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University of the Witwatersrand

Country: South Africa

University of the Witwatersrand

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27 Projects, page 1 of 6
  • Funder: UKRI Project Code: MR/V005790/1
    Funder Contribution: 2,957,400 GBP

    Throughout the world the numbers of people with non-communicable diseases (NCDs), like type 2 diabetes and high blood pressure, are increasing. The risk of developing diabetes is associated with being poorly nourished as a child then becoming obese later in life, being inactive, having a poor-quality diet, as well as influenced by genetic inheritance and poor intra-uterine growth. Low- and middle-income countries, like South Africa, have fast-growing numbers with NCDs yet health systems are struggling to cope with the ongoing burden of infectious disease (including HIV/AIDS and TB). We have shown that in rural and urban South Africa a third or more young women are either overweight or obese by 20 years of age; while the problem of stunted growth is stubbornly persistent. Five to eight percent of 7 to 15 year olds already show early warning signs for the development of diabetes. To combat an increasing prevalence of NCDs, it has been suggested that improving adolescent nutritional status may be a successful strategy, and that developing and evaluating pre-pregnancy interventions that promote nutrition and healthy behaviours in poor communities where childbearing tends to start at a younger age, may be part of the solution. Sub-Saharan Africa is the only region worldwide where the number of adolescents is predicted to grow, but it also faces a poor adolescent health profile. To-date, we are unclear about how best to intervene to improve the nutritional status of adolescents in low- or middle-income countries. Our extensive formative and pilot trial research, has informed the development of an intervention targeting adolescent girls who reflect the double burden of malnutrition. The trial will enrol 1248 underweight or overweight/obese girls aged 14-19y from two-suitable settings in South Africa, one rural and one urban, using age- and sex-appropriate cut-offs. After baseline assessment and randomisation, trial participants will be reassessed after at least 18 months follow-up. If a participant becomes pregnant in this follow-up period, the reassessment will be carried out early in her pregnancy (<18weeks), and additional measures and antenatal clinic data will be collected during the pregnancy and from the infant at birth. The trial will include process and economic evaluations. This approach will allow us to assess the effects of our intervention - and whether there are grounds for a major expansion (scale-up). The trial will employ and train community health workers (CHWs) to work with adolescents and their primary caregiver to address sub-optimal nutrition by: (i) promoting healthy behaviours and improving diets; (ii) providing a multi-micronutrient supplement to combat deficiencies, particularly anaemia; (iii) providing the primary caregiver with a conditional cash transfer to encourage and enable better household dietary diversity within the context of food insecurity and (iv) supporting adolescent girls who become pregnant to use antenatal care services earlier in their pregnancies and more frequently. CHWs will be trained in 'Healthy Conversation Skills', a set of skills to support behaviour change specifically developed and tested for use with socioeconomically disadvantaged women to improve their confidence so that they can achieve their health goals. CHWs will apply these skills in the rural and urban sites over the trial period, building relationships with adolescents and their families to encourage healthier adolescent lifestyles. The intervention is flexible and will focus on the most challenging areas for each participant. Health literacy seeks to increase adolescent access to health information, and develop their ability to use this information effectively. Adolescents who become pregnant will be further supported by CHWs to access and attend antenatal services, facilitate their caregiver's involvement, and reinforce optimal individual health during pregnancy.

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  • Funder: UKRI Project Code: MR/T023635/1
    Funder Contribution: 777,490 GBP

    The private sector provides a large proportion of health services in many low- and middle-income countries (LMICs), particularly for primary health care (PHC), even for poor patients. But the role of the private sector in expanding universal health coverage (UHC) in LMICs remains contentious. Proponents argue that the private sector could increase patient choice and PHC access, and that competition incentivises private providers to be more responsive and provide better quality care than public providers. However, evidence suggests that these advantages may not materialise. Arguments supporting the role of the private sector rely on the assumption that private providers compete for patients. Yet many factors influence market performance and health markets are often not competitive. Effective competition also requires that patients respond to changes in price or quality. Although these dynamics are critical in determining the health system impacts of private PHC provision in LMICs, they have received little attention in the literature. Understanding the role and impact of private sector provision is especially important in South Africa as policy proposals for achieving UHC promote the contracting of private providers to expand access to quality PHC for uninsured patients. There are concerns about the current performance of private PHC providers, and the functioning of the PHC market, with little empirical evidence to inform current debates. Expanding the role of the private sector as part of efforts to achieve UHC requires a more thorough understanding of the potential risks and benefits, and the likely responses of both the supply and demand sides of the market. The aim of this study is to undertake a detailed empirical investigation of the market for public and private primary care services. It will focus on the determinants of provider performance on the one hand, and demand for private services from uninsured cash-paying patients on the other. The study will be conducted in Soweto, Johannesburg, and it will include five components. Firstly, we will undertake a detailed description of the local PHC market through a census, mapping and interviews of all providers, an analysis of market concentration, and investigation of the strategies which private providers use to compete for patients. Secondly, using 'fake' standardised patients (SPs), we will compare the performance of private and public providers in terms of accessibility to services, technical quality of care and cost of treatment recommended. Thirdly, we will establish the relationship between competition and performance outcomes, testing if greater competition leads to better outcomes. Fourthly, using linked data on provider performance and cost, we will investigate if accessibility, quality and cost are important determinants of the demand for services by uninsured patients. Finally, in a small randomised pilot, we will test study how populations would react to the introduction of subsidised access to private services, and explore if information about quality influences demand. The study will provide important information on whether the private PHC market can contribute to better health system access, quality and efficiency. The results are relevant to many LMICs trying to expand UHC within mixed health care systems.

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  • Funder: UKRI Project Code: ES/T003839/1
    Funder Contribution: 609,347 GBP

    Over a three year period, the Academy for African Migration Research will undertake two key activities: (1) Four 'institutes' to provide capacity building for doctoral students and early-career researchers who are a maximum of 3-years post-PhD, to refine their research focus and promote professional development and scholarly contributions. (2) A series of research visits/exchanges for established academics and postdoctoral fellows to support building research capacity and strengthening the intellectual project for migration research in Africa. The Academy currently includes seven institutions in 5 countries [TBC]. Applications for the institutes will be accepted from doctoral students and early-career researchers from any African institute. 1. University of Addis Ababa and/or OSSREA, Ethiopia 2. University of Ghana, Legon, Accra, Ghana 3. Makerere University, Kampala, Uganda 4. Eduardo Mondlane University, Maputo, Mozambique 5. University of the Western Cape, Cape Town, South Africa 6. University of Cape Town, South Africa 7. University of the Witwatersrand, Johannesburg, South Africa Institutes: A series of four 'institutes' will be held at different locations across the ARUA network, each focusing on a different thematic area: migration and urbanization; migration, health and wellbeing; belonging, difference and diaspora; and, the knowledge politics of migration research in Africa. These institutes will also incorporate professional development training, including the development of peer-support and mentorship mechanisms. A final event will be held in the final/third year. This will take the form of a conference for early career researchers and postgraduate students - including those who have participated in the institutes - working on migration and mobility in Africa. The institutes will be designed to: - Support African migration scholars to embrace theory building, engagement with migration/social theory, and the knowledge politics associated with migration research in Africa. Participants will benefit from rigorous theoretical and methodological foundations in inter-disciplinary migration studies in addition to disciplinary perspectives from resource persons. - Offer practical professional advice/professional development including: academic publishing; project management; organising and managing data; consulting colleagues and others in the field; and the risks and benefits of interdisciplinary work in an academic universe still largely organised in disciplinary formations. - Provide mentorship and peer support by facilitating engagements between doctoral students, early career researchers and established academics both virtually and in-person. These structures will provide support for the required outputs associated with the institutes, including written work; presentation skills; and the development of professional CVs and online profiles. Research visits/exchanges: The Academy will fund various activities for established and early career researchers. Funds will be awarded on a competitive basis, and will be assessed by a review panel made up on their planned activities and outputs. Preference will be given to proposals aiming to support research capacity building and strengthening of the intellectual project for migration research in Africa. All proposals will need to demonstrate collaboration/partnership building as a central activity. - one-week visits for established researchers to travel to another institution to undertake teaching/supervision/research exchanges; - one-month visiting postdoctoral fellowships; and - symposiums and/or proposal development workshops to support the establishment of new research partnerships.

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  • Funder: UKRI Project Code: MC_PC_16100
    Funder Contribution: 328,267 GBP

    Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.

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  • Funder: SNSF Project Code: 208531
    Funder Contribution: 10,600
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