Low-income South African Community Research Articles

Efficacy of a dialogic book-sharing intervention in a South African birth cohort: A randomized controlled trial

ObjectiveEvidence shows that dialogic book-sharing improves language development in young children in low-middle income countries (LMICs), particularly receptive and expressive language. It is unclear whether this intervention also boosts development of other neurocognitive and socio-emotional domains in children. Using a randomized controlled trial (RCT) nested in the Drakenstein Child Health Study (DCHS), a book-sharing intervention was implemented in caregivers of 3.5-year-old preschool children living in low-income South African communities. Methods122 Caregivers and their children (mean age 3.5 years) were randomly assigned to an intervention group (n = 61) or waitlist control group (n = 61). A neurocognitive battery determined baseline receptive and expressive language, executive function, theory of mind, and behavior scores. ResultsNo differences were observed between intervention and control groups on receptive and expressive language, or any of the neurocognitive or socio-emotional measures from baseline (3.5 years) to 4 months post-intervention administration (4 years). ConclusionThe benefits noted in prior literature of book-sharing in infants did not appear to be demonstrated at 4 months post-intervention, in children from 3.5 to 4 years of age. This suggests the importance of early intervention and emphasizes the need for further research on adaptation of book-sharing for older participants in a South African context.Trial registration: retrospectively registered on 03/04/2022 PACTR202204697674974.

Community gardens and the social solidarity economy

ABSTRACT Although research has demonstrated the ecological, public health and food security benefits of community gardens, few studies have considered community gardens in relation to a broader social solidarity economy (SSE), that is, inter-community networks wherein people develop commitments to building just and equitable economic alternatives. In employing a thematic analysis on triangulated data (collected via an interview, participant observation, and a participatory film), the present case study explores how a community gardener from a low-income South African community engages with his community’s SSE. We analyse how this community garden fostered solidarity and established alternative micro-economic practices. We also consider the challenges facing community gardens when connecting with the SSE. By way of conclusion, we emphasise the importance of taking a critical, broad-based view of the SSE within research, and how case studies can assist us in understanding the various influences that SSE initiatives can have within and across communities.

Developmental characteristics of young children in a low-income South African community.

Adequate early childhood development is critical for later-life success. Developmental profiles of specific populations are required to support implementation of early intervention services. Three hundred fifty-three caregivers of children with mean age 17.9months (SD = 10.5) were selected from a primary healthcare clinic. Overall positive identification of signs of a developmental delay, with the Bayley Scales of Infant and Toddler Development III, was 51.8% (n = 183). Logistic regression analysis determined the effect of age and gender on results. Prevalence of developmental delay increased with age from 33.1% for children under 12months to 61.7% and 66.3% for children between 13-24months and 25-36months, respectively. Females were 1.82 times (95% CI [1.16, 2.85]) more likely to have had no signs of developmental delay; 2.30 times (95% CI [1.14, 4.65]) in motor and 2.06 times (95% CI [1.23, 3.45]) in adaptive behaviour domains. One-third of children presented with low levels of adaptive behaviour functioning. One hundred and one (28.6%) participants across age groups displayed superior social-emotional ability, possibly due to familial structures and relationships. One-third of children presented with poor adaptive behaviour function, attributed to cultural differences. This study contributes to information on developmental characteristics of children in South Africa.

A multiphased cultural and contextual adaptation of the Parents' Evaluation of Developmental Status tools for a low-income community: A South African case study.

Culturally relevant developmental screening is one of the best ways to appropriately identify developmental delays and disabilities in children as early as possible across diverse cultural backgrounds. This study aimed to adapt the Parents' Evaluation of Developmental Status (PEDS) tools for a low-income community in South Africa by using a detailed multiphased cultural and contextual adaption process. A three-phase mixed-method design relying on triangulation of data was used. Data were collected at an immunization clinic in a low-income community in Mamelodi, South Africa. Phase 1 was a focus group discussion with 11 community participants. The topics explored the possible changes to the PEDS tools to make them more relevant to the community. Phase 1 informed Phase 2 where 12 early childhood development experts achieved consensus through a two-round survey on a modified Delphi method. In Phase 3, a draft of the PEDS tools-SA was presented to the authors of the PEDS tools for final approval. Of 55 questions that were adapted for the PEDS tools-SA, two original questions (3.6%), 14 questions from the expert suggestions (25.4%) and 39 from the community participant's suggestions (71%) were included. A final version of the PEDS tools-SA was created. This study used a systematic method to adapt the PEDS tools to create the culturally appropriate PEDS tool-SA for a low-income community in South Africa, informed by community stakeholders' views from the first step. This resulted in a high-quality adaptation process that is more likely to result in a tool that is more acceptable to caregivers from a low-income South African community.

Prevalence and characteristics of hearing and vision loss in preschool children from low income South African communities: results of a screening program of 10,390 children

BackgroundThe majority of children with sensory impairments live in low- and middle-income countries. More studies of hearing and vision impairment prevalence are needed, in order to generate more accurate estimates of trends in sensory impairments. This study aimed to estimate the prevalence and describe the characteristics of hearing and vision loss among preschool children (4–7 years) in an underserved South African community following community-based mobile health (mHealth) supported hearing and vision services.MethodsA screening program of sensory impairments was undertaken of children attending preschools in the communities of Khayelitsha and Mitchell’s Plain, Cape Town, from September 2017 until June 2019. Hearing and vision screening were done by trained community health workers using mHealth technology. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were conducted using smartphones that host point-of-care validated and calibrated hearing and vision testing applications (hearTest app, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). Descriptive statistical analysis and logistic regression analysis were conducted after extracting data from a secure cloud-based server (mHealth Studio, hearX Group) to Microsoft Excel (2016).ResultsA total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6 and 4.4% of children failed hearing and vision screening respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of children of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was done on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.05), but not for hearing loss (p = 0.06). Gender was not a significant predictor of hearing (p = 0.22) or vision loss (p = 0.20).ConclusionsHearing loss is prevalent in at least 22 per 1000 and vision loss in at least 23 per 1000 preschool children in an underserved South African community. Timely identification of sensory losses can be facilitated through community-based hearing and vision services supported by mHealth technology.

Understanding community violence: A critical realist framework for community psychology.

Critical realism can unsettle a number of orthodoxies that surround the study of community violence within community psychology. This is to say, because critical realism is embraced so rarely by community psychologists, it can institute a parallax shift within the discipline, whereby we are granted alternative ways of perceiving violence within community contexts. Drawing on transdisciplinary thought, we offer in this article a retroductive framework for studying community violence. This framework, we argue, can facilitate an understanding of structurally violent causal mechanisms through interrogating how direct-or observable-violence intersects with epistemic violence (i.e., harmful and inaccurate representation). Demonstrating the efficacy of this framework, we provide an example from our work, where participants from a low-income South African community produced and screened a documentary film on community violence and collective resistance. Reflecting on the ways by which this film engaged xenophobic violence in particular, we examine how community members used the film to trouble perceptions of community violence and advance a multifaceted antiviolence agenda. By way of conclusion, we consider how our framework can be used to inform a critical realist community psychology, wherein violent social structures are analyzed against the agentic community-driven initiatives which oppose these structures.

Intensity Matters for Musculoskeletal Health: A Cross-Sectional Study on Movement Behaviors of Older Adults from High-Income Scottish and Low-Income South African Communities.

This study aimed to investigate differences in physical activity (PA) patterns and the associations between objectively measured 24-h movement behaviors and musculoskeletal measures (muscle strength, muscle mass, physical performance, and bone mineral density) in a high-income and a low-income community. This cross-sectional study recruited independent living older adults aged 60–85 years from high-income Scottish (n = 150) and low-income South African (n = 138) settings. Participants completed demographic and health questionnaires, and testing included body composition and bone mineral density (dual energy X-ray absorptiometry), physical performance (grip strength, gait speed), and PA (accelerometry). Participants accumulated similar amounts of weekly total PA, however, the Scottish cohort engaged in more moderate-to-vigorous intensity PA (MVPA) and sedentary behavior (SB), while the South African cohort spent more time sleeping and in light intensity PA (LPA). From compositional data analysis, more time spent in MVPA relative to the other movement behaviors was positively associated with higher muscle mass (p < 0.001) and strength (p = 0.001) in the Scottish cohort. Conversely, more time spent in MVPA was associated with faster gait speed (p < 0.001) and greater hip bone mineral density (p = 0.011) in the South African cohort. Our findings confirm the beneficial role of MVPA in both high- and low-income cohorts, however, the relationship MVPA had with components of musculoskeletal health in older adults differed between settings.

Developmental Risks in Vulnerable Children from a Low-Income South African Community.

To describe the developmental risks, and its influence, in young children from a low-income South African community. An exploratory, cross-sectional research study design was employed. Developmental screening was conducted during home visits with 126 caregivers and children between 0 and 42months of age from a low-income South African community. Children who failed the rescreen were referred for diagnostic assessment. A binomial logistic regression was used to determine the effect of developmental risks on developmental outcomes. Seventy-three percent of children screened were identified with a possible developmental delay (n = 59) according to caregiver-report using the PEDS tools. The regression model was statistically significant (χ2 (3) = 34.902, p < 0.001) with exposure to multiple languages (p < 0.05; odds ratio 3.810, CI 1.2-12.4) most indicative of potential developmental delay. Older children (19-42months) were also more at risk of developmental delay (p < 0.001) than younger children (0-18months). Healthcare professionals serving these vulnerable populations should create awareness amongst caregivers about the effect of developmental risks, in particularly multiple language exposure, on development.

A citizen science approach to determine perceived barriers and promoters of physical activity in a low-income South African community

ABSTRACTThe study’s objective was to assess the feasibility of using citizen science to identify and address physical activity (PA) barriers in a low-income South African community. We purposively selected as citizen scientists, eleven participants (21–45 years) from a cohort study who expressed interest in becoming physically active or were already active. They used the Stanford Neighborhood Discovery Tool mobile application to take photos and provide audio narratives of factors in their community that were barriers to or facilitated PA. Thereafter, in a facilitated workshop, citizen scientists thematically reviewed their findings, prioritised issues and proffered potential solutions. Researchers also thematically coded these data. PA levels were measured using standard questionnaires. None of the citizen scientists owned a car, and their PA was either work- or transport-related. Themes identified as priorities that hindered citizen scientists’ PA were dirt, sidewalks appropriated by vendors or homeowners, parks and gym vandalisation, and personal safety fears. Access to stadiums and parks enabled PA. Citizen scientists identified their local councillors and street committee chairpersons as fundamental for advocacy for a PA-friendly environment. Low-income community members can be empowered to gather meaningful data using mobile technology and work together to identify potential solutions for promoting PA-friendly environments.

Detecting developmental delays in infants from a low-income South African community: comparing the BSID-III and PEDS tools

ABSTRACT Detecting developmental delays is essential for early intervention in low to middle-income countries. A cross-sectional, within-subject, comparative design was employed to determine the performance of the Parents Evaluation of Developmental status (PEDS) tools smartphone application and the Bayley Scales of Infant and Toddler Development III (BSID III) to detect developmental delays in 174 young children aged 3–18 months. Data were collected at a primary healthcare (PHC) clinic in an underserved high-risk community in South Africa. The PEDS tools identified 56% (n = 97), and the BSID-III 35% (n = 61) of the 158 children with possible developmental delays, with an overall agreement of 65% between tests. The PEDS tools referral rate was significantly higher (p = 0.004) than that of the BSID-III. The high-risk nature and age group may have contributed to poor agreement across tools. A combination of tools for screening and assessment in infants in a South African PHC context may be necessary.

Hearing loss in preschool children from a low income South African community

ObjectiveThis study aimed to determine and describe hearing loss among preschool children in a South African community representative of typical low- and middle income countries (LMIC). MethodChildren between the ages of 3–6 years received a hearing screening at their early childhood development (ECD) center. If a child failed the hearing screening, he/she was seen for a follow-up rescreen and diagnostic assessment if necessary at their ECD center or closest referral clinic. Diagnostic testing consisted of otoscopy, tympanommetry and pure-tone diagnostic audiometry. ResultsA total of 6424 children were screened at ECD centers with a referral rate of 24.9%. Follow-up assessments were conducted on 45.3% (725) of these children. Diagnostic testing revealed that 9.3% of children presented with impacted cerumen and 18.7% presented with a hearing loss (56.5% binaural). Binary logistic regression revealed no gender or age effects (p > 0.05). Conductive hearing loss (65.2%) was the most common type of hearing loss found in children. ConclusionsMost preschool children who failed the hearing screening and received a diagnostic assessment were in need of intervention services for conductive hearing losses, followed by sensorineural and mixed losses.

Multilevel Connection as a Pathway to Healing in a Low-income South African Community

Combined forces of colonialism, tribalism and apartheid were influential, powerful and controlling legislators behind the continued cycle of violence in South Africa. The capacity for healing in the face of ongoing adversity has received growing attention in contexts of historical trauma and the developing world where an understanding of the cultural and historical past is crucial to healing. Notwithstanding, the parallel significance of multilevel and multidimensional connection as central to the process of healing trauma individually and collectively within the context of ongoing violence requires further exploration. This qualitative narrative study consisted of 18 in-depth individual interviews and two follow-up focus groups with women lay counsellors. Women’s narratives were subjected to narrative analysis. Themes reflect counsellors’ healing journeys in the context of historical and continuous trauma and demonstrate elements of connection which facilitate or hinder the process of healing in this community. Findings suggest that participants viewed the worth of multilevel connection to their internal worlds and the world around them as critical to their healing—without the element of connection, healing does not occur and the cycle of disconnection and violence continues.

Reflections on the development and utility of a participatory community violence surveillance methodology

The goal of this study was to illustrate the development and utility of a community violence surveillance methodology, as a component of a larger participatory violence prevention project in a low-income South African community. Using focus group discussions, data were collected from 12 community and academic researchpartners. These discussions were audio recorded, transcribed and then thematically analysed. The findings revealed that the participatory orientation to the research enabled researchers to develop an instrument that was appropriate for the community, collaboratively. The collaborative creation of the violence surveillance questionnaire and the use of community members to implement the system after intensive capacity building instilled a sense of ownership and promoted sustainability in this project. In addition, data generated by the surveillance system provided baseline and prevalence data which could be used to advocate for violence prevention and develop relevant interventions. This process also resulted in the provision of victim support through debriefing and referrals. Future research could focus on developing and implementing similar surveillance systems in communities and monitoring the effects thereof over time.Keywords: participatory, community, violence surveillance methodology

High prevalence of asymptomatic sexually transmitted infections among human immunodeficiency virus-infected pregnant women in a low-income South African community.

There is a lack of evidence on the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) among HIV-infected pregnant women in South Africa. We conducted a cross-sectional analysis of HIV-infected pregnant women in two healthcare facilities in a South African township to determine the prevalence of CT, NG and TV. HIV-infected pregnant women were recruited during the first antenatal care visit for their current pregnancy and requested to self-collect vulvovaginal swab specimens. Specimens were tested for CT, NG and TV using the Xpert® assay (Cepheid, Sunnyvale, CA). Of 247 tested for CT, NG and TV, 47.8% tested positive for at least one organism; CT = 36.8%, TV = 23.9%, NG = 6.9%. Forty three (17.4%) had multiple infections, of which 42 included CT as one of the infecting organisms. Of the 118 participants who tested positive for at least one sexually transmitted infection (STI), 23.7% reported STI-like symptoms. Among women who tested positive for CT, 29.7% reported symptoms while 47.1 and 27.1% of those who tested positive for NG and TV, respectively, reported symptoms. The high STI prevalence coupled with the low symptom prevalence among infected individuals justifies the use of diagnostic screening approaches rather than syndromic management of STIs in this setting.

Gossip girls: The power of girls’ gossip in a low-income South African community

ABSTRACTThis study explores the ways in which a particular group of early-adolescent coloured girls subjectively experience and understand gossip. Social constructionist grounded theory was applied to analyse qualitative data yielded by conducting feminist psychodynamic group therapy with three groups of girls aged 13–14. The discussion of the results was informed by the principles of discursive psychology and psychoanalytic theory. Gossip, as a form of democratic surveillance and an instrument of envious undermining, can become a source of power for those who indulge in it, while it can be destructive to those who are gossiped about. While gossip can be constructed as a potential instrument for questioning, subverting and undermining existing hierarchies, its potential power is compromised by existing social rules – often unspoken ones.

Socioeconomic factors associated with asthma prevalence and severity among children living in low-income South African communities.

Rates of asthma, poverty and social deprivation are high among young people in South Africa (SA), yet asthma interventions largely remain focused on biomedical factors. To investigate associations between socioeconomic factors and childhood asthma. We recruited 6 002 children aged 10 - 17 years from six low-income urban and rural sites in three SA provinces. Self-report questionnaires measured health status, sociodemographics and socioeconomic factors. Logistic regression and mediation analyses were used to test models of risk factors for asthma prevalence and severity (frequency of attacks). Child anxiety (odds ratio (OR) 1.08; 95% confidence interval (CI) 1.04 - 1.12) and community violence (OR 1.14; 95% CI 1.00 - 1.30) were associated with increased odds of having asthma. Children doing more outdoor housework (OR 0.83; 95% CI 0.71 - 0.98) and living in greater poverty (OR 0.93; 95% CI 0.88 - 0.99) had lower odds of having asthma. Severe asthma was predicted by child depression (OR 1.14; 95% CI 1.03 - 1.26) and greater household poverty (OR 1.14; 95% CI 1.01 - 1.28). Most socioeconomic factors operated in 'risk pathways', wherein structural factors (e.g. urban living) were associated with individual factors (e.g. fewer outdoor tasks), which predicted greater odds of having asthma or severe exacerbations. This study suggests the need to consider the context of childhood asthma in SA for improved prevention and treatment. A multidisciplinary approach may be more effective than a biomedical model, given the plausible effects of psychosocial stress and poverty on asthma outcomes.

Motherhood and the "Madness of Hunger": "...Want Almal Vra vir My vir 'n Stukkie Brood" ("...Because Everyone Asks Me for a Little Piece of Bread").

It is widely assumed that the social and economic conditions of poverty can be linked to common mental disorders in low-, middle- and high-income countries. Despite the considerable increase in quantitative studies investigating the link between poverty and mental health, the nature of the connection between poverty and emotional well-being/distress is still not fully comprehended. In this qualitative study, exploring how one group of Coloured South African women, diagnosed with depression and residing in a semi-rural low-income South African community, subjectively understand and experience their emotional distress, data was collected by means of in-depth semi-structured interviews and social constructionist grounded theory was used to analyse the data. We will attempt to show (1) that the depressed women in this group of respondents frequently refer to the emotional distress caused by hungry children and (2) that the emotional distress described by the respondents included emotions typically associated with depression (such as sadness, hopelessness and guilt), but also included emotions not necessarily associated with depression (such as anxiety, anger and anomie). In our attempt to understand (both psychologically and politically) the complex emotional response of mothers to their children's hunger, we argue that powerful gender and neo-liberal discourses within which mothers are interpellated to care for children, and more specifically, to make sure that children are not hungry, mean that the mothers of hungry children felt that they were not fulfilling their responsibilities and thus felt guilty and ashamed. This shame seemed, in turn, to lead to anger and/or anomie, informing acting out behaviours ranging from verbal and physical aggression to passive withdrawal. A vicious cycle of hunger, sadness and anxiety, shame, anger and anomie, aggression and withdrawal, negative judgement, and more shame, are thus maintained. As such, the unbearable rebukes of hungry children can be thought of as evoking a kind of "madness" in low-income mothers.

“I Want a Better Life for Her”: Father-Adolescent Daughter Relationships in a Minority, Low-Income South African Community

Although research indicates the importance of fathers in adolescent daughters’ psychosocial development, father–adolescent daughter relationships have been neglected in both international and local research. Furthermore, the relatively small body of research that does exist has mostly been conducted in North American and European contexts. Our study aimed to generate knowledge about father–adolescent daughter relationships in a minority, low-income South African community. In this social constructionist informed community-based study, we explored father–daughter relationships in 42 individual interviews with father–daughter dyads. This article focuses on a prominent theme in the interview data that revolves around fathers’ repeated statements that they wanted their daughters to have betters lives than they themselves had and the parenting strategies they reported to achieve this aspiration. We conclude that these fathers could benefit from reflecting on the apparent limitations of their parenting practices and from knowledge and skills regarding more effective parenting practices.

Fathers, adolescent daughters and gender in a low-income South African community

Knowledge about father–adolescent daughter relationships is mostly based on research in North-American and European contexts. Furthermore, it tends to rely on either fathers' or daughters' perspectives, and not on dyadic data. Informed by a social constructionist perspective, this study investigated the fatherhood constructions of fathers and adolescent daughters in a South African low-income community. We used Charmaz' social constructionist grounded theory method. Forty-two interviews were conducted separately with fourteen fathers and their adolescent daughters. Five conceptual categories were identified: (i) Predominance of fathers' provider role; (ii) Fathers and daughters having an ‘understanding’ in which daughters apparently complied with fathers authoritarian positions; (iii) explicit expressions of affection were mostly limited to special occasions; (iv) Fathers wished a better future for their daughters and attempted to keep them on track to such a future and (v) lastly, Fathers' expected daughters to follow their instructions and not their bad examples. Our findings highlight the influential and constricting role of dominant masculine and feminine gender notions in the discourses and practices of the fathers and adolescent daughters in our study. However, some evidence of contestations were present that suggests the potential of a shift towards more equitable gender relations.

Engaging Diverse Social and Cultural Worlds: Perspectives on Benefits in International Clinical Research From South African Communities

The issue of benefits in international clinical research is highly controversial. Against the background of wide recognition of the need to share benefits of research, the nature of benefits remains strongly contested. Little is known about the perspectives of research populations on this issue and the extent to which research ethics discourses and guidelines are salient to the expectations and aspirations existing on the ground. This exploratory study contributes to filling this void by examining perspectives of people in low-income South African communities on benefits in international clinical research. Twenty-four individuals with and without experience of being involved in clinical research participated in in-depth interviews. Respondents felt that ancillary care should be provided to clinical research participants, while a clinical study conducted in particular community should bring better health to its members through post-trial benefits. Respondents' perspectives were grounded in the perception that the ultimate goal of international clinical research is to improve local health. We argue that perspectives and understandings of the respondents are shaped by local moral traditions rather than clinical research specificities and require attention as valid moral claims. It is necessary to acknowledge such claims and cultural worlds from which they emerge, thus building the foundation for equal and embracing dialogue to bridge different perspectives and handle contradicting expectations.