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1.  Explaining household socio-economic related child health inequalities using multiple methods in three diverse settings in South Africa 
Despite free healthcare to pregnant women and children under the age of six, access to healthcare has failed to secure better child health outcomes amongst all children of the country. There is growing evidence of socioeconomic gradient on child health outcomes
The objectives of this study were to measure inequalities in child mortality, HIV transmission and vaccination coverage within a cohort of infants in South Africa. We also used the decomposition technique to identify the factors that contribute to the inequalities in these three child health outcomes. We used data from a prospective cohort study of mother-child pairs in three sites in South African. A relative index of household socio-economic status was developed using principal component analysis. This paper uses the concentration index to summarise inequalities in child mortality, HIV transmission and vaccination coverage.
We observed disparities in the availability of infrastructure between least poor and most poor families, and inequalities in all measured child health outcomes. Overall, 75 (8.5%) infants died between birth and 36 weeks. Infant mortality and HIV transmission was higher among the poorest families within the sample. Immunisation coverage was higher among the least poor. The inequalities were mainly due to the area of residence and socio-economic position.
This study provides evidence that socio-economic inequalities are highly prevalent within the relatively poor black population. Poor socio-economic position exposes infants to ill health. In addition, the use of immunisation services was lower in the poor households. These inequalities need to be explicitly addressed in future programme planning to improve child health for all South Africans.
PMCID: PMC3086829  PMID: 21463530
2.  Selling a service: experiences of peer supporters while promoting exclusive infant feeding in three sites in South Africa 
Even though it has been shown that peer support to mothers at home helps to increase exclusive breastfeeding, little is known about the experiences of peer supporters themselves and what is required of them to fulfil their day-to-day tasks. Therefore, a community-based randomised control trial using trained "lay" women to support exclusive infant feeding at home was implemented in three different sites across South Africa. The aim of this paper is to describe the experiences of peer supporters who promote exclusive infant feeding.
Three focus group discussions were held, in a language of their choice, with peer supporters. These meetings focused on how the peer educators utilised their time in the process of delivering the intervention. Data from the discussions were transcribed, with both verbatim and translated transcripts being used in the analysis.
Unlike the services provided by mainstream health care, peer supporters had to market their services. They had to negotiate entry into the mother's home and then her life. Furthermore, they had to demonstrate competence and come across as professional and trustworthy. An HIV-positive mother's fear of being stigmatised posed an added burden - subsequent disclosure of her positive status would lead to an increased workload and emotional distress. Peer supporters spent most of their time in the field and had to learn the skill of self-management. Their support-base was enhanced when supervision focused on their working conditions as well as the delivery of their tasks. Despite this, they faced other insurmountable issues, such as mothers being compelled to offer their infants mixed feeding simultaneously due to normative practices and working in the fields postpartum.
Designers of peer support interventions should consider the skills required for delivering health messages and the skills required for selling a service. Supportive supervision should be responsive both to the health care task and the challenges faced in the process of delivering it.
Trial registration
PMCID: PMC2987851  PMID: 20977716
3.  Missed opportunities for participation in prevention of mother to child transmission programmes: Simplicity of nevirapine does not necessarily lead to optimal uptake, a qualitative study 
The objective of this study was to examine missed opportunities for participation in a prevention of mother-to-child transmission (PMTCT) programme in three sites in South Africa. A rapid anthropological assessment was used to collect in-depth data from 58 HIV-positive women who were enrolled in a larger cohort study to assess mother-to-child HIV transmission. Semi-structured interviews were conducted with the women in order to gain an understanding of their experiences of antenatal care and to identify missed opportunities for participation in PMTCT.
15 women actually missed their nevirapine not because of stigma and ignorance but because of health systems failures. Six were not tested for HIV during antenatal care. Two were tested but did not receive their results. Seven were tested and received their results, but did not receive nevirapine. Health Systems failure for these programme leakages ranged from non-availability of counselors, supplies such as HIV test kits, consent forms, health staff giving the women incorrect instructions about when to take the tablet and health staff not supplying the women with the tablet to take.
HIV testing enables access to PMTCT interventions and should therefore be strengthened. The single dose nevirapine regimen is simple to implement but the all or nothing nature of the regimen may result in many missed opportunities. A short course dual or triple drug regimen could increase the effectiveness of PMTCT programmes.
PMCID: PMC2211501  PMID: 18034877

Results 1-3 (3)