Wand Handan, Vujovich-Dunn Cassandra, Derrick Kate, Moodley Jayajothi, Reddy Tarylee, Naidoo Sarita
Biostatistics and Databases Program ,Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Kensington, NSW 2052 Australia.
Emergency Department, Royal Prince Alfred Hospital, Sydney, Australia.
GeoJournal. 2023 Mar 7:1-17. doi: 10.1007/s10708-023-10851-4.
South Africa also has the highest burden of coronavirus disease 2019 (COVID-19) related comorbidities in Africa. We aimed to quantify the temporal and geospatial changes in unemployment, food insecurity, and their combined impact on depressive symptoms among South Africans who participated into several rounds of national surveys. We estimated the population-attributable risk percent () for the combinations of the risk factors after accounting for their correlation structure in multifactorial setting. Our study provided compelling evidence for immediate and severe effect of the pandemic where 60% of South Africans reported household food insecurity or household hunger, shortly after the pandemic emerged in 2020. Despite the grants provided by the government, these factors were also identified as the most influential risk factors (adjusted odds ratios (aORs) ranged from 2.06 to 3.10, < 0.001) for depressive symptoms and collectively associated with 62% and 53% of the mental health symptoms in men and women, respectively. Similar pattern was observed among pregnant women and 41% of the depressive symptoms were exclusively associated with those who reported household hunger. However, aORs associated with the concerns around pandemic and vaccine were mostly not significant and ranged from 1.12 to 1.26 which resulted substantially lower impacts on depressive symptoms (PAR%:7%-and-14%). Our findings suggest that South Africa still has unacceptably high rates of hunger which is accelerated during the pandemic. These results may have significant clinical and epidemiological implications and may also bring partial explanation for the low vaccine coverage in the country, as priorities and concerns are skewed towards economic concerns and food insecurity.
南非也是非洲2019冠状病毒病（COVID-19）相关合并症负担最高的国家。我们旨在量化参与多轮全国调查的南非人在失业、粮食不安全及其对抑郁症状的综合影响方面的时间和地理空间变化。在多因素环境中考虑风险因素的相关结构后，我们估计了风险因素组合的人群归因风险百分比（）。我们的研究提供了令人信服的证据，证明了疫情的直接和严重影响，2020年疫情出现后不久，60%的南非人报告家庭粮食不安全或家庭饥饿。尽管政府提供了补助，但这些因素也被确定为抑郁症状最具影响力的风险因素（调整后的优势比（aORs）范围为2.06至3.10，<0.001），分别与男性和女性62%和53%的心理健康症状相关。孕妇中也观察到类似模式，41%的抑郁症状仅与报告家庭饥饿的人相关。然而，与对疫情和疫苗的担忧相关的aOR大多不显著，范围为1.12至1.26，对抑郁症状的影响显著较低（PAR%：7%-和-14%）。我们的研究结果表明，南非的饥饿率仍然高得令人无法接受，在疫情期间有所加速。这些结果可能具有重大的临床和流行病学意义，也可能为该国疫苗接种率低提供部分解释，因为优先事项和担忧偏向于经济问题和粮食不安全。
