Tyler W. Myroniuk

Background. In South Africa (SA), consistently seeking out primary healthcare is more important than ever as the country ages and undergoes epidemiological transition. SA’s most racialised individuals – those identifying as black and coloured – often need to migrate within the country to ensure their families’ economic stability, and internal migrants often experience difficulties in accessing healthcare compared with non-migrants. But gender matters too, as women tend to seek out healthcare more than men throughout the world, and internal migration affects women’s and men’s lives differently in SA. Objectives. To examine differences in the consistency of healthcare-seeking behaviour between internal migrants and non-migrants, among black and coloured residents of SA, by gender. No study in SA to date has been able to examine all three of these elements, despite their important confluence stemming from apartheid and before. Methods. To do so, this article uses data from the first four waves (2008, 2010 - 2011, 2012, and 2014 - 2015) of the National Income Dynamics Study. A total of 6 131 black and coloured men and women aged ≥18 years in 2008 form the analytical sample. Logistic regressions, with panel weights adjusted for respondent loss to follow-up, predict the likelihood that individual respondents will be consistent in seeking health consultations over the four waves as a function of their racialised identity, internal migrant status, and gender. Results. Black residents (compared with coloured) and men (compared with women) have the lowest chances of consistently seeking out healthcare. There is no direct internal migration difference in seeking healthcare, but it is conditional upon racial and gender identity. Conclusion. Black South Africans – especially, but not exclusively, migrant men – do not have the same chances of seeking primary care as their also-racialised coloured counterparts. For population health and clinical efforts, identifying who is at risk of not seeing a doctor is crucial, and this article provides a key update on earlier striking differences in healthcare access between SA’s most racialised groups.

Background: Healthcare workers are at the forefront of the global battle against COVID-19. Their vaccination perspectives, particularly in regions like Sierra Leone that have faced health crises such as the Ebola outbreak, are essential for shaping public health strategies in low-income countries that routinely face infectious disease outbreaks. Objective: This research sought to understand the perceptions and experiences of Sierra Leone’s healthcare workers concerning COVID-19 vaccination and booster doses, set against the backdrop of global health resource disparities and regional vaccine distribution challenges. Methods: Utilizing a mixed-methods approach, the study analyzed data from an online survey, which saw 1001 complete responses from 2060 participants across six Ebola-impacted districts (October–November 2022), and in-depth interviews with 24 health workers from three of these districts (February–July 2022). Results: Approximately 80% of respondents reported having received a COVID-19 vaccine, predominantly Sinopharm and AstraZeneca, yet only 34% of vaccinated participants had received a booster dose. In multivariable analyses, personally knowing someone who experienced serious COVID-19 illness or death was associated with higher odds of both initial vaccination and booster uptake (p < 0.05). By contrast, prior Ebola-related experiences were not consistently associated with vaccination outcomes. Qualitative findings contextualized these patterns, highlighting the roles of professional exposure, limited booster-related information, and inequities in vaccine availability and distribution. Conclusion: These findings indicate that vaccination strategies must move beyond initial rollout to address barriers to sustained engagement, particularly for booster uptake among healthcare workers. They also emphasize the need for equitable vaccine access and transparent, locally tailored communication to mitigate structural and informational constraints in low-income settings.

Introduction: South Africa is experiencing a heterogeneous and rapid nutrition transition. Rural‐origin Black South Africans frequently migrate to access employment opportunities in urbanized areas, which could place individuals at risk for obesity due to accompanying dietary and lifestyle changes.Methods: We utilize longitudinal data—four waves from 2018 to 2022—with detailed internal migration and health information, and negligible participant attrition from the Migrant Health Follow‐Up Study, with origin households located in rural northeast South Africa—Agincourt. We employ lagged‐dependent variable regressions to test whether (1) the number of waves one is away from their rural home (0–4) and (2) residing in a densely populated urban area (Gauteng province) relative to other locations or remaining in Agincourt over the four waves, are differentially associated with having abdominal obesity, indicated by the preferable measure of the waist circumference‐to‐height ratio (WHtR), at Wave 4—after adjusting for Wave 1 obesity and other variables, including fast food consumption. WHtR is operationalized as a binary indicator of abdominal obesity as well as a standardized, continuous one. Our analytic sample includes women (N = 895) and men (N = 1010).Results: Our results show that internal migrant women and men face higher chances of having abdominal obesity at Wave 4 than their nonmigrant counterparts. For men, both the number of waves as a migrant and ever migrating to Gauteng are consistently, strongly associated with the chances of having abdominal obesity—considerably more so than women.Conclusion: As obesity rates rise throughout urbanizing low‐ and middle‐income countries, this research emphasizes the importance of understanding the correlates of the risks of obesity that internal migrants will face.

Background: Sierra Leone’s health system has faced significant challenges, including the long-term impacts of the 2014 Ebola outbreak, prolonged conflicts before that, and economic factors contributing to the fragility of healthcare systems in many low-income settings. This qualitative study explores COVID-19 prevention practices among healthcare workers in the context of their past experiences with disease outbreaks. Aim: This study aims to understand COVID-19 prevention practices among healthcare workers in Sierra Leone and how their past experiences with disease outbreaks influence these practices. Setting: The study was conducted in three districts of Sierra Leone – Freetown, Makeni and Kenema – focusing on healthcare workers in a low-income setting with ongoing public health challenges. Methods: In-depth interviews were conducted with 24 healthcare workers, and the data were analysed for themes using the Health Belief Model and Theory of Planned Behaviour. Results: Healthcare workers demonstrated positive attitudes and strict adherence to infection prevention measures, influenced by their Ebola outbreak experience. Barriers included limited personal protective equipment and social disapproval. Conclusion: Interventions should focus on improving access to infection prevention tools and combating disapproval through community engagement. These findings are crucial for enhancing infectious disease prevention among healthcare workers in low-income settings. Contribution: This study provides insights into how past outbreak experiences influence disease prevention practices among healthcare workers in Sierra Leone, highlighting the need to address adherence barriers. These findings contribute to a broader understanding of infectious disease prevention in low-income settings and enhance global efforts in preparing for future public health emergencies.

Strong expectations exist for the selectivity of migration along key demographic characteristics, such as age, sex, and education, which are often linked to social and economic drivers. Scholars acknowledge, however, that migratory behavior is also likely to be selective on characteristics that are less readily observable. This research note expands the list by examining “grit”—in other words, a measure of perseverance in the face of adversity. We test for a relationship between South African rural–urban migration, net of other standard covariates, and an established composite psychosocial measure of grit. We draw on two waves of survey data originating from a demographic surveillance platform but with respondents followed irrespective of their subsequent geographic mobility. Simple bivariate regressions suggest that grit is strongly associated with migration. Using multivariate models, we continue to detect a statistically significant association of migration with grit in the presence of controls. When the model is further refined to stratify by sex and separate geographic destinations, a sex differential emerges, with grit being more predictive for females. We conclude by suggesting that such findings should encourage broader inquiries that consider grit and other psychological characteristics, particularly investigations that might help further illuminate differentials by the experience of gender.

Changes in population distribution through migration and urbanization are associated with transitions in health exposure regimens and health outcomes. ¹ However, our understanding of these links remains limited. South Africa’s disease burden is among the highest of the world’s middle-income countries, with high prevalence of infectious disease (ID) and non-communicable disease (NCD), ^{2, 3} exacerbated by inadequate monitoring and availability of health information and services. ⁴ Internal mobility in South Africa is high as people move to urban areas in search of work, often on a temporary basis. These patterns of mobility are rooted in the apartheid legacy of circular and temporary migration between rural and urban areas. ^5–7

Objectives: We assess how age, the presence of mature adults aged 45+ years, and recent deaths in rural households are associated with coronavirus disease 2019 (COVID-19) preventative actions and the likelihood of getting vaccinated against the virus in Malawi during early stages of the pandemic. Methods: We draw upon data from 2,187 rural Malawians who participated in a 2020 COVID-19 Phone Survey. We estimate the log odds of engaging in “low-cost” and “high-cost” COVID-19 preventative actions based on age, gender, household composition, and recent household deaths. Low-cost prevention efforts were washing hands with soap and water frequently, avoiding close contact with people when going out, and avoiding shaking hands. High-cost actions included staying at home and decreasing time spent close to people not living in their household. We also estimate the chances of acquiring the COVID-19 vaccine in early stages of its availability. Results: Mature women (45+ years) in general and younger men (<45 years)—living with at least one mature adult in the household—were less likely than others to comply with low-cost actions. Mature men were more likely than younger men (<45 years) to take on high-cost actions. To some extent, individuals who experienced a recent family death were more likely to engage in high-cost COVID-19 preventative actions as well as getting vaccinated. Discussion: Gendered age differences in preventing the transmission of COVID-19 offer hints of larger social norms affecting protective efforts. The analyses also inform future COVID-19 public health outreach efforts in Malawi and other rural SSA contexts.

Introduction: College students routinely visit their families due to geographic proximity and their financial dependence. Consequently, the potential of transmitting COVID-19 from campus to their families’ homes is consequential. Family members are key sources of support for one another in nearly all matters but there is little research uncovering the mechanisms by which families have protected each other in the pandemic.Methods: Through an exploratory qualitative study, we examined the perspectives of a diverse, randomly sampled, group of students from a Midwestern University (pseudonym), in a college town, to identify COVID-19 prevention practices with their family members. We interviewed 33 students between the end of December 2020 and mid-April 2021 and conducted a thematic analysis through an iterative process.Results: Students navigated major differences in opinions and undertook significant actions in attempts to protect their family members from COVID-19 exposure. Students’ actions were rooted in the greater good of public health; prosocial behavior was on display.Discussion: Larger public health initiatives could target the broader population by involving students as messengers.