Community In Cape Town Research Articles

Determinants of diarrhoeal disease in children living in low-income households in a periurban community in Cape Town, South Africa

Background. Water, sanitation and hygiene are critically important in reducing morbidity and mortality from childhood diarrhoeal disease and malnutrition in low-income settings.Objectives. To assess the association of diarrhoeal disease with factors relating to domestic hygiene, the environment, sociodemographic status and anthropometry in children <2 years of age.Methods. This was a case-control study conducted in a periurban community 35 km from the centre of Cape Town, South Africa. The study included 100 children with diarrhoeal disease and 100 age-matched controls without diarrhoea, who were recruited at primary healthcare clinics. Sociodemographic status, environmental factors and domestic hygiene were assessed using a structured questionnaire; anthropometry was assessed using the World Health Organization’s child growth standards. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with diarrhoea. Results. The results of the univariate logistic regression showed significant susceptibility to diarrhoea in study cases compared with controls when the caregiver was ≥25 years old (odds ratio (OR) 1.82; 95% confidence interval (CI) 1.02 - 3.23; p=0.042); when children were in day care or cared for by a family member or a relative than when cared for by their mother (OR 1.97; 95% CI 1.06 - 3.65; p=0.032); and when the mothers were employed rather than at home (OR 2.23; 95% CI 1.21 - 4.12; p=0.01). Multivariate logistic regression analysis was used to identify predictors of diarrhoea, which entailed relaxing the inclusion criteria for the univariate analysis variables (p<0.25). The predictors significantly associated with diarrhoea were household problems relating to rat infestation (OR 2.44; 95% CI 1.13 - 5.28; p=0.027); maternal employment (OR 2.47; 95% CI 1.28 - 4.76; p=0.007); and children in day care or cared for by a relative (OR 2.34; 95% CI 1.21 - 4.54; p=0.01). Significantly more of the mothers who were employed than those who were unemployed had children in day care or cared for by a relative.Conclusion. Practices relating to employment, childcare and the domestic environment were significant predictors of diarrhoea. Effective policy implementation on water, sanitation and domestic hygiene could prevent diarrhoeal disease and reduce its impact on children’s growth, especially during the annual diarrhoeal surge season in this and similar periurban communities.

Associations of adverse maternal experiences and diabetes on postnatal maternal depression and child social-emotional outcomes in a South African community cohort.

Previous literature has identified associations between diabetes during pregnancy and postnatal maternal depression. Both maternal conditions are associated with adverse consequences on childhood development. Despite an especially high prevalence of diabetes during pregnancy and maternal postnatal depression in low- and middle-income countries, related research predominates in high-income countries. In a South African cohort with or without diabetes, we investigated associations between adverse maternal experiences with postnatal maternal depression and child social-emotional outcomes. South African mother-child dyads were recruited from the Bishop Lavis community in Cape Town. Participants consisted of 82 mother-child dyads (53 women had GDM or type 2 diabetes). At 14-20 months postpartum, maternal self-report questionnaires were administered to assess household socioeconomic status, food insecurity, maternal depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS)), maternal trauma (Life Events Checklist), and child social-emotional development (Brief Infant Toddler Social Emotional Assessment, Ages and Stages Questionnaires: Social-Emotional, Second Edition). Lower educational attainment, lower household income, food insecurity, living without a partner, and having experienced physical assault were each associated with postnatal maternal depressive symptoms and clinical maternal depression (EPDS ≥ 13). Maternal postnatal depression, lower maternal educational attainment, lower household income, household food insecurity, and living in a single-parent household were each associated with child social-emotional problems. Stratified analyses revealed maternal experiences (education, income, food insecurity, trauma) were associated with postnatal maternal depressive symptoms and child social-emotional problems only among dyads with in utero exposure to diabetes. Women with pre-existing diabetes or gestational diabetes in LMIC settings should be screened for health related social needs to reduce the prevalence of depression and to promote child social-emotional development.

Improving primary care antimicrobial stewardship by implementing a peer audit and feedback intervention in Cape Town community healthcare centres.

The increasing prevalence of antibiotic resistance is a major threat to public health. Primary care, where 80% of antibiotics are consumed, is a pivotal setting to direct antimicrobial stewardship (AMS) efforts. However, the ideal model to improve antibiotic prescribing in primary care in low-resource settings is not known. To implement a multidisciplinary audit and feedback AMS intervention with the aim to improve appropriate antibiotic prescribing at primary care level. The intervention was implemented and monitored in 10 primary care centres of the Cape Town metropole between July 2017 and June 2019. The primary and secondary outcome measures were monthly adherence to a bundle of antibiotic quality process measures and monthly antibiotic consumption, respectively. Multidisciplinary audit and feedback meetings were initiated and integrated into facility clinical meetings. Two Excel tools were utilised to automatically calculate facility audit scores and consumption. Once a month, 10 antibiotic prescriptions were randomly selected for a peer review audit by the team. The prescriptions were audited for adherence to a bundle of seven antibiotic process measures using the standard treatment guidelines (STG) and Essential Medicines List (EML) as standard. Concurrently, primary care pharmacists monitored monthly antibiotic consumption by calculating defined daily doses (DDDs) per 100 prescriptions dispensed. Adherence and consumption feedback were regularly provided to the facilities. Learning collaboratives involving representative multidisciplinary teams were held twice-yearly. Pre-, baseline and post-intervention periods were defined as 6 months before, first 6 months and last 6 months of the study, respectively. The mean overall adherence increased from 19% (baseline) to 47% (post intervention) (p<0.001). Of the 2 077 prescriptions analysed, 33.7% had an antibiotic prescribed inappropriately. No diagnosis had been captured in patient notes, and the antibiotic chosen was not according to the STG and EML in 30.1% and 31.7% of cases, respectively. Seasonal variation was observed in prescribing adherence, with significantly lower adherence in winter and spring months (adjusted odds ratio 0.60). A reduction of 12.9 DDDs between the pre- and post-intervention periods (p=0.0084) was documented, which represented a 19.3% decrease in antibiotic consumption. The study demonstrated that peer reviewed audit and feedback is an effective AMS intervention to improve antibiotic prescribing in primary care in a low-resource setting. The intervention, utilising existing resources and involving multidisciplinary engagement, may be incorporated into existing quality improvement processes at facility level, to ensure sustainable change.

Accelerating progress towards improved mental health and healthy behaviours in adolescents living in adversity: findings from a longitudinal study in South Africa

ABSTRACT Adolescents exposed to high levels of adversity are vulnerable to developing mental health challenges, with long-lasting adverse consequences. Promoting the psychological well-being of adolescents and protecting them from adverse experiences is crucial for their quality of life. There is a need for evidence on which combinations of protective factors can improve the wellbeing of adolescents to inform future programming efforts. We used data from a longitudinal study that took place in Khayelitsha, South Africa, a semi-urban impoverished community in Cape Town. Data were collected from adolescents when they were 12–14 years of age (n = 333) and again at follow-up when they were aged 16–19 years (n = 314). A path analysis was used to estimate associations between access to service, food security, safe environment, family support, and social support and five outcomes related to adolescent mental health and risky behaviours. The fitted model was used to calculate adjusted mean differences comparing different combinations of risk factors. Two protective factors (food security and safe environment) were positively associated with three outcomes relating to mental health and the absence of risky behaviours. Further investigation revealed that the presence of high food security and safer environments was associated with higher adjusted mean scores: +16.2% (p < .0001) in no substance use; +16.5% (p < .0001) in no internalising behaviour, +19.5% (p < .0001) in self-esteem; +12.2% (p < .0001) in positive peer relationships; and +11.4% (p < .0001) in no suicidal ideation. Interventions targeting adolescents, that aim to improve food security together with improving the safety of their environment, are likely to impact their well-being.

Exploring Funding Models in ‘’No-Fee’’ Schools in Cape Town: Evidence from Selected Public Primary Schools.

Purpose: The explicit goal of education funding policy is to raise educational standards by addressing historical financial disparities. This study, explored the funding models in three no-fees public primary schools within the Western Cape Education Department in Cape Town. The specific objective of this study was to explore and discuss the funding models’ initiatives of schools in resources scarce communities in Cape Town.&#x0D; Methodology: A qualitative research model was adopted for the investigation. Semi-structured guided questions were used to obtain the data. Using intentional sampling, which selects individuals based on their backgrounds and expertise, a total of nine people was recruited. Three school principals, three chairs of the governing body, and three administrators of the school's finances made up the group of participants. Due to the COVID-19 pandemic, data were recorded using telephone conversations. The researcher used a thematic data analysis approach to analyse the data after recording and meticulously transcribing the talks. Individual interviews, participant data, and document analysis were all merged by the researcher in order to make the research conclusions credible.&#x0D; Findings: As a result, it was determined whether the information from the case study and the interviews headed in the same direction. Additionally, the researcher gave each participant a chance to confirm that the facts were what they had provided as data. The study indicated that despite receiving 75% of their income from the government, certain no-fee public primary schools still had a high level of resource reliance. A sizeable part of school funding—25%—comes from voluntary donations. The funding attempts, however, have not succeeded in bringing in the money the schools sorely need. Due to government rules, schools feel they have too little money left over and are unable to make significant improvements. The study also showed that fundraising campaigns have an impact on education since they interfere with class time. Additionally, the study demonstrates that learner’s social competition has increased as a result of selling products on campus to raise extra money since learners whose parents cannot afford it do not want to feel afraid or humiliated.&#x0D; Recommendations: Selected schools should raise funds using stronger and more innovative funding initiatives rather than traditional, hands-on approaches. The government should rethink amending schooling policies to legally accord schools to collect fees, since studies show that parents in low-resource communities are removing their children from low-resource schools to well-resource schools. Governments also need to rethink school policy changes to give schools the flexibility to make significant budget changes.

Sexual Risk among Pregnant Women at Risk of HIV Infection in Cape Town, South Africa: What Does Alcohol Have to Do with It?

This study examines baseline associations between alcohol use and HIV sexual risk among a cohort of HIV-uninfected pregnant women (n = 1201) residing in a high HIV burdened community in Cape Town,South Africa. Alcohol use was measured using a modified version of the Alcohol Use Disorder Identification Test (AUDIT). HIV sexual risk was measured through a composite variable of four risk factors: diagnosis with a STI, self-report of > 1 recent sex partners, partner HIV serostatus (unknown or HIV+) and condomless sex at last sex. Any past year alcohol use prior to pregnancy was reported by half of participants (50%); 6.0% reported alcohol use during pregnancy. Alcohol use prior to pregnancy was associated with increased odds of being at high risk of HIV (aOR = 1.33, 95% CI 1.05-1.68, for 2 risks and aOR = 1.47, 95% CI 0.95-2.27 for 3 risks). In addition to reducing alcohol use, several other strategies to address HIV sexual risk were identified. Evidence-based interventions to address alcohol use and other HIV sexual risk behaviors during pregnancy in South Africa are desperately needed. Qualitative work exploring individual and community level drivers of alcohol use among pregnant and breastfeeding women in this setting could support development of a culturally tailored intervention to address these issues in this population.

The Ahmadis of Cape Town and the Spectre of Heresy: Polemics, Apostates and Boycotts

Abstract The principal issue which this paper addresses is the identity and status of the minority Ahmadi community within the larger majoritarian Sunni Muslim community in Cape Town (itself a minority in the country), which was characterised by hostility, violence and exclusion perpetrated against the Ahmadi community. By examining archival material, local Muslim publications and interviews regarding events that transpired during the 1960s, I will argue that the tools of public avowal and socio-economic boycotts were wielded as weapons to buttress the authority of a Sunni clerical leadership as custodians of an orthodox Islamic heritage and a Sunni iteration of Islamic theology and Muslim life against what was considered to be a heretical manifestation in the form of Ahmadiyyat.

DETECTING CHRONIC KIDNEY DISEASE BY LEVERAGING SCREENING INITIATIVES FOR OTHER NON-COMMUNICABLE DISEASES

Objective: Early diagnosis of chronic kidney disease (CKD) slows disease progression and reduces mortality; yet screening for CKD is sparse in clinical practice. Contrary, screening for CKD risk factors like hypertension and type 2 diabetes mellitus (T2DM) are included in clinical practice guidelines in most countries. Therefore, an opportunity exists to implement CKD screening as a by-product of these existing screening programmes. To evaluate the viability of CKD screening, we used the South African Diabetes Prevention Programme (SA-DPP) to assess the yield of CKD cases. Design and method: The SA-DPP was conducted across 16 resource-poor communities in Cape Town, South Africa, between 2017 and 2019. Participants, aged 25–65 years, were recruited by random and self-selected sampling techniques. The African diabetes risk score (ADRS), which is a screening tool comprising non-laboratory-based variables including age, waist circumference and the presence of hypertension, was used to identify adults at high risk for T2DM. Those at high-risk were invited for confirmatory oral glucose tolerance test (OGTT). Kidney function was estimated using the serum creatinine-based CKD Epidemiology Collaboration equation. CKD was defined as an estimated glomerular filtration rate (eGFR) of &lt; 90 ml/min/1.73 m2 and/or albumin-to-creatinine ratio &gt; 3 mg/mmol. Results: Of the 2039 individuals screened in the community, 690 participants deemed at high-risk of T2DM presented at the research clinic for an OGTT. Of these individuals, 9.6% (n = 66) had diabetes and 18.1% (n = 125) had CKD, with 2.2% (n = 15) presenting with both CKD and T2DM. Most CKD cases were in the early stages of the disease, with 73.6% (n = 92), 17.6% (n = 22) and 7.2% (n = 9) presenting with stage 1–3, respectively. Of those with CKD stages 1–3, 72.8%, 68.2% and 44.5% had microalbuminuria, respectively with 27.2%, 31.8% and 11.1% presenting with macroalbuminuria. Most participants with early-stage CKD were overweight/obese (95.1%) and 47.0% had hypertension. Conclusions: By including markers of kidney function into the scope of markers collected in an existing disease screening programme, we were able to detect a great proportion of CKD cases. Therefore, by utilizing an opportunistic approach, people with early-stage CKD can be identified and appropriately treated.

Pharmacist-led medication therapy management of diabetes club patients at a primary healthcare clinic in Cape Town, South Africa: A retrospective and prospective audit

Background. Diabetes mellitus (DM) is a complex chronic condition and remains a public health concern worldwide. In South Africa (SA), many patients with DM access public sector primary healthcare clinics, and those who are considered to be stable are referred to the club system, which is managed by a multidisciplinary team. Patients who have DM are often diagnosed with concurrent medical conditions, resulting in multiple medication therapies that lead to medication therapy problems (MTPs). Prescriber adherence to standard treatment guidelines (STGs) is aimed at improving glycaemic control to minimise complications and decrease healthcare costs. The pharmacist’s role in medication therapy management (MTM) for DM is underutilised in public sector healthcare facilities. Objectives. To evaluate the implementation of a pharmacist-led MTM intervention to optimise the management of stable patients with type 2 DM attending a diabetes club at a Cape Town community day centre. Methods. An evaluation study design using a case study approach was conducted over 8 months from November 2016 to June 2017. A retrospective and prospective audit was conducted from patient folders of stable patients who attended the club. Quantitative data were extracted from the folders. A trained pharmacist audited baseline (pre-intervention) data. Prescribing staff were notified of therapeutic discrepancies through written pharmacist’s pharmacotherapeutic recommendations (intervention). Pharmacist-led interventions audited prescriber adherence to SA STGs and the Essential Medicines List, and prescriber responses to the pharmacist’s recommendations (post-intervention) were recorded as accepted, partially accepted or rejected. Estimated costs were calculated for rational and irrational prescribing of aspirin during the MTM process. Results. Of 104 patient folders audited, most were for females (n=70; 67.3%). A total of 453 MTPs were identified, averaging four interventions per folder reviewed. The most common MTPs identified were the absence of basic clinical data: body mass index not documented (22.5%) in the folder, no medical indication noted (19.2%), and laboratory tests not requested (18.3%) by clinicians. Prescriber acceptance of the pharmacist’s recommendations was found to be low (26.8%), suggestive of clinical inertia. Aspirin was found to be irrationally prescribed to patients with DM (15.4%). Conclusion. Pharmacists can identify, resolve and prevent MTPs and rationalise appropriate medication therapy in patients with DM. Prescriber uptake of pharmacists’ pharmacotherapeutic recommendations seems overlooked. Pharmacist-led workshops to advocate for rational prescribing are needed to mitigate MTPs among stable patients with type 2 DM at public sector healthcare facilities.

Processes of frugal social innovation: Creative approaches in underserved South African communities

AbstractThe article presents three case studies of frugal social innovation developed by groups of citizens from underserved communities of Cape Town, South Africa. The processes are analyzed to highlight how innovation emerged. Three factors were crucial: lack of resources, social transformation goals, and flexibility of the approach to technologies. Their combination allowed for creativity and inclusivity to become the drivers of the processes. The information and communication technology outcomes are innovative in the context and for the participants. More innovative are the processes, which maintained a high level of participation, a collective collaboration and a focus on the social transformative impact of the digital solutions. Furthermore, while much of the literature on frugal and social innovation has a business perspective whereby users are referred to as customers, the cases present community groups as innovators. This approach contributes to the development of a theory, which expands existing ones on frugal and social innovation. The principles derived from the analysis represent the contribution to practice in the ICT4D domain. They show how in a space with limited technical and procedural knowledge, it is possible to reduce the blinders toward innovation and operate in an ecosystem where participation, inclusion, and growth develop.

A Historical Narrative of High School Athletics Amongst ‘Coloured’ Communities in Cape Town, South Africa, with Special Reference to the Western Province Senior Schools Sports Union, 1956-1972

The Western Province Senior School Sports Union had its genesis in smaller organizations that were deeply embedded in the context of the oppressed people of Cape Town. School athletics was a mirror of the social and political landscape of the broader city. Despite many constraints, both materially and in terms of human resources, the organization navigated the difficult socio-political environment, largely through the efforts of dedicated teachers and community based organizations. The final organization that emerged was able to successfully manage events and the administration and development of school athletics in difficult times. Prominent administrators of the organization were identified as well as outstanding athletes and participating schools.

Spiritual and material dimensions of home in J. M.Coetzee’s Age of Iron

The aim of the article is to analyse the living conditions presented in J. M. Coetzee’s novel Age of Iron with reference to differences between the white and black communities of Cape Town in South Africa. It argues that differences in the conditions of living related to social and racial divisions are also reflected in the visions of the afterlife. The protagonist of the novel, Mrs Curren, portrays white people as living in comfort and dying in old age due to natural causes. The moment of their death constitutes a transition from earthly life to spiritual or incorporeal existence. In contrast, black people die young in apartheid fights. The dismal portrayal of the destruction of black people’s housing corresponds to Mrs Curren’s naturalistic descriptions of the dead bodies of young black activists. Their death does not involve a transformation into a spirit that has shed its body; death offers no relief, since their bodies and souls remain in “African hell”.

The Contribution of Divorce to Parental-Self Efficacy and Perception of Parenting among Divorced Parents: A Qualitative Study

ABSTRACT The study explores the contribution that divorce has on parents’ parental self-efficacy. Divorce and self-efficacy of the are areas that have been extensively studied in recent decades. Going through a divorce has an effect on how parents parent their children, which in turn has an effect on the behavioral, emotional, social and academic outcomes of the child. Divorce is considered a significant factor in determining emotional and social problems that children begin to exhibit. However, limited research has been conducted on the relationship between divorce and parental self-efficacy and exploring the perceptions of parenting among divorced parents in South Africa. This study used qualitative interviews to explore the impact of divorce on parental self-efficacy and perceptions of parenting among ten divorced parents from working to middle class community in Cape Town, South Africa. The interviews were analyzed by making use of thematic analysis. Although participants experienced an initial period of elevated emotional distress and feeling overwhelmed at becoming a single parent, their confidence in their parenting increased over time as they began to adjust to their new lives and received adequate and regular support. This was accomplished through various techniques and coping mechanisms employed by the participants, and with their social support structure playing a significant role in contributing to their parental self-efficacy. These results suggest that even though newly divorced parents feel initially overwhelmed and emotionally distressed in the initial stages, if they are given sufficient support and time to stabilize while integrating in to their new lives, their parent self-efficacy increases and they are more confident in their parenting abilities.

Participatory Prototyping of a Tailored Undetectable Equals Untransmittable Message to Increase HIV Testing Among Men in Western Cape, South Africa.

Daily antiretroviral therapy (ART) suppresses viral replication, rendering HIV undetectable through viral load (VL) testing. People living with HIV (PLWH) who have an undetectable VL cannot transmit HIV to sexual partners or through giving birth, a message commonly referred to as U = U (undetectable equals untransmittable). To increase knowledge and understanding of U = U among men, who have poorer HIV testing and treatment outcomes than women, we engaged men from high HIV burden communities in Cape Town in two interactive human-centered design cocreation workshops to develop local U = U messaging for men. Two trained workshop facilitators, explained the U = U message to 39 adult men (in two separate workshops), and asked them how to effectively communicate U = U to other men in the local language (isiXhosa). Participant-designed messages sought to inform men about U = U to help assuage fears of testing HIV positive (by removing the stigma of living with HIV and being a vector of disease), and to explain that ART enables PLWH to live normal healthy lives, making HIV "untransmittable" to sex partners. Participants' messages emphasized that when virally suppressed, "I cannot spread HIV to the other person" and "(the pill) keeps on killing the virus so I can live a normal life for the rest of my life." Men cocreated simple local U = U messages to address fears of testing HIV positive and emphasizing ART's positive effects. Cocreated tailored messaging may reduce stigma associated with living with HIV and improve the uptake of HIV testing and treatment among South African men. This study was registered at clinicaltrials.gov under NCT04364165.

Experiences and Perceived Benefits of a Youth Skateboarding Program in South Africa: From the Physical to Emotional and Beyond

This study aimed to assess the mental health needs and risk behaviors of adolescents attending an afterschool life-skills skateboarding program, to evaluate the perceived benefits of the program, and to identify potential modifications required to meet the identified needs. Program participants were from three gang- and poverty-affected urban communities in Cape Town, South Africa. Seventy-six adolescents aged between 10 and 19 years old (83% male) completed a self-report survey, and 24 adolescents and 19 key influencers participated in in-depth interviews and focus groups. Descriptive analyses were conducted on survey data and a framework approach was used to analyze qualitative data. 72% of the adolescents reported symptoms of moderate to severe anxiety and/or depressive symptoms, 66% had experienced food insecurity, 45% had been physically abused at home, 47% had been bullied, and 59% had used alcohol. Benefits of the program included experiencing a sense of belonging to a skateboarding subculture, protection from gang recruitment and community violence, physical and emotional benefits of exercise, mentors as positive role models, and learning life skills. Recommendations to improve the program were to include information on depression, anxiety, suicidal thoughts and grief, and to include stress management and emotion regulation skills.

‘The Soul of the City’? Sound Performances and Community in Cape Town’s Two Minutes of Silence During the First World War

The origin of Britain’s annual Armistice Silence is often attributed to South Africa. This article considers the context of the Silence’s supposed origin: Cape Town, May – December 1918. Drawing on recent studies on war and sound history, it considers the Silence’s socio-cultural and affective dimensions, examining the collective statements and values embedded in the discourses about it, its urban staging and co-operative performance, and the instability of its meaning. The Silence was popular in Cape Town, with thousands of Capetonians observing the practice. Yet, the diversity of responses to the war in the city meant that those who participated in the Silence were not necessarily representative of the city as a whole. Nevertheless, it serves as an example of the importance of sound to defining and encouraging local and trans-Empire ideas of community and commemoration in the wartime, urban context.

"The Money, It's OK but It's not OK": Patients' and Providers' Perceptions of the Acceptability of Cash Incentives for HIV Treatment Initiation in Cape Town, South Africa.

Incentive-based interventions are used to encourage HIV testing, linkage to HIV care, and antiretroviral therapy (ART) adherence. Studies assessing efficacy of cash incentives have raised questions about the perceived ethicality of and attitudes towards incentives. Here we explore patients' and health providers' perspectives of the acceptability of a conditional cash transfer for ART initiation after receiving a positive HIV test through community-based services in resource-poor communities in Cape Town, South Africa. Drawing on in-depth interviews with patients and health care workers (HCWs), we find that, despite the perception that cash incentives are effective in promoting ART initiation, significant ambivalence surrounds the acceptability of such incentives. The receipt of a financial incentive was highly moralized, and fraught with challenges. Increasing the acceptability of cash incentives through careful design and delivery of interventions is central to the potential of this type of intervention for improving outcomes along the HIV care continuum.

Higher COVID-19 mortality in low-income communities in the City of Cape Town – a descriptive ecological study

Background Cape Town, a South African city with high levels of economic inequality, has gone through two COVID-19 waves. There is evidence globally that low-income communities experience higher levels of morbidity and mortality during the pandemic. Methods Age-standardized COVID-19 mortality in the eight sub-districts of Cape Town was compared by economic indicators taken from the most recent Census (unemployment rate, monthly income). Results The overall Standardized Death Rate (SDR) for COVID-19 in Cape Town was 1 640 per million, but there was wide variation across the different sub-districts. A linear relationship was seen between sub-districts with high poverty and high COVID-19 SDRs. Conclusions Low-income communities in Cape Town experienced higher levels of COVID-19 mortality. As we continue to contend with COVID-19, these communities need to be prioritized for access to quality health care.

Effects of Prenatal Alcohol Exposure on the Volumes of the Lateral and Medial Walls of the Intraparietal Sulcus.

Fetal alcohol spectrum disorders (FASD) continue to be the leading preventable cause of intellectual disability in the U.S., Europe, and in endemic areas, such as the Western Cape region of South Africa. Arithmetic is highly sensitive to prenatal alcohol exposure (PAE). The intraparietal sulcus (IPS) is known to play a critical role in number processing. In this study, we investigate whether smaller IPS volumes play a role in the number-processing deficits observed in children with PAE. Participants were 52 9- to 14-year-old children from a historically disadvantaged community in Cape Town, who are participating in our ongoing studies on the effects of PAE on the brain. The IPS was manually parcellated into its medial (MIPS) and lateral (LIPS) walls on magnetic resonance images. The study aimed to examine: (1) the effects of PAE on IPS regional volumes and asymmetry, (2) whether IPS regional volumes are related to number processing performance and, if so, whether these relations are moderated by PAE and (3) potential mediation by regional IPS volumes of the relation between PAE and number processing performance. Total intracranial volume (TIV) was associated with volumes in all regions except the right LIPS. Both left MIPS and left LIPS volumes were significantly smaller in children in the fetal alcohol syndrome (FAS)/partial FAS (PFAS) group compared to controls. The finding in the left LIPS remained significant after controlling for potential confounders and after adjustment for the smaller overall brain size of the children in the FAS/PFAS group. Smaller left LIPS volumes in the FAS/PFAS group may account for the absence of left-right asymmetry in the LIPS in children with FAS/PFAS compared to controls and nonsyndromal heavily exposed (HE) children. Bilaterally, larger MIPS volumes were associated with better WISC IQ Arithmetic scores. These effects, however, were not moderated by the degree of PAE, and regional IPS volumes did not mediate the effect of PAE on WISC Arithmetic scores. Although we found that certain regions of the IPS were smaller in children with FAS and PFAS, these PAE-induced changes in IPS volume did not mediate the alcohol-related deficits in arithmetic.

Higher COVID-19 mortality in low-income communities in the City of Cape Town - a descriptive ecological study.

Background Cape Town, a South African city with high levels of economic inequality, has gone through two COVID-19 waves. There is evidence globally that low-income communities experience higher levels of morbidity and mortality during the pandemic. Methods Age-standardized COVID-19 mortality in the eight sub-districts of Cape Town was compared by economic indicators taken from the most recent Census (unemployment rate, monthly income). Results The overall Standardized Death Rate (SDR) for COVID-19 in Cape Town was 1 640 per million, but there was wide variation across the different sub-districts. A linear relationship was seen between sub-districts with high poverty and high COVID-19 SDRs. Conclusions Low-income communities in Cape Town experienced higher levels of COVID-19 mortality. As we continue to contend with COVID-19, these communities need to be prioritized for access to quality health care.