South African National Income Dynamics Research Articles

Multimorbid life expectancy across race, socio-economic status, and sex in South Africa

Multimorbidity is increasing globally as populations age. However, it is unclear how long individuals live with multimorbidity and how it varies by social and economic factors. We investigate this in South Africa, whose apartheid history further complicates race, socio-economic, and sex inequalities. We introduce the term ‘multimorbid life expectancy’ (MMLE) to describe the years lived with multimorbidity. Using data from the South African National Income Dynamics Study (2008–17) and incidence-based multistate Markov modelling, we find that females experience higher MMLE than males (17.3 vs 9.8 years), and this disparity is consistent across all race and education groups. MMLE is highest among Asian/Indian people and the post-secondary educated relative to other groups and lowest among African people. These findings suggest there are associations between structural inequalities and MMLE, highlighting the need for health-system and educational policies to be implemented in a way proportional to each group’s level of need.

Preventing Stunting in South African Children Under 5: Evaluating the Combined Impacts of Maternal Characteristics and Low Socioeconomic Conditions

More than 140 million children under five suffered from stunting in 2020. This highlights the ongoing challenge of addressing childhood malnutrition globally. We utilized data from a nationally representative sample of children under five years of age (n = 14,151) who participated in five cycles of the South African National Income Dynamics Study (SA-NIDS) (2008–2017). We estimated the proportion of stunted children attributed to the mothers’ anthropometric characteristics and socioeconomic conditions. We also quantified the population-level burden of low-socioeconomic conditions on hunger/food insecurity among pregnant women (n = 22,814) who participated in the nine rounds of the South African General Household Surveys (GHS) (2008–2021). Results from weighted-multivariate logistic regression were incorporated into the population-level impacts of correlates of stunting and low-socioeconomic conditions. The prevalence of stunting declined from 25% in 2008 to 23% in 2017. Mothers’ anthropometric measures (underweight/height < 160 cm), marital status, low education, absence of medical insurance and low-socioeconomic conditions were all identified as the most influential risk factors for stunting. Their population-level impacts on stunting increased substantially from 34% (in 2008) to 65% (in 2017). Comprehensive strategies emphasizing enhanced food security, extended breastfeeding, appropriate nutrition, and access to adequate healthcare and education are urgently needed to reduce the burden of food insecurity low-socioeconomic, malnutrition, and its long-term consequences.

What drives the willingness to get vaccinated against COVID-19 in South Africa?

The willingness to get vaccinated in South Africa is among the highest in the world, measuring at 76%. This study investigated the impact of individual risk beliefs, self-reported health status, and familiarity with someone with coronavirus disease 2019 (COVID-19) on the willingness to get vaccinated in South Africa. Data were obtained from the Wave 5 of the South African National Income Dynamics Study &amp;ndash; Coronavirus Rapid Mobile Survey. Data were analyzed using descriptive statistics and binary logistic regression. More than 53% of the population believed that they were not at risk of COVID-19; 71.8% believed that they were in good health; and 31.6% knew someone with COVID-19. Beliefs (odds ratio [OR]: 1.287), health status (OR: 1.064), and COVID-19 case familiarity (OR: 1.034) were associated with willingness to get vaccinated. Other associations remained positive in the adjusted model. The relationship between case familiarity and willingness to get vaccinated shows that knowing someone who died of COVID-19 or suffered from the discomfort induced by the disease may drive other individuals to get vaccinated.

Linking Care and Support Systems to Improve Childhood Malnutrition: Early Childhood Development Practitioners’ Perceptions of Integrating Multisectoral Systems in South Africa

Introduction: Child malnutrition is a persistent global challenge. It is the cause of nearly 45% of global child mortalities. To ensure positive child health outcomes, integrated multisectoral approaches among families, communities, and government systems to ensure positive child health outcomes are neccesary. Objectives: This study identifies how different care support systems can be linked to ensure optimal childhood nutrition outcomes in South Africa. This is through multisectoral approaches from the early childhood development (ECD) practitioners' perspective. Materials and Methods: We integrated the components of the different support systems and multisectoral approaches. The conceptional framework of the causes of malnutrition by The United Nations Children's Fund (UNICEF) recognizes that malnutrition is due to inadequate care services, diet, and care practices influenced by individual, household, community, and structural determinants. While the Nurturing Care Framework, which looks at how policies and services can support families, parents, and other communities in providing nurturing care. Design: A sequential mixed methods approach was used. For the quantitative method, we did a cross-sectional descriptive analysis of 2 966 children who were under-five years' old in the 2017 South African National Income Dynamics Study (NIDS) between July and August 2022, we conducted five in-depth interviews with ECD practitioners using this qualitative method, and the data was analyzed using thematic analysis. Data was triangulated to understand the factors influencing children’s nutritional outcomes and to provide the narratives of ECD practitioners. This enabled us to highlight challenges and opportunities in linking children to services they need. Results: This study showed that 22.16% of children were stunted, 16.40% were overweight, and 5.04% were underweight. ECD practitioners reported a lack of support received at health facilities and other social services when making referrals, a lack of parental support in nutrition programmes, systemic challenges experienced in getting ECD centers registered, and the ECD's inability to qualify for subsidized nutrition grants. Conclusion: It is critical for us to understand the challenges and opportunities for multisector collaboration. This understanding will enable strategies and policies aimed at providing efficient and effective service referral and service delivery to improve childhood malnutrition in South Africa.

Perpetuation of household food insecurity during COVID-19 in South Africa

BackgroundPerpetual food insecurity has long-term health and development effects on populations. The global pandemic created sub-populations that were newly food insecure, but there exists sub-populations were food insecure, and COVID-19 held that situation. This study seeks to identify the demographic and socioeconomic characteristics of the perpetually food insecure in South Africa in order to obtain specific evidence of populations to be prioritised in the post-pandemic era.MethodsSecondary data from the South African National Income Dynamics CRAM Survey for rounds (Waves) 1 and 5 are analysed. The study population are those respondents who reported a household member not having enough food to eat in the early stages of the pandemic (1st round) and remained without sufficient food a year later (5th round). The study controls for the demographic and socioeconomic characteristics of the population but also changes to employment status, social grant access and willingness to be vaccinated. Descriptive and analytical statistical tests are used.ResultsA total of 26.15% of respondents were food insecure at the start of the pandemic. Of these, 41.09% remained food insecure a year later. The drivers of perpetual food insecurity during the pandemic include unemployment (OR = 2.09; CI 1.335293–3.265678), still being unemployed (OR = 1.86; CI 1.308032–2.636252), seven or more (≥ 7) household members (OR = 1.24; CI 1.1611329–1.610126), those with only a primary education (OR = 1.11; CI 1.5051066–2.434695), participants between the ages of 45 and 64 years old (ORs = 1.03 and 1.20; CIs 1.0171956–1.0171956 and 1.1733304–2.144875, respectively) and women (OR = 1.09; CI 1.0745444–1.406035).ConclusionsSouth Africa needs to address socioeconomic challenges and inequalities to assist the perpetually food insecure and to ensure that, should there be a pandemic resurgence, or a new pandemic, individuals and households in the country are in a better financial situation and appropriately supported to avoid food insecurity at all costs.

“Did You Wash Your Hands?” The Socioeconomic Inequalities Preventing Youth From Adopting Protective Behaviors During COVID-19 in South Africa

Background. Behavior change has been a critical factor in slowing the spread of COVID-19. In South Africa where infection rates are high, research is needed on the protective behaviors adopted by youth who have low infection rates but are carriers of the virus. Aims. The purpose of this study is to (1) identify the protective behaviors young people adopted during the pandemic and (2) to estimate the probability of positive behavior change by demographic and socioeconomic characteristics. Methods. The study uses data from the South African National Income Dynamics-Coronavirus Rapid Mobile Survey 2020. The sample includes 985 (n) youth aged 15-24 years. The outcome of interest is behavior change due to the Coronavirus. Cross-tabulations and an adjusted binary logistic regression model showing odds ratios, are fit to the data. Results. Not all youth adopted protective behaviors. The most prevalent behaviors adopted include washing hands (67.75%) and staying at home (54.02%). Youth in households with six or more members are more likely to change their behaviors (ORs = 1.67 and 1.64, both p-values < .05). However, youth who do not have access to water to wash hands (OR = 0.71), reside in households with food insecurity (OR = 0.94), and those living in nonformal housing (OR = 0.69) are less likely to adopt behavior change. Conclusion. Due to the socioeconomic inequalities associated with behavior change, there is need for more tailored approaches to address youth living in impoverished households in the country.

Water, sanitation and depression in rural communities: evidence from nationally representative study data in South Africa

ABSTRACT Clean water and sanitation provisions are essential for good hygiene and health, with rural South Africa facing a simultaneous access crisis of both, the direct health effect of restricted access to both on mental health remaining scarce and largely overlooked. This study investigated the association between access to clean water and sanitation on depression in rural South Africa utilizing the most recent data (year 2017) from the South African National Income Dynamics Study. Our study outcome was depression, based on the 10-item abridged version of the Center for Epidemiologic Studies Depression Scale (data available in SA-NIDS), the main exposures being access to clean water and adequate sanitation facilities (i.e. flushing toilets). Two types of analyses were conducted: first, adjusted logistic regression models were fitted to assess the relationship between lack of access to clean water and adequate sanitation to depression. Second, we conducted mediation analysis to investigate whether access to clean water mediated the relationship between lack of access to toilets and depression. A high proportion of rural participants lacked access to clean water (n = 6,188, 47.6%) and adequate toilets (n = 9,797, 81.6%). The regression analyses indicated that lack of access to both clean water (OR = 1.21, 95% CI: 1.06–1.39) and adequate sanitation (OR = 1.36, 95% CI: 1.10–1.69) were significantly associated with greater odds of depression. The mediation analysis indicated that access to clean water partially mediated the relationship between lack of access to adequate sanitation and depression, the total mediated effect being 18.2% (95% CI: 11.0%–51.0%). Most rural communities in South Africa lack access to basic services that are essential for human dignity and a decent quality of life, leading to opportunities for poor mental health, with its various consequences for socio-economic development and personal wellbeing, including avoidable depression.

Examining maternal depression, birthweight and linear growth: Findings from the South African National Income Dynamics Study

Background. Literature is inconclusive regarding an association between maternal depression, low birthweight (LBW) and stunting in early childhood. While some studies have found an association, others have not. Maternal food insecurity is a risk factor for both maternal depression and reduced linear growth in early childhood. &#x0D; Objective. This study examined the relationship between maternal depression, food insecurity, LBW and stunting in the first five years of life. The study employed longitudinal data of South African women and children from the National Income Dynamics Study (NIDS). &#x0D; Methods. Mothers were classified into four groups: food insecure and depressed; food insecure only; depressed only; and neither food insecure nor depressed. During data collection, 22% of women were pregnant and the remaining 78% were pre-conception. The primary outcomes were low birthweight and height-for-age (HAZ) scores. Generalised Linear Mixed Effects (GLME) models were used to account for women having more than one child. GLME models with a Gaussian link function were used to compare mean differences in birthweight and HAZ scores. Multivariable regression models were used to examine factors associated with depression. &#x0D; Results. Food insecurity was significantly associated with depression among pre-conceptional and pregnant women. There was no statistically significant difference in birthweight or linear growth across groups, but this may be influenced by proximity of depression measurement in relation to outcomes. &#x0D; Conclusion. Food insecurity is a potentially modifiable risk factor for depression and may be a confounding factor in studies that have found associations between depression and child health outcomes.

The prevalence and social determinants of multimorbidity in South Africa

AbstractMultimorbidity is an increasing global public health challenge, however, most existing research focuses on high‐income countries, with limited evidence from low‐ and middle‐income countries. This paper aims to estimate the prevalence of multimorbidity in South Africa and analyse the associations between multimorbidity and social determinants of health in the adult population. Multimorbidity will be defined as the coexistence of two or more chronic diseases in an individual throughout this paper. Data from the South African National Income Dynamics Survey of 2017 was used with a total sample of 20,833. A binary logistic regression was performed to analyse the associations between multimorbidity and several social determinants of health indicators based on the Commission on Social Determinants of Health Framework. Multimorbidity was prevalent in 5.4% of the South African adult population surveyed, with 71.35% of those with multimorbidity being female. Hypertension was the most common NCD and the highest contributor to multimorbidity. Multimorbidity was found to have statistically significant associations with age, obesity, being female, being of Colored or Asian/Indian ethnicity, being in employment, and having no schooling. This study highlights the importance of analysing the associations between multimorbidity and the social determinants of health. Further research on multimorbidity is required in low‐ and middle‐income countries to understand the specific challenges not identifiable in the existing research predominately based in high‐income nations.

Depression onset and its association with community HIV prevalence: A geospatial and panel analyses of nationally representative South African data, 2015–2017

• We compared depression onset overtime among depression-free individuals based on the HIV prevalence of their communities. • Communities with higher HIV prevalence had higher prevalence of depression onset. • Higher community HIV prevalence was associated with depressive consequences for individual residents over time. The scaling up of antiretroviral therapy services over the past decades has led to a remarkable reduction in HIV infections and HIV-related deaths in South Africa (SA). While this is a step in the right direction, it brings a new public health challenge into focus, namely psychological challenges associated with such chronic and often stigmatising condition in SA, home to the largest HIV epidemic. Given the current lack of national-level evidence, we investigated the role of the HIV epidemic on depression onset in SA using nationally representative panel data from the South African National Income Dynamics Study (SA-NIDS). Our incident cohort consisted of 13,020 sampled adult participants who were depression-free in Wave 4 (baseline year of 2015). We then measured the risk of depression onset in Wave 5 (year 2017) based on the level of HIV prevalence in the community where study participants resided at baseline. A High-resolution map of HIV spatial heterogeneity (i.e., community HIV prevalence) was generated using ordinary kriging mapping methods from a separate nationally representative data source that corresponded to the investigation period. Geospatial analyses were conducted to identify the spatial structure of HIV and depression onset, and generalised estimating equations (GEE) regression models were fitted to determine the risk of depression onset over time based on community HIV prevalence. Our geospatial analyses indicated that HIV and depression onset prevalence spatially overlapped in the eastern part of the country, particularly in Gauteng, KwaZulu-Natal, Mpumalanga, and Free State province. The GEE regression analyses indicated that individual residency in a community with high HIV prevalence was significantly associated with a higher risk of depression than a low HIV prevalence community (adjusted odds ratio =1.45, 95% CI=1.12-1.48). For the first time, we identified a geospatial overlap between HIV and depression, with a greater risk of depression onset in high HIV prevalence communities, at a national scale in SA. There is a need for place-based policy interventions that prioritise the availability of and access to mental health services in high HIV prevalent SA communities, in an ageing HIV epidemic.

Dietary diversity, food insecurity and the double burden of malnutrition among children, adolescents and adults in South Africa: Findings from a national survey.

Childhood stunting remains a global public health problem. Many stunted children live in the same household as overweight or obese adults (the so-called double burden of malnutrition), evidence that quality as well as quantity of food is important. In recent years, food security measurement has shifted away from anthropometry (e.g., stunting) to experiential measures (e.g., self-reported hunger). However, given the continued problem of stunting, it is important that national surveys identify malnutrition.ObjectivesTo examine the associations between a variety of food security indicators, including dietary diversity, with adult, child (0–4 years) (5–9 years) and adolescent (10–17 years) anthropometry. To estimate the prevalence of double burden households.MethodsThe study utilized cross-sectional data from the South African National Income Dynamics Survey NIDS (2008). We examined the associations between five food security indicators and anthropometry outcomes. The indicators were adult and child hunger in the household, self-reported household food sufficiency, food expenditure>60% of monthly expenditure and household dietary diversity. Multinomial and logistic regression models were employed to examine the associations with adult BMI categories and children's stunting and BMI.ResultsThe prevalence of stunting was 18.4% and the prevalence of wasting and overweight was 6.8 and 10.4%, respectively. Children <5 and adolescents with medium dietary diversity were significantly more likely to be stunted than children with high dietary diversity. Among children <5, child hunger and medium dietary diversity were significantly associated with wasting. None of the food security indicators were associated with stunting in children aged 5–9. Among stunted children, 70.2% lived with an overweight or obese adult. Among adults, increased dietary diversity increased the risk of overweight and obesity.ConclusionDietary diversity can be used as a proxy for poor nutritional status among children <5 years and adolescents but the relationship between dietary diversity and adult obesity is more complex. Given the double burden of malnutrition in many low- and middle-income countries, indicators of dietary quality remain important. These tools can be further refined to include an extra category for processed foods. Given the relative simplicity to collect this data, national surveys would be improved by its inclusion.

Modelling of South African Hypertension: Application of Classical Quantile Regression

Background: High blood pressure, medically known as hypertension is the major risk factor for cardiovascular diseases (CVDs) and premature death globally. The aim of the present study was to explore possible interactions amongst systolic blood pressure`s (SBP) and diastolic blood pressure`s (DBP) risk factors in South Africa. Methods:A retrospective study was conducted using data acquired from the South African National Income Dynamics Study Wave 5, Household Survey which was carried out in 2017-2018.A final data set of 21 180 adults was utilized for data analysis. An application of the hierarchical group-lasso approach to detect interactions between SBP`s and DBP`s risk factors and classical quantile regression analysis were performed in this study. Results: By using only upper quantilesbody mass index (BMI), age, race, never exercised, and the following nine interactions: BMI and age, BMI and gender male, age and never exercised, gender male and race African, race coloured and depression some or little of the time, BMI and cigarette consumption, age and race white, gender male and employment status, never exercised and cigarette consumptionwere found to be significantdeterminantsof hypertension in South Africa. Conclusion: The evidence of this study suggests that it is ideal to consider interactions amongst risk factors when modelling hypertension. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 772-781

Inequity in the Distribution of Non-Communicable Disease Multimorbidity in Adults in South Africa: An Analysis of Prevalence and Patterns.

Objectives: The present study examined the prevalence and patterns of non-communicable disease multimorbidity by wealth quintile among adults in South Africa. Methods: The South African National Income Dynamics Study Wave 5 was conducted in 2017 to examine the livelihoods of individuals and households. We analysed data in people aged 15 years and older (N = 27,042), including self-reported diagnosis of diabetes, stroke, heart disease and anthropometric measurements. Logistic regression and latent class analysis were used to analyse factors associated with multimorbidity and common disease patterns. Results: Multimorbidity was present in 2.7% of participants. Multimorbidity was associated with increasing age, belonging to the wealthiest quintile group, increasing body mass index and being a current smoker. Having secondary education was protective against multimorbidity. Three disease classes of multimorbidity were identified: Diabetes and Hypertension; Heart Disease and Hypertension; and Stroke and Hypertension. Conclusion: Urgent reforms are required to improve health systems responsiveness to mitigate inequity in multimorbidity patterns in the adult population of South Africa as a result of income inequality.

Household stock market participation in South Africa: the role of financial literacy and social interactions

PurposeOne of the most important phenomena that have been confronted in the field of household finance is the stock market participation puzzle. The puzzle describes the anomaly that the majority of households do not have ownership of stock market products, though empirically stocks give higher expected returns than risk-free assets. The stock market participation rate plays an important role as it has a direct bearing on the equity premium. In this study, the authors aim to investigate how financial literacy and various proxies of social interaction are associated with stock market participation in South Africa.Design/methodology/approachThe study uses probit regression and ordinary least squares using the South African National Income Dynamics survey Wave 5 of 2017 to investigate whether financial literacy and social interaction are significantly associated with stock market participation. The financial literacy index is computed using factor analysis on the responses to the financial literacy questions used in the survey. The authors use three proxies for social interaction, namely membership in a Stokvel, membership in a men's association and membership in a women's association.FindingsThe results reveal that an increase in financial literacy increases the odds of respondents participating in the stock market. Among the control variables, age, race and level of education are significantly associated with stock market participation. When it comes to social interaction, it is belonging to a men's association that is significantly associated with stock market participation. The other proxies for social interaction are insignificantly associated with stock market participation.Originality/valueThe study contributes to the extant literature by using a set of proxies for social interaction that have the potential to influence stock market participation which have not been used in a South African context.

Modelling of South African Hypertension: Application of Panel Quantile Regression.

Hypertension is one of the crucial risk factors for morbidity and mortality around the world, and South Africa has a significant unmet need for hypertension care. This study aims to establish the potential risk factors of hypertension amongst adults in South Africa attributable to high systolic and diastolic blood pressure over time by fitting panel quantile regression models. Data obtained from the South African National Income Dynamics Study (NIDS) Household Surveys carried out from 2008 to 2018 (Wave 1 to Wave 5) was employed to develop both the fixed effects and random effects panel quantile regression models. Age, BMI, gender (males), race, exercises, cigarette consumption, and employment status were significantly associated with either one of the BP measures across all the upper quantiles or at the 75th quantile only. Suggesting that these risk factors have contributed to the exacerbation of uncontrolled hypertension prevalence over time in South Africa.

Stressful life events, neighbourhood characteristics, and systolic blood pressure in South Africa.

The relationship between negative events, neighbourhood characteristics, and systolic blood pressure in developing countries is not well-documented, particularly using longitudinal data. To explore this relationship, we analysed panel data from the first three waves of the South African National Income Dynamics Study using a correlated random effects model adjusted for confounding risk factors. Our sample comprised of 15,631 respondents in 2008, 14,443 respondents in 2010/2011, and 14,418 respondents in 2012, all aged above 15 years. The prevalence of at least one negative household event across the three waves was approximately 30%. In any of the three waves, the adjusted prevalence of hypertension was 23.84%. This share was 21.75% in 2008 (95% CI 18.06-25.44), 23.16% in 2010/11 (95% CI 19.18-27.14), and 18.39% in 2012 (95% CI 16.03-20.75). In our adjusted correlated random effects model, we found that systolic blood pressure was significantly higher among respondents from households that reported death of a household member (0.85 mmHg; p = 0.02) and a reduction in grant income and remittances (2.14 mm Hg; p = 0.01). We also found no significant association between systolic blood pressure and neighbourhood income level. In a country with social and economic challenges, our results indicate that grief and negative financial events are adversely associated with blood pressure, which may explain in part the significant burden of hypertension in low- and middle-income countries.

Quantifying the impacts of clean cooking transitions on future health-age trajectories in South Africa

Reliance on highly polluting cooking technologies poses a significant risk for human health. This study quantifies and compares the impact of different clean cooking access scenarios on future health-age trajectories among population subgroups in South Africa. Using microdata from five waves of the South African National Income Dynamics Study, we develop a dynamic microsimulation model and a composite metric of individual health status that is used to explore how health status changes under alternative access scenarios for the period 2010–2030. We find that there are clear gains of using clean cooking technologies for population health, and that electrification alone does not improve health status, if it is not accompanied by an increase in the use of clean cooking technologies in homes. Our results imply that achieving universal access to clean cooking in South Africa can by itself improve average population health by almost 4% by 2030 compared to a scenario without clean cooking technologies, with the health of individuals of genders and races with the poorest health and well-being endowments improving the most. Thus, clean cooking can contribute to narrowing existing inequalities by improving health for the most vulnerable population groups that disproportionately depend on polluting cooking technologies.

Community disaster exposure and first onset of depression: A panel analysis of nationally representative South African data, 2008-2017.

Sub-Saharan Africa faces unprecedented disasters, with climate change expected to exacerbate the frequency and severity of unpredictable and stressful catastrophic events. Unlike developed nations, reconstruction in developing nations is hindered by resource constraints, with certain communities potentially experiencing multiple and enduring effects of disasters. Despite the potential danger of such cumulative community disaster exposure on mental health (e.g. depression), large-scale population-level evidence for the region is limited. We investigated the association between exposure to cumulative disaster and the first onset of depression in a nationally representative survey in South Africa. We used panel data from the South African National Income Dynamics Study (SA-NIDS) from 2008-2017, consisting of 17,255 adult study participants who were depression free at baseline. Risk of first depression onset between individuals exposed and unexposed to community disaster was measured, accounting for multiple disaster exposure over time by fitting generalized estimating equation (GEE) regression models. Data on the geographic location of disasters were obtained from the South African government gazette, and mapped with the government delineated SA-NIDS households' locations. Of the sampled individuals, 2,986 were exposed to disaster during the study duration (17.3%). Increased cumulative community disaster was significantly associated with the likelihood of depression onset (adjusted relative risk [aRR] = 1.20, p<0.01, 95% CI: 1.09-1.33), even after controlling for socio-demographic factors. In sub-group analyses, greater likelihood of depression onset was found among females [but not in men] (aRR = 1.23, p<0.01, 95% CI: 1.09-1.38), Black African [but not in other population group] (aRR = 1.21, p<0.01, 95% CI: 1.09-1.36), lower education attainment group [but not in tertiary and above educational attainment group] (aRR = 1.20, p<0.01, 95% CI: 1.08-1.33), and lower income attainment group [but not in the top income quartile group] (aRR = 1.24, p<0.01, 95% CI: 1.11-1.38), due to cumulative community disaster. Although cumulative community disaster exposure was significantly associated with the first onset of depression, its negative impact may be more pronounced among individuals considered chronically socially vulnerable (i.e. the groups above) in South Africa. Given that many individuals in South Africa rely on social, food parcel relief, and health services from government/public sector, timely access to community-based supportive intervention is needed for disaster survivors, prioritizing socially vulnerable groups to help mitigate problems associated with mental health challenges.

Intermarriage on Subjective Social Status and Spousal Dissimilarity in Life Satisfaction of Co-resident Heterosexual South African Couples

The aim of this study is to determine how intermarriage on subjective social status is associated with spousal dissimilarity in life satisfaction in co-resident heterosexual couples in South Africa. We apply fixed effect ordered logit regression models to a sample of 8652 married and cohabiting dyads constructed from the longitudinal and nationally representative South African National Income Dynamics Study. We find no spousal dissimilarity in overall life satisfaction under pure homogamy. In wife advantaged and currently hypogamic relationships females are more satisfied with life than their male partners, whereas the opposite is observed in husband advantaged and currently hypergamic relationships as well as in wife exchanges. Intermarriage on subjective social status may put marriages and relationships at risk of dissolution due to its association with spousal dissimilarity in overall life satisfaction. Further research is required to present a more complete and integrated account of how spousal dissimilarity in subjective well-being may mediate the impact of intermarriage on the dissolution of unions and relationships.

The Effect of Additional Childcare Roles on COVID-19 Symptom Knowledge Among Youth in South Africa

Background: As of March 2020, young people performed additional household responsibilities due to COVID-19 in South Africa. In particular, youth assisted with childcare since schools were closed. However, little is known of the impact of changing roles and additional responsibilities on young people’s ability to keep abreast of important information regarding the spread of the virus. Objective: The aim of the study was to determine the relationship between additional childcare responsibilities and complete awareness of the knowledge of symptoms of COVID-19 among young people in South Africa. Methods: Using data from the South African National Income Dynamics CRAM Survey (wave 1), 710 (72.08%) young individuals (18-24 years old) who listed symptoms of COVID-19 were analysed. The study controlled for covariates as additional childcare responsibilities, demographic and socioeconomic characteristics of the respondents. Cross-tabulations and a binary logistic regression model were used to determine the relationship between covariates and the outcome of the knowledge of symptoms. Results: None of the respondents reported 100% knowledge of the symptoms of COVID-19 while 57.5% reported having additional childcare responsibilities. Among youth with additional childcare, 90.71% knew regarding approximately half (50%) of the symptoms. Finally, not having additional childcare roles increased the odds of knowing at least three symptoms of the coronavirus (OR= 2.36; CI: 1.227387 - 2.543323). Conclusion: Youth, especially those spending increasing time caring for children, need more access to information regarding the virus. This information is key to protecting themselves and the children in their care.