Cape Town Research Articles

User information needs for hybrid public transport systems in Cape Town, South Africa

Public transport information imbalances are rife in cities with hybrid systems composed of scheduled and unscheduled modes, hindering users’ ability to access mobility. Though private and public entities alike are seeking information-based technological solutions to aid users to navigate these systems, there is still little understanding of what information users need to navigate these complex hybrid systems. Particularly for captive public transport users who do not have access to private alternative means of travel, access to relevant information across all modes could enable access to information on trips that better suit their needs and preferences. Through semi-structured interviews followed by a best-worst scaling survey with captive public transport users in Cape Town, South Africa, this study investigates what information users need to plan non-routine hybrid journeys. Information needs are extensive, ranging beyond that which is publicly offered, not only on available transport services in isolation, but also across these collective services. This paper provides a method for investigating the information needs of users to enable policy makers to better align information and data strategies to support the integration of hybrid public transport systems through passenger information.

Coping motives as a mediator of the relationship between child maltreatment and substance use problems in south African adolescents

BackgroundEvidence suggests that adults with a history of child maltreatment (CM) engage in substance misuse driven by ‘coping motives’: maladaptive beliefs that substances help them cope with negative emotions. However, the specificity of this risk pathway is under-researched in younger and non-Western cohorts. ObjectiveThe present study aimed to determine whether coping motives play a distinct role compared to other motives for substance use in mediating the relationship between CM and problematic alcohol and marijuana use in a sample of South African adolescents. Participants and settingA sample of 688 high school students (M age = 15.03 years; 62.5 % female) in Cape Town, South Africa, completed a cross sectional survey. MethodsParticipants completed self-report measures of CM exposure, motives for using alcohol and marijuana (coping, enhancement, social and conformity), and alcohol and marijuana related problems. Participants who endorsed using alcohol (N = 180) or marijuana (N = 136) were included in analysis. A parallel mediation model was conducted for each substance (alcohol and marijuana, respectively) to assess which motives mediated the relationship between CM exposure and substance-related problems. ResultsCM exposure predicted both alcohol-and marijuana related problems. The relationship between CM exposure and alcohol-related problems was partially mediated by coping motives (p < .001, 95%CI 0.028, 0.115) and, to a lesser extent, conformity motives (p < .01, 95%CI 0.001, 0.041), but not by social motives or enhancement motives. The relationship between CM exposure and marijuana-related problems was partially mediated by coping motives (p < .001, 95%CI 0.004, 0.037), but not by conformity, social or enhancement motives. ConclusionsThe findings support the importance of coping motives as a mediator between CM and problematic substance use across different substances of abuse in South African adolescents, and the role of conformity motives in problematic alcohol use. Future research should explore whether these findings hold across other sociocultural contexts, and the utility of interventions to address coping motives for substance use in adolescence.

Exploring Activity Interests of Older People with Low-Income

ABSTRACT Older people living on low incomes may experience inequitable access to activities they find interesting because they may live in homes with even fewer resources and may not be able to afford to participate in the activities they enjoy. The aim of this study was to explore the interests of older people living on low incomes living in residential homes. We used a cross-sectional analytic study design and the Interest Checklist to investigate the activity interests of 82 older people with low incomes in 9 residential homes in Cape Town, South Africa. Findings revealed 27 activities they were most interested in, within five categories: musical, everyday, social, free time, and religious or cultural activities. There were few statistically significant differences between men and women, or between residents with different levels of independence. Understanding the interests of older people with low incomes is a first step toward creating opportunities for participation, and growing well-developed individual interests.

MmpR5 protein truncation and bedaquiline resistance in Mycobacterium tuberculosis isolates from South Africa: a genomic analysis

The antibiotic bedaquiline is a key component of new WHO regimens for drug-resistant tuberculosis; however, predicting bedaquiline resistance from bacterial genotypes remains challenging. We aimed to understand the genetic mechanisms of bedaquiline resistance by analysing Mycobacterium tuberculosis isolates from South Africa. For this genomic analysis, we conducted whole-genome sequencing of Mycobacterium tuberculosis samples collected at two referral laboratories in Cape Town and Johannesburg, covering regions of South Africa with a high prevalence of tuberculosis. We used the tool ARIBA to measure the status of predefined genes that are associated with bedaquiline resistance. To produce a broad genetic landscape of M tuberculosis in South Africa, we extended our analysis to include all publicly available isolates from the European Nucleotide Archive, including isolates obtained by the CRyPTIC consortium, for which minimum inhibitory concentrations of bedaquiline were available. Between Jan 10, 2019, and July, 22, 2020, we sequenced 505 M tuberculosis isolates from 461 patients. Of the 64 isolates with mutations within the mmpR5 regulatory gene, we found 53 (83%) had independent acquisition of 31different mutations, with a particular enrichment of truncated MmpR5 in bedaquiline-resistant isolates resulting from either frameshift mutations or the introduction of an insertion element. Truncation occurred across three Mtuberculosis lineages, and were present in 66% of bedaquiline-resistant isolates. Although the distributions overlapped, the median minimum inhibitory concentration of bedaquiline was 0·25 mg/L (IQR 0·12-0·25) in mmpR5-disrupted isolates, compared with 0·06 mg/L (0·03-0·06) in wild-type M tuberculosis. Reduction in the susceptibility of M tuberculosis to bedaquiline has evolved repeatedly across the phylogeny. In our data, we see no evidence that this reduction has led to the spread of a successful strain in South Africa. Binary phenotyping based on the bedaquiline breakpoint might be inappropriate to monitor resistance to this drug. We recommend the use of minimum inhibitory concentrations in addition to MmpR5 truncation screening to identify moderate increases in resistance to bedaquiline. US Centers for Disease Control and Prevention.

Assessing the Prevalence and Dynamics of Emerging Campylobacterales in Human Stool Samples in Brussels by Filtration Culture.

Thermophilic C. jejuni/coli is reported to be the first bacterial cause of gastroenteritis worldwide and the most common zoonosis in Europe. Although non-jejuni/coli Campylobacter sp. are increasingly suspected to be responsible for diarrhoea or to be involved in inflammatory bowel disease, they remain poorly isolated due to their fastidious and non-thermophilic nature. Additionally, they are not targeted by commercial syndromic PCR assays. In this study, we present routine diagnostic results over 6 years (2017-2019 and 2021-2023) of Campylobacter sp. and related species, obtained by optimised culture from 51,065 stools by both 0.65 µm pore filtration on antibiotic-free agar, incubated in an H2-enriched atmosphere at 37 °C (also known as the Cape Town protocol), and the use of selective inhibitory Butzler medium incubated at 42 °C. This allowed the isolation of 16 Campylobacter species, 2 Aliarcobacter species, and 2 Helicobacter species, providing a completely different view of the epidemiology of Campylobacterales, in which C. jejuni/coli represents only 30.0% of all isolates, while C. concisus represents 44.4%. C. ureolyticus, representing only 5.5% of all Campylobacterales pre-COVID-19, represented 20.6% of all strains post-COVID-19 (218% increase; p < 0.05). At the same time, the proportions of C. jejuni, C. coli, and C. concisus decreased by 37, 53, and 28%, respectively (p < 0.05).

Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA).

Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programmes that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of 'assisting only'. In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its 'Seal of Approval' for the sustainability of endorsed programmes in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programmes could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.

Inflammatory markers in pregnancy are associated with postpartum weight in South African women living with HIV on antiretroviral therapy.

Postpartum weight (PPW) contributes to long-term obesity, a growing concern in persons with HIV (PWH). We investigated whether inflammatory markers in pregnancy may be involved in postpartum (PP) obesity in PWH. A total of 57 pregnant PWH enrolled at ≤14 weeks gestation (T1) in Gugulethu antenatal care clinic in Cape Town and followed through 48 weeks PP were included. Plasma soluble (s) CD14, sCD163, leptin, tumour necrosis factor receptor 1 (TNFR-1), resistin, adiponectin, and interleukin-6 (IL-6) were assayed in duplicate using the Luminex platform. We considered each inflammatory marker at T1 (n=57) and T3 (29-36 weeks gestation, n=31) as a separate exposure of interest. Linear mixed effects models were fit to examine whether each exposure was associated with average PPW and PPW trajectories; linear regression was used for associations with PPW change between T1 and 48 weeks. Median age was 32 years (IQR, 29-35), 98% were multigravida, and 49% had a BMI≥30 kg/m2. Higher T1 sCD14 levels were associated with higher average weight through 48 weeks PP (ß = 0.002, p=0.04), and T3 sCD14 with higher PPW gain (ß = 0.007, p=0.04). Leptin (ß = 0.414, p<0.01), TNFR-1 (ß = 11.048, p<0.01) and resistin (ß = 0.714, p=0.01) at T3 were associated with higher average PPW, and IL-6 (ß = 2.266, p=0.02) with PPW gain. These findings suggest that low-grade inflammation in pregnancy may play a role in postpartum obesity, pointing to potential mechanisms with implications for long-term cardiometabolic health in PWH.

Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study.

Outside of pregnancy, evidence shows that persons with HIV initiating or switching to dolutegravir (DTG)-based antiretroviral therapy (ART) experience greater weight gain compared to those on other ART classes. However, there are few data on the impact of DTG-based ART on gestational weight gain (GWG) in sub-Saharan Africa where HIV is most common. According to the National Academy of Medicine (NAM), GWG below and above NAM guidelines is associated with adverse birth outcomes. Therefore, the objective of this study was to describe GWG by HIV status and ART regimen, and examine the associations with adverse birth outcomes. We enrolled pregnant women with HIV (WHIV) and without HIV (≥18 years) in a peri-urban primary healthcare facility in Cape Town, South Africa between 2019 and 2022. GWG was study-measured at 24-28 (baseline) and 33-38 weeks gestation and converted to GWG rate (kg/week) in accordance with NAM guidelines. GWG z-scores were generated using the INTEGROWTH-21 and US standards to account for differing lengths of gestation. Birth outcome data were obtained from medical records. Associations of GWG z-score with adverse birth outcomes were assessed using multivariable linear or log-binomial regression. Among 292 participants (48% WHIV), median age was 29 years (IQR, 25-33), median pre-pregnancy body mass index (BMI) was 31 kg/m2 (IQR, 26-36) and 20% were primiparous at baseline. The median weekly rate of GWG was 0.30 kg/week (IQR, 0.12-0.50), 35% had GWG below NAM standards (59% WHIV) and 48% had GWG above NAM standards (36% WHIV). WHIV gained weight more slowly (0.25 vs. 0.37 kg/week, p<0.01) than women without HIV. Weekly rate of GWG did not differ by ART regimen (DTG-based ART 0.25 vs. efavirenz-based ART 0.27 kg/week, p = 0.80). In multivariable analyses, GWG z-score was positively associated with continuous birth weight (mean difference = 68.53 95% CI 8.96, 128.10) and categorical high birth weight of >4000 g (RR = 2.18 95% CI 1.18, 4.01). Despite slower GWG among WHIV, nearly half of all women gained weight faster than recommended by the NAM. GWG was positively associated with infant birth weight. Interventions to support healthy GWG in sub-Saharan Africa are urgently needed.

Genetic counseling in South Africa: A growing profession

The Genetic Counseling profession in South Africa (SA) was established 35 years ago when the first degree program was initiated at the University of the Witwatersrand in 1989. A second program was developed at the University of Cape Town in 2004. This article aims to describe the development of the profession in SA, with a focus on the last decade. The profession has been growing against the backdrop of a diverse population of 62 million with high rates of HIV/AIDS and tuberculosis and a poorly functioning health care system. SA was one of the first countries to regulate the profession when the Health Professions Council recognized genetic counselors (GCs) as health care professionals in 1992. Since 2017, the student body (now including some internationals) is becoming more representative of the local population and SA graduates are assisting in establishing counseling and training programs in Ghana and Oman. The professional group (GC-SA), formed in 2008, now represents the profession locally and internationally. Challenges remain, although training programs are established, and registration and billing in place. State employment opportunities are few and graduates have to become entrepreneurs, setting up private practice and seeking work in laboratories and research projects. With about a third (16) of qualified GCs (47) leaving the country and only 31 presently working locally, only about 10% of the genetic needs of the population can be met. Addressing these issues, as well as the lack of funding and political will, is a priority for the future.

Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA).

Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programmes that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of 'assisting only'. In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, it's 'Seal of Approval' for the sustainability of endorsed programmes in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programmes could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.

Establishing reliability and construct validity for the revised Emotional Social Screening Tool for School Readiness (E3SR-R)

School readiness assessments in South Africa still predominantly focus on the assessment of cognitive skills. The Emotional Social Screening Tool for School Readiness (E3SR) was developed to bridge the perceived gap in assessing emotional-social skills as a domain of school readiness. An emerging body of research reports exists on the psychometric properties and factor structure of the E3SR. An initial validation study recommended a 6-factor solution instead of the theoretical 9-factor model that was proposed in the development of the E3SR. The E3SR (Revised) was also reduced in length. We report here on a pilot study of which the aim was to establish the reliability and construct validity of the E3SR (Revised). A cross-sectional survey design was used to gather data from 9 pre-schools in Cape Town, South Africa. Pre-school teachers (n = 24) constituted the respondent group who completed the E3SR (Revised) screening questionnaires on Grade R learners (n = 394). Analysis was conducted on 321 completed screening questionnaires. With the data analysis we aimed to: a) summarise sample characteristics of teachers and children; b) establish reliability estimates; and c) establish construct validity and confirming the factor structure. Ethics clearance was given by the Humanities and Social Science Research Ethics Committee (HSSREC) of the University of the Western Cape. The study adhered to stipulated ethics requirements. Data failed to show multivariate normality; however, this violation of normality was expected and was theoretically supported. The sample size (n = 321) was sufficient for factor analysis of a 36-item scale. All subscales showed excellent reliability: Cronbach’s alphas ranged between .939 and .971. CFA results demonstrated a good model fit. The E3SR (Revised) was found to be reliable and valid for use. The use of a rigorous methodological process including the decision-making matrix represent good research practice that can be used in instrument development across cultures.

Designing a Smartphone-Based Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative Analysis of Human-Centered Design Workshops With Health Care Workers.

Pulse oximeters noninvasively measure blood oxygen levels, but these devices have rarely been designed for low-resource settings and are inconsistently available at outpatient clinics. The Phefumla project aims to develop and validate a pediatric smartphone-based pulse oximeter designed specifically for this context. We present the process of human-centered oximeter design with health care workers in South Africa. We purposively sampled 19 health care workers from 5 clinics in Khayelitsha, Cape Town. Using a human-centered design approach, we conducted participatory workshops with four activities with health care workers: (1) they received 3D-printed prototypes of potential oximeter designs to provide feedback; (2) we demonstrated on dolls how they would use the novel oximeter; (3) they used pile sorting to rank design features and suggest additional features they desired; and (4) they designed their preferred user interface using a whiteboard, marker, and magnetized features that could be repositioned. We audio recorded the workshops, photographed outputs, and took detailed field notes. Analysis involved iterative review of these data to describe preferences, identify key design updates, and provide modifications. Participants expressed a positive sentiment toward the idea of a smartphone pulse oximeter and suggested that a pediatric device would address an important gap in outpatient care. Specifically, participants expressed a preference for the prototype that they felt enabled more diversity in the way it could be used. There was a strong tendency to prioritize pragmatic design features, such as robustness, which was largely dictated by health care worker context. They also added features that would allow the oximeter device to serve other clinical functions in addition to oxygen saturation measurement, such as temperature and respiratory rate measurements. Our end user-centered rapid participatory approach led to tangible design changes and prompted design discussions that the team had not previously considered. Overall, health care workers prioritized pragmatism for pediatric pulse oximeter device design.

Field study to determine the reliability of HIV viral load results shows minimal impact of delayed testing in South Africa.

Understanding factors that impact HIV viral load (VL) accuracy in resource-limited settings is key to quality improvement. We evaluated whether testing delay and specimen storage between 25 °C and 30 °C before testing affected results. Between November 2019 and June 2023, 249 individuals on antiretroviral therapy, or with newly diagnosed HIV, were recruited from clinics in Cape Town and Gqeberha, South Africa, and three plasma preparation tubes were collected. One tube was tested within 24 h, while the others were stored uncentrifuged at ambient temperatures before testing. Centrifugation and testing of matched samples were performed on Day 4 and Day 7 after collection. Time delay and ambient storage had minimal impact in specimens with a Day 1 VL of > 100 copies/mL. When grouped by Day 1 VL range, 96% - 100% of specimens at Day 4 and 93% - 100% at Day 7 had VLs within 0.5 log copies/mL of the first result. The greatest variability at Days 4 and 7 was observed when the Day 1 VL was < 100 copies/mL. However, there was no trend of increasing difference over time. Of Day 1 specimens with undetectable VL, or VL < 50 copies/mL, 80% had concordant results at Day 4 and 78% at Day 7. These results show that VL is stable in plasma preparation tubes for 7 days when stored at room temperature. There is significant variability in specimens with low VL, but variability is not affected by testing delay. Ideal HIV VL testing conditions are frequently unachievable in resource-limited settings. Data are needed on whether this impacts on the validity of test results. Our results provide reassurance that storage at ambient temperature for up to 7 days before testing does not substantially affect the VL result.

Waste Work in the Global South: Exploring Activity Theory as a Framework for Understanding Distributed Roles of Intermediaries in Cape Town’s Urban Waste Economy

AbstractWaste work in cities of the Global South is arranged with myriad actors, both formal and informal, who individually and collectively, and to varying capacities, play a distinctive yet interconnected role in the urban waste economy. These roles are interrelated and involve the management, movement and monetisation of recyclable waste. However, given the complexity of infrastructure(s), technology as well as urban socio-spatial stratification within contexts of the Global South, conventional frameworks that seek to explain waste work have limited capacity in delineating the varying role(s) of actors within a community of practice and how these roles are continuously changing through mutual interconnections and adaptation. This article explores Activity Theory as a framework for understanding how the role(s) of actors are continuously negotiated through mediating factors such as (i) technology/infrastructure; (ii) rules and regulations; (iii) community of actors and (iv) the division of labour. This article draws on an ethnographic case of intermediary waste workers within Cape Town’s urban waste economy, and rather than focussing on the role of individual actor(s) as (an) isolated element(s), this article embeds their individual roles in relation to a composite network of actors. The results of this article demonstrate how the role(s) of actors doing waste work are non-linear and are continuously mediated through their relations with technology, infrastructure and their interconnections with other actors. Moreover, this article provides holistic insight into new forms of knowledge production through waste work in the Global South, collaboration among myriad actors and the development of common consciousness toward the transformation and valorisation of waste.

The utility of computed tomography at a district-level public hospital in Cape Town.

Computed tomography (CT) has become an invaluable aid in medical diagnostic workup, and its global usage has been shown to be consistently increasing across all departments. While typically located in regional or central hospitals in South Africa, its recent introduction at the district level has many foreseeable benefits. We evaluated its utility at one of the first district hospitals in the Western Cape to obtain a CT suite. This study aimed to describe the type of CT scans ordered, the clinical indications, the prevalence of significant abnormal findings and the agreement between the clinical opinion and radiological diagnosis. A descriptive cross-sectional study was conducted over a 1-year period at Khayelitsha Hospital, an entry-level hospital just outside of Cape Town. A total of 3242 CT scans were analysed. The mean age of patients was 46 years; 51.4% were males. A mean of 13 scans were performed per working day. The head and neck area were the most scanned region (n= 1841, 52.3%). Predominantly requested by the Emergency Centre (n= 1382, 42.6%), indications were mainly for general medical conditions workup (n= 2151, 66.4%). Most scans showed abnormalities (n= 2710, 83.6%), with 2115 (65.2%) considered relevant ('positive yield'). Clinical and CT diagnoses agreed in 1610 (49.7%) cases. Computed tomography usage at the district level demonstrated positive yield rates comparable to that of tertiary centres. This implies an appropriate utilisation of the service with a potential decrease in the burden on the referral centre.Contribution:Computed tomography scanners at district-level facilities are appropriately utilised and can provide greater access to care while potentially decreasing the burden on referral centres.

The struggle for housing and basic services in South Africa: a case for service delivery protests

ABSTRACT This paper examines how struggles for housing and other basic services such as water and electricity are characterised in South Africa. There has been a shift in categorising local protests from the previously accepted “service delivery protests” to other phrases such as “local political protests” or “local protests” or “community protests.” Drawing from data gathered through in-depth interviews and focus group discussions in Gugulethu and Khayelitsha, two townships in Cape Town, South Africa, I argue that these new concepts conceal the service delivery-related challenges faced by poor communities throughout South Africa. The paper’s focus on housing stems from the fact that a house often functions as a site where several services come together. While protests are nuanced and have varying reasons, they have a large service delivery component. As such, the study of protest in South Africa will benefit from research that spotlights service delivery problems. This also helps to highlight the prevalence of such protests throughout the country.

Gardasil® as adjunctive therapy for respiratory papillomatosis at Red Cross Children’s Hospital, Cape Town

Background: Juvenile onset recurrent respiratory papillomatosis (JoRRP) is an incurable condition caused by human papilloma virus (HPV) types 6 and 11, often requiring repeated surgeries and in severe cases, tracheostomy. This imposes a significant socioeconomic burden on patients and families. Gardasil®, a proven prophylactic HPV vaccine, is emerging as a potential adjuvant therapy. We studied its response on JoRRP patients at our center.Methods: We conducted a retrospective review at Red Cross War Memorial Children’s Hospital from January 2015 to June 2022 on histologically confirmed JoRRP cases. Age at diagnosis, baseline and post-dosing Derkay-Coltrera (DC) scores (disease severity measure), inter-surgical intervals and tracheostomy, were collected.Results: Twenty-five of 30 confirmed cases were included. Average age at diagnosis was 60 months (about 5 years old), with HPV Type 6 in 40% and Type 11 in 48% of patients. All patients received at least one Gardasil® dose, 84% received a second dose and 64% a third dose. Total population DC score decreased from an average of 17 (range: 4-34) pre-first dose to 8 (range: 0-16) after three doses, indicating a 50% reduction. Surgical intervals modestly increased. More significant improvements were seen in patients with aggressive forms of the disease.Conclusion: This is the first study in Southern Africa highlighting Gardasil® as adjuvant therapy. Despite our limited sample size, new cases observed a linear reduction in DC scores and tracheostomy rates.Contribution: This suggests that Gardasil® as adjuvant therapy has the potential to reduce disease severity and extend surgical intervals.

Education about Planetary Health and Sustainable Healthcare in low- and middle-income countries: Planetary Health Report Card assessment of perceptions at University of Cape Town Faculty of Health Sciences

Background. The Planetary Health Report Card (PHRC) was developed by medical students in the USA as a metric-based scorecard and institutional advocacy tool for planetary health (PH), with respect to five categories: Curriculum, Community Engagement, Student Leadership, Research, and Campus Sustainability. The PHRC has expanded into a global initiative, although its use by faculties in low- and middle-income countries (LMICs) has been very limited. Objectives. To assess perceptions at the Faculty of Health Sciences (FHS) of the University of Cape Town (UCT) about PH and sustainable healthcare (SH); and perceptions of the barriers and opportunities for integrating PH and SH into curricula in the UCT FHS. Methods. A PHRC was completed for the UCT FHS by means of interviews with key educators. Interview summaries, and scored report cards (where applicable), were shared for validity checking before compilation of the UCT FHS summary report. Results. Thirty-nine interviews were conducted, 31 of them with key educators representing nine academic departments. Twenty- three graded report cards were completed with those engaged in PH and SH activities. The PHRC category scores ranged from a grade of D minus (20%) for Student Leadership to a C grade for Curriculum (54%), with an overall grade of C minus (42%). Education about PH and SH in the UCT FHS is seen as increasingly important yet insufficient. Curriculum overload, “siloed” learning, and poor understanding among educators were perceived as key barriers. PH and SH were proposed as cross- cutting curricular themes for all health sciences disciplines in the UCT FHS. More community engagement, student leadership development, collaborative research, and campus sustainability interventions were recommended in the other PHRC categories. Conclusion. The PHRC provides a baseline assessment of PH and SH in a faculty of health sciences in a LMIC contributing towards greater environmental accountability. It should be repeated regularly at the UCT FHS to measure and evaluate progress in integrating PH and SH into transformed curricula, engagement with the communities it serves, development of student leadership, in ch, and campus sustainability.

The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study

BackgroundCommunity health workers (CHW) are an integral part of primary health care re-engineering in South Africa. Cape Town is developing community-orientated primary care, with a central role for CHWs. Their role in human immunodeficiency virus, tuberculosis, maternal and child health has been articulated, but is less clear for non-communicable diseases (NCDs). Non-communicable diseases are now a major contributor to the burden of disease. The aim was to explore the current role of CHWs regarding NCDs in the Eastern sub-district of Cape Town, South Africa.MethodsAn exploratory descriptive qualitative study made use of non-participant observation and qualitative interviews with CHWs, their managers, and nurse coordinators. Data from nine semi-structured interviews and ten observations were analysed with the framework method and Atlas-ti.ResultsThe CHWs were embedded in their communities and provided services via support groups, household visits and delivery of medication. They linked people to care with assistance of nurse coordinators. They could also provide physical care in the home. They lacked the ability to counsel people on the risk factors for NCDs and their role in rehabilitation and palliative care was unclear. More nurse coordinators were needed to provide supportive supervision. Inter-sectoral collaboration was weak and hindered CHWs from addressing social issues. More standardised and comprehensive training should equip CHWs for health promotion and disease prevention during household visits. Data collected in the community needed to be analysed, reported on and integrated with data from the primary care facility. This should also contribute to a community diagnosis. Their relationship with facility-based members of the primary health care team needed to be improved. Attention needed to be given to the requirements for and conditions of employment, as well as working hours and remuneration. Some equipment was absent and hindered their services for NCDs.ConclusionsCHWs have the potential to provide a comprehensive approach to NCDs, but community-orientated primary care needs to be strengthened in many of the key areas to support their activities. In relation to NCDs, they need training in basic and brief behaviour change counselling and risk factors as well as in the areas of rehabilitation and palliative care.

Predictive simulation of the water-energy-food nexus for the City of Cape Town

The City of Cape Town (CoCT), South Africa faced a critical situation between 2015 and 2018 in which the municipal water supply was almost completely exhausted. This situation, commonly referred to as Day Zero in South Africa emanated from a decline in rainfall, resulting in one of the most severe droughts in history. The crisis was also aggravated by rapid population growth and urbanization. CoCT was on the verge of becoming the first city in the past decade to experience a complete cessation of water supply for urban and agricultural purposes. In addition to the effects of low rainfall and population surge, urban energy consumption and increased food demand impacted directly the available water resources. To evaluate the interlinkages between water utilization, water production, energy supply and demand, and food production and demand, this study employed a system dynamics modeling (SDM) approach. The model was developed as a stock and flow diagram utilizing Stella Architect and encompassed five interconnected nodes: water, energy, food, land, and population. The findings revealed that by the end of the 20-year modeling period, the volume of accessible and stored water in all the major dams will be approximately 459 million cubic meters, with residential use accounting for about 85 % of urban water use and agriculture accounting for approximately30.37 % of total water demand. The model illustrates the impacts of precipitation rate, runoff, and evaporation on variables such as land-use change and population dynamics. It is anticipated that the outcomes of this study will serve as valuable inputs for decision-making processes, not only within the CoCT as it aims to mitigate or prevent the recurrence of Day Zero, but also for other cities facing similar challenges.