Rural South Africans Research Articles

Intensity of care and the health status of caregivers to elderly rural South Africans.

Informal caregivers play an indispensable role in and are often the sole source of care for older adults in low and middle-income settings worldwide. Intensive informal care predicts mortality and morbidity among caregivers in higher-income settings. However, there is limited evidence from poorer settings, including Africa countries, where caregiving is shared widely, including across generations. We therefore investigated caregivers' health status in rural South Africa. We conducted quantitative interviews with all household members and all non-household caregivers aged ≥12 (n=1012) of 106 older adults in rural Mpumalanga, South Africa. We used multivariable regression with care-recipient random intercepts to assess the relationships between four caregiving characteristics and both self-reported chronic conditions and self-reported health status, considering how caregiver age moderated each association. Over half of all caregivers reported at least one chronic health condition, despite half being aged under 40. Caregivers self-reporting the worst health status provided high hours of care. However, caregivers' health status was not significantly associated with weekly care quantity or history of caring. Those aged ≥40 who reported being a main caregiver had 52% increased odds of reporting poorer health compared to other same-aged carers (95% confidence interval: 0.99, 2.35), while having more chronic conditions was associated with being expected to act as a sole caregiver more often among caregivers aged ≤39. Greater caring responsibilities for older adults were not consistently associated with caregivers' health in a setting where poor health is common, and caregiving is spread widely. Longitudinal data is necessary to unpack possible explanations of these findings, and to determine whether intensive caregiving speeds downward health trajectories for carers.

Pathologies of representation: Lungisile Ntsebeza on the political misrepresentation of rural South Africans

Lungisile Ntsebeza’s empirical work on rule and resistance in South Africa’s countryside has a subterranean philosophical seam. Implicit in both his historical studies and his contemporary fieldwork-based studies of rural conflict is a philosophical question: what constitutes adequate political representation? Ntsebeza’s work, exemplifying engaged scholarship, is rich in evaluative insights. But the conception of democracy which is his explicit evaluative yardstick is both too narrow and too indeterminate. It leaves no space for the crucial work of representation carried out by unelected non-governmental organisations and local organisations; and we are given no concrete detail about how participatory and representative democracy are to be integrated, as Ntsebeza insists they should be. Showing that his writings can be brought into conversation with approaches to political representation in contemporary political philosophy, this article argues that Ntsebeza’s evaluative work is most helpfully understood as identifying and diagnosing several pathologies of representation. Normative theory is often most constructive when it articulates distinctive types of system failure, rather than simply stating ideals. Each of the pathologies of representation recoverable from Ntsebeza’s analytical work is a recurring way in which rural South Africans have been politically misrepresented or otherwise inadequately represented – a type of flaw which all systems of representation must guard against.

Prevalence and associated risk factors for elevated blood pressure in young adults in South Africa.

Sub-Saharan Africa has been shown to have a high prevalence of hypertension (58% in rural black South Africans) with an accelerated course ending in end-stage renal disease. We sought to determine whether the prevalence of elevated blood pressure (EBP) in early adulthood was associated with any risk factors and/or renal target-organ damage in young adulthood, which could prevent development of these cardiorenal sequelae. Data including risk factors for hypertension and markers of kidney damage were collected from young adults (n = 933; age 28 years; 52% female) participating in the Birth to Twenty Plus (BT20) cohort in Soweto, South Africa. Blood pressure was measured on one occasion. Fifty-four per cent of the study sample had EBP with more men affected (62%) than women (47%) (p < 0.001). Body mass index (BMI), hyperuricaemia and albuminuria had significant associations with EBP in men. In women, BMI, hyperuricaemia and a self-reported history of gestational hypertension had significant associations. Our findings suggest that the pathophysiology of EBP in young adults differs between the genders and highlights a number of modifiable factors in its development.

Mental health, lifestyle factors and subsequent falls among ageing adults in South Africa

The purpose of this study was to evaluate longitudinal associations between mental health and lifestyle factors with falls among rural South Africans in the Agincourt sub-district in Mpumalanga province. We analysed longitudinal data from two consecutive waves of the Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), comprising 5 059 participants at baseline in 2014/2015 and 4 176 participants at follow-up in 2018/2019. The 2018/2019 survey included data on fall history. The mean age of the participants at baseline was 62.4 years (SD = 13.1 years). The prevalence of subsequent falls was 3.3% and associated with older age, short sleep, persistent depressive symptoms and low hand grip strength. Other fall incident-related factors are sedentary behaviour, functional disability and restless sleep. Those self-reporting physical activity had a lower risk for falls. Fall prevention programmes with rural living and ageing South Africans should target modifiable factors of short sleep, depressive symptoms and sedentary behaviour.

“I’m Getting Life from the Treatment”: Perceptions of Life and Death Among Middle-Aged and Older Medication-Adherent Persons Living with HIV in Rural South Africa

ABSTRACT The widespread availability of health information and treatment for HIV in Southern Africa does not reach all populations. Few programs and materials are developed with middle-aged and older rural individuals living with HIV as the target audience, despite this being a growing population. This vacuum inevitably exacerbates the disjuncture between clinical and experiential knowledge. This study uses in-depth interviews from 2018 with middle-aged and older rural South Africans who self-report medication adherence to ART in order to explore experiences of living with HIV and beliefs about anti-retroviral treatment (ART). Participants revealed a general sense of vulnerability as a major motivation for HIV medication adherence. A majority of the participants believed that death was imminent if they defaulted on ART at any point in time. Although the availability of ART brought hope to many, HIV was still perceived as a death sentence, particularly if ART adherence was imperfect. The study findings suggest a need to examine the psychosocial component of community programs for middle-aged and older people living with HIV. For this growing population that experienced the full course of the epidemic, more research is needed on the burden of psychological and mental health issues emerging from the need for long-term HIV medication adherence.

Determination and Isolation of Valuable Bioactive Compound (lupeol) from Portulacaria afra Jacq.

Portulacaria afra is a small succulent tree, previously belonging to the Portulacaceae family, but with further studies, the plant transferred to the Didieracea family. P. afra was used as an ornamental, vegetable, and ethnomedicinal plant. Uses of the plant by rural South Africans to treat chronic skin conditions and rashes, alleviate exhaustion, and aid in treating TB and diarrhea have been documented in folklore. According to pharmaceutical research, plant extracts off er a wide range of remedial outcomes, such as antidiabetic, antifungal, antibacterial, anticancer, antioxidant, and anti-infl ammatory. The study aims to determine some bioactive constituents responsible for pharmacological activities and traditional usefulness. Thinlayer chromatography (TLC) is used for detecting lupeol by specifi c reagents; a p-anisaldehyde sulfuric acid reagent and 10% methanolic sulfuric acid. And high-performance liquid chromatography was used to detect pentacyclic triterpenoids (lupeol) in the n-hexane. The lupeol was isolated by preparative layer chromatography (PLC). Testing the effi cacy of the separation method, the isolated compounds have been identifi ed and characterized by diff erent chromatographic and chemical analyses (TLC, ATR-FTIR, LC-CMS-APCI+, and 1H-NMR).

Values of COVID-19 Self-Testing among Urban and Rural South Africans: A Cross-Sectional Survey

Self-testing for COVID-19 may be a preferable strategy for identifying SARS-CoV-2 infection among populations in low- and middle-income settings. To determine South Africans’ values related to COVID-19 self-testing should it become widely available, a cross-sectional survey was administered in Durban, KwaZulu-Natal Province and the King Sabata Dalindyebo sub-district of the Eastern Cape.A 35-question survey was administered to 531 participants (268 female) in one urban and one rural setting of South Africa. Survey participants were randomly selected by household in the rural setting, while in the urban setting participants were approached in randomly selected public places. The survey assessed participants’ likelihood of using and willingness to pay for a COVID-19 self-test and actions they would take following a COVID-19 self-test. The results were analysed using descriptive statistics and bivariate and multivariate regression.Overall, 93.03% of participants supported COVID-19 self-testing, 61.62% of participants were willing to pay for self-testing, and 90.15% indicated they would communicate their results if they tested positive. Rural participants were more positively associated with each of these outcomes compared with urban-based participants. Should they test positive, most participants said they would: go in-person to a health facility for counselling (76.45%), self-isolate (95.85%), notify close contacts (97.74%), and inform their employer (95.14%).COVID-19 self-testing was a preferable option for most participants, although this varied with setting and demographic characteristics. Self-testing may overcome barriers to care for South Africans, but to achieve this, policies for self-testing and delivery methods must not exacerbate individuals’ underlying economic vulnerabilities.

Mental distress and incident functional disability among a rural ageing population in South Africa.

The aim of the study was to investigate the association between mental symptoms and incident functional disability among middle-age and older adults in South Africa. Longitudinal data from two consecutive population surveys (2014/2015-2018/2019) in Agincourt, South Africa, were analysed. In total, 298 of 3813 participants without functional disability in wave 1 (8.8%) had functional disability in wave 2. The prevalence of baseline functional disability was 9.1%. In the fully adjusted models for people without functional disability at baseline, depressive symptoms (AOR: 1.74, 95% CI: 1.08-2.80) among men and lower life satisfaction among men (AOR: 0.86, 95% CI: 0.80-0.93) and among women (AOR: 0.90, 95% CI: 0.83-0.98) increased the odds of incident functional disability. Posttraumatic stress disorder symptoms, poor sleep quality, restless sleep, and loneliness were not significantly associated with incident functional disability. Depressive symptoms among men and lower life satisfaction among both sexes were independently associated with incident functional disability in ageing rural South Africans.

Chemical Characterization and Nutritional Markers of South African Moringa oleifera Seed Oils.

Moringa oleifera Lam (syn. M. ptreygosperma Gaertn.) leaves are globally acclaimed for their nutritional content and mitigation of malnutrition. In most impoverished rural communities including Limpopo, Mpumalanga and KwaZulu Natal of South Africa, powdered leaves of Moringa oleifera are applied as a nutritional supplement for readily available food such as porridge for malnourished children and even breast-feeding mothers. Widely practiced and admired is also the use of the plant seed in the do-it-yourself purification of water by rural South Africans. This study aimed at identifying the chemical and nutritional marker compounds present in South African Moringa oleifera seed oils using high resolution 1-2-dimension gas chromatography in order to give scientific validation to its uses in cosmetics and particularly in culinary practices. Results obtained from two-dimension tandem mass spectrometry chemical signature revealed over 250 compounds, five times more than those reported from one-dimension gas chromatography. Whereas previous reports from gas chromatography-mass spectrometry analysis reported oleic acid (70–78%) as the major compound from oil samples from other countries, M. oleifera seed oil from South Africa is marked by cis-13-octadeaconic acid with 78.62% and 41.9% as the predominant monounsaturated fatty acid in the hexane and dichloromethane extracts respectively. This was followed by cis-vaccenic acid, an isomer of oleic acid at 51% in the acetone extract, 9-octadecanoic acid-(z)-methyl ester at 39.18%, 21.34% and 10.06% in dichloromethane, hexane and acetone extracts respectively. However, a principal component analysis with R2 = 0.98 of the two-dimension tandem mass spectrometry cum chemometric analysis indicated n-hexadecanoic acid, oleic acid, 9-octadecanoic acid-(z)-methyl ester and cis-vaccenic acid with a probability of 0.96, 0.88, 0.80 and 0.79 respectively as the marker compounds that should be used for the quality control of moringa seed oils from South Africa. This study demonstrates that South African Moringa oleifera oils contain C-18 monounsaturated fatty acids similar to oils from Egypt (76.2%), Thailand (71.6%) and Pakistan (78.5%) just to mention but a few. These fatty acids are sunflower and olive oil type-compounds and therefore place moringa seed oil for consideration as a cooking oil amongst its other uses.

Making Sense of Troubled Livelihoods: Gendered Expectations and Poor Health Narratives in Rural South Africa

When men and women cannot attain idealized gendered forms of economic provision and dependence, how do they make sense of this perceived failure? In this article, we posit that poor health narratives serve as a gendered tool to make sense of inadequate livelihoods, even when that inadequacy is attributable to structural conditions. We draw on survey and life-history interview data from middle-aged and older rural South Africans. The survey data show that even after adjusting for biometrically measured health differences, working-age (40–59 years) men report poorer health when they are unemployed, and women (age 40+) and pension-age men (age 60+) report poorer health when they live without household earners. Life-history interviews show parallel patterns: When their economic circumstance is not troubled, individuals regularly minimize health concerns; conversely, when they have a troubled livelihood, individuals draw on poor health to explain it. When women and men cannot perform idealized gendered practices in the family, poor health becomes a tool to reduce the resulting cognitive dissonance. Poor health narratives recast perceived gender failures to an individualized, biological explanation. Our study illustrates how the epidemiological context can be a resource that forestalls a redefinition of gender norms when the gender order is in crisis.

Lifestyle factors, mental health, and incident and persistent intrusive pain among ageing adults in South Africa.

The purpose of this study was to evaluate longitudinal associations with incident and persistent intrusive pain among rural South Africans. Longitudinal data from two consecutive waves in 2014/2015 and 2018/2019 in Agincourt, South Africa, were analysed. Pain was assessed with the Brief Pain Inventory. In all, 683 adults of 3,628 participants without intrusive pain in Wave 1 (19.1%) had incident intrusive pain in Wave 2, 94 adults of 254 participants who had intrusive pain in Wave 1 (38.3%) had intrusive pain at both Wave 1 and 2 (persistent intrusive pain). Furthermore, 358 (7.2%) participants had intrusive pain at baseline. In the fully adjusted model for people without intrusive pain at baseline, the study found that obesity (AOR: 1.31, 95% CI: 1.05-1.63), depressive symptoms (AOR: 1.67, 95% CI: 1.34-2.08), PTSD (AOR: 1.71, 95% CI: 1.19-2.45), and poor sleep quality (AOR: 1.30, 95% CI: 1.04-1.62) were positively associated with incident intrusive pain. Older age was positively, and male sex and daily alcohol use were negatively associated with incident intrusive pain. Furthermore, in the final adjusted logistic regression model, this study found that older age was positively, and underweight, overweight, and high sedentary behavior were negatively associated with persistent intrusive pain. Several modifiable risk factors for incident and/or persistent intrusive pain were identified.

Marital experiences and depressive symptoms among older adults in rural South Africa

This paper advances the understanding of how marital transitions may influence mental health by investigating these associations among a population of rural, Black South Africans aged 40+ that was directly impacted by apartheid. Using two waves of data from 4,176 men and women in Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we investigated associations between marital experiences and depressive symptoms, by gender, and explored whether economic resources is a moderator of these associations. We found that experiencing a marital dissolution was associated with more depressive symptoms than remaining married for both men and women. We also found that men, but not women, report greater depressive symptoms if they remained separated/divorced, remained widowed, or remained never married between waves. We found no evidence that a decline in wealth moderated the impact of marital dissolution on depressive symptoms for women or men. These findings suggest that the documented benefits of marriage for mental health, and differences by gender in those benefits, may extend to older, rural South Africans, despite the unique experiences of this population.

Hand grip strength and depression among rural older South Africans.

The study aimed to assess the relationship between hand grip strength (HGS) and depressive symptoms among ageing women and men in a longitudinal study in rural South Africa. We analyzed longitudinal data from two consecutive population-based surveys in Agincourt, South Africa, 2014/2015-2018/2019. Results indicate that in all, 835 adults of 3268 participants without depression in Wave 1 (25.0 percent) had incident depression in Wave 2, and 184 adults of 3866 participants who had depression in Wave 1 (4.8 percent) screened positive for depression at both Wave 1 and 2 (persistent depression). The prevalence of weak HGS was 51.5 percent at baseline. In the fully adjusted model, weak HGS increased the odds of incident depressive symptoms between both sexes (AOR: 1.24, 95 percent CI: 1.04-1.47) among women (AOR: 1.33, 95 percent CI: 1.05-1.68), but not among men. No models among both sexes, among men and women, showed an increased odds of weak HGS with persistent depressive symptoms. Weak HGS was independently associated with the incident, but not persistent depressive symptoms between the two sexes and between women but not between men.

Evaluation of South African Equisetum arvense as an Antidiabetic, Antioxidant and Immune Booster using Economical Thin Layer Chromatography Bio-autography

Introduction: Equisetum arvense (E. arvense) is an herbal medicinal plant that is mostly found in Limpopo and the North West Provinces of South Africa. Traditionally, the infusions and decoction of this plant are used in the management of type 2 diabetes, compromised immune system and oxidative stress related disorders. We investigated E. arvense in an attempt to authenticate its traditional use by cost-effective thin layer chromatography. Methods: The anti-diabetic activity was assayed by spraying a developed TLC plate with a buffered β-glucosidase enzyme and bovin solution and incubating at 36.9°C for 20 mins. A freshly prepared solution of 2-naphthyl-β-D-glucopyranoside and fast blue salt (1:4 v/v) was used for detecting inhibitory activity of the enzyme by the plant extract. Immune boosting potentials were evaluated by analysing for the presence or absence of β-sitosterol, a known immune booster in the 3 extracts (chloroform, ethanol, and water) and enriched fractions E and F. The antioxidant activity was investigated using 2,2-Diphenyl-1-Picryl-Hydrazyl (DPPH), H2O2 solution free radical scavenging as well as the reducing power of iron (+3) to (+2) by the extracts and enriched fractions. Standards and positive controls were used for the respective assays conducted. Results: Results obtained indicated the potentials of E. arvense extracts and enriched fractions as antidiabetic (inhibits β-glucosidase implicated in type 2 diabetes), immune boosting (presence of β-sitosterol) and antioxidant (IC50 values of 5.48 ± 0.13 - 12.38 ± 0.09 for FRAP, 12.00 ± 0.02 – 14.01 ± 0.23 for DPPH and 18.07 ± 0.06 - 62.01 ± 0.18 for H2O2) assays. The quantified amount of β-sitosterol and the antidiabetic compound in the plant ethanol extract were determined as 323.85 ng/mg and 130.04 mg/ml or 1.3 x 1011 ng/ml respectively. Conclusions: This study has preliminarily authenticated the traditional uses of E. arvense by rural South Africans.

The association between an energy-adjusted dietary inflammatory index and inflammation in rural and urban Black South Africans.

To quantify the inflammatory potential of the diet of rural and urban Black South Africans using an adapted energy-adjusted dietary inflammatory index (AE-DII) and to investigate its relationship with inflammatory and cardio-metabolic disease risk markers. Dietary inflammatory potential has not been investigated in African populations. Cross-sectional investigation. Rural and urban sites in the North West province of South Africa. 1885 randomly selected, apparently healthy Black South Africans older than 30 years. AE-DII scores ranged from -3·71 to +5·08 with a mean of +0·37. AE-DII scores were significantly higher in men (0·47 ± 1·19) than in women (0·32 ± 1·29), and in rural (0·55 ± 1·29) than urban participants (0·21 ± 1·19). Apart from its dietary constituents, AE-DII scores are primarily associated with age, rural-urban status and education. Contrary to the literature, alcohol consumption was positively associated with AE-DII scores. Of the four tested inflammatory and thirteen cardio-metabolic biomarkers, the AE-DII was only significantly negatively associated with albumin and HDL cholesterol, and positively with waist circumference and fasting glucose, upon full adjustment. Rural men consumed the most pro-inflammatory diet, and urban women the least pro-inflammatory diet. The diet of the participants was not overtly pro- or anti-inflammatory and was not associated with measured inflammatory markers. The inflammatory potential of alcohol at different levels of intake requires further research. Understanding dietary inflammatory potential in the context of food insecurity, unhealthy lifestyle practices and lack of dietary variety remains limited.

Exclusion of South African Rural Communities from Digital Communication Podia: A Regulatory Conundrum

This article reports on a study that examined how SA Connect (i.e., the South African broadband policy that was approved in 2013) has sought to integrate rural South Africans into the digital communication podia. The study drew from a major recent study focusing on selected themes as captured in SA Connect. Furthermore, it interrogated the current configurations of the South African telecommunications market and the role of the Independent Communications Authority of South Africa (ICASA) in levelling the playing field within the sector. Located within the terrain of telecommunications policy and regulation, the study interrogated the interplay between mobile operators and ICASA in expediting broadband penetration into rural South Africa. Theoretically, the study was guided by the tenets of the knowledge gap theory as proposed by Philip Tichenor, George Donohue and Clarice Olien in 1970 and the principles of universal access within the context of the broadband ecosystem. The findings showed that an unreconstructed and predisposed skewed urban market as well as the indecisive regulator stance led to failure to reduce the digital divide. Thus, despite relentless attempts to address these challenges at policy level, South African rural areas remain excluded from the digital communication podia, subsequently causing digital inequality. The findings confirmed critical perspectives on digital inclusion which maintain that, the more information is circulated through the new conduits of information technology, the more communities from the low economic stratum of society are excluded from the information society and participation in the digital economy.

Subjective social position and cognitive function in a longitudinal cohort of older, rural South African adults, 2014–2019

BackgroundThe relationship between subjective social position (SSP) and cognitive ageing unclear, especially in low-income settings. We aimed to investigate the relationship between SSP and cognitive function over time among older...

From "Secret" to "Sensitive Issue": Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment.

As HIV shifts from "death sentence" to "chronic condition," disclosure of HIV status to intimate partners and family is a significant component of both prevention and treatment adherence. While disclosure is closely considered in many studies, few examine middle-aged and older persons' (age 40+) perspectives or practices. We trace older rural South Africans' views on HIV disclosure to their partners and family members in a high prevalence community over a period of extensive antiretroviral treatment (ART) rollout. Community focus group discussions (FGD) conducted in 2013 and 2018 show shifts in older persons' thinking about HIV disclosure. Our FGD participants saw fewer negative consequences of disclosure in 2018 than in 2013, and highlighted positive outcomes including building trust (partners) as well as greater support for medication collection and adherence (family). Particularly as the epidemic ages in South Africa and globally, tracing changes in older persons' views on disclosure is an important step in developing messaging that could enhance treatment as prevention and ART adherence.

Livestock production and marketing for small emerging farmers in South Africa and Kenya: comparative lessons

Poor production methods and limited market access are some of the challenges that prevent small African farmers from developing. In cattle farming, poor grazing practices and a lack of vaccination produce poor quality animals. Limited information, poor infrastructure, cultural issues and other factors, lead to low participation levels of these farmers in livestock markets. This study explored the prevalence of these challenges in two geographical locations of two African countries (South Africa and Kenya) with the intention to identify possible cross lessons for developing small rural farmers. Ethnographic and case study methods were used to collect and analyse data in two provinces (one in each country) where cattle farming by small rural farmers is predominant. From the two countries, three cases of distinguishable cattle production and marketing challenges were identified. Firstly, rural South African (SA) small farmers are generally faced with high production and marketing challenges, which prevent them from developing into successful commercial farmers. Secondly, Kenyan small rural farmers face similar production challenges as those faced by their SA counterparts, but perform better at marketing their animals, although they still face a lot of structural marketing issues, with brokers controlling the market to the disadvantage of farmers. Thirdly, the study identified a case of rural Black SA farmers who are being assisted through a research project in the Eastern Cape Province that embraces a more holistic environmental approach to rural development to overcome most production and marketing challenges. Given the successes of the holistic view, this study concludes that the environmental approach presents the best case lessons for replication across SA in developing small African farmers. It is argued that the replication of lessons across SA would require central coordination by a government agency. The national agricultural extension office (one of whose mandates is to work directly with farmers for their development) would be most appropriate for this coordination role.

Grandchild Caregiving and Cognitive Health Among Grandparents in Rural South Africa.

Objectives: We investigate how caregiving for grandchildren is associated with cognitive function among rural South Africans, and whether the association differs by gender. We further investigate whether measures of physical activity or social engagement mediate this association. Methods: Data were from interviews with 3668 Black, South African grandparents in the "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" study, conducted between 2014 and 2015. Results: We find that caregiving grandparents have better cognitive function than non-caregiving grandparents, and this association does not differ by grandparent gender. Although grandchild caregiving is associated with physical activity and social engagement measures, and some of these measures are associated with cognitive function, we do not find conclusive evidence of mediation. Discussion: Providing care for grandchildren may stimulate cognitive function for both grandmothers and grandfathers. Neither physical activity nor social engagement explains the association between caregiving and cognitive function.