South African Department Research Articles

Exploring factors associated with uptake of breast cancer screening among a subset of women in a South African metropolitan area: research to inform public health interventions

Aim Breast cancer represents a significant global health concern and remains a leading cause of cancer-related mortality, particularly among women in developing countries. Despite the South African Department of Health recommending early breast cancer detection to improve overall survival rates and enhance patients’ quality of life, there is lack of awareness among women regarding the importance of regular breast cancer screening and available options. This study investigates the factors associated with breast cancer screening uptake among a subset of women attending public health services in a South African metropolitan area. Methods A cross-sectional survey of adult women attending primary health care services at a community health centre was conducted in February-March 2020. Data on sociodemographics, health beliefs, access to information, and breast cancer screening uptake were subjected to descriptive and logistic regression analyses. Results Out of 252 women, 48.0% were older than 30 years, 69.4% were unemployed, and 56.0% self-reported breast cancer screening non-uptake. After adjusting for other variables, marital status, employment status, home language, and perceived breast cancer screening benefits were significantly associated with breast cancer screening uptake. Married women were twice (AoR: 2.3; CI: 1.19-4.58) as likely to self-report breast cancer screening than their unmarried counterparts. Employed women were almost thrice (AoR: 2.6; CI: 1.41-4.83) as likely to self-report breast cancer screening uptake relative to unemployed women. Women whose home language was Sesotho were almost twice (AoR: 1.9; CI: 1.05-3.43) as likely to self-report breast cancer screening than women reporting other home languages. Self-reported uptake of breast cancer screening was also more likely with every unit increase in perceived benefit scores (AoR: 1.1; CI: 1.02-1.16). Conclusions A significant proportion of women were in the age range where breast cancer screening is typically recommended, with more than half self-reporting breast cancer screening non-uptake. Results highlight the necessity of addressing socioeconomic, cultural and individual perceptions to improve breast cancer screening rates and promote early detection.

Efficacy of continuous employee learning and development in the South African public service between 2014 to 2023 era

Modern technologies have intensified innovations and necessitated changes in public service processes and operations. Continuous employee learning development (CELD) is one means of the molecule-atom that keep employees motivated and sustain competitiveness. The study explored the efficacy of CELD in relation to modern technology in the South African (SA) public service departments between 2014 to 2023 era. Departments are faced with challenge of equipping their employees with adequate professional and technical skills for both the present and the future in order to deliver specific government priorities. Data for the study were gathered utilizing a qualitative semi-structured e-questionnaire. The study sample consisted of 677 human capital development practitioners from national and provincial government departments in SA. The inefficacy CELD and the inadequacy of technological infrastructure and service delivery can be attributed to the failure by executive management and senior managers to invest in CELD to prepare employees for digital world. It is recommended that departments should use Ruggles’s knowledge management, Kirkpatrick’s training, and Becker and Schultz’s human capital models as sound measurement tools in order to gain a true return on investment. The study adds pragmatic insight into the value of CELD in the new technological environment in public service departments.

Lessons From an Exploratory Qualitative Survey on Simulation Opportunities for Clinical Education in Speech-Language Pathology and Audiology in South Africa

Phenomenon : This study explored experiences of simulation-based clinical education in the Speech-Language Pathology and Audiology professions in South Africa, a Global South context where research on this topic is limited. In this context, the COVID-19 pandemic brought simulation to the forefront of clinical education as a training solution when in-person encounters were impossible. As these simulation-based training approaches gain traction, with continued use post-pandemic, it is important to understand how they are currently being used so that appropriate support can be offered to ensure their efficiency and success in the future. Approach : We distributed a survey to South African university departments offering Speech-Language Pathology and Audiology training, inviting participation from students across years of study and clinical educators. Data were collected between October 2022 and February 2023. Twelve responses were received: three from clinical educators and nine from students. We analyzed the responses using descriptive statistics and a domain summary approach. Findings : Simulated activities were implemented as options for clinical education in South African Speech-Language Pathology and Audiology (SLP/A) programs during the pandemic, albeit in a somewhat haphazard way depending on available resources, often with limited preparation or guidance. Some universities have continued using aspects of simulation training post-pandemic. Insights : Our findings, although preliminary, are somewhat consistent with Global North literature, particularly regarding barriers and challenges to implementing these approaches in clinical education. We offer suggestions for enhancing the support of simulation-based clinical education in our context.

Feasibility of Provision and Vaccine Hesitancy at a Central Hospital COVID-19 Vaccination Site in South Africa after Four Waves of the Pandemic.

As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic. Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments. To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital. Mixed-methods study using quantitative and qualitative methods. Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% (n = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters. This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient-clinician engagement about the benefits of vaccination is essential to reach highly vulnerable populations routinely attending hospital outpatient departments with an appropriate vaccination program.

Writing against the chain transmission of fear: Reflections on institutionalised ethics

As a master's student investigating curricular decolonisation at South African tertiary music departments, I found myself in a chain of fear driven by previous contestations of similar critical projects. Despite stringently following the institutional ethics requirements, ethical concerns regarding the critical content of my work were still raised, perpetuating this fear. In this article, I discuss my concerns that the issues raised stemmed from an environment in which moral knowledge has become codified in a template for ethical research. I consider the problems that occur when ethical procedures such as anonymity, protecting ‘vulnerable’ interviewees and member checking become mere tick-boxes on a template for ethical research, as well as how such templates can become a method of imbuing fear into the researcher. In conclusion, I propose the development of an ethical praxis premised on an ethics of care that enables, rather than stymies, critical research.

Examining the Learning Style Preferences of Offenders at the Johannesburg Female Correctional Centre, South Africa

This study examined the learning style preferences of offenders at the Johannesburg Female Correctional Centre, South Africa. Followed a quantitative approach and used cross-sectional survey design. Enu-meration sampling technique was applied due to small size of the pop-ulation (n = 571). Data were collected from 402 participants, yielding to response rate of 70.40%. A Kolb Learning Style Questionnaire was used to collect data. Kolb ‘s instrument can assess learning styles and provide a valuable framework for the design and management of learn-ing activities. The results show that many offenders strongly prefer di-verging/reflector learning style. This learning style influence the of-fenders’ learning experiences to a great extent. It is recommended that the South African Department of Correctional Services should consider providing customised training programmes to build the capacity of teachers/facilitators/learning designers so that they are able to ac-commodate the diverse learning styles of offenders during the classes and/or rehabilitation programmes.

Occupational therapy practice with burn injuries: A Rapid Review

Introduction: The Occupational Therapy Association of South African commissioned a task team to gather evidence that would inform upcoming National Health policies on the role and practice of occupational therapists. This rapid review aimed to identify level 1 and 2 peer reviewed published evidence that describes occupational therapists’ practice and intervention in all types of burn injuries, at all levels of care, and for all age groups.
 Method: Using the South African Department of Health template and the Cochran Rapid Reviews method guide, a search for level 1 and 2 evidence sourced articles from CINAHL (EBSCO), MEDLINE (EBSCO), the Cochrane Library (Wiley) and OTSeeker data bases through the Stellenbosch University library with hand searching of references in the selected articles. Rayyan was used for the screening and selection of articles. The CASP appraisal tool was used for risk bias and quality assessment of the selected articles. Data was captured in Excel and Word, and analysed and synthesised in Microsoft Excel and Taguette. Results were presented in the form of an online workshop to stakeholders and discussions and questions incorporated into the discussion and conclusion of this review.
 Results: Eleven articles were selected and their quality assessed. Seven categories of evidence of occupational therapy interventions were extracted from selected articles: pain, oedema, scaring and abnormal skin sensations, joints and range of motion, psycho-social and functional impact of burn injuries, the education of burn injury victims and their families, and vocational rehabilitation. All interventions took place in healthcare facilities. Nine articles referred to occupational therapists working in multi-disciplinary teams. Occupational therapist worked with children and adult burn injury victims and with a variety of type of burn injury from acute to post discharge phases.
 Conclusion: There is level 1 and 2 evidence conderming occupational therapy intervention with burn injury victims with all ages and at all stages of injury within healthcare facilities. None of the evidence found is from the South African context. Such levels of evidence are needed to promote occupational therapy intervention in primary, preventative and community contexts.
 Implications for practice:
 Internationally there is level 1 and 2 evidence that conderms occupational therapists are members of multi-disciplinary teams addressing the functional ability and participation in activities of burn injury victims. None of this evidence is from South Africa. As a matter of priority, South African clinical occupational therapy practice and intervention within the deeld of burn injury, need to be researched and disseminated as level 1 and 2 evidence

Importance of Utilizing Non-Communicable Disease Screening Tools; Ward-Based Community Health Care Workers of South Africa Explain.

The screening of patients in the community is important and is a commonly used indicator to detect, prevent, and treat abnormal health changes. As such, the South African Department of Health following the initiative of the World Health Organization has appointed ward-based community health care workers through a primary health care reengineering program. The main objective of their appointment was to screen household members to reduce the burden of diseases such as diabetes mellitus and hypertension. As such, the study investigated the importance of using non-communicable disease screening tools by ward-based community health care workers in South Africa. A qualitative, exploratory, and descriptive design was used. A non-probability purposive sampling method was used to select forty participants from primary health care facilities. Four focus group discussions were held with ten participants in each group. Semi-structured focus group discussions were held with participants in their workplaces. Content data analysis was applied to come up with one theme and six subthemes. The study findings revealed that the use of screening tools facilitated comprehensive household assessments, helped identify risk factors and symptoms, and facilitated health education and patient referrals. The continuous supply of screening tools and updates on their use was recommended to reduce the rate and burden caused by non-communicable diseases to society at large.

Reporting and presentation of statistical analyses: instructions for authors of health sciences journals based in South Africa

Background: Statistical analyses are a key component of quantitative research in health sciences. Objectives: To review the instructions for authors on reporting and presentation of statistical methods by all health sciences journals based in South Africa. Methods: Health sciences journals based in South Africa that publish original quanti-tative research articles were identified using three sources, namely the list of accred-ited South African journals compiled by the South African Department of Higher Education and Training in 2022, relevant journals covered in Scopus, and web pages of major health sciences publishers in South Africa. The list was cross-checked against the listing of journals in Sabinet, an online database covering South Africa, under the category ‘Collection: Medicine and Health’. The instructions for authors given by the journals were accessed through their websites. The form for recording data was based on items listed in the ‘Statistical Analyses and Methods in the Published Literature’ (SAMPL) guidelines. Results: All except one of the 52 journals could be located online. Of the 51, 13 (25%) made no mention of statistics in their instructions, and 11 (22%) made only a gen-eral statement regarding statistical content with no further guidance. The statistical item most frequently mentioned was the P value (45% of journals), whereas the rest of the items appeared in the instructions of 20% or fewer journals. Nine journals (18%) referred to the EQUATOR guidelines, mainly CONSORT (10%). Conclusion: Nearly half of the health sciences journals based in South Africa either did not mention statistics at all in their instructions for authors or made only a cur-sory reference to statistics. The study thus emphasizes that these journals, in their instructions for authors, need to cover in greater detail the reporting and presenta-tion of statistical methods in articles reporting quantitative research.

Comparison and analysis research on occupational exposure limits of coal dust between China and foreign countries

Objective: To study and compare the occupational exposure limits (OELs) of coal dust between China and foreign countries, understand the OEL of coal dust in China, and provide data and basis for revising the OEL of coal dust in China. Methods: In August 2023, by searching the official websites of limits setting institutions in relevant countries and regions at home and abroad, collecting and sorting out the OELs of coal dust issued by 10 limit setting institutions in 6 countries and the background information of the formulation, and conducting specific analysis on the classification, limit level and formulation principles of coal dust OEL in each country/institution. Results: In China and Japan, the total dust and respirable dust of coal dust OEL were established respectively, while in other countries, only the time-weighted average concentration (TWA) of respirable coal dust exposure was established. The TWA prescribed by China's Notional Health Commission, the United States Occupational Safety and Health Administration (OSHA) , the United States Mining Safety and Health Administration (MSHA) and the Australian Safety Work Bureau when the SiO(2) content was less than 5% were 5, 2.4, 2 and 3 mg/m(3) respectively. China GBZ 2.1-2019 sets the limit of 2.5 mg/m(3) for respirable coal dust with SiO(2) content less than 10%. The TWA set by the American Conference of Government Industrial Hygienists (ACGIH) and the South African Department of Mines and Energy (DME) for anthracite coal were 0.4 and 0.8 mg/m(3), respectively, and bituminous coal or lignite were 0.9 and 1.8 mg/m(3), respectively. The respirable coal dust TWA set by the National Institute for Occupational Safety and Health (NIOSH) in the United States was 1 mg/m(3), and the TWA set by the New Zealand Work Safety Authority was 3 mg/m(3). Conclusion: At present, the OEL of coal dust in China is at a relatively loose level, and it is suggested to further explore the possibility of revising coal dust OEL.

Institutionalised Xenophobia: African Migrants’ Experiences and Perceptions of Service Delivery at a Selected South African Department of Home Affairs

This study delved into a conceptual analysis of African migrants’ experiences and perceptions of service delivery at a purposely selected Department of Home Affairs and Immigration Services in South Africa. A mixed-methods design comprising a cross-sectional survey and focus group discussions was conducted with black African migrants awaiting service delivery at the Durban Department of Home Affairs. The findings were discussed within the context of the relative deprivation theory. The study unfolds South Africans’ negative perceptions of African immigrants as vectors of insecurity, criminality and economic hardship for the citizenry, as well as a systemic anathema to South Africa’s state sovereignty. It holistically ascribes the phenomenon to an attendant consequence of unlawful racial discrimination emanating from institutionalised xenophobia, a recently emerged concept that this current study has referred to as Afrophobia.

Employee Perceptions: Disjuncture between Goals of Performance Management Systems and Effective Implementation in South Africa

This study sought to investigate employee perceptions of the implementation of the Employee Performance Management Development System in a South African government department. Quantitative and qualitative data were collected from employees in the department in the form of an on-line survey. The primary findings reveal a large gap between the goal of the system and its implementation. The results of the study indicate employees perceive the EPMDS to be an ineffective and inefficient system, largely because supervisors and managers are not implementing it objectively. As a result, employees believe the system is not fairly applied in managing their performance. The study makes a significant contribution by illuminating the misalignment between the intent of the system and its actual implementation. It also points to managerial bias and the focus on punitive action rather than rewarding performance according to goal achievement and developing future performance. A major implication of the results is that the need for a monitoring function as, as required by an EPMDS directive and framework. Employees perceive its implementation to be unfair, marked by bias and punitive measures.

A Retrospective Review of Neglected Tropical Diseases Diagnosed on Histopathological Specimens in the Free State Province, South Africa, 2015-2020.

Neglected tropical diseases (NTDs) are a heterogeneous group of medical conditions that commonly occur in underprivileged populations. NTDs are primarily diagnosed in tropical areas. Although South Africa is not situated in a tropical region, the high poverty rate makes the country susceptible to some NTDs. Limited data are available on the burden of NTDs in the Free State province of South Africa. This study aimed to determine the number of NTDs diagnosed on histopathological specimens in the public sector of the Free State province over a six-year period and to evaluate the patient demographics. A retrospective, descriptive study was performed. All NTDs diagnosed in histopathological specimens from public sector hospitals in the province submitted to the Department of Anatomical Pathology, National Health Laboratory Service, and University of the Free State between 1 January 2015 and 31 December 2020 were included in the study. The demographic information, biopsy site, and referring hospital were noted for each case identified. A total of 72 NTDs were diagnosed. The five most common diagnoses were echinococcosis (n = 33; 45.8%), bilharzia (n = 13; 18.1%), leprosy (n = 9; 12.5%), mycetoma (n = 8; 11.1%), and intestinal worms (n = 5; 6.9%). Ten (30.3%) patients diagnosed with echinococcosis came from the Free State's neighbouring country, Lesotho. Echinococcosis was the most prevalent NTD diagnosed in central South Africa. We recommend that the South African Department of Health add echinococcosis to the principal NTDs of significance in South Africa, alongside soil-transmitted helminths, schistosomiasis, leprosy, and rabies.

Do black women's lives matter? A study of the hidden impact of the barriers to access maternal healthcare for migrant women in South Africa.

Studies on the barriers migrant women face when trying to access healthcare services in South Africa have emphasized economic factors, fear of deportation, lack of documentation, language barriers, xenophobia, and discrimination in society and in healthcare institutions as factors explaining migrants' reluctance to seek healthcare. Our study aims to visualize some of the outcome effects of these barriers by analyzing data on maternal death and comparing the local population and black African migrant women from the South African Development Countries (SADC) living in South Africa. The heightened maternal mortality of black migrant women in South Africa can be associated with the hidden costs of barriers migrants face, including xenophobic attitudes experienced at public healthcare institutions. Our analysis is based on data on reported causes of death (COD) from the South African Department of Home Affairs (DHA). Statistics South Africa (Stats SA) processed the data further and coded the cause of death (COD) according to the WHO classification of disease, ICD10. The dataset is available on the StatsSA website (http://nesstar.statssa.gov.za:8282/webview/) for research and statistical purposes. The entire dataset consists of over 10 million records and about 50 variables of registered deaths that occurred in the country between 1997 and 2018. For our analysis, we have used data from 2002 to 2015, the years for which information on citizenship is reliably included on the death certificate. Corresponding benchmark data, in which nationality is recorded, exists only for a 10% sample from the population and housing census of 2011. Mid-year population estimates (MYPE) also exist but are not disaggregated by nationality. For this reason, certain estimates of death proportions by nationality will be relative and will not correspond to crude death rates. The total number of female deaths recorded from the years 2002 to 2015 in the country was 3740.761. Of these, 99.09% (n = 3,707,003) were deaths of South Africans and 0.91% (n = 33,758) were deaths of SADC women citizens. For maternal mortality, we considered the total number of deaths recorded for women between the ages of 15 and 49 years of age and were 1,530,495 deaths. Of these, deaths due to pregnancy-related causes contributed to approximately 1% of deaths. South African women contributed to 17,228 maternal deaths and SADC women to 467 maternal deaths during the period under study. The odds ratio for this comparison was 2.02. In other words, our findings show the odds of a black migrant woman from a SADC country dying of a maternal death were more than twice that of a South African woman. This result is statistically significant as this odds ratio, 2.02, falls within the 95% confidence interval (1.82-2.22). The study is the first to examine and compare maternal death among two groups of women, women from SADC countries and South Africa, based on Stats SA data available for the years 2002-2015. This analysis allows for a better understanding of the differential impact that social determinants of health have on mortality among black migrant women in South Africa and considers access to healthcare as a determinant of health. As we examined maternal death, we inferred that the heightened mortality among black migrant women in South Africa was associated with various determinants of health, such as xenophobic attitudes of healthcare workers toward foreigners during the study period. The negative attitudes of healthcare workers toward migrants have been reported in the literature and the media. Yet, until now, its long-term impact on the health of the foreign population has not been gaged. While a direct association between the heightened death of migrant populations and xenophobia cannot be established in this study, we hope to offer evidence that supports the need to focus on the heightened vulnerability of black migrant women in South Africa. As we argued here, the heightened maternal mortality among migrant women can be considered hidden barriers in which health inequality and the pervasive effects of xenophobia perpetuate the health disparity of SADC migrants in South Africa.

Implementing the Supervision Framework for the Social Work Profession: Supervisors’ Views and Experiences

This study focused on social work supervision and its impact on the occupational development and service delivery of supervisees, specifically within the South African Department of Social Development (DSD). While previous research has often examined the views and experiences of supervisees and student social workers, the study uniquely explored the perspective of social work supervisors. Utilising the systems theory as a theoretical framework, qualitative research with semi-structured interviews and thematic analysis was employed. The findings revealed significant structural challenges that hindered the alignment of social work supervision with the DSD’s established Supervision Framework. As the scope of the study was limited to the Mahikeng Service Point, North West, South Africa, generalisation is cautioned, necessitating further research in other welfare organisations for a broader understanding.

Editorial

It gives me great pleasure to present this brief introduction to our 2023 issue of JOVACET, now in its sixth year of publication and seeking to increase its footprint with each passing year. To illustrate these endeavours, this year saw JOVACET being accepted on two more platforms: the first is the Directory of Open Access Journals (DOAJ), and, more recently, our journal has joined the Scientific Electronic Library Online (SciELO), an open-access searchable database that is managed in South Africa by the Academy of Science of South Africa (ASSAf ), is funded by the South African Department of Science and Technology (DST), and has the endorsement of the South African Department of Higher Education and Training (DHET; see https://www.scielo.org.za for more information about the broader SciELO initiative). As part of the conditions of the SciELO listing, journals are required to publish individual articles on the platform for online access in advance of the completed journal being published. This was a new challenge for JOVACET, as we had not experimented with this requirement previously, and it meant putting some pressure on our time frames for reviewing and editing (so ably managed by Dr Catherine Robertson) so that at least one article could be published as a stand-alone that would also be included in the full journal for this year. MORE > DOWNLOAD THE FULL EDITORIAL HERE

Utilisation of Maternal Health Services and its Impact on Maternal Mortality Rate: A Case for KwaZulu-Natal, South Africa

Despite several strategies in place in South Africa and globally to prevent maternal mortality and morbidity, maternal deaths remain high, especially in sub-Saharan Africa and lower to middle-income countries. The aim of the study was to identify the challenges that lead to pregnant women’s delays in seeking antenatal care (ANC) early and to find strategies to prevent such delays, contributing to a reduction of maternal deaths in South Africa. The study was conducted in two phases. Phase one analysed data on maternal deaths collected by the District Health Information System (DHIS) of the KwaZulu-Natal Department of Health from all 11 districts over a 10-year period (2009–2019). The data on maternal deaths revealed that there was a very high maternal mortality rate; between 800 and 1 780 per 100 000 live births. This correlated with very low antenatal visits; between 695–895 per 100 000 live births. In phase two, a literature review was conducted using several computer-assisted databases, bibliographies and websites to identify and source current policies. The literature review presents causes of delay in seeking ANC and strategies to prevent maternal deaths. Recommendations were made to consider strengthening education and awareness related to family planning; women empowerment through community health programmes and change in healthcare providers’ behaviours and attitudes; ensuring availability of maternal health resources; and developing strategies to ensure that the ANC services delivered are in line with the South African Department of Health Guidelines.

Effect of COVID-19 on inclusive mathematics education

The COVID-19 pandemic has dramatically changed education all over the world. As part of emergency remote teaching (ERT), the switch to online instruction had several technological, pedagogical and social challenges. Oral hearing impaired (HI) learners experienced difficulties during synchronous online lessons with hearing devices not picking up sounds, disruption to comprehend the lesson, not familiar with the online devices and emotional side-effects (Krishnan et al., 2020). The research question that guided this study is what is the influence of COVID-19 on mathematics teachers’ inclusive practices for oral HI learners? This study followed a case study design and collected data from two high school inclusive mathematics teachers before the pandemic and during ERT. The South African Department of Basic Education’s (DBE, 2011) Guidelines for responding to learner diversity in the classroom through curriculum and assessment policy statements and Whittle, Tiwari, Yan and Williams’ (2020) ERT environment framework’s design step guided the data collection and analysis processes. Data was collected in the form of interviews, observations and document analysis. It was found that teachers should receive adequate training when teaching in an inclusive school focusing on hearing impairments. During ERT the teachers felt teaching became a 24-hour job, the school’s expectations were high and they had strict requirements on the appearances of the videos. They had to produce between 12 and 16 videos per week for asynchronous teaching. Hardly any inclusive practices were implemented during ERT. The HI learners were neglected during the lockdown of schools during the COVID-19 pandemic as the teachers only focussed on making videos and tried to cope with the demands. More research needs to be done to determine how the COVID-19 pandemic, and possible future pandemics, and lack of inclusive practices influence the HI learners’ understanding and progression in mathematics. From that a framework can then be constructed to guide inclusive teachers in possible future pandemics and ERT scenarios.

Potential Toxic-Element Pollution in Surface Water and Its Implications for Aquatic and Human Health: Source–Pathway–Receptor Model

This study focused on assessing the extent of pollution in both flowing and non-flowing surface water within the Matjhabeng mining area of South Africa, with particular emphasis on the substantial impact of gold mine tailings. A comprehensive analysis of physical water-quality attributes, including potentially toxic elements (PTEs), and relevant pollution risk indices was undertaken. To comprehensively elucidate the potential risks to aquatic organisms and human health, a risk assessment framework predicated upon the source–pathway–receptor model was developed. Principal Component Analysis (PCA) was employed as a multivariate statistical tool to discern the potential origins of PTE contamination within the environment. The results substantiate pronounced pollution manifestations within the surface water milieu of the Matjhabeng mining area. Specifically, concentrations of critical PTEs, such as arsenic, cobalt, copper, iron, selenium, and zinc, exhibited transgressions of the regulatory thresholds stipulated by both the South African Department of Water Affairs and Forestry (DWAF) and the Canadian Council of the Ministers of the Environment (CCME). Additionally, concentrations of the aforementioned elements exceeded the stipulated DWAF guidelines for irrigation water usage. Pollution indices, encompassing the Single-Factor Pollution Index and the Nemerow Integrated Pollution Index, discerned moderate contamination stemming from As, while remarkably elevated pollution levels were identified for selenium. PCA elucidated 94.5% of the aggregate variance, revealing cobalt, copper, nickel, and zinc as coalescing within PC1, indicative of a common anthropogenic provenance that is conceivably linked to historical gold mine tailings. PC2 exhibited an aggregation of chromium, iron, and lead, reaffirming this shared anthropogenic etiology. The third PCA component was characterized by selenium, followed by arsenic and magnesium in the fourth. The resultant PTE contamination underscores a profound ecological and public health risk, impacting both the aquatic ecosystems and the local community within the precincts of the Matjhabeng Local Municipality (MLM) area, with consequential amplification of susceptibilities to deleterious health consequences. Urgent and concerted interventions are imperative to ameliorate the emergent decline in surface-water quality within the MLM locale. The adoption of nature-based remediation paradigms holds promise for efficaciously elevating water quality, ameliorating community health, and underpinning the long-term economic viability of the region.

The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey

The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases. We analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution. Of 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis. Although people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabetes. In South Africa, adapting current, widely available HIV care services to integrate non-communicable disease care is of high priority. Fogarty International Center and the National Institutes of Health, the Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, the South African Medical Research Council, the South African Population Research Infrastructure Network, and the Wellcome Trust. For the isiZulu translation of the abstract see Supplementary Materials section.