter Five) focuses on the existing quantitative ACDIS data, examining whether there exists a relationship between church affiliation, participation in church activities and sexual behaviours. The second part uses ethnographic data in order to provide explanations of the observed relationship. Overall, the study found that unlike church affiliation which had no influence on individual sexual behaviour, individuals who participated regularly in church activities were less likely to engage in behaviour that would put them at risk of acquiring the HIV infection. The study found, however, that there existed denominational differences and that churches where participation was high were the same churches likely to influence protective behaviour. The explanation provided from qualitative findings suggested that the ability of these churches to minimise risky sexual behaviour was found in the Intensive Social Spaces that churches and their members constructed. The study concluded that the ability of churches to minimise risky sexual behaviours resulted from an individual negotiating losing the benefits provided by fellow members of the church when she/he ceases to be a member.Item The dynamics of undocumented Mozambican labour migration to South Africa.(2008) Muanomoha, Ramos Cardoso.; Maharaj, Bridgemohan.; Preston-Whyte, Eleanor.Labour migration from Mozambique to South Africa is a historical process in Southern African region that dates from the 18th century. However, its formalisation and regulation took place in the late nineteenth and early twentieth centuries, becoming a part of the Southern African labour market system. Within this labour market system Mozambique is one of the longstanding suppliers, with relatively consistent numbers of contract migrants for the South African mines. In the last two decades the number of contract migrant labourers for the mining industry in South Africa has declined. In contrast, there has been an increase in undocumented migrants from Mozambique to South Africa. The aim of this thesis is to analyse the dynamics of undocumented labour migration to South Africa. The undocumented migrants are mostly male youths from rural areas of southern Mozambique who are pushed by poverty and lack of employment conditions. They enter into the South Africa pulled by a demand for cheap unskilled labour, and they work mainly in the agriculture, construction, informal trade and domestic sector. Their aim is to send or carry back home remittances in cash or kind. However, the presence of undocumented Mozambican immigrants, as well as those from other parts of Southern Africa, has given cause for concern. There is social pressure in South Africa, where in some circles the undocumented migrants are seen as taking jobs from locals, which leads to xenophobic attitudes. The South African government has been forced to adopt restrictive measures, including the repatriation or deportation of undocumented immigrants. Notwithstanding the undocumented migration from Mozambique continues to increase. Findings from the fieldwork in Mozambique and South Africa, obtained through both quantitative and qualitative approaches, confirmed that the undocumented Mozambican labour migration to South Africa was a self-sustaining process through social networks, which helped in the process of adjustment and also allowed migrants to make multiple entries into South Africa. The study concludes that stopping undocumented migration requires the creation of job opportunities in migrant sending areas, particularly in the rural areas, so that people can be employed locally, reducing their dependency on migrant labour. In addition, policies are required that encourage migrants to organize in order to be involved productively in development projects of their communities.