Contextual effects from the physical and social environment contribute to inequitable protection for a large proportion of road users, especially in low- and middle-income countries like South Africa ...where distorted urban planning and socio-spatial disparities from the apartheid era prevail.
This paper examines the differentiated risk of road traffic crashes and injuries to vulnerable road users in South Africa, including pedestrians, females and users of some modes of public transport, in relation to characteristics of the crashes that proxy a range of contextual influences such as rurality and socio-economic deprivation.
The study is based on a descriptive analysis of 33 659 fatal crashes that occurred in South Africa over a three-year period from 2016-2018. Measures of simple proportion, population-based fatality rate, "impact factor" and crash severity are compared between disaggregated groups using Chi-Square analysis, with the Cramer's V statistic used to assess effect size.
Key findings show a higher pedestrian risk in relation to public transport vehicles and area-level influences such as the nature of roads or extent of urbanity; higher passenger risk in relation to public transport vehicles and rurality; and higher risk for female road users in relation to public transport vehicles. The findings have implications for prioritising a range of deprivation-related structural effects. In addition, we present a "User-System-Context" conceptual framework that allows for a holistic approach to addressing vulnerability in the transport system. The findings provide an important avenue for addressing the persistently large burden of road traffic crashes and injuries in the country.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background Injury due to ingestion of harmful chemicals has become an area of concern globally. In South Africa, paraffin has been widely implicated in multiple health outcomes, including ...severe ingestion injuries. A specific category of such injuries is those that are self-inflicted. A significant proportion of self-inflicted ingestion is reported to be intentional, although intentionality for self-infliction may be difficult to determine. Nonetheless, the identification of key explanatory risks and demographic factors of self-inflicted ingestion may contribute towards a better understanding of self-inflicted and harmful chemical ingestion injuries. Methods This study used secondary data that had been collected on burn injuries of all causes, including those due to the ingestion of harmful chemicals, from a sample of South Africans from low-income communities close to major metropolitan centres. The current analysis focused on the risks for self-inflicted ingestion injuries and used logistic regression to determine risks for self-inflicted ingestion as differentiated from ingestion due to the actions of another person (other-inflicted ingestion) by sex and age cohort of the victim, and the presence of alcohol, by examining paraffin ingestion versus that of other chemicals. Results The overwhelming majority of ingestion injuries (92.1%) were self-inflicted. The current findings indicate that sex (with females almost twice as likely to present with self-inflicted ingestion), age cohort (with those aged 18–29 and 30–44 years old four times more likely affected than older adults), presence of alcohol (twice as likely present than amongst individuals reporting ingestion injuries inflicted by others), and chemicals other than paraffin (three times more likely) are key explanatory factors for an increased risk for self-inflicted ingestion of harmful chemicals. Conclusions The study empirically confirms the role of several key risk factors in what remains a relatively unreported and understudied phenomenon, but which appears to align with the demographic and risk profile reported for suicidal injuries through chemical ingestion, i.e. intentional self-inflicted ingestion. The findings may contribute towards improved safety policies on the availability and sale of chemical products and more focussed community interventions for at-risk individuals such as females and young people. It also flags the importance of assessing for alcohol use and alcohol use disorders at hospital admission of self-ingestion injuries.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The objective of this study was to understand the impact of hazardous and harmful use of alcohol and/or other drugs on ARV adherence and disease progression among HIV patients. A cross-sectional ...study design was used. A total of 1503 patients attending HIV clinics in Cape Town, South Africa were screened for problematic substance use. A sub-sample of 607 patients (303 patients who screened positive for problematic substance use and 304 who did not) participated in this study. Hazardous or harmful alcohol use and problematic drug use predicted missing and stopping ARVs which, in turn, was associated with a decrease in CD4 counts and more rapid HIV-disease progression and poorer health outcomes in people living with HIV/AIDS (PLWHA). The findings of this study underscore the need for an integrated approach to managing substance-use disorders in PLWHA.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This study examined the construct validity and internal consistency of modified versions of the job autonomy and control, job pressure, work contact, work-family conflict, psychological distress, and ...sleep problems scales developed by Schieman and Young (2013) among construction professionals through confirmatory factor analysis and tests of internal consistency.
Using a cross-sectional design, survey data were collected from 942 South African construction professionals, of which 630 responses were considered for analysis. Confirmatory factor analysis was used to examine construct validity. Cronbach's coefficient alpha was used to determine the internal consistency, and convergent validity was tested using correlation analysis.
The final CFA indicated very good model fit to the data (χ2 /df ratio = 2.11, IFI = .95, CFI = .95, RMSEA = .06, and Hoelter (95%) = 176). The scales demonstrated satisfactory internal consistency: .82; .91; .83; .90; .90; and .73, respectively. Convergent validity was largely demonstrated with respect to direction of association, but not in relation to magnitude. A limitation of the validation study was the lack of available data for a more robust examination of reliability beyond internal consistency, such as test-retest.
The six scales developed by Schieman and Young (2013) hold promise as measures of work contact, work-family conflict, psychological distress, and sleep problems in relation to working conditions of construction professionals.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Treatment completion rates for outpatient services can be improved.•Treatment completion is associated with abstinence at treatment exit.•Treatment engagement, duration, and intensity predicted ...treatment completion.•Improving completion rates and patient-service fit may enhance treatment outcomes.
Optimizing the effectiveness of substance use disorder (SUD) treatment is critical in low-and middle-income countries (LMICs) with limited opportunities for SUD treatment. This is the first study to identify targets for interventions to improve the quality of SUD treatment in a LMIC.
We explored correlates of three indicators of treatment quality (treatment engagement, completion and abstinence at treatment exit) using data from a SUD performance measurement system implemented in the Western Cape Province of South Africa. The sample included data from 1094 adult treatment episodes representing 53% of the treatment episodes in 2016. Using multivariate logistic regression analyses, we modeled socio-demographic, substance use and program correlates of treatment engagement, completion, and abstinence at treatment exit.
Overall, 59% of patients completed treatment (48% of patients from outpatient services). Treatment completion was associated with greater likelihood of abstinence at treatment exit. Patients were more likely to complete treatment if they engaged in treatment, were older, and had more severe drug problems (characterized by daily drug use and heroin problems) and attended programs of shorter duration. Residential treatment was associated with greater likelihood of treatment engagement, completion, and abstinence at treatment exit.
Improving rates of outpatient treatment completion will enhance the effectiveness of South Africa’s SUD treatment system. Interventions that promote engagement in treatment, particularly among younger patients; reduce program length through referral to step-down continuing care; and ensure better matching of drug problem to treatment level and type could improve rates of treatment completion.
Burn injuries remain a significant cause of death and disability in the global south, with children amongst the most vulnerable. In South Africa, burns are a critical health and economic burden in ...densely populated and energy-impoverished communities. This study used secondary data on burn injuries from 19 health facilities to differentiate between risk for scalds and flame burns across three household energy sources (firewood, paraffin and electricity). The sample was 2 933 cases of child burn victims, with key analytical procedures being descriptive statistics and logistic regression analysis. Results showed that 52% of burn injury admissions reported electricity as the household energy source used at the time of injury. Most burn injuries were scalds (85.3%), with infants and toddlers at greatest risk. The differentiation between wood and paraffin was associated with a threefold increase in scalds relative to flame burns, while that between paraffin and electricity indicated a sevenfold increase in scalds and nineteen times such an increase between wood and electricity. This was an indication of continued challenges for the country in addressing paediatric burns despite, and in the context of, the continued electrification of poor households. The study recommends improved regulation of electrical appliances used by low-income households, and targeted household safety education initiatives.
Contemporary communication technology blurs the boundaries between work-life and family-life environments, through after-hours, work-related contact. We examined the relationship between work ...contact, work-family conflict and consequent outcomes of psychological distress and sleep problems experienced by South African construction professionals. An integrated model of these factors was proposed and tested using path analysis and responses from 630 survey respondents. Work experience, gender, domestic situation and employment status explain the relationship between job autonomy and control, job pressures, and work contact, which were hypothesized to multivariately explain their negative effects. The final integrated model was a good fit to the data. The results indicate that the antecedents of work-family conflict are job autonomy and control, job pressure and work contact. Psychological distress is determined by work-family conflict, work experience, and job pressure. Sleep problems are influenced by work-family conflict, work contact and psychological distress. An important insight gained is the pivotal role played by job pressure, directly and indirectly, in work stress outcomes. Interventions aimed at reducing psychological distress and sleep problems among construction professionals should target the boundary permeability of work contact and work-family conflict, particularly for less experienced, female and junior professionals with low job control but high job pressure.
The global trend of poorer outcomes across the HIV treatment cascade for men has drawn attention to the importance of engaging men in prevention and treatment services. The South African construction ...industry is one of the economic sectors most adversely affected by HIV/AIDS. Previous research on HIV testing behaviour among workers in the industry has revealed that male workers are less likely to be tested than female workers. Given this gender differential, this study employed a field-administered survey to gather data from 450 site-based, male construction workers in Western Cape, South Africa. An integrated model comprising demographic, cognitive, and behavioural factors was then hypothesised to explain HIV testing behaviour. Bivariate analysis and structural equation modelling were then used to test the model. Findings indicate that HIV knowledge, having previously had an STI, and possessing a positive attitude towards HIV testing are terminal predictors of testing behaviour. As a strategy for positively influencing testing behaviour, employers should ensure that effective communication about HIV testing is established with workers across all levels of education and ethnic groups. Interventions relating to risky sexual behaviour need particular attention, and where possible HIV testing should be coupled with general STI screening.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Alcohol consumption is an accepted part of many social and cultural practices, but excessive alcohol consumption is a global public health concern. Aside of its detrimental effects on health, it is ...linked to HIV-related health behaviours such as unprotected sex, multiple/concurrent sexual partnerships, and lower levels of HIV testing. Little is known about the association between alcohol use and HIV-related heath behaviours in construction. Using data from 450 workers drawn from 18 construction sites in the Western Cape, the Alcohol Use Disorders Identification Test (AUDIT) was used to predict alcohol risk of harm as a function of demographic characteristics and sex-related behaviours among workers. Binary logistic regression determined factors associated with increased risk of alcohol harm. The most proximal factor predicting risk of alcohol harm was the frequency of alcohol or drug use before and/or during sex, followed by attitude towards condom use, education, and HIV testing behaviour. Future research efforts should develop a better appreciation of the role of sex-related alcohol expectancies in explaining harmful alcohol use, and intervention management practices should focus on this.
There are indications that gender has an effect on individual risk factors and pathways to HIV diagnoses and treatment. Furthermore, there is growing recognition that to improve HIV-related health ...outcomes for men, it is important to understand their experiences and perspectives. Perhaps because of the physical nature of construction work, the South African construction industry is dominated by men. Given that employed men are a hard-to-reach community population group, the construction workplace offers an ideal environment for data collection and delivery of non-health-facility-based HIV prevention and treatment interventions. Furthermore, workers in the construction industry have been identified as being at a heightened risk of acquiring HIV and AIDS because of work-related travel, the ubiquity of transactional sex around worker hostels and having an increased likelihood of multiple and concurrent sex partnerships. As a consequence, this study examines the association between condom use and sexual partnerships among men working in the construction industry. A purposive cross-sectional survey was used to collect data from 450 workers across 18 construction sites in the Western Cape province of South Africa. The types of sexual partnership had three categories: regular sex partnerships, casual sex partnerships and sex worker partnerships. Frequency of condom use was determined to be highest with casual sex partners (51.2%), followed by sex workers (40.6%) and regular sex partners (25.6%). Hierarchical multiple linear regression analysis was used to examine the demographic, experiential, behavioural and cognitive predictors of condom use across the three categories of sexual partnership. The results indicate that an individual’s perception of control over condom use, and the perceived threat posed by HIV and AIDS are significantly associated with consistent condom use, even after accounting for differences in partner type. Implications of the findings are discussed, and directions for future research on the association between sexual partnerships and condom use are offered.
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