Community In Cape Town Research Articles

First 1000 days: first-time mothers’ understanding and experiences of nutritional care

ABSTRACT Within South Africa, approximately 1.5 million children suffer from malnutrition and stunting with dire effects on their early development and thriving potential. Nutritional care within the first 1000 days of children's life plays pivotal role in their holistic development when a stable, safe, nurturing and responsive relationship is provided by their mothers. This study explored first-time mothers’ understanding and experiences of nutrition within the first 1000 days of their child's life. A total of 12 first-time mothers with infants aged 4–21 months living in low-income communities in Cape Town completed semi-structured interviews. A thematic analysis suggested that mothers generally acknowledged nutrition as crucial for the development of young children; however, many were unfamiliar with the phrase ‘first 1000 days’. The findings provide contextual grounding for the gap in knowledge and awareness of the first 1000 days within South African low-income communities.

The nexus between financial literacy and entrepreneurial success among young entrepreneurs from a low-income community in Cape Town: a mixed-method analysis

PurposeThis paper aims to explore the association between financial literacy and entrepreneurial success among young entrepreneurs within an economically disadvantaged community in Cape Town, South Africa.Design/methodology/approachThe mixed-method approach was adopted for the study. In-depth interviews were used in collecting the qualitative data while structured interviews using questionnaires were administered in collecting the quantitative data. The participants for the study were strictly young entrepreneurs.FindingsThe study found that entrepreneurs understood the concept of financial literacy and this was corroborated by their financial literacy average score of 59.03, which is above the national financial literacy average score of 54.00. The study further revealed that a positive association exists between financial literacy and entrepreneurial success. Hence, high levels of financial literacy result in increased business success.Research limitations/implicationsThe sample size of the study was relatively small, for which reason, a mixed-method approach was adopted to strengthen the research findings. The research also considered only one disadvantaged community in South Africa (Khayelitsha).Originality/valueTo the best of the knowledge, the influences of financial literacy on the success of small and medium enterprises (SMEs) among young entrepreneurs have not been well-explored in economically disadvantaged areas within the South African context. As a result, this study sheds light by assessing the level of financial literacy among young entrepreneurs in economically disadvantaged communities and by determining the relationship between financial literacy and entrepreneurial success. The study further provides recommendations on policy-making to ensure that through successful entrepreneurship, developmental challenges such as unemployment can be reduced.

Carriage of colistin-resistant Gram-negative bacteria in children from communities in Cape Town (Tuberculosis child multidrug-resistant preventive therapy trial sub-study).

Colistin is a last-resort antibiotic against multidrug-resistant, Gram-negative bacteria. Colistin resistance has been described in the clinical settings in South Africa. However, information on carriage of these bacteria in communities is limited. This study investigated gastrointestinal carriage of colistin-resistant Escherichia coli and Klebsiella spp. and mcr genes in children from communities in Cape Town. Colistin-resistant E. coli was isolated from two participants (4%, 2/50), and mcr-1-mcr-9 genes were not detected. Gastrointestinal carriage of colistin-resistant Enterobacterales was rare; however, continuous extensive surveillance is necessary to determine the extent of carriage and its contribution to resistance observed in clinical settings.

Barriers to care: The influence of gang violence on heterosexual men’s initiation and adherence within the HIV/TB care cascade

ABSTRACT South Africa is burdened by twin epidemics of HIV and tuberculosis (TB) in which men are less likely than their female counterparts to engage with prevention, treatment and care. In some Cape Flats communities in Cape Town, South Africa, the challenge to men is compounded by high levels of gang violence. This study investigates the role of gang violence as a barrier to men’s entry and retention in the HIV/TB care cascade. Data for this study drew from six weeks of participant observation and eleven in-depth interviews in Hanover Park, a largely Coloured township of Cape Town. Key findings concerned men’s restricted mobility due to gang violence as a result of conflict over gang territory. Men both inside and outside gangs are affected by this violence, with men in gangs, in most cases, being totally cut off from healthcare services. Men in gangs are a key risk population group for both HIV and TB programming. Community-based interventions that address the effects of violence on health services should be designed for the communities on the Cape Flats. Findings could potentially be extrapolated to other settings affected by gang violence, both within South Africa and abroad.

The lasting social value of mega events: experiences from green point community in Cape Town, South Africa

A growing area of mega event research focuses on the long-term social value of outcomes and the impact of their far-reaching benefits. This paper questions whether mega events present opportunities for interventions through an exploration of the social value of the 2010 FIFA World Cup in the community of Green Point, Cape Town. Drawing on Chalip’s (2006) understanding of the liminal social value of events, the main considerations are whether the outcome of feel-good experiences were leveraged to enable community building in the long-term. Following the narrative inquiry approach, stories were collected from community members. The findings suggest community members from Green Point have a mixed perception of the event’s lasting social value. These perceptions were influenced by the participants’ wide-ranging experiences of the event and subsequent outcomes. The findings have a number of implications for future practice, affirming that the issues and challenges related to leveraging social impacts beyond the existence of a mega event can affect people’s perceptions of the social value attached. Looking to future research, this paper calls for investigations that involve repeated exploration of participant experiences over a longer timeframe, suggesting the value of the longitudinal perspective.

“You are not alone”: a qualitative study to explore barriers to ART initiation and implications for a proposed community-based youth treatment club among young adults newly diagnosed with HIV in South Africa

ABSTRACT In South Africa, despite universal antiretroviral therapy (ART) availability, 60% of persons living with HIV (PLWH) ages 15–24 are not on treatment. This qualitative study aimed to identify barriers to ART initiation and the implications for a proposed community-based Youth Treatment Club to improve ART initiation for young PLWH in limited-resource, high HIV-prevalence communities in Cape Town, South Africa. Recruiting participants at community testing sites from 2018 to 2019, we conducted semi-structured interviews, informed by Social Action Theory (SAT), with 20 young adults, ages 18- to 24-years-old, newly diagnosed with HIV, along with 10 healthcare providers. Through systematic qualitative analysis, we found that young PLWH face barriers to treatment initiation in three SAT domains: (1) stigmatizing social norms (social regulation processes); (2) challenges coping with a new diagnosis (self-regulation processes); and (3) anticipated stigma in the clinic environment (contextual factors). Participants shared that a proposed community-based Youth Treatment Club for newly diagnosed youth would be an acceptable strategy to promote ART initiation. They emphasized that it should include supportive peers, trained facilitator support for counseling and education, and a youth-friendly environment.

The Practice of Biblical Lament as a Means Towards Facilitating Authenticity and Psychological Well-Being

Biblical lament provides a vital way of maintaining a healthy relationship with God when one’s life experience does not match up with one’s beliefs. Not to lament in such a situation is to deny authenticity. And, as the psychological theories of authenticity indicate, this leads to a person having reduced self-esteem and a lower sense of personal well-being. In this study, women (and a few men) from a poor community in Cape Town, South Africa, were invited to study some psalms of lament and then to compose their own laments. A validated measure of authenticity (the Authenticity Index) was administered to them before and after the lament exercise, as well as Rosenberg’s Self-Esteem Scale and two measures of personal well-being (the Affect Balance Scale and the Satisfaction with Life Scale). It became apparent that the opportunity to express themselves using the form of biblical lament led to a greater sense of authenticity for participants. Their responses on the other scales also indicated that they found the opportunity to lament led to an enhanced sense of self-esteem and well-being. This suggests that those committed to facilitating psychological healing for those who have suffered trauma will do well to provide space for pain-bearers to lament following the biblical pattern.

The relation between subjective well-being and career aspirations amongst a sample of adolescents in low socioeconomic status communities in Cape Town.

The study aimed to determine the relation between adolescents' subjective well-being and career aspirations. The study further aimed to determine the extent to which social support mediates this relation. The sample comprised 1082 adolescents in Grades 8-11, selected from schools located in low socioeconomic status communities in Cape Town, South Africa. The overall model demonstrated a nonsignificant relation between adolescents' subjective well-being and career aspirations. Across gender, the results indicated a significant relation between subjective well-being and career aspirations for the male group, but not for females. The results further indicate that social support did not mediate the relation between adolescents' subjective well-being and career aspirations for the pooled sample. However, for females, the study found a significant negative relation between social support and aspirations. We recommend targeting interventions at an institutional level, inclusive of challenging gender roles and providing information about educational and career opportunities for young people.

Key ingredients for a collaborative urban regeneration strategy in the Global South

The paper documents the development of a collaborative regeneration strategy for a marginalised community in Cape Town that was led by a Non-Profit Company (NPC). NPC’s vision for the strategy was to incorporate key inputs from the community to unlock the economic potential of the area and promote upliftment. A case study methodology was adopted which included a series of interviews and community engagement workshops. The research aimed to identify the key ingredients required to drive collaborative urban regeneration in marginalised communities in the global south. The study established that in the absence of effective leadership and service delivery from local authorities the community feel disenfranchised as their community is not seen as an immediate priority. There was a deep-rooted mistrust in the process being driven by the NPC and the visioning process was met with resistance and suspicion. The engagement process lacked depth/scope and reflected a top-down approach. It is concluded that fundamental ingredients for effective collaborative urban regeneration is trust between the key stakeholders, a diverse assortment of expertise and skills, and an in-depth engagement process. Without these factors urban regeneration is likely to only entrench the complex urban issues it seeks to reconcile.

Youngsta’s debut album offers a no-holds-barred account of life for marginalized communities in Cape Town

Youngsta’s debut album offers a no-holds-barred account of life for marginalized communities in Cape Town

Preferences for long-acting Pre-Exposure Prophylaxis (PrEP) for HIV prevention among South African youth: results of a discrete choice experiment.

IntroductionExisting biomedical HIV prevention options, though highly effective, present substantial adherence challenges. End‐user input on early‐stage design of new HIV prevention approaches is critical to yielding products that achieve high uptake and adherence. The iPrevent Study examined youths’ preferences for key attributes of long‐acting Pre‐Exposure Prophylaxis (PrEP), with a focus on characteristics pertinent to product delivery alongside key modifiable product attributes.MethodsA discrete choice experiment was conducted with female and male youth aged 18 to 24 in two high‐density communities in Cape Town, South Africa during the period July 2017 to January 2019. Sexually active, PrEP‐naïve youth were recruited using population‐based sampling; targeted sampling was used to enrol men who have sex with men (MSM). In a series of nine questions, participants were asked to choose between two hypothetical products composed of five attributes (form, dosing frequency, access, pain, insertion site). We used a random‐parameters logit model to estimate preference weights and trade‐offs among product alternatives. We examined differences across three subgroups: females, men who have sex with only women (MSW) and MSM.ResultsA total of 807 participants (401 female) were enrolled with a median age of 21 years. Males included 190 MSM. Most youth had tested for HIV (95%) and reported being HIV‐negative (91%). Across all groups, duration of effectiveness was the most important attribute, with strong preference for less frequent dosing. Injections were favoured over implants, though these preferences were strongest for females and MSM. Females preferred a product offered at a health clinic and disliked pharmacy access; all groups preferred the arm as the insertion site. Youth were willing to trade their preferred product form for longer duration.ConclusionsYouth indicated strong preferences for longer duration products. Each attribute nonetheless influenced preferences, offering insight into trade‐offs that inform long‐acting PrEP development.

Findings from Community-Based Screenings for Type 2 Diabetes Mellitus in at Risk Communities in Cape Town, South Africa: A Pilot Study

Completed and ongoing implementation activities globally advocate for community-based approaches to improve strategies for type 2 diabetes prevention. However, little is known about such strategies in the African region where there are higher relative increases in diabetes prevalence. We reported findings from the first 8-month pilot phase of the South African diabetes prevention program. The study was conducted across eight townships (four black and four mixed-ancestry communities) in Cape Town, South Africa, between August 2017 and March 2018. Participants were recruited using both random and self-selected sampling techniques because the former approach proved to be ineffective; <10% of randomly selected individuals consented to participate. Non-laboratory-based diabetes risk screening, using the African diabetes risk score, and based on targeted population specific cut-offs, identified potentially high-risk adults in the community. This was followed by an oral glucose tolerance test (OGTT) to confirm prevalent pre-diabetes. Among the 853 adults without prior diabetes who were screened in the community, 354 (43.4%) were classified as high risk, and 316 presented for further screening. On OGTT, 13.1% had dysglycemia, including 10% with screen-detected diabetes and 67.9% with glycated haemoglobin (HbA1c)-defined high risk. Participants with pre-diabetes (n = 208) had high levels of common cardiovascular risk factors, i.e., obesity (73.7%), elevated total cholesterol (51.9%), and hypertension (29.4%). Self-referral is likely an efficient method for selecting participants for community-based diabetes risk screening in Africa. Post-screening management of individuals with pre-diabetes must include attention to co-morbid cardiovascular risk factors.

TB transmission is associated with prolonged stay in a low socio-economic, high burdened TB and HIV community in Cape Town, South Africa

BackgroundWhile several studies have assessed the associations between biological factors and tuberculosis (TB) transmission, our understanding of the associations between TB transmission and social and economic factors remains incomplete. We aimed to explore associations between community TB transmission and socio-economic factors within a high TB-HIV burdened setting.MethodsWe conducted a cross-sectional molecular epidemiology study among adult patients attending a routine TB clinic. Demographic and clinical data were extracted from TB registers and clinical folders; social and economic data were collected using interviewer-administered questionnaires; Mycobacterium tuberculosis isolates were genotyped and classified as clustered/non-clustered using IS6110-based Restriction Fragment Length Polymorphism. Composite “social” and “economic” scores were generated from social and economic data. Data were analyzed using StataCorp version 15.0 software. Stratified, bivariable analyses were performed using chi-squared. Wilcoxon signed rank tests; univariable and multivariable logistic regression models were developed to explore associations in the social, economic, traditional and composite TB risk factors with TB transmission.ResultsOf the 505 patient Mtb strains, 348(69%) cases were classified as clustered and 157(31%) were non-clustered. Clustered cases were more likely to have lived longer in the study community, (odds ratio [OR] = 1.05, 95% Confidence interval [C.I]:1.02–1.09, p = 0.006); in the same house (OR = 1.04, C.I: 0.99–1.08, p = 0.06); and had increased household crowding conditions (i.e fewer rooms used for sleeping, OR = 0.45, C.I:0.21–0.95, p = 0.04). Although a higher proportion of clustered cases had a low economic score, no statistically significant association was found between clustering and either the economic score (p = 0.13) or social score (p = 0.26).ConclusionsWe report a novel association between Mtb transmission and prolonged stay within a high burdened community. Transmission was also associated with fewer rooms for sleeping in a household. Increased social interaction and prolonged residence in a high burdened community are important factors linked to Mtb transmission, possibly due to increased probability of higher effective contact rates. The possible importance of degrees of poverty within low socio-economic setting warrants further study.

Development of a Tool to Increase Physical Activity among People at Risk for Diabetes in Low-Resourced Communities in Cape Town.

Targeted lifestyle interventions, including physical activity (PA), have been proven to prevent or delay the onset of diabetes. South Africa’s unique context, complex environment and varied cultures and ethnicities require tailored interventions. Our objective was to develop a context-appropriate tool for the South African Diabetes Prevention Programme’s PA lifestyle component in order to enable people at risk of developing diabetes to adopt PA. We used mixed methods to inform the development of the tool. Descriptive analyses of baseline survey data included socio-demographics, anthropometrics, blood pressure and biochemical measurements, reported medical history, PA behaviours, and built environment information. Focus group discussions assisted in understanding perceived challenges, barriers and facilitators/opportunities to PA. A literature search on successful South African PA interventions was done, and PA experts in Cape Town were consulted. Quantitative data were analysed using the software R, version 3.4.4 and qualitative data were thematically analysed. Participants (n = 316) recruited were mostly black (54.4%) and of mixed-ancestry (44.6%); they were mainly female (80.1%), obese (75.2%), and had an haemoglobin A1c (HbA1c) above 5.7% (65.5%), with 30% having hypertension and 87% (self-reported) meeting the World Health Organisation (WHO) PA recommendation. Main barriers to PA practice were safety, cost and accessibility of sports facilities, and laziness. We included practising moderate-intensity aerobic and resistance exercises and take-home self-help materials as recommended. By combining results, we produced a targeted, practical and promotional PA booklet.

Validity of automated FreeSurfer segmentation compared to manual tracing in detecting prenatal alcohol exposure-related subcortical and corpus callosal alterations in 9- to 11-year-old children

In recent years a number of semi-automated and automated segmentation tools and brain atlases have been developed to facilitate morphometric analyses of large MRI datasets. These tools are much faster than manual tracing and demonstrate excellent test–retest reliabilities. Reliabilities of automated segmentations relative to “gold standard” manual tracings have, however, been shown to vary by brain region and in different cohorts. It remains uncertain to what extent smaller brain volumes and potential changes in grey/white matter contrasts in paediatric brains impact on the performance of automated methods, and how pathology may influence performance. This study examined whether using data from automated FreeSurfer segmentation would alter our ability, compared to manual segmentation, to detect prenatal alcohol exposure (PAE)-related volume changes in subcortical regions and the corpus callosum (CC) in pre-adolescent children. High-resolution T1-weighted images were acquired, using a sequence optimized for morphometric neuroanatomical analysis, on a Siemens 3T Allegra MRI scanner in 71 right-handed, 9- to 11-year-old children (27 fetal alcohol syndrome (FAS) and partial FAS (PFAS), 25 non-syndromal heavily exposed (HE) and 19 non-exposed controls) from a high-risk community in Cape Town, South Africa. Data from timeline follow-back interviews administered to the mothers prospectively during pregnancy were used to quantify the amount of alcohol (in ounces absolute alcohol per day, AA/day) that the children had been exposed to prenatally. Volumes of corpus callosum (CC) and bilateral caudate nuclei, hippocampi and nucleus accumbens (NA) were obtained by manual tracing and automated segmentation using both FreeSurfer versions 5.1 and 6.0. Reliability across methods was assessed using intraclass correlation (ICC) estimates for consistency and absolute agreement, and Cronbach’s α. Ability to detect regions showing PAE effects was assessed separately for each segmentation method using ANOVA and linear regression of regional volumes with AA/day. Our results support findings from other studies showing excellent reliability across methods for easy-to-segment structures, such as the CC and caudate nucleus. Volumes from FreeSurfer 6.0 were smaller than those from version 5.1 in all regions except the right caudate, for which they were similar, and right hippocampus and CC, for which they were larger. Despite poor absolute agreement between methods in the NA and hippocampus, all three segmentation methods detected dose-dependent volume reductions in regions for which reliabilities on ICC consistency across methods reached at least 0.70, namely the CC, and bilateral caudate nuclei and hippocampi. PAE-related changes in the NA for which ICC consistency did not reach this minimum were inconsistent across methods and should be interpreted with caution. This is the first study to demonstrate in a pre-adolescent cohort the ability of automated segmentation with FreeSurfer to detect regional volume changes associated with pathology similar to those found using manual tracing.

Adapting the Diabetes Prevention Program for low and middle-income countries: protocol for a cluster randomised trial to evaluate ‘Lifestyle Africa’

IntroductionLow and middle-income countries like South Africa are experiencing major increases in burden of non-communicable diseases such as diabetes and cardiovascular conditions. However, evidence-based interventions to address behavioural factors related...

Socio-economic determinants and environmental hygiene factors of female caregiver burden in two selected low-income communities in Cape Town, South Africa.

IntroductionStudies on female caregiver burden and its determinants in relation to physical environment and social support in low-income and middle-income countries are limited. This study evaluates the relationship between caregiving physical environment, social support and well-being of female caregivers and care recipients in Cape Town, South Africa.MethodsOne hundred (100) each of black African and coloured female caregivers from two different population settlements were randomly selected. Structured questionnaire was employed to gather information from caregivers. Description and correlation analyses were used to examine the association between health status of care recipients, environmental hygiene factors and female caregiver burden.ResultsAbout 49.5% of the female caregivers were between 50-59 years and worked full-time (≥40 hours per week). Better hygiene environment and working conditions are major determinants of caregiver burden and care recipient's physical health. Better hygiene conditions in the kitchen and toilet significantly increased care recipients' and caregivers’ physical health (P<0.05). Diarrhoea was found to be significantly associated with poorer environmental hygiene. Over 50% of the reported diarrhoea cases were among care recipients with poorer kitchen and toilet hygiene. Bad environmental hygiene increased the risk of diarrhoea among care recipients and caregivers. Physical health of the care recipients and social grants influenced the burden on the female caregiver.ConclusionIncrease social grants and attention to environmental conditions of caregiving will improve the physical health and living standard of the care recipients and caregivers.

Benefits of Activity-Based Interventions Among Female Adolescents Who Are Overweight and Obese.

The purpose of this study was to compare the effects of 2 activity-based motor interventions among female adolescents who are overweight and obese. This study was conducted in a low-income community of Cape Town, South Africa. The study involved 52 participants classified as overweight and obese. Participants were randomly assigned to task-oriented functional training or Wii Fit intervention. Both interventions were 45 minutes of active training once a week for 14 weeks. Outcome measures included aerobic fitness, motor coordination, and self-efficacy. Data were collected before and after the interventions. Participants in both groups demonstrated significant improvement in aerobic fitness and motor coordination but not self-efficacy. However, no between-group differences were observed on any of the outcomes. Activity-based interventions may improve aerobic fitness and motor coordination in female adolescents who are overweight and obese and may also help prevent declines in physical fitness and coordination in this population.

Early childhood socio-emotional development indicators: Pre-school teachers’ perceptions

This study explored pre-school teachers’ classroom experiences of socio-emotional development in early childhood. Participants were twelve coloured/mixed race pre-school teachers from low-income communities in Cape Town, South Africa. The teachers completed semi-structured interviews focusing on their classroom experiences of socio-emotional development in early childhood. This included teachers’ influence on socio-emotional development, activities to foster socio-emotional development, and challenges related to learners’ socio-emotional development. A thematic analysis of the data suggests teachers perceived that boys displayed more emotional immaturity and poorer peer relations than girls. Learners also had poor adherence to following instructions. The teachers reported that they engaged in reinforcing prosocial behaviour and routinised behaviour for a positive classroom environment.

Disability, cash transfers and family practices in South Africa

Relative to other low and middle-income countries, South Africa provides a generous set of cash transfers (social grants) targeted at people with disabilities. This article explores the influence of disability-related grants on family practices and configurations, care arrangements and household composition in the Western Province of South Africa. The article draws on the findings of two studies: 1) an ethnographic study of disability grant recipients and applicants in a low-income Cape Town community and; 2) a study of interactions between healthcare staff, disability grant applicants and their families. Findings show that disability grant income is shared within households and the contribution of a stable income provides opportunities for people with disabilities to exercise agency, be seen as valuable household members and secure care and support from other household members. However, conflicts may arise over how income is shared and may lead to the extortion, abuse and neglect of people with disabilities, particularly in cases of severe disablement. Given the lack of adequate social provisioning for those who are able-bodied and unemployed, disability also becomes highly valued in households and the potential suspension or cancellation of a grant can interfere with adherence to treatment. The study emphasises the influence of policy structures and economic conditions on household dynamics and care outcomes and contributes to the sparse international evidence-base on the role that disability welfare benefits play in household dynamics and care outcomes.