bluuebunny/crossref_metadata_2025_split huggingface dataset:
सोनभद्र जिले की बैगा जनजाति की सामाजिक/शैक्षिक समस्याओं का समाजशास्त्रीय अध्ययन
Authors: सिंह प्रमोद कुमार 
Published: September 2023

भारत के विभिन राज्य में भिन्न-भिन्न जनजातियाँ रहती हैं। जिन जनजातियों को संविधान की अनुसूची में दिया गया है, उन्हें अनुसूचित जनजाति के नाम से जाना जाता है।1
उ0प्र0 में जनगणना 2011 के अनुसार प्रदेश की कुल जनसंख्या में एस0टी0 0.6 प्रतिशत हैं। वर्तमान में सूचीबद्ध जनजातियों की संख्या 12 है जिनमें से एक है बैगा जनजाति। 2
बैगा जनजाति उ0प्र0 का एकमात्र जिला सोनभद्र में पायी जाती है जिसकी जनसंख्या 30006 है। बैगा जनजाति की बहुत-सी सामाजिक-शैक्षिक समस्याएँ हैं जिनके समाधान के लिए तथा विकास के लिए उ0प्र0 में कई परियोजनाएँ संचालित की गई हैं।
इस शोध पत्र में शोधार्थी द्वारा बैगा जनजाति की सामाजिक-शैक्षिक समस्याओं का समाजशास्त्रीय दृष्टिकोण से अध्ययन कर उससे जुड़ी अन्य जानकारी प्रस्तुत किया गया है।
Editorial
Authors: Govender Kaymarlin , George Gavin , Padarath Ashnie , Moeti Themba 
Published: September 2023

The 24th edition of the South African Health Review (SAHR) presents evidence of steps taken towards answering these questions. This edition describes some of the key challenges facing our health system and, through germane illustrations, actions that lead to adaptable and innovative responses to the epidemic in South Africa. The 29 chapters are authored by a diverse range of public health practitioners who offer a range of experiential and reflexive perspectives in responding to the pandemic. These accounts encompass topics depicting the impact of COVID-19 on existing health services and programmes; the impact of socio-economic disparities on adherence to nonpharmaceutical interventions (NPIs) and access to vaccines and treatment; the rationing of healthcare services and implications for achieving equity of access to these services; the emergence of innovative collaborations, networks and partnerships; the impact of measures taken to balance saving lives with saving livelihoods; and emerging lessons for future management for prevention of pandemics and other public health emergencies. Overview of chapters The suite of chapters is presented in five sections. The first section shares insights on evidence-informed decisionmaking to inform national responses amid the many uncertainties that typify the effects of the pandemic. Section two describes lessons learnt from the experiences of service providers and vulnerable populations. Sections three and four examine sectoral collaborations and the COVID-19 response in relation to the needs of vulnerable groups. The final section covers barriers to service access, and availability of vaccines and other COVID-19 health products for the general population.
‘Following the science’: the role of an independent advisory structure in the COVID-19 pandemic response and beyond
Authors: Gray Andrew , Miot Jacqui , Mokgatle Mathildah , Rees Helen 
Published: September 2023

Background As the COVID-19 pandemic spread in 2020, many governments across the globe put structures in place to access rapid independent scientific evidence. The South African Minister of Health established an advisory committee in March 2020 to provide high-level strategic advice. This technical guidance, developed as topic-specific ‘advisories’, was expected to be context-specific and based on the best available evidence, locally and internationally. The authors developing the advisories could draw on systems-wide, multidisciplinary experience. Approach This chapter provides a reflective experience of the process of preparing advisories, the development of rapid evidence syntheses and their use in decision-making, the outputs and the lessons learned from that process, and the structural and operational changes over the course of the pandemic. As South Africa has moved out of the acute phase of the pandemic, the lessons learned must be embraced and best practices adopted to inform future pandemic preparedness. Advisories needed to use the best available evidence rather than wait for the best possible evidence. Some advisories were therefore revised multiple times, as new evidence emerged. Advisories were submitted to the Minister of Health for consideration prior to public release. However, in some cases, delays in such release led to confusion as to the scientific basis of policy decisions. The confidentiality of the committee debates also needed to be balanced against the need for engagement with the public. In order to promote accountability and build public trust, from March 2022 all advisories were published on a dedicated website within seven days of receipt by the Minister. The public were thus informed of the scientific basis of the advice, providing important context for subsequent executive decisions. Consistent feedback to the committee from decision-makers was also important, as their advice was only one of many inputs considered by a complex array of government bodies, across different departments. Conclusions The world faces a significant risk of further pandemics and other public health emergencies and is engaged in high-level negotiations on strengthening global capacity to respond. Whether that involves a global pandemic accord, strengthened International Health Regulations, or a strengthened global approach to medical countermeasures, rapid, credible, independent and country-specific scientific advice will remain essential. The lessons learned during COVID-19 should not be lost. Submitted on behalf of the Ministerial Advisory Committee on COVID-19.
COVID-19 infections, hospital admissions and mortality outcomes: the associated risk factors among private medical insurance beneficiaries
Authors: Mametja Selaelo , Shapiro Daniel , Semenya Mabatlo , Hattingh Jolene , Kantor Gareth , Cohen Cheryl , Jassat Waasila , Getz Craig , Moloabi Stanley , Tempia Stefano 
Published: September 2023

COVID-19 has had a significant impact on morbidity and mortality in South Africa. This study aims to identify risk factors, including occupation, for SARS-CoV-2 infection, hospital admission, and mortality within the Government Employees Medical Scheme population across the three pandemic waves. This is a retrospective cohort study. The study population consisted of 760 000 principal members of the scheme. Demographic data and claims information were used to identify age, income, province, occupation, and pre-existing chronic conditions. The incidence and adjusted relative risk for infections were higher in people younger than the 40−49 age group; however, intensive care unit admissions and deaths increased with age; and a lower adjusted relative risk for infections and hospital admission. Males had a higher adjusted relative risk for intensive care admissions and mortality. The incidence and adjusted relative risk for infections and intensive care admissions increased with increasing income quintile; however, deaths were similar across all income quintiles. This study confirms that older age, male gender, occupation and comorbidities are associated with COVID-19 infection, hospital admissions, intensive care admissions, and death. Females were more likely to be infected; however, males had a high risk for intensive care admission and death. The highestrisk occupations for COVID-19 infection are Health, Correctional Services and Police Services. The reduced relative risk in Wave 3 among healthcare workers was likely to have been attributable to their access to protective vaccination as well infection in previous waves.
COVID-19: insights from contracting the private sector for critical care
Authors: Solanki Geetesh , Blecher Mark , Cornell Judith , Crisp Nicholas , Engelbrecht Beth , Manning Michael , Morar Reno , Myburgh Neil , Patel Bhavna 
Published: September 2023

The COVID-19 epidemic was expected to result in shortages of public-sector critical care beds. This prompted the Western Cape Department of Health to explore ways to address the shortfall, culminating in a service-level agreement with the private sector and national level development of a system of reimbursement for critical care. This chapter describes the experience of formulating the agreement and the insights gained. Since the shift of patients between the sectors did not materialise, the most important outcome was that the parties were able to conclude this agreement, and the engagement provided insights beyond the original problem. The process revealed a lack of national leadership and co-ordination capacity; high levels of fragmentation; different visions of what care should be provided; the complexity entailed in contracting; capacity constraints in both sectors; and data constraints to inform policy choices. The most prominent lesson was that a trusting relationship was essential to the success of this initiative, built on a vision and a value system that all parties could endorse. We recommend the establishment of national-level capacity for public−private engagement, reviewing the regulations constraining contracting, fast-tracking the national data management system, enhancing in-house administrative capacity to complement the use of intermediaries, conducting a critique of this engagement, and a cost assessment of the options for expanding critical care capacity. It is premature to make a judgement on the success of the agreement. However, it provided a real-time demonstration of the complexities and constraints for such engagement within the South African context and it showed how, with trust and commitment, we can develop solutions. We should build on this experience by addressing the constraints, so that progress is made towards the more integrated health system as envisaged by National Health Insurance and required for universal health coverage.
The impact of COVID-19 on use of maternal and reproductive health services and maternal and perinatal mortality
Authors: Pattinson Robert , Fawcus Sue , Gebhardt Stefan , Soma-Pillay Priya , Niit Ronelle , Moodley Jack 
Published: September 2023

South Africa experienced two waves of COVID-19 infection in the financial year 2020/21. This study examines the impact of these waves on maternal and perinatal mortality and their effect on the use of and access to maternal and reproductive health services. Data from the District Health Information System on maternal and perinatal deaths, births, antenatal visits, and use of contraceptive termination of pregnancy services were used, and the 2020/21 and 2019/20 financial years were compared in order to formulate national and provincial perspectives. Data on visits for initiating antenatal care, births, contraceptive prescriptions and termination-of-pregnancy services were used to assess utilisation of maternal and reproductive health services respectively; and the number and rates of maternal and perinatal deaths were examined to assess impact. A second descriptive analysis of pregnant women who had delivered after having contracted COVID-19 was performed using a separate database set up by the National Department of Health/South African Medical Research Council/University of Pretoria (NDoH/ SAMRC/UP), specifically to monitor the effects of COVID-19). The data suggest that there was a marked increase (of 40%) in maternal deaths (p<0.00001), 10% in stillbirths (p<0.00001), and 3% in (p=0.31) neonatal deaths when compared with the same period in 2019/20. There was a mean 28% increase in the institutional maternal mortality ratio in all provinces during the second wave compared with the first wave (p<0.0001), except in the Western Cape which had a decrease of 1%. Data from the National Institute for Communicable Diseases showed that the case fatality rate for pregnant women with COVID-19 was high (4.5%), as was the perinatal mortality rate (70.6 per 1 000 births), while the institutional maternal mortality ratio for South Africa was 16.94/100 000 live births. An increase of 3.6% in in-facility births in 2020/21 compared with 2019/20 was observed, with increased movement of pregnant women to the more rural provinces and districts for delivery. Antenatal care services were maintained overall, but use of reproductive health services declined (contraceptive prescriptions by 5%, and termination of pregnancy by 17% overall). The effect of the COVID-19 epidemic on pregnant women and its collateral damage is severe. Strengthening the health system to maintain essential services during a pandemic and vaccination of healthcare workers and pregnant women are key to reducing maternal and perinatal mortality.
Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base
Authors: George Gavin , Nota Phiwe B. , Strauss Michael , Lansdell Emma , Peters Remco P.H. , Brysiewicz Petra , Nadesan-Reddy Nisha , Wassenaar Douglas 
Published: September 2023

Background Studies have shown that healthcare workers (HCWs) are considered trusted sources of coronavirus disease 2019 (COVID-19) information in their communities, ideally placing them as effective vaccine advocates. However, limited data exist on the role of HCWs in the promotion of vaccines, and whether they feel adequately equipped to fulfil this role. This study therefore aimed to determine the willingness of HCWs in promoting COVID-19 vaccines, how this correlated with their own vaccination behaviour and attitudes to alternative therapies, and whether they felt they had adequate knowledge and skills to communicate effectively with patients. Methods A mixed-methods design was adopted, involving an online web-based survey and in-depth interviews (IDIs). HCWs were recruited for the online survey from an integrated health system database in South Africa using voluntary response sampling, with follow-up qualitative interviews conducted with HCWs who indicated interest in participating in an interview. Univariate and multivariate logistical regression models were used to understand how demographic characteristics, HCW roles, vaccination status, attitudes and practices around alternative medications, and information on COVID-19 vaccines were related to the willingness of HCWs to recommend vaccination to their patients. Results Most of the survey sample were vaccinated (90.7%) and indicated that they would recommend vaccination (81.7%). However, a significant proportion of the sample (58.6%) felt that they did not have enough information on COVID-19 vaccines, while 59.8% felt that they required additional guidance on how to educate their patients on COVID-19 vaccines. Vaccinated HCWs were more likely to recommend vaccination (OR=10.63 [95% CI: 6.53-17.31]) than their unvaccinated counterparts. The qualitative results provide further insights into why HCWs were willing or unwilling to administer and promote vaccines, with three themes emerging: (i) HCWs’ belief in the value of vaccines and their promotion strategies; (ii) challenges facing HCWs in fulfilling their mandate of administering and promoting COVID-19 vaccination; and (iii) the rationale for HCWs discouraging vaccination and promoting alternative medicines for COVID-19 prevention and treatment. Conclusions This study posits that if HCWs are key to the success of national vaccination programmes, then they will need to be provided with clear, contextual, up-to-date information in order to enhance patient communication and vaccine uptake.
Left behind: why South Africa must develop migration-aware responses to COVID-19 and future pandemics
Authors: de Gruchy Thea , Vearey Jo 
Published: September 2023

The Coronavirus 2019 disease pandemic and strategies to mitigate its impact have restricted and complicated migration globally, including in Southern Africa, a region associated with diverse population movements within and between countries. Despite this, health system responses – including in South Africa − fail to engage with migration. Drawing from ongoing research, this chapter explores whether South Africa’s COVID-19 response is ‘migration-aware’ − a term for interventions, policies and systems that embed migration as a central concern in their design. Methods included a desk review; key informant interviews; participant observation in various policy processes; policy and media analysis; and establishment of the Researching Migration and Coronavirus in Southern Africa project. Findings generated to date indicate that South Africa’s COVID-19 response is not migration-aware. Four key concerns are highlighted: amplification of existing structural challenges faced by migrants; manifestation of new challenges, including exclusion of non-citizens from national response; justification of increasingly restrictive approaches to immigration management; and undermining of efforts towards Universal Health Coverage. Without addressing these concerns, South Africa’s COVID-19 response will fail. Everyone in the country must be included in COVID-19 interventions, particularly the national vaccination programme, to ensure population-effective protection. Recommendations include establishing a National Migration and COVID-19 Task Team and developing a basic ‘score-card’ to guide responses, with administrative systems and a legal firewall to ensure that undocumented persons can access COVID-19 services, including vaccination programmes, and face no penalties when doing so. These recommendations should be expanded to the regional and continental levels to guide co-ordinated, migration-aware responses.
Supporting early childhood development during COVID-19 using telehealth: stakeholders’ perspectives
Authors: Van der Linde Jeannie , Eccles Renata , du Toit Maria 
Published: September 2023

Timely assessment and intervention for developmental delays is a high priority in child healthcare, yet obtaining access to early developmental care services remains a challenge in low-and middle-income countries, such as South Africa, which has a shortage of healthcare professionals. The outbreak of COVID-19 in 2020 exacerbated these barriers, and alternative solutions for service delivery are needed. Telehealth holds potential as an innovative approach for the provision of early childhood developmental care services during the COVID-19 pandemic. The chapter aims to explore the feasibility of early developmental telehealth through stakeholders’ perspectives. To explore perspectives of tele-assessment, 30 caregivers of children (birth to 36 months) completed an online developmental assessment followed by an online questionnaire probing their perspectives thereof. Nineteen final-year student healthcare clinicians completed a survey on their initial experiences of tele-intervention, which was initiated mid-year during lockdown level 4. The perspectives of four caregivers and 10 student-clinicians were probed at the end of 2020 through synchronous online interviews. Almost all caregivers (96.7%, n=29) rated their overall tele-assessment experience as positive. The majority (66.7%, n=20) identified tele-assessment as a viable assessment mode; however, 53.8% (n=14) indicated that they would want face-to-face assessments to supplement tele-assessments. This suggests that families may prefer a hybrid approach to developmental assessment. Although they were initially apprehensive, caregivers and student-clinicians found tele-intervention to be a viable and positive approach to service delivery during the COVID-19 pandemic. Caregivers and student-clinicians faced similar technological challenges, but all experienced benefits from the telehealth services, including continued access to services during the pandemic. The tele-intervention framework successfully provided structure to online interventions. Telehealth, as part of the proposed hybrid service delivery model, provides caregivers access to developmental care, despite COVID-19 restrictions.
Trends in COVID-19 public health intervention adherence and vaccine hesitancy in South Africa: 2020–2021
Authors: Köhler Timothy , English René , Christian Carmen 
Published: September 2023

South Africa’s stringent national lockdown Regulations served to contain the spread of COVID-19, but at a tremendous social and economic cost. The prioritisation of public health intervention adherence in combination with widespread vaccination coverage is critical in the effort to save lives without endangering livelihoods − but for these interventions to have an impact, sufficiently high levels of public acceptance and adherence are required. We assessed changes in attitudes and adherence between May/June 2020 and April/May 2021 using longitudinal individual-level data from five rounds of the National Income Dynamics Study − Coronavirus Rapid Mobile Survey, a nationally representative survey conducted during the COVID-19 pandemic. We used these weighted data to estimate relevant population estimates over the period under review. We observed a large increase in the prevalence of mask-wearing over time, from just half of all adults (53%) in May/June 2020 to the vast majority (83%) in April/May 2021. Hand hygiene decreased by approximately 20 percentage points over the same 12-month period (67% to 48%). Staying home and physical distancing adherence remained relatively low. On aggregate, the proportion of adults who reported ‘some’ combination prevention behaviour (either mask-wearing or hand hygiene) increased over the year. In high-risk groups, the prevalence of mask-wearing among the hypertensive and obese adult sub-populations increased substantially, from approximately 55% in May/June 2020 to over 80% one year later. Similar trends were noted for those aged 60 years and older and those with other chronic conditions. Vaccine acceptance when first estimated in February/March 2021 was relatively high at 71%, and increased further by April/May 2021 to 76%. As expected given the surge of COVID-19 cases, we observed a strong increase in mask-wearing adherence and intention to be vaccinated. Adherence to hand hygiene declined considerably over time, and staying at home and physical distancing remained low. Implications for policymakers are to continue with accurate, continuous, and targeted communication, health systems strengthening, and supporting multi-disciplinary research.
RETRACTED: Gender differences in mental health outcomes during the first COVID-19 pandemic lockdown in South Africa
Authors: Kleinhans Atholl , Lentoor Antonio , Maepa Mokoena 
Published: September 2023

Background While the COVID-19 pandemic affected everyone in society, it was women who bore the brunt during the first hard lockdown in South Africa. This study examined the gender differences in mental health outcomes during the first COVID-19 pandemic lockdown in the country. Methods A cross-sectional, survey-based study was done, with a total of 327 participants recruited in South Africa via convenience sampling using online platforms such as Facebook, Twitter, university websites, WhatsApp, forums, and emails. The participants completed socio-demographic and COVID-19 threat- and stress-related questions. The Patient Health Questionnaire (PHQ-9) was completed as a measure of depression. The chi-squared test and Analysis of Variance (ANOVA) were applied during analysis. All analyses were conducted using IBM SPSS Statistics version 20 (IBM Corporation, Armonk, NY, USA), with a level of significance set at 0.05, two-tailed. Results The study found that fear of COVID-19 disease impacted stress and depression levels in both genders, with a significantly greater impact among women. A higher proportion of women than men reported stress related to the lockdown (62.9% versus 23%, p = 0.01). Subjective risk at work, work stress, and being required to continue work during lockdown were significantly associated with depression among women. Conclusions The study highlights the differential effect of stress, fear, and worry during the pandemic lockdown on vulnerability to depression, by gender. This has major implications for mental health interventions post-pandemic. It brings an opportunity to reduce gender difference in mental health through providing tailored care services, especially to working women during times of high stress.