Browsing by Author "Khuzwayo, Nelisiwe."

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Effective coverage of emergency obstetric and newborn care services in Wolaita Zone, Southern Ethiopia=Ukubhekana nesimo esiphuthumayo sokubelethisa nezinsiza zokunakekela izinsana endaweni iWolaita eNingizimu ye-Etopiya.
(2023) Arba, Mihiretu Alemayehu.; Khuzwayo, Nelisiwe.; Yota, Bereket Yakob.
Background: Despite the significant improvement in the availability and access of facilities in low and middle-income countries, a considerable burden of maternal and child morbidity and mortality exists, further suggesting the need for effective coverage of EmONC services. Understanding the extent to which the health system delivers quality service and the factors that predict the gap in providing the services are vital to evidence-based decisions at the local, national, and global levels. However, evidence is lacking on the effective coverage of EmONC services and factors influencing quality service provision. Objective: This study aimed to understand, explore, and describe the contexts, correlates, and levels of effective coverage of EmONC services in the Wolaita Zone, southern Ethiopia, and develop a model for effective coverage of EmONC services. Methods: After mapping the evidence for effective coverage of EmONC services in Africa, the study employed an explanatory sequential mixed-method approach. The quantitative study applied a cross148 sectional design, including 414 (facility-based survey) and 402 (house-to-house survey) study participants. The quantitative data were collected using an Open Data Kit (ODK) tablet phone software and exported to Stata version 17 for analysis. Simple and multiple linear regressions, along with p151 values, coefficients, and 95% confidence intervals, were used to declare the statistical significance and strength of the association. The qualitative study employed a case-study research design including 37 participants (selected using maximum variation sampling) to explore the barriers and enablers of EmONC services utilization. The coding and thematic analysis of the qualitative study were assisted by NVIVO version 12 software. The qualitative study assured trustworthiness by establishing credibility, transferability, conformability, and dependability. Result: The scoping review showed a paucity of evidence on the effective coverage of EmONC services in Africa. It also provided a summary of existing evidence on the crude coverage, quality of EmONC services assessed through diverse indicators, and factors linked with the quality of EmONC services. The household survey identified 72.1% crude coverage of EmONC services. The facility-based survey of EmONC services revealed that the indices of structural, process, and output quality were 74.2%, 69.4%, and 79.6%, respectively. Overall, 59.2% of women with EmONC service-need received poor quality services. Women’s education grade 1–8 (B=5.35, 95% C.I: 0.56, 10.14), and grade 9–12 (B=8.38, 95% C.I: 2.92, 13.85), age (B= 3.86, 95% C.I: 0.39, 7.33), length of stay at health facility (B= 3.58, 95% C.I: 2.66, 4.9), crowding in the delivery room (B= -4.14, 95% C.I: -6.14, -2.13), and health professional’s experience (B= 1.26, 95% C.I: 0.83, 1.69) were statistically significant predictors of observed EmONC service quality. Overall, the effective coverage (the crude coverage adjusted by the observed quality of care) of EmONC services in the Wolaita Zone was 50%, indicating half of the potential health gain loss in EmONC services. The qualitative study of barriers and facilitators of EmONC services utilization identified five themes that interacted at different levels. Theme one was women’s perceptions and experiences with EmONC services, including their knowledge and awareness of the availability of services, perception of the quality of care, reputation, respectful care, and care providers’ gender. Theme two was community-related factors encompassing misconceptions, traditional management of obstetric complications, the role of traditional birth attendants, and family and peer influence on EmONC services utilization. Theme three was the accessibility and availability of EmONC services, including infrastructure and delays in transportation. Theme four was healthcare financing which focused on drugs and supplies, out-of-pocket expenses, and service fee exemption. Theme five was the health facility-related factors related to the care provider, referral system, waiting time, and leadership. Conclusion: The study showed that the effective coverage of EmONC services in the Wolaita Zone (Southern Ethiopia) was low, where half of the potential health gain was lost due to barriers centered on the women, community, access and accessibility, healthcare financing, and health facility linked factors. The quality of EmONC services was sub-optimal, where women and newborns received inadequate services, and the care providers poorly adhered to the standard clinical actions. The study also underlined that the care providers’ adherence to the standard clinical actions was poor and is significantly associated with the age and education of women, length of stay in the facility, crowding of the delivery room, and health professionals’ experience. The inequitable effective coverage of EmONC services implied loose emphasis and suggested an urgent need for the health system’s intervention. Therefore, interventions directed at the identified bottlenecks can improve the utilization and quality of care, ultimately enhancing effective coverage. Furthermore, the model developed by the study can be utilized to enhance maternal and newborn health. Iqoqa Isingeniso: Nakuba kubonakala ukuthuthuka ekutholakaleni nasekufinyeleleni kwezikhungo emazweni anengenisomali ephansi nemaphakathi, kusenomthwalo omkhulu wokugula komama nokufa kwezingane okukhona, futhi kuphakamisa isidingo sokuhlinzekwa ngempumelelo kwezinsiza eziphuthumayo zokubelethisa nokunakekela izinsana (Emergency Obstetric and Newborn Care - EmONC) nezinto ezinomthelela ekuhlinzekeni ngensiza yezingabunjalo. Lolu cwaningo, lwaluhlose ukuqonda, ukuhlola nokuchaza ingqikithi, ukuhambisa, namazinga okufaka ngempumelelo izinsiza ze-EmONC endaweni iWolaita, eNingizimu ye-Etopiya. Izindlelakwenza: emva kokwenza inkombandlela yobufakazi yobungako bokusebenza kwezinsiza ze–EmONC e-Afrika, ucwaningo lusebenzise indlela echazayo ngokulandelanayo kwendlelakwenza eyingxube. Ucwaningo lwekhwantithethivu lusebenzise umklamomumo wocwaningo oyimpambanazigaba (isikhungo sezempilo nenhlwayalwazi yomuzi nomuzi) ngokuqoqa imininingo kusetshenziswa iOpen Data Kit yethabhulethi foni softhiwe nokuyihlaziya kusetshenziswa uhlobo lwe-17 software. Ucwaningo lwekhwalithathivu lusebenzise umklamomumo wocwaningo, futhi ukuhlaziya kulekelelwe ngeNVIVO yohlobo lwe-12 lwesofthiwe. Umphumela: ukubuyekezwa kokuhloliwe kukhombise ukuswelakala kobufakazi ngokufaka okusebenzayo kwezinsiza ze-EmONC e-Afrika. kuphinde kwabeka ngamafuphi ubufakazi obukhona nokwenza obala, ubunjalozinga bezinsiza nezinto ezihlobene. Kukho konke, ukufaka okusebenzayo kwezinsiza ze-EmONC. Inhlwayalwazi ebizinze esikhungweni idalule ukuthi izinkomba zesakhiwo, inqubo nezingabunjalo lokuphumayo kube ngama-74.2%, 69.4%, nama-79.6%, ngokulandelana. Imfundo yabesifazane, iminyaka yobudala, isikhathi sokuhlala esikhungweni sezempilo, ukuminyana endlini yokubeletha nolwazi lwabezempilo abangongoti kwakuqagula okubalulekile ngokwezibalo zezingabunjalo lokunakekelwa. Ucwaningo lwekhwalithethivu luhlonze izingqikithi ezinhlanu: imibono yabesifazane nolwazi oluhambisana nezinsiza ze-EmONC, izinto ezihambisana nomphakathi, ukufinyelela nokutholakala kwezinsiza ze-EmONC, ukufaka imali kwezempilo nezinto ezihlobene nesikhungo sezempilo. Isiphetho: Lolu cwaningo luhlonze ukubika okuphansi kokusebenza kwezinsiza ze-EmONC, ekubeni yingxenye yenzuzo yezempilo eyayingaba khona yalahleka ngenxa yemigoqo eyimixhantela. Ubunjalozinga bensiza belisezingeni eliphansi, lapho abesifazane nezinsana bethole izinsiza ezingenele, futhi abahlinzeka ngonakekelo bengagxilisisi kahle ezenzweni ezejwayelekile emtholampilo. Ukusatshalaliswa kokufaka okusebenzayo okungalingani kukhomba ukuyekethisa nokuphakamisa isidingo esiphuthumayo sohlelo lwezempilo ukuba lubhekane nezithiyo ezihlonziwe.
An in-depth investigation of the experience of sexual assault and factors that determine non-adherence to post exposure prophylaxis (PEP) after sexual assault in a sample of raped women survivors attending a public health clinic in the Eastern Cape.
(2008) Khuzwayo, Nelisiwe.; Govender, Kaymarlin.; Abrahams, Naeemah.
Prevention of HIV following sexual assault is an important aspect of rape care. This includes taking Post Exposure Prophylaxis for 28 days. The present study aimed to provide an in-depth understanding of social and environmental factors that predisposed, promoted and also served as barriers to adherence to post exposure prophylaxis to prevent HIV infection after sexual assault in women in the Eastern Cape Province. The study involved a purposive sample of women who were offered Post Exposure Prophylaxis (PEP) after a sexual assault. Sixteen women were accessed at the Sinawe Referral Centre and participated in the study. Their ages ranged from 16 to 73 years. An interview guide was developed to assist the researcher, and semistructured, in-depth interviews were used to collect data. These women were interviewed at the end of 28 days of taking the prophylactic medication. The data were analyzed inductively using grounded theory. Only three women completed the 28 days of PEP treatment. Participants gave different explanations for why they did not complete the treatment with only four participants returning to the centre for their medication. Some reported having no money for transport; others mentioned deciding to discontinue the medication because of its side-effects. Poor support systems, both within the community and the health services, including the provision of conflicting information also played a role. The study showed that few women were able to complete their PEP medication and knowledge about the service and access to it were the main factors that lead to non-adherence. There is an urgent need for the improvement of PEP services particular in the support to the women during the period of taking the PEP treatment to ensure protection from HIV after a sexual assault.
Intimate partner violence against women living with and without HIV: contexts and associated factors in Wolaita Zone, Ethiopia.
(2021) Koyira, Mengistu Meskele.; Khuzwayo, Nelisiwe.; Taylor, Myra.
Background: Intimate partner violence (IPV) and Human Immunodeficiency Virus (HIV) are overlapping or intersecting public health challenges. Intimate partner violence is considered to be strongly related to HIV infection among women in Africa. However, the evidence is not conclusive. Women who are abused physically by their partners seek medical treatment in public institutions, yet, in Ethiopia, the experience of healthcare workers (HCWs) in screening IPV among HIV-positive and HIV-negative clients is not fully understood Purpose: This study aimed to map the evidence of IPV in Sub-Saharan Africa, to measure the factors associated with IPV, to explore the experience of IPV against women living with and without HIV, and the health care workers' IPV screening experience in Wolaita Zone, southern Ethiopia. Objectives 1. To conduct a scoping review of IPV among women living with HIV/AIDS in Sub- Saharan Africa. 2. To explore the lived experience of IPV against women using antiretroviral therapy (ART) and other outpatient services in Wolaita Zone. 3. To explore the experiences and challenges in screening for IPV among women who use ART and other health services in Wolaita Zone. 4. To measure the prevalence and associated factors of IPV among women living with and without HIV in Wolaita Zone. Methods: This is a mixed-methods study. I conducted both qualitative and quantitative studies.. Initially, I mapped the evidence of IPV among HIV-positive women in Sub-Saharan Africa using a scoping review. Then, I conducted an exploratory sequential design of mixed-methods research. An interpretative (hermeneutic) phenomenological design was used to explore the lived experiences of women who were living with and without HIV. Additionally, I used a descriptive phenomenological study design to explore the IPV screening experiences of 16 HCWs. I also used a comparative cross-sectional study comprising 816 women between 18-49 years who were living with and without HIV for the quantitative study. I used the standard questionnaire of the World Health Organization (WHO) multi-country study on women's health and domestic violence against women (translated). The scientific rigour, dependability, and credibility relating to this sensitive subject were maintained. I used STATA software, version 15 for the quantitative data analysis; NVIVO 12 assisted us in developing a framework, and Colaizzi's analysis for the qualitative data. I used the binary and multivariable logistic regression model for the quantitative analysis. Results: The scoping review provided a summary of the evidence of IPV experiences among women with HIV/AIDS. As this review has shown, the HIV-positive women were at considerable risk of IPV after disclosure of their serostatus to a male partner. Psychological and emotional abuse was the most common form of violence reported by the review. Subsequently, in the quantitative study, we found a high lifetime prevalence of IPV among all women in Wolaita Zone, 487 (59.68%, [95% CI:56.31%-63.05%]. It was slightly higher among women living with HIV, 250 (61.3%), than among those who were HIV negative, 238 (58.09%). Factors associated with IPV were the controlling behaviour of husband/partner [AOR=8.13; 95% CI: 4.93-13.42], poor wealth index [AOR=3.97; 95% CI:1.81-8.72], bride price payment to bride‘s family[AOR=3.46; 95% CI:1.74-6.87], women‘s decision to refuse sex [AOR=2.99;95% CI:1.39-6.41], age group of women [AOR=2.86; 95% CI:1.67-4.90], partner‘s family choosing a wife [AOR=2.83; 95% CI:1.70-4.69], alcohol consumption by partner [AOR=2.36; 95% CI:1.36-4.10], number of sexual partners [AOR=2.35; 95% CI:1.36-4.09], and if a partner ever physically fought with another man [AOR=1.83; 95% CI: 1.05-3.19]. Inappropriate legal punishment of the perpetrator and the lack of a supportive women's network to avert IPV were perceived as limitations by the women. There were HCW and health system-related challenges in screening for IPV. These challenges comprised a gap in the medico-legal report provision, absence of separate record-keeping for IPV cases, lack of client follow-up, and lack of coordination with an external organisation. Conclusions and recommendations: There was a high prevalence of IPV among women, both living with and without HIV. The extent of IPV and its presentation in the different forms (physical, sexual and psychological), which frequently overlapped, highlights the urgency of intervention measures. Women reported terrifying experiences of violence, which affected their health physically, mentally, and psychologically. There are also challenges concerning HCWs, health systems, and the clients, relating to screening for IPV. Scoping review revealed evidence of IPV experience among women with HIV/AIDS, evidence of how HIV status disclosure influences IPV, and proof of the association of socio-demographic characteristics with IPV. It was concluded that marriage arrangements should be by mutual consent of the marriage partners rather than being made by parents; it is advisable to involve males in all programmes of genderbased violence prevention to change their violent behaviours; there is a need for the arrangement of separate record-keeping of IPV cases at the health facilities and for standardising the medico-legal reporting system. Finally, this study emphasises the importance of executing more gender-equitable policies.
Socio-cultural factors influencing intimate partner violence among school-going young women (15−24 years old) in Maputo-City (Mozambique)
(2021) Maguele, Maria Suzana Bata.; Khuzwayo, Nelisiwe.; Taylor, Myra.
Although there is increased awareness about intimate partner violence (IPV) since the 2013 WHO report, providing solutions to address the problem remains a concern. According to the WHO (2020), research investigating factors underpinning IPV among young women remains of particular importance since the prevalence around the world is still escalating. Sub-Saharan Africa (SSA) carries the heaviest burden of intimate partner violence (36.6% of the global estimates). The burden is skewed toward young women aged 15−24 (19% to 66%) and is a public health concern (2, 5). Cultural and contextual geographical overlap of risk factors elevates the chances of early occurrence of IPV. Thus, the World Health Organization encourages integrated and contextual prevention programs to promote awareness and gender equality, targeting adolescents and young girls for effective interventions. However, the harmful social norms and the acceptance of the males’ dominant role in society perpetuates gender inequality to the detriment of females. Although the Mozambican constitution entrenches gender equality, these negative, harmful norms and the community acceptance of violence and male-dominant norms are upheld by society and place younger women in a subservient role and at increased risk of IPV (6-8). Cultural practices such as lobola, where the brides' families receive gifts and money, and in exchange, their daughter joins the husband’s family, were reported as promoting violence. The rationale for this is that some families do not allow their daughters to divorce when their partners abuse them because of the stigma and the fact that they would need to return the acquired lobola (8, 9). Although it is acceptable and normal for men to have more than one partner in some societies, this is likely to promote disharmony and lead to violence (6-8, 10-12). Further, with the current prevalence of epidemics such as HIV and other sexually transmitted infections, the risk of multiple sexual partners can affect the health outcomes of all women (13-15). IPV is deeply entrenched in cultural practices and decision-making processes. Men make all the decisions concerning their relationship and women’s sexual and reproductive health. Prevention programs have been mainly addressed towards adult and ever married or cohabiting women. There is no available data quantifying the burden of IPV and the prevalence and contextual factors influencing intimate partner violence among younger women in Mozambique. Thus, the prevention of IPV among this group is one of the main challenges regarding reducing the prevalence of IPV. Purpose The study aimed to determine the prevalence and investigate the socio-cultural factors influencing IPV among younger school-going women in the KaMpfumu district, Maputo city. Objectives • To conduct a scoping review of the evidence of socio-cultural factors influencing IPV among young women in SSA • To explore individual and socio-community factors influencing IPV among school-going young women in KaMfhumu district, Maputo city • To estimate the prevalence of physical, sexual and psychological violence among school-going young women in KaMfhumu district, Maputo city • To identify contextual risk factors associated with IPV among young women in KaMphumu district, Maputo city • To inform a model of a preventive intervention to target school-going young women in Maputo city Methods The study, which used mixed methods, employed an exploratory sequential design using both qualitative and quantitative methods. It was underpinned by the Social-Ecological Theory (1), based on the evidence that a range of interactive factors at the individual, relationship, community, and societal levels explain the risk of IPV. Phase 1 was a scoping review study carried out to determine the extent to which studies on socio-cultural factors influencing IPV among young women (15−24 years) have been conducted. Further, it determined how well different geographic areas are represented and whether the methodologies used are sufficient to describe the prevalence and risk factors associated with IPV among young women in Sub-Saharan Africa. We used online databases to identify published studies. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines by Arksey and O’Malley were used to select studies, and primary studies were assessed using the Mixed Method Appraisal Tool, version 2011. Thematic content analysis was used to summarize the findings of the scoping review. Phase 2 of the study used an exploratory, descriptive qualitative study design. We used purposive sampling to enrol 66 participants. We held six focus group discussions, each comprising 10−12 female students in schools in the KaMpfumu district, to explore the study objectives. The data were analyzed using a thematic content analysis approach. Phase 3 was a cross-sectional study conducted among younger women aged 15−24 years attending schools in the KaMpfumu district, which used a questionnaire to investigate the study objectives. We used a probability proportional random sampling strategy to recruit participants. The data were collected using a self-administered questionnaire, informed by the exploratory study results and the combined questionnaire from the WHO Multi-country surveys of violence against women. Binary and multivariate logistic regression analyses were performed, investigating the association between IPV and the predictors. Odds ratio (OR) and 95% confidence interval (CI) were reported, and for statistically significant associations, p<0.05. Results The scoping review results revealed that the majority of publications, 8 (61.5%), reported cross-sectional studies, while 4 (31.5%) were qualitative studies. Using a customized quality assessment instrument, 12 (92.3%) studies achieved a “high” quality ranking with a score of 100%, and 7.7% of the studies achieved an “average” quality ranking with a score of 75%. The scoping review results show that while the quality of the studies is generally high, research on socio-cultural factors influencing IPV among young women would benefit from a careful selection of methods and reference standards, including direct measures of the violence affecting young women. Prospective cohort studies are required linking early exposure with individual, community and societal factors and detailing the abuse experienced from childhood, adolescence and youth. The qualitative study results revealed four main themes that emerged from the data and included: 1) (Individual level), related to knowledge of young women about IPV through witnessing friends being physically abused by their partners, from friends sharing personal experiences of IPV and experiencing the accepting attitudes of their mothers toward IPV; The meanings that young women give to the occurrence of IPV viewed as a violation of the human rights of women; The alcohol use a contributing factor for IPV and the economic status of women leading to acceptance of IPV. 2) (Relationship level) related to the Influence of friends. 3) (Community level) related to religious beliefs that placed men at the head of the social order above women and 3) (societal level) related to factors promoting acceptance of IPV, and these included social acceptance of violence and the male chauvinism; The recommendations advocated by the young women to prevent IPV, and these included the promotion of awareness about IPV and the use of support services for the victims and the need to create specific IPV counselling centres for young women to meet their needs and to allow the counsellors to screen for other potential sexual and reproductive problems which affect young women. The quantitative results revealed that of the 413 participants, 248 (60%) (95% CI: 55.15-64.61) had experienced at least one form of IPV in their lifetime. This includes one act of psychological or sexual, or physical violence. Of the 293 participants who had had a partner in the previous 12 months, 186 (63.4%) (95% CI: 57.68-69.00) reported IPV in the 12 months before the data collection. Psychological violence was the predominant type of violence, with lifetime prevalence reported by 270 230 (55.7%) and over the previous 12 months, by 164 (55.9%) young women. The risk of IPV was associated with young women lacking religious commitment (AOR, 1.596, 95% 272 CI: 1.009–2.525, p=0.046) and if the head of the young women’s household was unemployed (AOR, 1.642 95% CI: 1.044–2.584, p=0.032). Conclusion The prevalence of IPV in young women attending schools in Maputo is high. Those young women not committed to religion, young women whose head of the household was unemployed, young women with a much older and employed partner and young women’s beliefs about male superiority emerged as important socio-cultural factors influencing IPV in the study setting. The findings thus confirmed the contextual gaps that may hinder programs aimed at preventing IPV among younger women. The results highlighted socio-ecological factors that interact at the individual, community and societal levels in fostering IPV risk. Recommendations This study highlights that the government’s policies to reduce IPV should incorporate the contextual socio-cultural factors that emerged, and interventions need to consider a multilevel approach. The educational sector should also develop comprehensive programs that integrate socio-economic empowerment strategies to increase young women’s autonomy to decide about their lives. There is also a need to address religious beliefs from their cultural perspectives in such programs and improve social interactions that promote violence-free relationships. Community development interventions to reduce IPV are required to ensure effective and supportive programs tackling gender-egalitarian norms, to safeguard the physical, sexual and emotional wellbeing of young women in Maputo city.