Gugu Mchunu

Bio: Gugu Mchunu is an academic researcher from University of KwaZulu-Natal. The author has contributed to research in topics: Health care & Population. The author has an hindex of 12, co-authored 59 publications receiving 732 citations. Previous affiliations of Gugu Mchunu include Human Sciences Research Council & University of Natal.

Adolescent pregnancy and associated factors in South African youth

Abstract: Background: Adolescent pregnancy, occurring in girls aged 10–19 years, remains a serious health and social problem worldwide, and has been associated with numerous risk factors evident in the young people’s family, peer, school, and neighbourhood contexts. Objective: To assess the prevalence of adolescent pregnancy and associated factors in the South African context, as part of a population-based household survey that formed part of an evaluation of the impact of loveLife, South Africa’s national HIV prevention campaign for young people. Methods: A cross-sectional population-based household survey was conducted using a multi-stage stratified cluster sampling approach. The total sample included 3123 participants, aged 18-24, 54.6% men and 45.4% women, from four of nine provinces in South Africa (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). Results: Among female youth 19.2% said that they had an adolescent pregnancy, while 5.8% of male youth indicated that they had impregnated a girl when they were an adolescent (12-19 years), 16.2% of the women indicated that they ever had an unwanted pregnancy and 6.7% had ever terminated a pregnancy. In multivariable analysis among women it was found that being employed or unemployed, greater poverty, having higher sexually permissive attitudes and scoring higher on the contraceptive or the condom use index was associated with adolescent pregnancy, and among men wanting the pregnancy and having a sense of the future were associated with adolescent pregnancy. Conclusion: Adolescent pregnancy was found to be high in this sample of South African youth. Multiple factors contributing to adolescent pregnancy have been identified which can be used in targeting young people on the prevention of adolescent

Prevalence of psychological distress and associated factors in tuberculosis patients in public primary care clinics in South Africa

Abstract: Psychological distress has been rarely investigated among tuberculosis patients in low-resource settings despite the fact that mental ill health has far-reaching consequences for the health outcome of tuberculosis (TB) patients. In this study, we assessed the prevalence and predictors of psychological distress as a proxy for common mental disorders among tuberculosis (TB) patients in South Africa, where over 60 % of the TB patients are co-infected with HIV. We interviewed 4900 tuberculosis public primary care patients within one month of initiation of anti-tuberculosis treatment for the presence of psychological distress using the Kessler-10 item scale (K-10), and identified predictors of distress using multiple logistic regressions. The Kessler scale contains items associated with anxiety and depression. Data on socio-demographic variables, health status, alcohol and tobacco use and adherence to anti-TB drugs and anti-retroviral therapy (ART) were collected using a structured questionnaire. Using a cut off score of ≥28 and ≥16 on the K-10, 32.9 % and 81 % of tuberculosis patients had symptoms of distress, respectively. In multivariable analysis older age (OR = 1.52; 95 % CI = 1.24-1.85), lower formal education (OR = 0.77; 95 % CI = 0.65-0.91), poverty (OR = 1.90; 95 % CI = 1.57-2.31) and not married, separated, divorced or widowed (OR = 0.74; 95 % CI = 0.62-0.87) were associated with psychological distress (K-10 ≥28), and older age (OR = 1.30; 95 % CI = 1.00-1.69), lower formal education (OR = 0.55; 95 % CI = 0.42-0.71), poverty (OR = 2.02; 95 % CI = 1.50-2.70) and being HIV positive (OR = 1.44; 95 % CI = 1.19-1.74) were associated with psychological distress (K-10 ≥16). In the final model mental illness co-morbidity (hazardous or harmful alcohol use) and non-adherence to anti-TB medication and/or antiretroviral therapy were not associated with psychological distress. The study found high rates of psychological distress among tuberculosis patients. Improved training of providers in screening for psychological distress, appropriate referral to relevant health practitioners and providing comprehensive treatment for patients with TB who are co-infected with HIV is essential to improve their health outcomes. It is also important that structural interventions are promoted in order to improve the financial status of this group of patients.

Predictors of tuberculosis (TB) and antiretroviral (ARV) medication non-adherence in public primary care patients in South Africa: a cross sectional study

Abstract: Background Despite the downward trend in the absolute number of tuberculosis (TB) cases since 2006 and the fall in the incidence rates since 2001, the burden of disease caused by TB remains a global health challenge. The co-infection between TB and HIV adds to this disease burden. TB is completely curable through the intake of a strict anti-TB drug treatment regimen which requires an extremely high and consistent level of adherence.The aim of this study was to investigate factors associated with adherence to anti-TB and HIV treatment drugs.

Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary public care clinics in South Africa: results from a cluster randomized controlled trial

Abstract: In 2008 the World Health Organization (WHO) reported that South Africa had the highest tuberculosis (TB) incidence in the world. This high incidence rate is linked to a number of factors, including HIV co-infection and alcohol use disorders. The diagnosis and treatment package for TB and HIV co-infection is relatively well established in South Africa. However, because alcohol use disorders may present more insidiously, making it difficult to diagnose, those patients with active TB and misusing alcohol are not easily cured from TB. With this in mind, the primary purpose of this cluster randomized controlled trial was to provide screening for alcohol misuse and to test the effectiveness of brief interventions in reducing alcohol intake in those patients with active TB found to be misusing alcohol in primary public health care clinics in three districts in South Africa. Within each of the three provinces targeted, one district with the highest TB burden was selected. Furthermore, 14 primary health care facilities with the highest TB caseload in each district were selected. In each district, 7 of the 14 (50%) clinics were randomly assigned to a control arm and another 7 of the 14 (50%) clinics assigned to intervention arm. At the clinic level systematic sampling was used to recruit newly diagnosed and retreatment TB patients. Those consenting were screened for alcohol misuse using the Alcohol Use Disorder Identification Test (AUDIT). Patients who screened positive for alcohol misuse over a 6-month period were given either a brief intervention based on the Information-Motivation-Behavioural Skills (IMB) Model or an alcohol use health education leaflet. Of the 4882 tuberculosis patients screened for alcohol and agreed to participate in the trial, 1196 (24.6%) tested positive for the AUDIT. Among the 853 (71%) patients who also attended the 6-month follow-up session, the frequency of positive screening results at baseline/follow-up were 100/21.2% for the AUDIT (P < 0.001) for the control group and 100/16.8% (P < 0.001) for the intervention group. The intervention effect on the AUDIT score was statistically not significant. The intervention effect was also not significant for hazardous or harmful drinkers and alcohol dependent drinkers (AUDIT: 7–40), alcohol dependent drinkers and heavy episodic drinking, while the control group effect was significant for hazardous drinkers (AUDIT: 7–19) (P = 0.035). The results suggest that alcohol screening and the provision of a health education leaflet on sensible drinking performed at the beginning of anti-tuberculosis treatment in public primary care settings may be effective in reducing alcohol consumption. PACTR201105000297151

Quality of life among tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health care patients in three districts in South Africa

Abstract: Introduction TB and HIV co-morbidity amount to a massive burden on healthcare systems in many countries. This study investigates health related quality of life among tuberculosis (TB), TB retreatment and TB-HIV co-infected public primary health care patients in three districts in South Africa.

تقويم البرنامج : طرق بديلة و إرشادات عملية = Program evaluation Alternative Approaches and Practical Guidelines

Abstract: I. INTRODUCTION TO EVALUATION. 1. Evaluation's Basic Purpose, Uses, and Conceptual Distinctions. 2. Origins of Modern Program Evaluation. 3. Recent Developments and Trends in Evaluation. II. ALTERNATIVE APPROACHES TO PROGRAM EVALUATION. 4. Alternative Views of Evaluation. 5. Objectives-Oriented Evaluation Approaches. 6. Management-Oriented Evaluation Approaches. 7. Consumer-Oriented Evaluation Approaches. 8. Expertise-Oriented Evaluation Approaches. 9. Adversary-Oriented Evaluation Approaches. 10. Participant-Oriented Evaluation Approaches. 11. Alternative Evaluation Approaches: A Summary and Comparative Analysis. III. PRACTICAL GUIDELINES FOR PLANNING EVALUATION. 12. Clarifying the Evaluation Request and Responsibilities. 13. Setting Boundaries and Analyzing the Evaluation Context. 14. Identifying and Selecting the Evaluative Questions and Criteria. 15. Planning How to Conduct the Evaluation. IV. PRACTICAL GUIDELINES FOR CONDUCTING AND USING EVALUATIONS. 16. Dealing with Political, Ethical, and Interpersonal Aspects of Evaluation. 17. Collecting, Analyzing, and Interpreting Quantitative Information. 18. Collecting, Analyzing, and Interpreting Qualitative Information. 19. Reporting and Using Evaluation Information. 20. Evaluating Evaluations. V. EMERGING AND FUTURE SETTINGS FOR PROGRAM EVALUATION. 21. Conducting Multiple-Site Evaluation Studies. 22. Conducting Evaluations of Organizations Renewal and Training in Corporate and Nonprofit Settings. 23. The Future of Evaluation. Appendix: Some General Areas of Competence Important in Education Evaluation.