Search

A syndemic has been theorized as a cluster of epidemics driven by harmful social and structural conditions wherein the interactions between the constitutive epidemics drive excess morbidity and mortality. We conducted a mixed-methods study to investigate a syndemic in Soweto, South Africa, consisting of a population-based quantitative survey (N = 783) and in-depth, qualitative interviews (N = 88). We used ethnographic methods to design a locally relevant measure of stress. Here we show that multimorbidity and stress interacted with each other to reduce quality of life. The paired qualitative analysis further explored how the quality-of-life impacts of multimorbidity were conditioned by study participants' illness experiences. Together, these findings underscore the importance of recognizing the social and structural drivers of stress and how they affect the experience of chronic illness and well-being.

Background: The risk of dementia, including the most common form, Alzheimer's disease, is forecasted to increase in low- and middle-income countries due to longer lifespans and the rising prevalence of non-communicable diseases. However, little research has been conducted on the knowledge and perceptions about dementia in rural communities in Kenya. Objective: To explore the community's knowledge, attitudes, and perceptions about dementia in Kilifi County, a resource constrained rural coastal area in Kenya. Methods: We conducted an ethnographic study comprising five focused group discussions (n = 35, each with 7–8 people) and 25 key informant interviews with various stakeholders from Kilifi County. The interviews and discussions were recorded, transcribed verbatim and thematically analyzed. Results: There was a general lack of knowledge about dementia by community members. People suspected to have dementia were labeled using stigmatizing and derogatory words such as " neurologically deficient ", " crazy", or " wendawazimu " [mad person]. Dementia was also associated with normal aging. Others associated neurodegenerative behaviors associated with dementia to witchcraft or curses. This led to individuals suspected to have dementia being isolated from the community, neglected, dispossessed assets, killed or denied medical care. Conclusions: Dementia is not well understood in Kilifi County, Kenya. People with dementia are stigmatized, neglected and socially excluded from community. Our results could be leveraged by the Kenyan government, the healthcare system, and communities to develop policies and strategies for protecting elderly people with dementia and improving their care, especially in rural areas. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is the most common type of dementia globally and is the fifth leading cause of death and disability. About half of all people suffering from the disease are living in sub‐Saharan African Countries including Kenya. However, research on dementia has been almost exclusively focused on the Global North societies. In Kenya, little is known about patients' lived experiences with AD. Objective: To explore patient's experiences living with and managing Alzheimer's disease in Kenya. Method: We employed ethnographic methods encompassing clinical and home observations and lengthy interviews among people with early‐stage Alzheimer's disease (n = 30) in Kenya. Patients were purposively recruited from the neurology clinic at the Aga Khan University Hospital in Nairobi. We also conducted 10 home visits to understand existing social support systems and self‐management practices. Field notes and qualitative interviews were transcribed and analyzed verbatim with use of QSR NVivo 12 software. Result: Two‐thirds of the patients were aged 50 years and above, had low education levels and fully depended on close family members for support. Patients experienced challenges such as higher cost of hospital care and treatment, comorbidities (e.g., depression, diabetes and hypertension), language barrier, forgetfulness, being misunderstood and conflicts with loved ones. These challenges made managing their AD difficult. Social connectedness – which entailed: (i) Self‐connectedness – including active participation in self‐care, relaxation and having personal time; and (ii) Connectedness with others (e.g., relationships with family, friends to prevent loneliness and isolation) were found to be key on how patients managed and coped with their Alzheimer's disease. Conclusion: People living with AD in Kenya cannot be understood without knowing about their inner lives, other people around them and the background where they belong. Alzheimer's disease can transform people's self‐identities but with good social support system, patients can live quality lives. There is a need to train family members and other informal caregivers to improve care and foster a sense of belonging amongst the patients. More research on Alzheimer's disease in Kenya is needed as well as increased public awareness and community sensitization regarding dementias. [ABSTRACT FROM AUTHOR]

Faith, belief, and religion can powerfully shape how people live with and heal from illness. Engaging in religious practices, from gathering for services to reading the holy texts and engaging in private prayer, can serve as a critical way of coping or building resilience amidst everyday social, moral, and medical challenges. In this article, we investigate why, what, and how people living with chronic illness in an urban South African township prioritise healing practices of the Church over the Clinic. We conducted 88 in-depth qualitative interviews to understand how people think about health, chronic illness, and healing. Most people described complex socio-spiritual beliefs and practices that many prioritised or practiced apart from biomedical care. This included religious practices, such as prayer and drinking church water, as well as one's spirituality, which was an essential way in which people found healing. Recognising how socio-spiritual practice fosters healing and wellness is critical for thinking about health and healing for Soweto residents. [ABSTRACT FROM AUTHOR]

The quality and success of postgraduate education largely rely on effective supervision. Since its inception in 2008, the Consortium for Advanced Research Training in Africa (CARTA) has been at the forefront of providing training to both students and supervisors in the field of public and population health. However, there are few studies on supervisors' perceptions on effective doctoral supervision. We used a mostly descriptive study design to report CARTA-affiliated doctoral supervisors' reflections and perceptions on doctoral supervision, challenges and opportunities. A total of 77 out of 160 CARTA supervisors' workshop participants responded to the evaluation. The respondents were affiliated with 10 institutions across Africa. The respondents remarked that effective supervision is a two-way process, involving both supervisor and supervisee's commitment. Some reported that the requirements for effective supervision included the calibre of the PhD students, structure of the PhD programme, access to research infrastructure and resources, supervision training, multidisciplinary exposure and support. Male supervisors have significantly higher number of self-reported PhD graduates and published articles on Scopus but no difference from the females in h-index. We note both student and systemic challenges that training institutions may pursue to improve doctoral supervision in Africa. [ABSTRACT FROM AUTHOR]

A steady and consistent national and local government leadership is crucial in times of crisis. The trust in government – which can be so fragile – was strong in Eldoret town, a large municipal in western Kenya widely known for ethnic conflicts. In our interviews with 20 business people and 30 community members from Eldoret town, we found that the trust built early in the pandemic was broken due to individual leaders who eventually dismissed public health promotion and engaged in politics and corruption of funds for COVID-19 relief. When leadership was strong, locals in Eldoret town (and especially business owners) engaged in public health prevention measures for the greater good. But when leadership slipped, people complained and eventually ignored public health prevention measures at home, on the bus, and in businesses around town, causing the intensification of outbreaks. This was most common among those engaged in the formal economy as those in the informal economy were more likely to mistrust the government altogether. We show who falls through the cracks when government policy targets viral threats and suggest how local government and public health agencies might work to control COVID-19 infections while ensuring that all Eldoret residents are cared for. [ABSTRACT FROM AUTHOR]

Objective: To: (i) understand facilitators and barriers to healthy eating practices and physical activity in younger and older urban adolescent South African boys and girls; and (ii) understand how the views of caregivers interact with, and influence, adolescent behaviours. Design: Semi-structured focus group discussions (FGD) were conducted in July 2018. Data were analysed using thematic analysis. Setting: Soweto, Johannesburg, South Africa. Participants: Seventy-five participants were stratified into eight FGD as follows: two for young boys and girls (10–12 years); two for older boys and girls (15–17 years); two for caregivers of young adolescents (boys and girls); and two for caregivers of older adolescents (boys and girls). Results: Unlike their caregivers, adolescents were not motivated to eat healthily and failed to appreciate the need to develop consistent patterns of both healthy eating and physical activity for their long-term health. Although adolescents gained independence with age, they commonly attributed unhealthy food choices to a lack of autonomy and, thereby, to the influence of their caregivers. Adolescents and caregivers perceived their engagement in physical activity according to distinct siloes of recreational and routine activity, respectively. Both similarities and differences in the drivers of healthy eating and physical activity exist in adolescents and caregivers, and should be targeted in future interventions. Conclusions: Our study identified a complex paradigm of eating practices and physical activity in South African adolescents and their caregivers. We also highlighted the need for a new narrative in addressing the multifaceted and interrelated determinants of adolescent health within urban poor settings. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems across the globe are adopting patient-centred care (PCC) approach to empower patients in taking charge of their illnesses and improve the quality of care. Although models of patient-centredness vary, respecting the needs and preferences of individuals receiving care is important. South Africa has implemented an integrated chronic disease management (ICDM) which has PCC component. The ICDM aims to empower chronic care patients to play an active role in disease management process, whilst simultaneously intervening at a community/population and health service level. However, chronic care is still fragmented due to systemic challenges that have hindered the practice of PCC. In this article, we explore provider perspectives on PCC for patients with comorbid type 2 diabetes and HIV at a public tertiary hospital in urban South Africa. Methods: This study utilizes ethnographic methods, encompassing clinical observations, and qualitative interviews with healthcare providers (n = 30). Interview recordings were transcribed verbatim and data were analyzed inductively using a grounded theory approach. Results: Providers reported various ways in which they conceptualized and practiced PCC. However, structural challenges such as staff shortages, lack of guidelines for comorbid care, and fragmented care, and patient barriers such as poverty, language, and missed appointments, impeded the possibility of practicing PCC. Conclusion: Health systems could be strengthened by: (i) ensuring appropriate multidisciplinary guidelines for managing comorbidities exist, are known, and available, (ii) strengthening primary healthcare (PHC) clinics by ensuring access to necessary resources that will facilitate successful integration and management of comorbid diabetes and HIV, (iii) training medical practitioners on PCC and structural competence, so as to better understand patients in their sociocultural contexts, and (iv) understanding patient challenges to effective care to improve attendance and adherence. [ABSTRACT FROM AUTHOR]

Community engagement (CE) has increasingly been recognized as a critical element for successful health promotion and intervention programs. However, the term CE has been used to mean different things in different settings. In this article, we explore how CE has been conceptualized in the field of mental and brain health in Kilifi County, Kenya. We used ethnographic methods encompassing focused group discussions, key informant interviews, and observations with 65 participants, purposively recruited from Kilifi County. Data were transcribed verbatim and thematically analyzed. Our findings show that community members and stakeholders had diverse perceptions of and experiences with CE. Factors such as trust between researchers and community members, sensitization, and awareness creation were key for acceptance of research projects. Partial involvement in research, lack of access to information, poverty and socio-economic challenges, and financial expectations from researchers hindered CE and led to resistance to participation in research projects. For effective CE, there is a need to work closely with community gatekeepers, create awareness of the research projects, use local languages, and ensure continuous engagement that promotes equitable research participation. Our findings suggest that tacit knowledge, context, and mechanisms for research are all critical features of CE and should be considered to enhance acceptance and sustainability of mental and brain health interventions in Kenya. [ABSTRACT FROM AUTHOR]

More people with HIV live in South Africa than anywhere else in the world. As people with HIV increasingly confront comorbid conditions, such as Type 2 diabetes, the need for integrated chronic care continues to grow. However, chronic care for patients with multimorbidities is limited in many public hospitals in South Africa. This ethnographic study describes patients' experiences seeking care for comorbid HIV and diabetes at a public tertiary hospital in Soweto, South Africa, and self-management at home. Findings illustrate how fragmented care, multiple clinic appointments, conflicting information, and poor patient–provider communication impeded patients' access to care for their multimorbidities. Socio-economic factors such as poverty, costly transport to the hospital, and food insecurity impeded management of multimorbidities. Integrated care for patients with multimorbidities in Soweto is imperative and must recognize the critical role social and economic conditions play in shaping the experiences of living with HIV, diabetes, and their overlap. [ABSTRACT FROM AUTHOR]

Objective: A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa’s use of a tax to reduce SSB consumption. Design: We conducted six focus group discussions using a semi-structured guide. Setting: The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa’s SSB tax was implemented. Participants: Adults aged 18 years or above living in Soweto (n 57). Results: Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government’s stated motivation in introducing the tax for health rather than revenue reasons. Conclusions: While an SSB tax is a policy tool that could be used with other strategies to reduce people’s high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks. [ABSTRACT FROM AUTHOR]