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Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK. (Umeå Centre for Global Health Research)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Nursing. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. (Umeå Centre for Global Health Research)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH – An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana. (Umeå Centre for Global Health Research)
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2016 (English)In: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 6, no 1, 010406Article in journal (Refereed) Published
Abstract [en]

Background South Africa faces a complex burden of disease consisting of infectious and non–communicable conditions, injury and interpersonal violence, and maternal and child mortality. Inequalities in income and opportunity push disease burdens towards vulnerable populations, a situation to which the health system struggles to respond. There is an urgent need for health planning to account for the needs of marginalized groups in this context. The study objectives were to develop a process to elicit the perspectives of local communities in the established Agincourt health and socio-demographic surveillance site (HDSS) in rural north–east South Africa on two leading causes of death: HIV/AIDS and violent assault, and on health surveillance as a means to generate information on health in the locality. Methods Drawing on community–based participatory research (CBPR) methods, three village–based groups of eight participants were convened, with whom a series of discussions were held to identify and define the causes of, treatments for, and problems surrounding, deaths due to HIV/AIDS and violent assault. The surveillance system was also discussed and recommendations generated. The discussion narratives were the main data source, examined using framework analysis. Results The groups identified a range of social and health systems issues including risky sexual health behaviors, entrenched traditional practices, alcohol and substance abuse, unstable relationships, and debt as causative. Participants also explained how compromised patient confidentiality in clinics, insensitive staff, and a biased judicial system were problematic for the treatment and reporting of both conditions. Views on health surveillance were positive. Recommendations to strengthen an already well–functioning system related to maintaining confidentiality and sensitivity, and extending ancillary care obligations. Conclusion The discussions provided information not available from other sources on the social and health systems processes through which access to good quality health care is constrained in this setting. On this basis, further CBPR in routine HDSS to extend partnerships between researchers, communities and health authorities to connect evidence with the means for action is underway.

Place, publisher, year, edition, pages
2016. Vol. 6, no 1, 010406
Keyword [en]
Community-based participatory research, South Africa, verbal autopsy, health and demographic surveillance, HIV, violence
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Nursing
Identifiers
URN: urn:nbn:se:umu:diva-118032DOI: 10.7189/jogh.06.010406ISI: 000396976400014Scopus ID: 2-s2.0-84999273743OAI: oai:DiVA.org:umu-118032DiVA: diva2:912743
Available from: 2016-03-17 Created: 2016-03-10 Last updated: 2017-09-19Bibliographically approved

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