Low-income Townships Research Articles

The extent of outdoor food and beverage advertising surrounding primary and secondary schools in poorly resourced townships in Cape Town, South Africa

BackgroundThe targeted marketing of unhealthy food and beverages to vulnerable populations, particularly children and adolescents in lower-income communities, is pervasive and coincides with increased non-communicable disease (NCD) rates. This study examined the extent of food and beverage advertising surrounding schools in three townships in Cape Town, South Africa: Gugulethu, Nyanga, and Kensington. MethodologyTrained fieldworkers used web-based surveys on smartphones to capture all observable outdoor food and beverage advertisements in the three townships. Surveys recorded product brand, type, placement, Global Positioning System (GPS) coordinates, and a digital photograph. Advertisements were categorised as sugar-sweetened beverages (SSBs), unhealthy food (excluding beverages), alcohol, staple food, and miscellaneous food, following the INFORMAS Outdoor Food Advertising Protocol. Advertisements visible within 100m- and 400m buffer zones surrounding primary and secondary schools were mapped using the Quantum Geographic Information System (QGIS) software. Descriptive analyses were conducted to determine the extent of outdoor food and beverage advertising surrounding schools. ResultsWe mapped 26 primary and 7 secondary schools, observing 253 and 1587 food and beverage advertisements within 100m and 400m of schools, respectively. Unhealthy advertisements comprised 69.9% and 68.5% of all observations within 100m- and 400m zones, respectively. There were 117 SSB, 57 unhealthy food, 3 alcohol, 64 staple food, and 12 miscellaneous food advertisements within 100m zones. Nyanga zones contained the most SSB (71, 60.7%) and unhealthy food advertisements (37, 64.9%). Secondary schools had higher SSB advertisement rates than primary schools (p < 0.001). Within 400m zones, there were 623 SSB, 370 unhealthy food, 93 alcohol, 445 staple food, and 56 miscellaneous food advertisements, with Nyanga leading in SSB (335, 53.8%) and unhealthy food advertisements (224, 54.9%). ConclusionThe results highlight a concerning level of exposure to unhealthy food and beverage advertisements around schools, particularly secondary schools in low-income townships. This could have implications for the dietary choices and health of students in these areas. The findings underscore the need for policy interventions and community awareness programs to address and regulate the advertising environment around schools, promoting healthier food and beverage choices for students.

Research on the Development and Integration of Inclusive Finance in Agricultural Economy Based on the Artificial Intelligence Machine Learning Algorithm

Inclusive finance can help rural low-income groups, township small and microenterprises, and other groups in China to improve their living and economic standards and can meet the relevant credit needs of relevant rural personnel under the condition of risk prevention. The integration of AI and HP finance has built a more professional information and data platform for customers with different credit needs in the agricultural economy. Based on the development and integration of agricultural economy, this study makes effective analysis and judgment on poor customers with credit needs through the artificial intelligence system platform under the application of inclusive finance, so as to scientifically and effectively identify and screen the big data of different credit data of customers and finally select the most qualified high-quality credit customers, so as to effectively improve the overall economic income of customers with agricultural credit needs. It has laid a foundation for the development of agricultural economy and more effectively extracting high-quality credit customers, so that the development of agricultural economy has been widely used.

South Africa's Health Promotion Levy on Pricing and Acquisition of Beverages in Local Spazas and Supermarkets.

In response to concern over rising sugar-sweetened beverage (SSB) consumption, in April 2018, South Africa became the first Sub-Saharan African country to implement an SSB tax. We assess changes in pricing and acquisition of beverages from local supermarkets and small stores among 18-39 year old adults living in one township in the Western Cape, before and after tax implementation. This study is among the first evaluations of an SSB tax on the local food environment in a low-income township. Store beverage pricing and participant surveys were cross-sectional, analyzed 1 month before and 11 months after implementation of the tax (March 2018 and March 2019). Langa, Western Cape, South Africa. Surveyed participants were residents of Langa between 18-39 years old (N=2,693 in 2018 and N=2,520 in 2019). Prices of taxed SSBs increased significantly among small shops and supermarkets between 2018 and 2019. There were non-significant decreases in prices of untaxed beverages in small shops, but prices of untaxed beverages increased in supermarkets. Across all store types, there was a 9 percentage point decrease in the probability of purchasing regular soda weekly pre/post-implementation. Reductions in purchasing were larger in small shops than supermarkets. We found some differential impacts of the levy on pricing and acquisition of beverages by retailer type in one low-income township. As other Sub-Saharan African countries consider similar fiscal policies to curb soda consumption, obesity and related diseases, this work can be used to understand the implications of these policies in the retail setting.

Tsoku Maela

I grew up in a low-income township in the Limpopo province of South Africa. We don't have the vocabulary for issues of the mind such as depression or anxiety in our native languages, nor do we have adequate health systems or facilities to care for those afflicted. We do, however, have a word for crazy, and that is what we settle for. We call those who have suffered traumatic experiences such as abject poverty, violence, and abuse, and those living with mental illnesses and personality disorders crazy, while the world we live in is laid to waste by the sane.

Adapting the Diabetes Prevention Program for Low and Middle-Income Countries: A Cluster Randomized Trial to Evaluate 'Lifestyle Africa'

Background: Low- and middle-income countries (LMIC) are experiencing major increases in diabetes and cardiovascular conditions linked to overweight and obesity. We evaluated an adapted version of the Diabetes Prevention Program (DPP) named Lifestyle Africa, tailored for an under-resourced community in South Africa. Methods: Participants with BMI ≥ 25 kg/m2 who were members of existing social support groups or “clubs” based in low-income townships were enrolled in a cluster-randomized controlled trial that compared the adapted intervention to usual care. The Lifestyle Africa intervention consisted of 17 video-based group sessions delivered by trained community health workers (CHWs). CHWs, participants, and research team members could not be blinded to condition. Percentage weight loss (primary outcome), HbA1c, blood pressure, triglycerides, and LDL cholesterol were assessed 7–9 months after enrollment. An individual-level intention-to-treat analysis was conducted adjusting for clustering within clubs and baseline values. Findings: Between February 2018 and May 2019, 782 individuals were screened and 494 (89% female) were enrolled. Participants from 28 clusters were allocated to Lifestyle Africa (15, n=240) or usual care (13, n=254). Fidelity assessments indicated the intervention was generally delivered as intended. The modal number of sessions held across all clubs was 17 and the mean attendance of participants across all sessions was 61%. Outcome assessment was completed by 215 (90%) intervention and 223 (88%) control participants. Average weight change was -0·67% (95% CI = -1·28 – -0·06) in Lifestyle Africa and 0·47% (95% CI = -1·08 – 0·14) in control with no significant difference (group difference = -0·20%, 95% CI -1·06 – 0·67; p = 0·65). However, HbA1c was significantly lower at follow-up in Lifestyle Africa compared to the usual care group (mean difference = -0·26, 95% CI -0·41 – -0·11, p = 0·0009). There were no significant differences between groups in the other outcomes. Interpretation: Lifestyle Africa was feasible for CHWs to deliver and although it had no effect on weight loss it had a significant effect on HbA1c. The intervention holds promise for addressing cardiovascular disease and diabetes at scale in LMIC. Clinical Trial Registration Details: ClinicalTrials.gov (NCT03342274). Funding Information: Supported by the National Heart Lung and Blood Institute of the National Institutes of Health (R01HL126099). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the ethics committees at the University of Cape Town (primary) and Children’s Mercy Kansas City. Participants completed written informed consent.

Handling and Illegal Disposal of Excess Household Solid Wastes in Katutura Township of Namibia

This study examined the modes of handling of generated excess household solid wastes and attitude towards illegal disposal in Katutura township in Windhoek, Namibia. This was particu- larly significant because the capital city, Windhoek was once the cleanest city in Africa. Hence, the study aimed at generating data that would be of benefit to the local municipality towards review of waste management operational strategies and applicable local byelaw especially in this densely populated low-income township. A mixed method of qualitative (observational) and quantitative survey through the use of questionnaire was adopted. Presented data was based on a total of two hundred and thirty-four (234) respondents. Results showed that 46.6% of respondents were between the ages of 21-30 (43.7%) and employed with a 92.3% literacy level. About 66.7% were well aware of the concept of waste management and possessed the knowledge (94%) of its implementation. Majority of respondents (70.9%) generate wastes with- in the 240L waste bin volume per week while those that generate excess handle the wastes in several ways. About 44.3% place excess wastes beside the bin before municipal collection while a combination of 46.4% engage in different forms of illegal disposal. Ironically, about 77.8% of respondents were aware of what constitutes illegal waste disposal. A good number of respondents (62.1%) were satisfied with the municipal waste management. Suggestions on further improvements were however provided. Of great concern in this study was the apathetic attitude (50.4%) of respondents towards the illegal waste disposal practices. This might be contributing factor towards the loss of cleanliness ranking by the city.

Psychosocial barriers and enablers of exclusive breastfeeding: lived experiences of mothers in low-income townships, North West Province, South Africa

BackgroundDespite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32 %. The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeeding mothers at postnatal time points 3–14 days, 4–8 weeks, 10–14 weeks and 20–24 weeks.MethodsThis community-based mixed-methods study collected data within a prospective cohort study on sociodemographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6–8 weeks with infant feeding data collected at 4–8, 10–14 and 20–24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6–24 weeks were conducted. Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data.ResultsThe majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%). Exclusive breastfeeding decreased from 34% at 4–8 weeks to 9.7% at 20–24 weeks. Mixed feeding with infant formula increased from 17.0 to 30.6% and food feeding from 3.1 to 54.2%. While there were no statistically significant associations between EBF and any of the quantitative sociodemographic variables, in the qualitative data, codes associated with barriers were more than enablers. The themes were Mothers’ attributes (wellbeing, experiences and relationships) with the code mother’s stress the strongest barrier, Mother’s knowledge, attitudes and practices of breastfeeding with the code conventional medicines the strongest barrier, Family environment with the code home setting the strongest barrier, Social environment with public spaces and places a barrier and in Baby cues the code baby stomach ailments the barrier. Within these same themes mother’s positive emotions, benefits of breastfeeding, support in the home, access to information and services from health professionals and baby’s health were strong enabling factors.ConclusionsLow EBF, high mixed feeding and a high EPDS score were explained by the barriers identified in the qualitative data. The data suggests that mothers from low-income households would be better supported through interventions that address food insecurity; family relationships and those that build confidence in mothers and resilience in confronting difficult and hostile breastfeeding environments.

Anthropometric nutritional status, and social and dietary characteristics of African and Indian adolescents taking part in the TALENT (Transforming Adolescent Lives through Nutrition) qualitative study.

To describe the anthropometry, socioeconomic circumstances, diet and screen time usage of adolescents in India and Africa as context to a qualitative study of barriers to healthy eating and activity. Cross-sectional survey, including measured height and weight and derived rates of stunting, low BMI, overweight and obesity. Parental schooling and employment status, household assets and amenities, and adolescents' dietary diversity, intake of snack foods, mobile/smartphone ownership and TV/computer time were obtained via a questionnaire. Four settings each in Africa (rural villages, West Kiang, The Gambia; low-income urban communities, Abidjan, Cote D'Ivoire; low/middle-class urban communities, Jimma, Ethiopia; low-income township, Johannesburg, South Africa) and India (rural villages, Dervan; semi-rural villages, Pune; city slums, Mumbai; low-middle/middle-class urban communities, Mysore). Convenience samples (n 41-112 per site) of boys and girls, half aged 10-12years and another half aged 15-17years, were recruited for a qualitative study. Both undernutrition (stunting and/or low BMI) and overweight/obesity were present in all settings. Rural settings had the most undernutrition, least overweight/obesity and greatest diet diversity. Urban Johannesburg (27 %) and Abidjan (16 %), and semi-rural Pune (16 %) had the most overweight/obesity. In all settings, adolescents reported low intakes of micronutrient-rich fruits and vegetables, and substantial intakes of salted snacks, cakes/biscuits, sweets and fizzy drinks. Smartphone ownership ranged from 5 % (West Kiang) to 69 % (Johannesburg), higher among older adolescents. The 'double burden of malnutrition' is present in all TALENT settings. Greater urban transition is associated with less undernutrition, more overweight/obesity, less diet diversity and higher intakes of unhealthy/snack foods.

Maternal HIV does not affect resiliency among uninfected/HIV exposed South African children from birth to 5 years of age.

Examine resiliency among a South African population cohort of children of mothers living with HIV (MLH) and mothers without HIV (MWOH) in low-income townships over the first 5 years of life. A cluster randomized controlled intervention trial evaluating child resiliency and the effects of home visiting in township neighborhoods from pregnancy through 5 years postbirth. The population of pregnant women in 24 matched neighborhoods were recruited and randomized by neighborhood to a standard care condition (n = 594) or a paraprofessional home visiting intervention condition (n = 644). Mothers and children were assessed at 2 weeks, 6, 18, 36, and 60 months postbirth (92-84% follow-up; 10.2% mortality). Resilient children were identified based on consistently meeting global standards for growth, cognitive functioning, and behavior. Maternal HIV status (n = 354 MLH; n = 723 mothers without HIV MWOH), intervention condition, maternal risks, caretaking, sociodemographic characteristics, and neighborhood were examined as predictors of child resiliency over time using analysis of variance, chi-square analyses, and Fisher's exact tests, where appropriate. None of HIV-seropositive children (n = 17) were resilient; 19% of 345 HIV-exposed but uninfected children of MLH were resilient, a rate very similar to the 16% among MWOH. Resiliency was significantly associated with lower income, food security, not having a live-in partner, and the absence of maternal risk (i.e., not being depressed, using alcohol, or being a victim of intimate partner violence). Being randomized to a home visiting intervention, maternal breastfeeding for at least 3 months and attending a preschool crèche were also unrelated to resiliency. Although matched pairs of neighborhoods had similar rates of resilient children, resiliency varied significantly by neighborhood with rates ranging from 9.5 to 27%. We set a new standard to define resiliency, as consistently recommended by theoreticians. Although seropositive children are not resilient, uninfected children of MLH are as resilient as their peers of MWOH. Typical protective factors (e.g., home visiting, breastfeeding, preschool) were unrelated to resiliency over the first 5 years of life. ClinicalTrials.gov registration #NCT00996528.

Part of the solution – an engaged scholarship approach for the sustainable reduction of street pesticides and poisonings

ABSTRACT In low-income townships, pests are rife, a nuisance and are vectors of disease. Although alternatives are available, chemical means of pest control is often the first resort due to lack of knowledge of other methods, convenience and presumed efficacy. The demand for chemical pest control has created a unique business opportunity for informal vendors in South Africa servicing predominately low socio-economic communities. That is the selling of ‘street pesticides’, which are either containing agricultural pesticides too toxic for domestic use or illegally imported products. Poisonings from street pesticide exposures, particularly in children, are increasingly common and, along with pest-related diseases, creates a double burden of disease. Solutions are needed to decrease these incidences and to develop pest control strategies that are low- or non-toxic. It is imperative that, for sustainable problem-solving, all stakeholders, including vendors, be part of the solution in tackling this public health issue. This manuscript outlines an engaged scholarship approach for developing a sustainable resolution for reducing street pesticide use. This cyclical and iterative approach encompasses: the establishment of relationships, co-creation of solutions, co-implementation, co-monitoring, co-evaluation, co-reflection and co-re-design. The significance of the research and proposed engagement are discussed, as are anticipated challenges.

Mixed-methods analysis of the applicability of the Career Adapt-Abilities Scale for isiXhosa-speaking South African township adolescents

In the present research study, key career adaptability constructs and the extent to which these constructs are relevant in a non-Western and developing world context were explored. The Career Adapt-Abilities Scale (CAAS) was administered to 396 Grade 11 isiXhosa speaking high school students from a low-income township in South Africa (Mage = 18, SD= 1.3 years). Data were analysed to assess measure suitability in comparison to two previous CAAS administrations, the international version and a previous South African administration. This mixed-methods psychometric exploration included Delphi panel focus group data to gain a deeper analysis of contextually bound and culturally sensitive factors.

A Gender and Marital Status Analysis of Household Income in a Low-Income Township

Abstract The analysis of income at household level is highly important for understanding the poverty and for supporting the efforts to deal with poverty. Poverty measures can be calculated from a multitude of approaches. A common approach is to use household income and draw a minimum level of income required for a household to be considered above or below poverty. This paper looked at income at household level from a gender perspective and a marital status perspective in order to draw conclusions of the nature of household’s characteristics that are associated with higher or lower income as a proxy for poverty. Based on data collected in a low income township in South Africa, the regression analysis was applied to investigate the differences between different marital statuses and gender and how they are associated with different levels of income. The regression results reveal that female headed households have, on average, lower incomes compared to male headed households, and also, that married heads of households have higher incomes compared to the single, divorced, and widowed. The widowed had the lowest average income.

The Benefits of Early Book Sharing (BEBS) for child cognitive and socio-emotional development in South Africa: study protocol for a randomised controlled trial

BackgroundChildren in low and middle-income countries (LMICs) are at risk for problems in their cognitive, social and behavioural development. Factors such as a lack of cognitive stimulation, harsh parenting practices, and severe and persistent aggression in early childhood are central to the genesis of these problems. Interventions that target the intersection between early childhood development, parenting, and early violence prevention are required in order to meaningfully address these problems.MethodsWe are conducting a randomised controlled trial to evaluate a parenting intervention for caregivers of children aged between 23 and 27 months, designed to promote child cognitive and socioemotional development in Khayelitsha, a low-income peri-urban township in South Africa. Families are randomly allocated to a book-sharing intervention group or to a wait-list control group. In the intervention, we train caregivers in supportive book-sharing with young children. Training is carried out in small groups over a period of 8 weeks. Data are collected at baseline, post intervention and at 6 months post intervention. In addition to targeting child cognitive development, the intervention aims to improve child socioemotional functioning.DiscussionThe Benefits of Early Book Sharing (BEBS) trial aims to evaluate the impact of an early parenting intervention on several key risk factors for the development of violence, including aspects of parenting and child cognition, prosocial behaviour, aggression, and socioemotional functioning. The study is being carried out in a LMIC where violence constitutes a major social and health burden. Since the intervention is brief and, with modest levels of training, readily deliverable in LMIC contexts, a demonstration that it is of benefit to both child cognitive and socioemotional development would be of significance.Trial registrationThe BEBS trial is registered on the International Standard Randomised Controlled Trial Number database, registration number ISRCTN71109104. Registered on 9 February 2016. This is version 1 of the protocol for the BEBS trial.

Societal Factors and Life Satisfaction: Evidence from Low Income Urban Societies in a Developing Country

This paper tested the influence of four societal factors, namely marital status, religion, age and gender on the life satisfaction of low income urban earners in a developing country. A survey was conducted using a sample consisting of 985 individuals drawn from three low income townships in Gauteng Province, South Africa. In order to measure life satisfaction the validated Satisfaction with Life Scale developed by Diener et al. (1985), was utilised. Associations between each societal factor and life satisfaction were tested using multiple regression analysis. Marital status was statistically insignificant (β=0.058; P=0.170). All categories of religion were statistically significant, with Christianity (β=0.424; P=0.044) exerting the highest influence on life satisfaction. In terms of age, young adults demonstrated higher satisfaction with life than older adults, with young adults (β=0.369; P=0.019) exerting the highest influence on life satisfaction than other age categories. Gender was statistically insignificant (β=0.059; P=0.307) depicting that life satisfaction is not dependent on gender. The paper closes by drawing conclusions based on the results and suggesting several policy implications for improving the impact of each societal factor on life satisfaction.

The impact of household size on poverty: An analysis of various low-income townships in the Northern Free State region, South Africa

Poverty is a multi-dimensional socio-economic problem in most sub-Saharan African countries. The purpose of this study is to analyse the relationship between household size and poverty in low-income communities. The Northern Free State region in South Africa was selected as the study region. A sample of approximately 2 900 households was randomly selected within 12 poor communities in the region. A poverty line was calculated and 74% of all households were found to live below the poverty line. The Pearson’s chi-square test indicated a positive relationship between household size and poverty in eleven of the twelve low-income communities. Households below the poverty line presented larger households than those households above the poverty line. This finding is in contradiction with some findings in other African countries due to the fact that South Africa has higher levels of modernisation with less access to land for subsistence farming. Effective provision of basic needs, community facilities and access to assets such as land could assist poor households with better quality of life. Poor households also need to be granted access to economic opportunities, while also receiving adult education regarding financial management and reproductive health.

An overview of regional and local characteristics of aerosols in South Africa using satellite, ground, and modeling data.

We present a comprehensive overview of particulate air quality across the five major metropolitan areas of South Africa (Cape Town, Bloemfontein, Johannesburg and Tshwane (Gauteng Province), the Industrial Highveld Air Quality Priority Area (HVAPA), and Durban), based on a decadal (1 January 2000 to 31 December 2009) aerosol climatology from multiple satellite platforms and detailed analysis of ground-based data from 19 sites throughout Gauteng Province. Satellite analysis was based on aerosol optical depth (AOD) from MODIS Aqua and Terra (550 nm) and MISR (555 nm) platforms, Ångström Exponent (α) from MODIS Aqua (550/865 nm) and Terra (470/660 nm), ultraviolet aerosol index (UVAI) from TOMS, and results from the Goddard Ozone Chemistry Aerosol Radiation and Transport (GOCART) model. At continentally influenced sites, AOD, α, and UVAI reach maxima (0.12-0.20, 1.0-1.8, and 1.0-1.2, respectively) during austral spring (September-October), coinciding with a period of enhanced dust generation and the maximum integrated intensity of close-proximity and subtropical fires identified by MODIS Fire Information for Resource Management System (FIRMS). Minima in AOD, α, and UVAI occur during winter. Results from ground monitoring indicate that low-income township sites experience by far the worst particulate air quality in South Africa, with seasonally averaged PM10 concentrations as much as 136 % higher in townships that in industrial areas. We report poor agreement between satellite and ground aerosol measurements, with maximum surface aerosol concentrations coinciding with minima in AOD, α, and UVAI. This result suggests that remotely sensed data are not an appropriate surrogate for ground air quality in metropolitan South Africa.

Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa: study protocol for a randomized controlled trial.

BackgroundMaternal depression carries a major public health burden for mothers and their infants, yet there is a substantial treatment gap for this condition in low-resourced regions such as sub-Saharan Africa. To address this treatment gap, the strategy of “task sharing” has been proposed, involving the delivery of interventions by non-specialist health workers trained and supervised by specialists in routine healthcare delivery systems. Several psychological interventions have shown benefit in treating maternal depression, but few have been rigorously evaluated using a task sharing approach. The proposed trial will be the first randomised controlled trial (RCT) evaluating a task sharing model of delivering care for women with maternal depression in sub-Saharan Africa. The objective of this RCT is to determine the effectiveness and cost-effectiveness of a task sharing counseling intervention for maternal depression in South Africa.Methods/DesignThe study is an individual-level two-arm RCT. A total of 420 depressed pregnant women will be recruited from two ante-natal clinics in a low-income township area of Cape Town, using the Edinburgh Postnatal Depression Scale to screen for depression; 210 women will be randomly allocated to each of the intervention and control arms. The intervention group will be given six sessions of basic counseling over a period of 3 to 4 months, provided by trained community health workers (CHW)s. The control group will receive three monthly phone calls from a CHW trained to conduct phone calls but not basic counseling. The primary outcome measure is the 17-Item Hamilton Depression Rating Scale (HDRS-17). The outcome measures will be applied at the baseline assessment, and at three follow-up points: 1 month before delivery, and 3 and 12 months after delivery. The primary analysis will be by intention-to-treat and secondary analyses will be on a per protocol population. The primary outcome measure will be analyzed using linear regression adjusting for baseline symptom severity measured using the HDRS-17.DiscussionThe findings of this trial can provide policy makers with evidence regarding the effectiveness and cost-effectiveness of structured psychological interventions for maternal depression delivered by appropriately trained and supervised non-specialist CHWs in sub-Saharan Africa.Trial registrationClinical Trials (ClinicalTrials.gov): NCT01977326, registered on 24/10/2013; Pan African Clinical Trials Registry (http://www.pactr.org): PACTR201403000676264, registered on 11/10/2013.

A qualitative analysis of factors influencing HPV vaccine uptake in Soweto, South Africa among adolescents and their caregivers.

BackgroundIn South Africa, the prevalence of oncogenic Human Papillomavirus (HPV) may be as high as 64%, and cervical cancer is the leading cause of cancer-related death among women. The development of efficacious prophylactic vaccines has provided an opportunity for primary prevention. Given the importance of psycho-social forces in vaccine uptake, we sought to elucidate factors influencing HPV vaccination among a sample of low-income South African adolescents receiving the vaccine for the first time in Soweto.MethodsThe HPV vaccine was introduced to adolescents in low-income townships throughout South Africa as part of a nationwide trial to understand adolescent involvement in future vaccine research targeting human immunodeficiency virus (HIV). We performed in-depth semi-structured interviews with purposively-sampled adolescents and their care providers to understand what forces shaped HPV vaccine uptake. Interviews were recorded, transcribed, translated, and examined using thematic analysis.ResultsOf 224 adolescents recruited, 201 initiated the vaccine; 192 (95.5%) received a second immunization; and 164 (81.6%) completed three doses. In our qualitative study of 39 adolescent-caregiver dyads, we found that factors driving vaccine uptake reflected a socio-cultural backdrop of high HIV endemnicity, sexual violence, poverty, and an abundance of female-headed households. Adolescents exercised a high level of autonomy and often initiated decision-making. Healthcare providers and peers provided support and guidance that was absent at home. The impact of the HIV epidemic on decision-making was substantial, leading participants to mistakenly conflate HPV and HIV.ConclusionsIn a setting of perceived rampant sexual violence and epidemic levels of HIV, adolescents and caregivers sought to decrease harm by seeking a vaccine targeting a sexually transmitted infection (STI). Despite careful consenting, there was confusion regarding the vaccine’s target. Future interventions promoting STI vaccines will need to provide substantial information for participants, particularly adolescents who may exercise a significant level of autonomy in decision-making.

Socio-economic status and self-reported tuberculosis: a multilevel analysis in a low-income township in the Eastern Cape, South Africa.

Few studies have investigated the interplay of multiple factors affecting the prevalence of tuberculosis in developing countries. The compositional and contextual factors that affect health and disease patterns must be fully understood to successfully control tuberculosis. Experience with tuberculosis in South Africa was examined at the household level (overcrowding, a leaky roof, social capital, unemployment, income) and at the neighbourhood level (Gini coefficient of inequality, unemployment rate, headcount poverty rate). A hierarchical random-effects model was used to assess household-level and neighbourhood-level effects on self-reported tuberculosis experience. Every tenth household in each of the 20 Rhini neighbourhoods was selected for inclusion in the sample. Eligible respondents were at least 18 years of age and had been residents of Rhini for at least six months of the previous year. A Kish grid was used to select one respondent from each targeted household, to ensure that all eligible persons in the household stood an equal chance of being included in the survey. We included 1,020 households within 20 neighbourhoods of Rhini, a suburb of Grahamstown in the Eastern Cape, South Africa. About one-third of respondents (n=329; 32%) reported that there had been a tuberculosis case within the household. Analyses revealed that overcrowding (P≤0.05) and roof leakage (P≤0.05) contributed significantly to the probability of a household tuberculosis experience experience, whereas higher social capital (P≤0.01) significantly reduced this probability. Overcrowding, roof leakage and the social environment affected tuberculosis prevalence in this economically disadvantaged community. Policy makers should consider the possible benefits of programs that deal with housing and social environments when addressing the spread of tuberculosis in economically poor districts.

The distribution, abundance and composition of street trees in selected towns of the Eastern Cape, South Africa

Street trees are an important component of the urban forest as they provide critical ecosystem services which contribute to human health and environmental quality. However, little is known about the distribution, diversity and density of street trees, particularly in the developing world where urbanisation is most rapid. Thus, the aim of this paper was to assess the distribution, composition and abundance of street trees across three towns along an environmental gradient in the Eastern Cape of South Africa, and identify the key challenges faced by local officials concerned with the provision of street trees. In each town, streets were randomly sampled in the commercial, affluent residential, township settlement and low cost housing areas under the Reconstruction and Development Program (RDP). Attributes recorded per tree were species, circumference, height and health, while semi-structured interviews were conducted with the municipal officials involved in the establishment and maintenance of street trees. A total of 1,485 trees were encountered, comprising 61 species. The majority (56%) of trees were alien species. Noticeable differences in tree density and species richness were evident across suburbs, being highest in the more affluent suburbs and poorly represented in the low income township and RDP areas. There was a decreasing mean tree height and health score along the environmental gradient from the coastal town to the inland town. Although awareness of the benefits of street trees was high, as was the need to reduce the proportion of alien species, the primary constraint to establishment and maintenance of street trees in the three towns was limited budget and human resources.