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All papers that are published / presented (or in the process of being published / or to be presented) at a scientific conference by SAMRC staff.
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Publication Exploring an African perspective to tobacco Endgame(2023-03-04) Egbe, C.O; Ngobese, S.P; Gwambe, S; Khan, A; Ngcobo, Z.P; Bialous, S.APublication Perspectives on maternal and infant outcomes of pregnant people treated for DR-TB(2022-09-27) Loveday, MPublication Intention to quit using tobacco among school-going adolescents in South Africa: Results from global youth tobacco surveys over a 12-year period(2021) Egbe, C.O; Londani, M; Ayo-Yusuf, O.APublication Cigarette smoking and nicotine dependence among male offenders at correctional centers in Tshwane, South Africa(2022-03-15) Nkosi, S; Egbe, C.O; Ratele, K; Morojele, N.KItem “I carry the trauma and can vividly remember”: Mental health impacts of the COVID-19 pandemic on frontline health care workers in South Africa(2023-04-24) Mahlangu, P; Sikweyiya, Y; Gibbs, A; Shai, N; Machisa, M; , M"We know from research that pandemics and disease outbreaks expose HCWs to an increased risk of short and long-term psychosocial and occupational impacts. We conducted qualitative research among 44 frontline health care workers (FHCWs) practicing in seven South African hospitals and clinics. FHCWs were interviewed on their experiences of working during the first-wave of the COVID-19 pandemic and its perceived impact on their wellness. In this study, FHCWs included the non-medical and medical professionals in direct contact with COVID-19 patients, providing health care and treatment services during the COVID-19 pandemic. Most of the FHCWs reported stressful and traumatic experiences relating to being exposed to a deadly virus and working in an emotionally taxing environment. They reported depression, anxiety, traumatic stress symptoms, demoralization, sleep difficulties, poor functioning, increased irritability and fear of being infected or dying from COVID-19. The mental health impacts of COVID-19 on HCWs were also associated with increased poor physical wellbeing, including fatigue, burnout, headache, and chest-pains. FHCWs reported professional commitment and their faith as critical intrinsic motivators that fostered adaptive coping while working on the frontline during the first-wave of the COVID-19 pandemic. Many alluded to gaps in workplace psychosocial support which they perceived as crucial for coping mentally. The findings point to a need to prioritize interventions to promote mental wellness among FHCWs to ensure the delivery of quality healthcare to patients during pandemics or deadly disease outbreaks."Item Harm towards women from men’s drinking: A global review of the qualitative literature(2023-06-05) Ramsoomar, L; Wilson, I.M; Willoughby, B; Tanyos, A; Graham, K; Walker, M; Laslett, ABackground: Global evidence shows that men’s alcohol use contributes to intimate partner violence (IPV) and other harms. Yet interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men’s drinking have not been well articulated, particularly from an international perspective. Aim: To document the breadth and nature of harms and impact of men’s drinking on women. Methods: A narrative review was conducted of peer-reviewed qualitative studies that: (a) focused on alcohol (men’s drinking), (b) featured women as primary victims, (c) encompassed direct/indirect harms, and (d) explicitly featured alcohol in the qualitative results. Papers were selected following a non-time-limited systematic search of key scholarly databases. Results: Twenty-nine papers were included in this review. The majority of studies were conducted in low to middle income countries. The harms in the studies were collated and organised under three main themes: (i) harmful alcohol-related actions by men (e.g., violence, sexual coercion, economic abuse), (ii) impact on women (e.g., physical and mental health harm, relationship functioning, social harm), and (iii) how partner alcohol use was framed by women in the studies. Conclusion: Men’s drinking results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women’s disempowerment. An explicit gendered lens is needed in prevention efforts to target men’s drinking and the impact on women to improve health and social outcomes for women worldwide.Item A social impact bond to improve HIV and pregnancy outcomes in adolescent girls and young women(South African HIV Clinicians Society, 2023-11-09) Abdullah, F; Slingers, N; Davids, LItem Evidence mapping of methods for incorporating economic considerations in clinical guideline development for Malawi, Nigeria, and South Africa.(2023-09-10) Bango, F; Kredo, T; Vorster, P; Arikpo, D; Manthalu, G; Brand, A; Naude, C; Nkonki, LItem Introducing the Cochrane nutrition & public health thematic group(2023-09-03) Wolfenden, L; Bauman, A; Doyle, J; Durao, S; Kristjansson, E; McCrabb, S; Naude, C; Schwingshackl, LItem The role of alcohol restriction on femicide in South Africa: Evidence from the COVID-19 epidemic(2024-05-25) Abrahams, N; Mhlongo, S; Dekel, B; Ketelo, A; Lombard, C; Shai, N; Ramsoomar, L; Mathews, S; Labuschagne, G; Matzopoulos, R; Prinsloo, M; Martin, LJ; Jewkes, R; Chirwa, EIntroduction Alcohol is a key risk factor for femicide (killing of women and girls), the most extreme and severe form of gender-based violence (GBV). The objective of this study was to examine the relationship between different types of femicides and alcohol, over a period of alcohol prohibition during the COVID-19 lockdown restrictions in South Africa. Study Methods : A retrospective analysis of women and girls 14 years and older killed (femicides) between 1 April 2020 and 31 March 2021 were identified from a proportionate random sample of mortuaries. We used poison regression models and incidence rate ratios (IRR) to compare the number of cases of intimate partner femicides (IPF) or non-intimate partner femicides (NIFP) across periods when alcohol sales were completely or partially banned with a period with no restrictions. We also calculated the Age-Standardised Rates (ASR) for overall femicides, IPF and NIPF and used incidence rate Ratios (IRR) to compare the two studies. Results: There was a 63% decrease among all femicides (IRR=0.37: 95%CI: 0.30-0.47) during the complete alcohol ban period compared to periods of no restrictions with a similar statistical significant decline for IPF (IRR=0.39: 95%CI: 0.28-0.53)) and NIPF (IRR=0.39: 95%CI: 0.27-0.55). This pattern is non-existent for the corresponding calendar periods of the 2017 study. Despite the decline during specific lock down periods, an overall significant increase in the ASR for intimate partner femicide was found in 202/21 compared to 2017 (IRR=1.12: 95%CI: 100-1.26) while the ASRs for all femicide (IRR=0.95: 95%CI: 0.88-1.03) and non-intimate partner femicide (IRR= 0.98: 95% CI: 0.86-1.11) were similar across the two surveys. Conclusion: The unintended social experiment during COVID-19 lockdown has shown the definitive role of alcohol on femicide in South Africa. We have shown a clear trend of decrease in all forms of femicides during the period of complete alcohol prohibition compared to partial or no ban periods. This analysis confirms the role of alcohol in women and girl’s vulnerability to GBV and the importance of addressing alcohol in prevention interventions.Item Change in emotional distress, anxiety, depression and PTSD from pre- to post-flood exposure in women residing in a low-income setting in South Africa(2023) Nothling, J; Gibbs, A; Washington, L; Gigaba, S.G; Willan, S; Abrahams, N; Jewkes, RFloods are increasing in frequency and may increase the risk for experiencing emotional distress, anxiety, depression and PTSD. The aim of this study was to determine the extent of damage, loss, injury and death resulting from floods that occurred in and around the city of Durban, South Africa, in April 2022, and associated changes in mental health pre- to post-floods in a low-income setting. Seventy-three women between the ages of 18 and 45, residing in flood affected, low-income settings, were interviewed prior to the floods occurring. Mental health measures were repeated with 69 of the 73 women during the post-flood interview along with a questionnaire measuring flood-related exposures. Loss of infrastructure (lacked access to drinking water, electricity, fresh food, could not travel to work, had to stay in a shelter and could not get hold of friends or family) was a predictor of post-flood change in levels of emotional distress and anxiety. Higher levels of prior trauma exposure were associated with higher post-flood levels of emotional distress. Higher pre-flood food insecurity was also associated with higher post-flood anxiety. Women affected by poverty, food insecurity and a history of trauma are vulnerable to the additive adverse mental health effects of floods. Proactive approaches to diminishing the impact of floods on the livelihood of women is needed and post-flood relieve efforts may be more affective if they are enhanced by providing mental health support.Item The impact of seeking protection orders for severe violence on the lives of female survivors in South Africa(2023-09-11) Ramsoomar, L; Moretlo, M; Mtimkulu, S.W; Jewkes, RSevere intimate partner violence (IPV) has an enduring impact on affected women. In South Africa, the two predominant routes for women experiencing severe IPV are social and legal services. Protection orders (POs) are a common legal route to prevent the recurrence of intimate partner violence. However, evidence on the effectiveness of POs is almost entirely from high-income countries, and little is known about its impact on women’s lives. This study aims to address a critical research gap among women who seek POs in South Africa by examining their severe violence experience/s, and the impact of obtaining a POs on their overall well-being.Methods: In-depth interviews were conducted with 20 demographically diverse women recruited from a magistrate’s court in South Africa. Participants were at differing stages of the PO process. Findings: This study highlights the complex decision-making process in applying for a PO; experiences of severe violence; barriers to obtaining a PO. It shows that most PO -seeking women in South fear being killed by their intimate partner. Key precipitating factors to applying for a PO include: keeping themselves and children safe, obtaining justice, ending a life of violence and “starting over”. Conclusions and implications: Deciding to obtain a PO is complex and multi-faceted including “ a fear of being killed”. Women face personal, social and legal barriers in applying for, obtaining and finalizing POs against their IPs. Findings have important implications for health-care, legal practitioners, and key stakeholders in the social and criminal justice system.Item Young men’s reflections on their experience of co-developing an intervention to address their masculinities: Siyaphambili Youth Project (“Youth Moving Forward”)(2024) Mkhwanazi, S; Washington, L; Khaula, S; Mannell, A; Gibbs, A"Interventions working with young, poor, black men to ‘transform’ masculinities often exclude the voices of those ‘targeted’, drawing on stereotypical ideas about masculinity, resulting in less effective interventions and mischaracterizing young men. Siyaphambili Youth Project in South Africa worked with young men to co-develop an intervention including their concepts of masculinities. We conducted a co-development process involving an NGO (Project Empower), two research organizations (South African Medical Research Council, and University College London and 8 young men (18-24 years) referred to as Youth Peer Research Associates (YPRAs), recruited from one rural and one urban community. Over 24 months we co-developed an intervention addressing the overlapping challenges of masculinities, HIV, violence, and poor mental health. YPRAs were involved in three activities: (1) participatory research activities to understand how structural inequalities impacted on lived experiences, (2) co-developing a Theory of Change and (3) intervention design. We interviewed YPRAs about their experiences of being involved in co-development. The co-development process helped YPRAs explain how they experienced structural marginalisation (racism, economic, and political) and how this shaped their identities and interpersonal practices including their experience and perpetration of violence. Through involvement in the process, some described reflection and starting to change: talking about their problems, rather than resorting to physical violence, recognising how they used alcohol to deal with conflict and stress and starting to talk about HIV-prevention/treatment. Despite this, the co-development process did not address their structural exclusion, and they continued to face and struggle with the wider challenges of their lives, however, potentially with a different set of response options to these challenges. Co-developing an intervention enabled a more nuanced picture of how structural marginalization shaped young men’s lives, and for YPRAs enabled some to reflect on their masculinities and strategize new ways to address their challenges."Item Circumstances and attrition of alcohol-related rapes in the South African criminal justice system(2023-10-24) Machisa, M; Jina, R; Labuschagne, G; Vetten, L; Loots, L; Swemmer, S; Meyersfeld, B; Jewkes, RStudy Settings & Methods: RAPSSA Study - the first national study of investigation, prosecution and adjudication of rape matters reported to the police. Aims: Deepen understanding of epidemiology, context and circumstances of rape to inform prevention “Track” case progression/attrition within the criminal justice system and Investigate (amenable) factors for case attrition Findings & Recommendations: Alcohol intoxication is a situational factor that affects the collection of evidence and impedes possibilities of securing justice for victims through pathways involving prosecutor biases about the credibility of evidence and perception of the potential for convictability. Qualitative data shows that prosecutors are motivated to pursue cases where they perceive higher convictability and that contribute to meeting performance targets. Continual gender-affirming training is a necessary intervention to address the prosecutor biases and rape stereotyping that negatively impact case outcomes. Given the limitations of statement evidence in such cases, there is a need for the NPA to investigate systemic challenges in performance management that negatively affect victims. Strengthening other evidence collection, especially medico-legal and forensic evidence, which is useful, especially in cases where perpetrators are unidentified. Sexual violence risk reduction interventions must incorporate elements sensitising communities about the sexual-violence-related risks of alcohol and other drug intoxicationItem Circumstances and attrition of alcohol-related rapes in the South African criminal justice system(2023-04-18) Machisa, M; Jina, R; Labuschagne, G; Vetten, L; Loots, L; Swemmer, S; Meyersfeld, B; Jewkes, RStudy Settings & Methods: RAPSSA Study - the first national study of investigation, prosecution and adjudication of rape matters reported to the police. Aims: Deepen understanding of epidemiology, context and circumstances of rape to inform prevention “Track” case progression/attrition within the criminal justice system and Investigate (amenable) factors for case attrition. Findings & Recommendations: Alcohol intoxication is a situational factor that affects the collection of evidence and impedes possibilities of securing justice for victims through pathways involving prosecutor biases about the credibility of evidence and perception of the potential for convictability. Qualitative data shows that prosecutors are motivated to pursue cases where they perceive higher convictability and that contribute to meeting performance targets. Continual gender-affirming training is a necessary intervention to address the prosecutor biases and rape stereotyping that negatively impact case outcomes. Given the limitations of statement evidence in such cases, there is a need for the NPA to investigate systemic challenges in performance management that negatively affect victims. Strengthening other evidence collection, especially medico-legal and forensic evidence, which is useful, especially in cases where perpetrators are unidentified. Sexual violence risk reduction interventions must incorporate elements sensitising communities about the sexual-violence-related risks of alcohol and other drug intoxication.Item The harms to women and children from men’s drinking and effective policy options(2023-10-24) Ramsoomar, L; Laslett, AM; LaslettItem Case studies describing cost analyses that supported evidence informed decision – going beyond the ICER(2023-09-10) Leong, T.D; Miot, J; Parrish, A; Johnson, Y; Kredo, TItem Incorporating economic evidence into guidelines to inform local policy and best practices for child health in Malawi, Nigeria and South Africa(2023-09-10) Bango, F; Nkonki, L; Brand, A; Arikpo, L; Manthalu, G; Mthethwa, M; Mpando, T; Vorster, P; Naude, C; Kredo, TItem The feasibility and acceptability of mobile phone-delivered adherence counselling to address HIV-stigma concerns to improve ART adherence among people attending public health services(2023-06-20) Kedama, A; Ndunge, N; Mathews, C; Banas, E; Shkembi, B; Kalichman, MItem Healthcare workers' experience and perspectives on primary healthcare integration: A scoping review(2023-09-10) Moloi, H; Daniels, K; Brooke-Sumner, C; Cooper, S; Odendaal, W.A; Thorne, M; Akama, E; Leon, NNo abstract available.