Graduated with a PhD in Public Health

About 50 students are currently enrolled for doctoral studies; some are our own staff, some are attached to research projects which carry PhD scholarships, and some are self-funded. While the number of graduates from the PhD programme was initially small, this is increasing as the programme matures, such that in 2019 and 2020, nine students graduated with PhDs, one of whom is a member of SOPH staff. The topics of their studies are given on the next few pages. Working towards a doctorate requires the ability to overcome doubt, exhaustion, and loneliness – and the tenacity to persist despite competing demands for time and attention. It really helps when students investigate a topic that fascinates them and/or is part of their daily work. The reasons why three graduands chose their particular topics and what their research had focussed on are also given – as well as how their research, and having a PhD, will impact their careers.

Citation: BABATOPE ADEBIYI Foetal alcohol spectrum disorders: The development of guidelines to inform policy

Supervisor: Dr A-M Beytell Co-supervisor: Dr C Mukumbang

While South Africa has the highest prevalence of FASD [foetal alcohol spectrum disorders] globally due to the excessive rate of alcohol consumption during pregnancy, there is no specific policy addressing FASD in the country. This study used a multi-method research with a modified Delphi technique to develop a guideline to inform policy on the prevention and management of FASD in South Africa. The guideline developed from this thesis has the potential to assist policy makers to formulate a multi-sectoral policy for the prevention and management of FASD in SA. Five of seven articles from the thesis have been published in high impact peer-reviewed international journals and two are under review.

THEODOSIA ADOM Individual and environmental factors associated with obesity among young children in primary schools in Ghana

Supervisor: Prof T Puoane Co-supervisor: Prof AP Kenge

Citation:

Overweight and obesity are risk factors for non-communicable diseases such as cardio-vascular diseases and some cancers. Understanding factors associated with overweight/ obesity among children presents an opportunity for timely and appropriate interventions. Utilising the socio-ecological framework, the study assessed the prevalence and determinants of childhood overweight/obesity and explored population level policies that encourage supportive environments for healthy living. The prevalence of overweight/obesity was 16.4%, indicating that overweight/obesity is a public health issue in primary school learners. There were gaps in the literature in terms of populationbased interventions. A number of modifiable risk factors were identified and recommendations made for relevant stakeholders.

THEODOSIA ADOM

‘My research focused on how children’s health behaviours interacted with the food and physical activity environments in the home, school, community and at policy level to contribute to overweight/ obesity.’

Why did you undertake this study?

‘In my experience as a researcher in human nutrition, I have witnessed firsthand the phenomenon of the double burden of malnutrition resulting from human and socio-economic development. Middle class families in urban Ghana are relying more and more on rapidly growing fast food chains, with high intakes of energy-dense foods and sugary drinks, as these are seen as a status symbol. This is coupled with sedentary lifestyles, obesity and increasing prevalence of non-communicable diseases. The pre-adolescent children in these families, who are at a critical stage of developing independent physical activity and dietary behaviours, are most vulnerable to the changes that are occurring in their environments.’ ‘I undertook this research to explore the magnitude and correlates of unhealthy weight of pre-adolescent school children who are, most often, under-represented in national surveys in Ghana. The findings could be helpful in guiding the design of timely public health interventions.’

What will you be doing now that you have a PhD?

‘I will continue my work as a researcher. A career in academia is a path I will like to pursue in the near future ... It will be great to mentor students and early career academics by imparting needed knowledge and skills.’

MAMOTHENA MOTHUPI

‘I specialised in qualitative and quantitative methods for the measurement and assessment of determinants of maternal health outcomes, particularly those related to health system interventions and social determinants of health. I relied on theory that accommodates complexity in emergence of health outcomes, and laid the ground work for a more comprehensive way to assess public health performance in maternal health. I say ‘public health performance’ because I also argued for expansion of the boundaries of the ‘health system’ when we consider the indicators/factors that make a difference. This also justifies the current focus on multi-sectoral collaboration and multi-sectoral accountability for maternal health outcomes.

What will you be doing now that you have a PhD?

‘I am keen on a research-oriented career, where I design and conduct research and evaluation of public health/ population health interventions. I will be looking for different avenues to which I can contribute my evolving theoretical understandings and research findings – including communities of health systems and policy, implementation science, and health outcomes research practitioners. I also want to get more involved in the advocacy for just and equitable systems that ultimately impact people’s health and wellbeing. ‘There are a lot of practitioners and institutions who are working in the advocacy space across different disease areas and issues, from the grassroots to global health levels, trying to influence the political economy of health. I admire their work and I want to learn more from them and hopefully contribute a significant chunk of my time to supporting causes.’

WOLDEKIDAN KIFLE AMDE Unpacking capacity development: A systemic exploration of a partnership of African universities to develop capacity on health workforce development

Supervisor: Prof U Lehmann Co-supervisor: Prof D Sanders

Citation:

This study explored the partnership between the University of the Western Cape (UWC) and three African universities and health ministries (in Rwanda, Mozambique and Ethiopia) to develop capacity in health workforce development, geared to strengthening national leadership and training capacity in health workforce development. All three international examiners praised the thesis as an important, politically and culturally sensitive contribution to our understanding of the importance and complexity of collaboration between academic institutions, and between academic institutions and ministries of health – and to strengthening collaborative practice in future.

MARIO CLAYFORD Investigating predictors of health-related quality of life and functional status in middle-aged to older adults with hypertension living in a selected urban community in South Africa

Supervisor: Prof T Puoane Co-supervisor: Prof P Naidoo

Citation:

Hypertension is one of the leading risk factors for heart disease, strokes, and preventable causes of premature deaths in South Africa. Quality of life (QoL) is inherent to everyone, and a decrease in QoL increases susceptibility to other ailments. This study investigated which socio-demographic, psycho-social and disease characteristics are the best predictors of QoL and functionality in individuals with hypertension. The outcome of the study revealed higher QoL and functionality in people who were married, less stressed using proactive coping, more highly educated, and who were disability free. It highlighted the adverse impact of disability and presence of co-morbid diseases on QoL and functional status. The value of the study lies in the fact that assessing how an individual perceives his or her health is necessary to developing appropriate treatment strategies which should lead to positive health outcomes.

MAMOTHENA MOTHUPI Development of an approach for measurement and monitoring of the continuum of care for maternal health in the South African health system

Supervisor: Assoc Prof L Knight Co-supervisor: Dr H Tabana

Citation:

The continuum of care is a public health framework for providing comprehensive maternal health care at the community and health system level, and according to needs throughout the lifecycle.

This study developed and tested a novel model for measuring and monitoring the continuum for maternal health in South Africa, called the adequacy model. The model guided the assessment of service provision, selection and evaluation of indicators, and development of a performance tracking index that can be used at district and provincial levels. The research used a mixed method design to strengthen understanding of continuum and make recommendations for maternal health research and practice. The analytical framework developed in this study can also be adapted within other LMIC contexts to improve performance measurement and monitoring.

MICHAEL MULONDO Participatory action research approach to address the poor water, sanitation and hygiene conditions in an informal urban settlement in Windhoek, Namibia

Supervisor: Prof B van Wyk

Citation:

Water, sanitation and hygiene (WASH) are fundamental to health and are regarded as a fundamental human right for survival, dignity, productivity, reproductive health and happiness. In informal urban settlements appropriate WASH interventions are not in place, and the risks of mortality and morbidity are high. This study conducted a participatory action research study to address the poor WASH conditions in Havana informal urban settlement in Windhoek, Namibia. It was informed by a scoping review of WASH interventions globally. Starting with a situation analysis of WASH conditions in Havana, the study developed, implemented and evaluated a community WASH action plan, combining health education and social entrepreneurship to address the poor WASH conditions in the community by the community.

SULAKSHANA NANDI Equity, access and utilisation in the state-funded universal insurance scheme (RSBY/MSBY) in Chhattisgarh State, India: What are the implications for universal health coverage?

Supervisor: Prof H Schneider

Citation:

This study examined the equity and access impacts of a major insurance scheme introduced in India in 2009, which enabled public funds to be used extensively for private hospital care for the first time. Through a series of empirical studies in Chhattisgarh State, where the researcher has lived and worked as a health advocate for many years, the study demonstrated the failure of the publicly funded health insurance scheme to achieve its goals of improved affordability, access and equity of health care. This study raises important questions on the value of such financing models for advancing universal health coverage, particularly in the context of a highly commercialised private health sector – providing important lessons for other countries (such as South Africa) which are embarking on similar reforms.

NONDUMISO NCUBE

‘I specialised in pharmaceutical public health, where I researched the rational/appropriate use of medicines, including antibiotics, in public sector facilities in Eswatini (formerly Swaziland).’

How will it impact your career and your world?

‘Findings from my research were used in the revision of Eswatini’s current standard treatment guidelines and essential medicines list (STG/EML). Findings also raised awareness of the high and inappropriate use of antibiotics in the country. ‘The work I did for my PhD has equipped me with skills that I have used as a contributor to the STG/EML revision, the development of the National Supply Chain Strategy for health commodities in Eswatini – and the development of a roadmap for the introduction and phase-out of antiretroviral medicines in Eswatini. It also contributes to my current work, a project that is facilitating the establishment of an antimicrobial use/ consumption/resistance (AMU/C/R) surveillance system in Eswatini using a One Health Approach.’

What will you be doing now that you have a PhD?

‘I am using the skills acquired in my current position where I am working on an AMU/C/R surveillance project supported by the Fleming Fund and implemented by ICAP at Columbia University, Eswatini Country Office. The project aims to establish AMU/C/R surveillance in human health, animal health, and the environment using a One Health Approach. I am also supporting upcoming public health professionals, particularly those enrolled at UWC, in their quest to become public health professionals.’

NONDUMISO NCUBE A systematic approach to improve rational medicine use in Swaziland

Supervisor: Dr H Bradley Co-supervisors: Prof R Laing, Prof H Schneider

Citation:

Irrational use of medicines is a global problem that results in mismanagement of patients, wastage of resources and public health problems. This study assessed patterns of medicine use, identified the reasons for this and tested a short intervention (audit and education) in public health facilities in eSwatini. The research documented widespread irrational use of medicines, such as polypharmacy and high antibiotic use, including amongst patients with non-communicable diseases. Factors contributing to irrational use of medicines were found at multiple levels - system, provider and patient - and the limited intervention was not able to sustainably shift practices. Achieving rational medicines use will require a combination of interventions involving a range of system players and levels.

IAN NEETHLING Enhancing Burden of Disease information for health sector decision making

Supervisor: Prof H Schneider Co-supervisor: Dr D Bradshaw

Citation:

This study proposes a framework to guide decision makers on the use of burden of disease information for health planning. Showing limits to the established disability-adjusted life year methodology in the South African context, it developed and presented an alternative approach namely, amenable and preventable mortality. Using this approach, the research was able to show the extent of under-performance of the health system, and the still huge racial and geographical inequities in health status in South Africa. It offered recommendations for using amenable and preventable mortality to assess health system performance and public health intervention effectiveness, benchmarking and resource allocation – which have major relevance to future health reforms in South Africa.