Greater Cape Town Research Articles

Does ‘Shaken baby syndrome’ occur in South Africa? A review of emergency room and inquest records in Cape Town

ABSTRACT Abusive head trauma (AHT, formerly known as Shaken Baby Syndrome) is a serious form of maltreatment of young children. It appears to be virtually absent in South Africa, which is puzzling in a country where maltreatment rates are several times higher than the global average. Children under age 3 are most vulnerable to injury or death from shaking. We examined two sources of data to establish whether AHT occurs in South Africa and what the incidence rate is: records of injuries of children under age 3 from a tertiary hospital trauma unit (the ChildSafe database 1996–2015), and autopsy records of deaths of children under age 3 from three Magistrates’ Courts in greater Cape Town, South Africa (2006–2016). Of the 52,165 injuries in this age-group in the ChildSafe database, there were only three accounts of shaking, of which only one caused injury. However, the structure of the database made it impossible to identify clusters of injuries that may have resulted from AHT, nor were doctors constrained to indicate whether shaking had occurred. There were no reports of shaking in autopsy findings, although several cases had indications that shaking may have occurred. It therefore remains unclear as to whether AHT is occurring in South Africa. In order to detect shaking in future, we recommend that: (1) the form which doctors in trauma units are required to complete explicitly enquires about this; (2) doctors performing autopsies are provided with a standard protocol that requires them to investigate the possibility of AHT; (3) a prospective study of infants and caregivers be conducted, to establish the incidence of shaking and whether it causes injury.

Predicting Posttraumatic Stress Disorder Caseness Using the PTSD Checklist for DSM‐5 Among Patients Receiving Care for HIV

This study assessed the ability of the Posttraumatic Stress Disorder (PTSD) Checklist for the DSM-5 (PCL-5) to distinguish between caseness and noncaseness for PTSD among South Africans receiving care for HIV. The PCL-5 and the Structured Clinical Interview for DSM-5-Research Version (SCID-RV) module for PTSD were administered to 688 patients receiving antiretroviral therapy (ART) at two HIV care clinics in the greater Cape Town (South Africa) area. In total, nearly half of the sample (n = 324, 47.1%) reported experiencing an index traumatic event, and 101 participants (14.74%, 95% CI [12.17%, 17.62%]) met the diagnostic criteria for PTSD as measured using the SCID-RV. An ROC curve analysis suggested that a PCL-5 cutoff score of 32 yielded optimal sensitivity (0.88) and specificity (0.88), indicating that the measure was successful in determining caseness for PTSD 88% of the time and noncaseness 88% of the time. The AUC was 94.3%, 95% CI [92.6% to 96.1%], indicating high accuracy. The positive predictive value and negative predictive values were 56.3% and 97.7%, respectively, which suggests that the PCL-5 is an effective screening instrument to determine the presence of PTSD among South African ART users. Undetected and, thus, untreated PTSD may reduce quality of life, impede optimal adherence to ART, and increase the likelihood of risk behaviors among individuals living with HIV, contributing to further infections. The PCL-5 may be used for detection, referral, and treatment of PTSD as a way to enhance its management among individuals receiving HIV care.

Validation of simple dichotomous self-report on prenatal alcohol and other drug use in women attending midwife obstetric units in the Cape Metropole, South Africa

Background This paper examines the degree of agreement among simple dichotomous self-report, validated screening results, and biochemical screening results of prenatal alcohol and other drug use among pregnant women. Method Secondary analysis was conducted on a cohort of pregnant women 16 years or older, presenting for prenatal care in the greater Cape Town, South Africa. Dichotomous verbal screening is a standard of care, and pregnant patients reporting alcohol and other drug use in dichotomous verbal screenings were asked to engage in screening using the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) and urinalysis. Results Significant agreements between dichotomous and ASSIST scores were observed (K = 0.73–0.76). A higher rate of self-reported (36.9%) alcohol use was detected, relative to urine screening (19.6%) with a predictive value of 34.9; while underreporting of illicit substance use was observed (3.6% self-report vs. 8.8% urine screening) with an overall predictive value of 50.0. Conclusion Dichotomous verbal screening was considered valid after comparison with the ASSIST; however, combined use with urine screenings can be recommended especially for identifying illicit substance use in order to accurately detect alcohol and other drug use in pregnancy, so that women can be identified and referred for appropriate interventions where needed.

Parental misperceptions of in‐group norms for child discipline

AbstractThe influence of perceived social norms on behaviour has been studied in a variety of domains. However, little research has examined their application to child discipline. This study explored social norms perceptions and their associations with parental discipline in greater Cape Town, South Africa. A cross‐sectional study of 195 mothers (using convenience sampling) from two Early Childhood Development centres examined self‐reported violent and non‐violent parenting behaviour, and perceived descriptive (usual behaviour in a group) and injunctive (appraisal of such behaviour) group norms. Parents overestimated the prevalence of violent parenting. Perceived descriptive norms of violent parenting were associated with self‐reported violent parenting behaviour; and perceived descriptive norms of non‐violent parenting were associated with self‐reported non‐violent parenting behaviour. Estimation of support for violent and for non‐violent parenting differed by centre, as did the relationship between perceived injunctive norms of non‐violent parenting and self‐reported non‐violent parenting behaviour. We also found significant effects of social identification, parent educational attainment and parent‐reported child misbehaviour. Parents' perceptions of group norms of parental discipline may be mistaken yet influence their own behaviour, providing the potential basis for violence prevention interventions.

Predictors of Alcohol Use during Pregnancy among Women Attending Midwife Obstetric Units in the Cape Metropole, South Africa

ABSTRACTIntroduction: Little is known about the nature and extent of substance use among pregnant women in Cape Town (South Africa) despite the very high levels of substance use and related consequences such as FASD in this part of the country. The aim of the study was to determine predictors of alcohol use among pregnant women. Methods: A cross-sectional survey was conducted among pregnant women attending 11 Midwife Obstetric Units (MOUs) in greater Cape Town. A two-stage cluster survey design was used. In total, 5231 pregnant women were screened to assess self-reported prevalence estimates. Of these, 684 (13.1%) were intentionally sub-sampled and completed an interviewer-administered questionnaire and provided a urine sample for biological screening. Univariate and multivariate statistical procedures were used to determine factors predictive of alcohol use. Results: Findings highlight various demographic, social and partner substance use predictors for both self-reported and biologically verified alcohol use in two different models. Being Coloured, having a marital status other than being married, experiencing violence or aggression in the past 12 months compared to more than 12 months ago, having a partner who drinks, and partner drug use are all independently associated with higher odds of self-reported alcohol use. In contrast, only partner tobacco use is independently associated with higher odds of biologically verified alcohol use. Conclusion: Knowing the risk factors for alcohol use in pregnancy is important so that intervention efforts can accurately target those women in need of services. Intervention programs addressing risk factors of high-risk pregnant women are needed.

Toxin A-negative toxin B-positive ribotype 017 Clostridium difficile is the dominant strain type in patients with diarrhoea attending tuberculosis hospitals in Cape Town, South Africa.

The molecular epidemiology of C. difficile strains causing disease in South Africa is currently unknown. Previously, multidrug resistant ribotype (RT)017 strains were those most commonly isolated from patients with diarrhoea attending Groote Schuur Hospital in Cape Town, South Africa. This larger study aimed to investigate the molecular epidemiology and antibiotic susceptibility profiles of C. difficile strains in the greater Cape Town and regional areas. C. difficile strains were isolated from patients with diarrhoea attending hospitals in the Western Cape region of South Africa that tested positive using the GeneXpert CDiff diagnostic test. Ribotyping and multilocus variable-number tandem-repeat analysis (MLVA) were used to type isolates, and their susceptibilities to several antibiotics were determined by gradient diffusion test strips. A total of 269 non-repeat C. difficile isolates were obtained. A large proportion of isolates (64.3%) belonged to the RT017 group, many of which were clonally related when investigated by MLVA. RT017 strains were particularly prevalent in patients attending specialist tuberculosis (TB) hospitals. The majority of RT017 isolates were co-resistant to moxifloxacin and rifampicin, two antibiotics which are used intensively during anti-TB therapy. Non-RT017 strains were generally susceptible to both antibiotics. Resistance to erythromycin was observed for both groups of strains. RT017 C. difficile strains are the most commonly isolated strains from patients attending healthcare facilities in the greater Cape Town and regional areas. The presence of multidrug resistant RT017 strains in patients with diarrhoea attending local TB hospitals reflects a potential reservoir for future infections.

Identity construction through phonetic crossing among young Capetonian gang members

Uncountable gangs operate in post-Apartheid South Africa, particularly in greater Cape Town, competing over turf and controlling the drug trade. Consequently, gang violence is rife in Western Cape and especially widespread in urban areas. In this paper young Capetonians’ narratives of gang violence are analyzed. In the narratives of attacks on Black or White South Africans by Coloured gang members, the Coloured narrators make use of their victims’ varieties of English, more precisely, of phonetic features. Hence, the aggressors do language crossing towards their targets when narrating their feats. Rampton (1995a:485) considers language crossing a ‘code alternation by people who are not accepted members of the group associated with the second language that they are using (code switching into varieties that are not generally thought to belong to them)’. This switching involves a transgression of social or ethnic boundaries that allows the young gangsters to construct, negotiate, uphold and manage their social identities, as language still functions as an utterly important identity marker in post-Apartheid South Africa.

Recent Trends of the Kelp Gull (Larus dominicanus) in South Africa

Abstract. South Africa's population of Kelp Gulls (Larus dominicanus vetula) numbered about 10,000 pairs during 1976/1977–1980/1981, increased to 21,000 pairs from 2000/2001–2004/2005 and then decreased to 17,500 pairs from 2009/2010–2013/2014. The increase in the late 20th century and the decrease in the early 21st century were mainly attributable to large increases and decreases in numbers breeding at islands off the west coast of South Africa. The increases followed cessation of controls on Kelp Gulls at the islands in the 1970s and were associated with supplementary food provided by fisheries and landfill sites, whereas the decreases were influenced by substantial predation of chicks by Great White Pelicans (Pelecanus onocrotalus). The decreases of Kelp Gulls at islands off the west coast of South Africa in the early 21st century were offset to some extent by an increase in numbers breeding on mainland sites, especially around greater Cape Town and along the south coast. The proportion of Kelp Gulls b...

The Post-humanist Gaze: Reading Fanie Jason's Photo Essay on Carting Lives

SummaryThis article proposes a post-humanist reading of Fanie Jason's photo essay on carthorses in Greater Cape Town. When social realist photography includes non-human animals, they tend to be relegated to the margins of representation: sentimentalised, sensationalised, denigrated or ignored, both metaphorically and literally, they all but disappear. Jason's photographs, however, pose provocative questions about the carthorse body and its intersomatic connections with the human body. The horses demand attention, often looking back at the camera lens and the viewer. Conventional anthropocentric theories of photography offer nothing to a methodology which seeks to engage with the visual non-human animal, but theories of animals in art and in film contribute valuably to such a methodology. A post-humanist gaze not only subverts the human and non-human as necessarily inimical realms, but analyses how the photographs themselves extend the purview of social realist images. Post-humanism – in its denial of the exceptionalism of the human subject in relation to the non-human animal and in its discounting of the humanist preoccupation with consciousness, language and individual agency – theorises human-non-human animal relations in new ways. Thus, a post-humanist reading of Jason's photographs considers the embodied commonalities of human and horse. It eschews a humanist celebration of agency on which the notion of subjectivity is predicated, preferring instead to regard agency as relational and exterior – as Jonathan Burt suggests in his discussion of the “visual animal” (2002: 31).

Alcohol and Other Drug Use during Pregnancy among Women Attending Midwife Obstetric Units in the Cape Metropole, South Africa

Little is known about the nature and extent of alcohol and other drug (AOD) use among pregnant women in Cape Town, South Africa, despite the very high levels of AOD use in this part of the country. A cross-sectional survey was conducted among pregnant women attending 11 Midwife Obstetric Units (MOUs) in greater Cape Town. A two-stage cluster survey design was used. In total, 5231 pregnant women were screened to assess self-reported prevalence estimates. Of these, 684 (13.1%) were intentionally subsampled and completed an interviewer-administered questionnaire and provided a urine sample for biological screening. Urinalyses showed that 8.8% (95% CI: 6.7–10.9) of the subsample tested positive for at least one illicit drug. This is higher than the self-reported prevalence (3.6%). In addition, 19.6% (95% CI: 16.3–22.8) of the sub-sample tested positive for alcohol which is lower than the self-reported prevalence (36.9%). There are high levels of substance use among pregnant women attending public sector antenatal clinics. There is a need for routine screening for AOD use and appropriate responses depending on the women's level of risk.

The clinical evaluation of the expressive syntax of bilingual English preN.schoolers in the greater Cape Town area: suggested modificat:;ons to the 1981 LARSP profile

Introduction. The NEPI-report (1992:13) states that the national tendency of parents is to choose English as the medium of school instruction for their children. This tendency is very much present in the greater suburban area of Cape Town^'^ and particulary in the Cape Flats and District Six (McCormick 1989:149). In preparing their children for school, the parents in the Area usually try to raise their children in English from birth^. In some cases the parents are not mother tongue speakers of English, but of the local variety of Afrikaans. This results in second language English input being given to the children at home. According to McCormick (1993:66), the scenario of children acquiring English second language as their first language is thus not uncommon in the Area. The reader is referred to Appendix 1 for a brief discussion of the grammatical characteristics of the English spoken in the Area.

Apartheid and the Erosion or Preservation of Medicinal Plant Knowledge

Aston Philander et al. (2011) present data from a fascinating, important and carefully researched study of local plant knowledge in greater Cape Town, illustrating variation in knowledge of medicinal plants, a correlation between levels of knowledge and length of urban residence, and evidence for the continued transmission of knowledge among recent Xhosa-speaking rural–urban migrants. From this, they draw the questionable conclusion that these patterns can be attributed to apartheid. The authors take apartheid on the terms of its designers, as a policy of ethnic separation, while ignoring the consequences of the massive forced displacement which was used to put this policy into effect. Nationwide, under the Group Areas Act of 1950, which created segregated residential zones, more than 3.5 million people were forcibly displaced between 1962 and 1980 (Hallett 1984: 316), transforming many rural landscapes into denuded and densely populated slums (e.g., Murray 1992). South Africa and its “homelands” also forcibly moved nearly three million Africans under villagization and soil conservation programs (de Wet 1995: 28) which were not applied to whites. Before turning to Cape Town, prima facie evidence compels skepticism that apartheid could lead to the preservation of medicinal plant knowledge, given the known effects of resettlement on social capital and (dis)continuity in cultural transmission and natural resource use (e.g., Cernea 1997, Ross 2002). The geography of apartheid-era displacement further suggests that forced resettlement likely destroyed, rather than sustained, environmental knowledge. In greater Cape Town, 150,000 people classified as Coloured were “evicted from their natal homes and communities in the Cape Peninsula between 1957 and 1985 under the Group Areas Act.” In particular, communities living in what became the whites-only southern suburbs, closest to the natural areas of Table Mountain and amongst the farms of Constantia and nearby areas, were displaced into the newly-created Cape Flats townships (Besteman 2008). Conversely, the region least affected by forced displacement was the predominantly Xhosa-speaking “Transkei” region of what is now the Eastern Cape province, which remained free of large-scale white settlement and largely free of internal removals. Substantial migration of Xhosa-speakers to Cape Town (in particular to the Cape Flats townships, where those classified as African were not allowed to live during apartheid) is largely a voluntary, post-apartheid phenomenon, precipitated by the end of influx control (the infamous “pass laws”) in 1986 (Bekker 2002: 24), and is “dominated by people from

Age-disparity, sexual connectedness and HIV infection in disadvantaged communities around Cape Town, South Africa: a study protocol

BackgroundCrucial connections between sexual network structure and the distribution of HIV remain inadequately understood, especially in regard to the role of concurrency and age disparity in relationships, and how these network characteristics correlate with each other and other risk factors. Social desirability bias and inaccurate recall are obstacles to obtaining valid, detailed information about sexual behaviour and relationship histories. Therefore, this study aims to use novel research methods in order to determine whether HIV status is associated with age-disparity and sexual connectedness as well as establish the primary behavioural and socio-demographic predictors of the egocentric and community sexual network structures.Method/DesignWe will conduct a cross-sectional survey that uses a questionnaire exploring one-year sexual histories, with a focus on timing and age disparity of relationships, as well as other risk factors such as unprotected intercourse and the use of alcohol and recreational drugs. The questionnaire will be administered in a safe and confidential mobile interview space, using audio computer-assisted self-interview (ACASI) technology on touch screen computers. The ACASI features a choice of languages and visual feedback of temporal information. The survey will be administered in three peri-urban disadvantaged communities in the greater Cape Town area with a high burden of HIV. The study communities participated in a previous TB/HIV study, from which HIV test results will be anonymously linked to the survey dataset. Statistical analyses of the data will include descriptive statistics, linear mixed-effects models for the inter- and intra-subject variability in the age difference between sexual partners, survival analysis for correlated event times to model concurrency patterns, and logistic regression for association of HIV status with age disparity and sexual connectedness.DiscussionThis study design is intended to facilitate more accurate recall of sensitive sexual history data and has the potential to provide substantial insights into the relationship between key sexual network attributes and additional risk factors for HIV infection. This will help to inform the design of context-specific HIV prevention programmes.

Seasonality, distribution and taxonomic status of avian haemosporidian parasites within the Greater Cape Town area, South Africa

A total of 9 304 birds representing 29 families, 55 genera and 78 species were captured at 10 sites within the Greater Cape Town area. Forty-one avian haemosporidian parasites from three genera were present in 20 avian families, with 1 978 (21.2%) individuals infected with one or more parasite species. Leucocytozoon spp. (12.6% of infected birds) exhibited the highest infection rate, followed by Haemoproteus spp. (9.6%) and Plasmodium spp. (0.6%). Prevalence of infection varied from 4.5% at Patryskraal to 28.0% at Tygerberg Nature Reserve. Columbidae had the highest infection rate by Haemoproteus spp. Ploceidae and Sylviidae were infected by all three haemosporidian genera, with Ploceidae the most heavily infected, with six species of avian haemosporidia. All study sites had similar seasonal patterns with two peaks. The first peak coincided with the end of the rainy season in August or September, and the second during January and February, when population sizes peaked on account of seasonal breeding and the presence of large numbers of immature birds susceptible to infection. The prevalence of infections had two seasonal lows, without a complete winter interruption, with the first low occurring in late autumn/early winter. The second low, known as ‘spring relapse’, resulted from acute primary parasitaemia, which follows a peak in haemosporidian infection. Seasonal prevalence patterns as recorded throughout the year in this study are typical of medium latitudes with mild climates and warm seasons. Avian haemosporidian parasites are classified according to the avian families or subfamilies that they infect; this is also taken as the maximum level of specificity for the practice of avian haemosporidian taxonomy. Description of a new species is based upon morphology of gametocyte development in the peripheral blood of the avian host. This does not distinguish between morphologically identical gametocytes from different avian host families, nor is species or family level a valid taxonomic character. Thus, Haemoproteus and Leucocytozoon spp. encountered in this study are considered to be relegated to synonymy with previously described, morphologically similar valid species in avian hosts of other families following the taxonomic path of Valkiunas, thereby eliminating duplication of species.

White Matter Correlates of Apathy in HIV-Positive Subjects: A Diffusion Tensor Imaging Study

White Matter Correlates of Apathy in HIV-Positive Subjects: A Diffusion Tensor Imaging Study

Sexual risk behaviours and HIV-1 prevalence among urban men who have sex with men in Cape Town, South Africa

Distinct homosexual and heterosexual HIV epidemics have previously been recognised in South Africa. However, linked HIV prevalence and self-reported sexual risk behaviour data have not been reported for men who have sex with men (MSM) in Cape Town since 1986. We conducted a cross-sectional, anonymous, venue-based HIV risk behaviour and prevalence study of 542 self-identified MSM in greater Cape Town using a self-administered risk questionnaire and the OraSure testing device to asses HIV-1 prevalence. This sample had an overall HIV prevalence of 10.4% (56/539). We found that self-identifying as gay, homosexual or queer (adjusted odds ratio (AOR) 4.5, 95% confidence interval (CI) 1.0-20.0) and reporting ever having had a sexually transmissible infection diagnosis (AOR 4.3, 95% CI: 2.3-8.3) were significantly predictive of testing HIV-1 positive, while reporting unprotected anal intercourse with a known HIV-negative partner (AOR 0.4, 95% CI: 0.2-0.9) was significantly protective. These data suggest a mature epidemic with consistent high-risk taking among MSM in Cape Town, and significant associations of select self-reported risk behaviours and HIV-1 serostatus. There is a need for continued and robust HIV surveillance along with detailed risk behaviour trends over time to inform the development of targeted risk-reduction interventions for this population.

Land Conflicts in Informal Settlements: Wallacedene in Cape Town, South Africa

Given the history of South Africa, which has resulted in a significantly skewed pattern of access to scarce resources in favor of a wealthy racial minority, the issue of access to land and shelter is a central and emotive one. It is also a potential arena of conflict and social and political divisions. It is therefore important to understand, monitor, and resolve these conflicts. This paper is the first in a series of case studies, drawn from within greater Cape Town, which examine conflicts over land and housing and how these conflicts are being managed. This case is that of Wallacedene, a primarily informal settlement in the north of the city, which has been the subject of an informal settlement upgrading process. Different forms of conflict occur over the life cycle of an informal settlement. Community-based institutions form an essential component of conflict management strategies. However, there have to be checks and balances on how these institutions operate. Moreover, accurate, local level records of transactions in land rights, which are often informal transactions, are an essential part of land and housing delivery.

The Male Attitude Norms Inventory-II

This article describes the development of the Male Attitude Norms Inventory-II (MANI II). Empirical findings and theoretical debate contributed toward the development of a measure of South African masculinity ideology. Three hundred and thirty-nine male participants, drawn from universities across greater Cape Town, were included in the study. Exploratory factor analysis rendered a three-factor model of traditional masculinity. This accounted for 31.44 percent of total item variance. Results informed the development of a Total Scale ( α = 0.90)as well as three subscale measures (Toughness, α = 0.81; Control, α = 0.82; and Sexuality, α = 0.85). The MANI-II displayed satisfactory convergent validity with the Male Role Norms Inventory (MRNI) (r = 0.84; p < 0.001). The MANI-II and MRNI subscales were also meaningfully interrelated. The MANI-II offers a contextually sensitive and multidimensional measure of masculinities. Future research should include a representative sample, establish test-retest reliability, and further examine total and subscale construct validity.

Risk of breast cancer in relation to the use of injectable progestogen contraceptives and combined estrogen/progestogen contraceptives.

Recent studies have suggested that progestogen-only contraceptives and combined estrogen/progestogen oral contraceptives (COCs) may increase the risk of breast cancer among women less than 35 years of age or among recent users. The authors conducted a case-control study, in which cases of breast cancer (n = 484) [corrected] and controls (n = 1,625) hospitalized for conditions unrelated to contraceptive use were interviewed from 1994 to 1997 in hospitals in greater Cape Town, South Africa. The women were aged 20-54 years, resided in a defined area around Cape Town, and were Black or of mixed racial descent. The relative risk for exposure to injectable progestogen contraceptives (IPCs), mostly depot medroxyprogesterone acetate, was 0.9 (95% confidence interval (CI) 0.7, 1.2). There were no consistent associations within categories of age or recency or duration of use. For exposure to COCs, the overall relative risk was 1.2 (95% CI 1.0, 1.5). Among women below age 35 years, the relative risk was 1.7 (95% CI 1.0, 3.0), and it was unrelated to the duration or recency of use. The findings suggest that IPCs do not increase the risk of breast cancer, and that COCs may increase the risk among women below age 35 years, although bias cannot be excluded.

Deciding on cadaveric organ donation in Black African families.

This study explores factors that have affected the decision of Black African families to donate cadaveric organs. Semi-structured interviews were conducted with ten families living in greater Cape Town, South Africa. Addresses were obtained from records of the transplant co-ordinators at Groote Schuur Hospital. The data were analysed according to broad themes emerging from the interviews. The most important themes were the influence of violent, criminal deaths; the need for a longer period of consultation among family members: belief in the integrity of the ancestor's body; lack of understanding of brain death; and experiences of grief and loss.