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Kobus Herbst

Publications and source records attributed to Kobus Herbst.

3 recordsLinked to original sources
PubMed2006

Modelling and understanding primary health care accessibility and utilization in rural South Africa: an exploration using a geographical information system.

Physical access to health care affects a large array of health outcomes, yet meaningfully estimating physical access remains elusive in many developing country contexts where conventional geographical techniques are often not appropriate. We interviewed (and geographically positioned) 23,000 homesteads regarding clinic usage in the Hlabisa health sub-district, KwaZulu-Natal, South Africa. We used a cost analysis within a geographical information system to estimate mean travel time (at any given location) to clinic and to derive the clinic catchments. The model takes into account the proportion of people likely to be using public transport (as a function of estimated walking time to clinic), the quality and distribution of the road network and natural barriers, and was calibrated using reported travel times. We used the model to investigate differences in rural, urban and peri-urban usage of clinics by homesteads in the study area and to quantify the effect of physical access to clinic on usage. We were able to predict the reported clinic used with an accuracy of 91%. The median travel time to nearest clinic is 81 min and 65% of homesteads travel 1h or more to attend the nearest clinic. There was a significant logistic decline in usage with increasing travel time (p < 0.0001). The adjusted odds of a homestead within 30 min of a clinic making use of the clinics were 10 times (adjusted OR = 10; 95 CI 6.9-14.4) those of a homestead in the 90-120 min zone. The adjusted odds of usage of the clinics by urban homesteads were approximately 20/30 times smaller than those of their rural/peri-urban counterparts, respectively, after controlling for systematic differences in travel time to clinic. The estimated median travel time to the district hospital is 170 min. The methodology constitutes a framework for modelling physical access to clinics in many developing country settings.

Computer Simulation↗
PubMed2004

The impact of adult mortality on household dissolution and migration in rural South Africa.

OBJECTIVE: To investigate the effect of adult death on household dissolution and migration. DESIGN: Demographic surveillance of the population in a rural area of northern KwaZulu Natal, South Africa. METHODS: Data on households resident in the surveillance area on 1 January 2000 were used to examine the effect of adult mortality and household risk factors on household dissolution and mobility between January 2000 and October 2002. Cox regression models were used to assess the risk of household dissolution and migration, controlling for multiple risk factors including causes of death, household composition and household assets. RESULTS: By October 2002, 238 households (2%) had dissolved and 874 (8%) migrated out of the area; 21% (2179) of all households had at least one adult death (18 years and older). Households where one or more adult members died during the follow-up period were four times more likely to dissolve, after controlling for household and community level risk factors [4.3; 95% confidence interval, (CI), 3.3-5.7]. The risk of dissolution was significantly higher in households with multiple deaths (2.3; 95% CI, 1.3-4.3). There were no significant differential risks associated with cause of death, age or sex of the deceased. Adult mortality in the household was not associated with migration. CONCLUSIONS: Poorer households, as measured by asset ownership, and households trying to cope with adult deaths are vulnerable to dissolution. The dramatic increase in adult mortality attributable to AIDS will increase the number of households that do not survive as a functional and cohesive social group.

Adolescent↗