Rural South African Community Research Articles

Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site.

.Knowledge and practices of rural South African populations with regard to antibiotic access and use (ABACUS) remain understudied. By using the case of four villages in the north east of the country, our aim was to investigate popular notions and social practices related to antibiotics to inform patient-level social interventions for appropriate antibiotic use. To achieve this, we investigated where community members (village residents) were accessing and sourcing medication, and what they understood antibiotics and antibiotic resistance (ABR) to be. Embedded within the multicountry ABACUS project, this qualitative study uses interviews and focus group discussions. A sample of 60 community members was recruited from the Agincourt Health and Demographic Surveillance System, situated in Mpumalanga Province, from April to August, 2017. We used the five abilities of seek, reach, pay, perceive, and engage in access to healthcare as proposed by Levesque’s “Access to Healthcare” framework. Respondents reported accessing antibiotics prescribed from legal sources: by nurses at the government primary healthcare clinics or by private doctors dispensed by private pharmacists. No account of the illegal purchasing of antibiotics was described. There was a mix of people who finished their prescription according to the instructions and those who did not. Some people kept antibiotics for future episodes of infection. The concept of “ABR” was understood by some community members when translated into related Xitsonga words because of knowledge tuberculosis and HIV/AIDS treatment regimens. Our findings indicate that regulation around the sale of antibiotics is enforced. Safer use of antibiotics and why resistance is necessary to understand need to be instilled. Therefore, context-specific educational campaigns, drawing on people’s understandings of antibiotics and informed by the experiences of other diseases, may be an important and deployable means of promoting the safe use of antibiotics.

Exploring How a Study Abroad and International Service-Learning Project Shaped Preservice Teachers’ Understanding of Humanizing Pedagogy

In an attempt to better prepare future teachers to fight against social injustice, support their culturally and linguistically diverse students and wrestle with social and educational complexities around the globe, many education programs have increased the number of study abroad programs and international service learning projects. In this qualitative study, we explored seven preservice teachers’ experiences related to humanizing pedagogy after participating in a study abroad program combined with an international service-learning project in a South African rural community. Analyzing multiple data sources such as interviews and reflective journals, we discovered that the preservice teachers grappled with the political, social, economic, and educational differences they encountered during the international project and wrestled with conflicting ideas and beliefs about poverty and language. They identified their relationships with students as catalysts to address these educational issues and their need to reverse systemic inequities. They built caring relationships with students in the community and developed additive perspectives the focused on the students’ community cultural capital. The preservice teachers expressed deep critical reflection and a desire to promote a more fully human educational world where students have the opportunities to enact their agency, their creativity, and their language and culture.

Gendered adversity and mental health of adolescents orphaned by AIDS in a rural South African community: An exploratory study

This study explored gender differences in adversity and mental health among South African adolescents orphaned by AIDS. Adolescents (N = 121; females = 45.5%; mean age 14.14 years, SD = 2.09) self-reported their childhood adversities and probable mental ill health on the Child Trauma and General Health Questionnaire. Results revealed that female participants orphaned by AIDS were significantly more likely to report childhood adversity at total score level as compared to male participants. However, both male and female participants reported comparable scores on subscales of childhood adversity (emotional abuse, physical abuse, sexual abuse, and physical neglect). Moreover, female participants displayed higher composite mental ill health and all its subscales except for social dysfunction. Our findings suggest that gender-sensitive programmes and policies to address the effect of childhood adversity and mental ill health among adolescents orphaned by AIDS, are urgently needed.

The association between perceived household educational support and HIV risk in young women in a rural South African community (HPTN 068): A cross sectional study.

ObjectiveTo characterise perceived household support for female education and the associations between educational support and HIV prevalence, HSV-2 prevalence and sexual risk behaviours.MethodsThis cross-sectional study used baseline survey data from the Swa Koteka HPTN 068 trial undertaken in Mpumalanga, South Africa. The study included 2533 young women aged 13–20, in grades 8–11 at baseline. HIV and HSV-2 status were determined at baseline. Information about patterns of sexual behaviour and household support for education was collected during the baseline survey. Linear regression and binary logistic regression were used to determine associations between household support for education and both biological and behavioural outcomes.ResultsHigh levels of educational support were reported across all measures. HIV prevalence was 3.2% and HSV-2 prevalence was 4.7%, both increasing significantly with age. Over a quarter (26.6%) of young women reported vaginal sex, with 60% reporting condom use at last sex. The median age of sexual debut was 16 years. Household educational support was not significantly associated with HIV or HSV-2; however, the odds of having had vaginal sex were significantly lower in those who reported greater homework supervision (OR 0.82, 95%CI: 0.72–0.94), those who engaged in regular discussion of school marks with a caregiver (OR 0.82, 95%CI: 0.71–0.95) and when caregivers had greater educational goals for the young woman (OR 0.82, 95%CI: 0.71–0.96). In contrast, greater caregiver disappointment at dropout was significantly associated with reported vaginal sex (OR 1.29, 95%CI: 1.14–1.46).ConclusionYoung women in rural South Africa report experiencing high levels of household educational support. This study suggests that greater household educational support is associated with lower odds of having vaginal sex and engaging in risky sexual behaviour, though not with HIV or HSV-2 prevalence.

Technical Efficiency of African Indigenous Vegetable Production in Vhembe District of Limpopo Province, South Africa

Abstract African indigenous vegetables (AIVs) have long been known in South African rural communities as essential food that is being consumed with starchy staples, and their consumption has increased over the past few decades. There is now a growing interest and awareness of AIVs due to their nutritional benefits and outstanding potential to generate farm incomes. However, several factors are militating against their production along the supply chains of value addition. This study analysed the technical efficiency of AIVs production in Vhembe district of Limpopo province. The data were collected from 114 AIVs farmers through a multi-stage sampling technique. Data analysis was carried out using Stochastic Frontier model via the Cobb-Douglas production function. The results revealed that the average age and years of farming experiences of the farmers were 59.6 and 30.9 years respectively. About 84% of the farmers lacked access to formal credit, while 92% had access to extension services. Elasticity values of land area cultivated, fertiliser, seeds, labour and tractor days in relation to AIV production were 0.4441, 0.1749, 0.1311, 0.2663 and 0.2360 respectively. Furthermore, the results revealed that average technical efficiency in the production of indigenous vegetables was 0.79%. The variables that significantly influenced technical inefficiency were years of schooling, extension services, gender and access to the irrigation system. In conclusion, production of AIV exhibits decreasing returns to scale. However, promotion of AIV production and efficiency requires consideration of gender issues in accessing resources, educational attainments of farmers, access to irrigation services and proper reorientation of the components of agricultural extension services delivery in order to benefit AIV farmers.

The association between perceived household educational support and HIV risk in young women in a rural South African community (HPTN 068): A cross sectional study

The association between perceived household educational support and HIV risk in young women in a rural South African community (HPTN 068): A cross sectional study

Documentary subjects speak out: Relational empathy and ethics in intercultural documentary film education

The teaching of documentary film faces particular ethical and practical challenges in intercultural environments when working with marginalized groups. The author of the paper was one of the acting teachers for an intercultural group of film students making documentaries on sex workers in rural South African communities in 2015. The paper explores the pedagogical and ethical dimension of the encounters between students and the documentary subjects. It argues for the benefits of creating shared meaning – a third culture – through the fostering of relational empathy between student film-makers and their subjects. The focus of the analysis lies in the emotional reactions of the documentary subjects, observed in community screenings in 2016. Conclusions suggest that the concept of relational empathy can help us understand and develop the teaching of documentary in novel ways. It represents a pedagogical choice that is ethical, as it allows for consent that is truly informed.

Religious beliefs and climate change adaptation: A study of three rural South African communities.

This article argues that religious beliefs significantly influence a community’s understanding and experience of climate change adaptation, indicating the need for an inclusion of such information in climate change adaptation education. Data were collected using the Q-method, whereby recurring statements were identified from semi-structured interviews with participants from three rural communities in the North-West province of South Africa: Ikageng, Ventersdorp and Jouberton. The research found that community members who regard themselves as religious (overall of the Christian faith) fall under two groups: the religious determinists or fatalists, who see climate as a natural process that is governed by God, and religious participants who deny this ‘naturalness’ and acknowledge humans’ impact on the climate.

Community perspectives on tuberculosis care in rural South Africa.

Patient nonadherence to tuberculosis (TB) treatment is an ongoing challenge, particularly since the advent of drug-resistant TB and complications posed by HIV/AIDS. Some solutions may lie in understanding patient and community perspectives about barriers to TB care and treatment adherence. Using a qualitative framework, we explored community perceptions and beliefs about TB and perceived facilitators and barriers to care in a rural South African community affected by TB. We were particularly interested in capturing cross-cutting themes and the "merged voices" of participants. Interviews were conducted in 2013 and 2014 with 43 participants, including home-based care workers, clinic staff, patients living with TB and community members in and around a primary healthcare clinic. The data were analysed using principles of thematic analysis. The study reveals the complex interplay between contextual factors and community understandings of the disease. Cultural beliefs about causality and treatment-seeking paths were often mentioned in conjunction with biomedical views. There was a strong interface between TB and HIV in this community, and knowledge of TB was often confused with HIV. HIV-related stigma has been extended to those living with TB. The impact of poverty on treatment adherence was a particularly important theme. Other themes related to the role of the clinic in the community. Our study highlights the socioeconomic vulnerability of this community and the fragility of existing care systems. The findings reinforce the need for a community-centred approach to TB care that takes cognisance of lifeworld issues. We discuss some implications of this study for practice and policy.

Ethnozoological Survey of Traditional Uses of Temminck’s Ground Pangolin (Smutsia temminckii) in South Africa

Abstract Pangolins are elusive and threatened mammals, considered the most widely traded mammals on Earth supplying local African and Asian traditional medicine markets. African pangolins are sourced as bushmeat and perceived to cure diverse ailments when body parts are used in traditional medicine practices. Currently, there is no documentation on cultural uses of Temminck’s ground pangolin throughout this mammal’s distribution range in South Africa. We interviewed 344 community members from seven indigenous tribal communities in four provinces overlapping with the distribution of Smutsia temminckii in South Africa; only 191 respondents (55.5%) had any knowledge of the species, its cultural and/or medicinal uses. Pangolin is highly sought after and held in high regard where this mammal’s body parts, particularly scales, blood and fat, are utilized traditionally for treating various physical ailments and spiritual remedies in rural South African communities. This utilization undoubtedly has a significant impact on the population of this threatened species.

Are circumcised men safer sex partners? Findings from the HAALSI cohort in rural South Africa.

IntroductionThe real-world association between male circumcision and HIV status has important implications for policy and intervention practice. For instance, women may assume that circumcised men are safer sex partners than non-circumcised men and adjust sexual partnering and behavior according to these beliefs. Voluntary medical male circumcision (VMMC) is highly efficacious in preventing HIV acquisition in men and this biological efficacy should lead to a negative association between circumcision and HIV. However, behavioral factors such as differential selection into circumcision based on current HIV status or factors associated with future HIV status could reverse the association. Here, we examine how HIV prevalence differs by circumcision status in older adult men in a rural South African community, a non-experimental setting in a time of expanding VMMC access.MethodsWe analyzed data collected from a population-based sample of 2345 men aged 40 years and older in a rural community served by the Agincourt Health and socio-Demographic Surveillance System site in Mpumalanga province, South Africa. We describe circumcision prevalence and estimate the association between circumcision and laboratory-confirmed HIV status with log-binomial regression models.ResultsOne quarter of older men reported circumcision, with slightly more initiation-based circumcisions (56%) than hospital-based circumcisions (44%). Overall, the evidence did not suggest differences in HIV prevalence between circumcised and uncircumcised men; however, those who reported hospital-based circumcision were more likely to test HIV-positive [PR (95% CI): 1.28 (1.03, 1.59)] while those who reported initiation-based circumcision were less likely to test HIV-positive [PR (95% CI): 0.68 (0.51, 0.90)]. Effects were attenuated, but not reversed after adjustment for key covariates.ConclusionsMedically circumcised older men in a rural South African community had higher HIV prevalence than uncircumcised men, suggesting that the effect of selection into circumcision may be stronger than the biological efficacy of circumcision in preventing HIV acquisition. The impression given from circumcision policy and dissemination of prior trial findings that those who are circumcised are safer sex partners may be incorrect in this age group and needs to be countered by interventions, such as educational campaigns.

Nutritional Status of perinatally HIVinfected children onantiretroviral therapy from a resourcepoor rural South African community

Objective: In Sub‑Saharan Africa, millions of children are suffering from HIV and coexisting child undernutrition. Despite efforts to curb the spread of HIV through the availability of treatment and various nutritional programmes, it has been argued that undernutrition remains highly prevalent in rural areas. The objective of this study was to describe the prevalence and psychosocial factors influencing the nutritional status in the sample of rural‑based HIV‑infected children on antiretroviral therapy. Materials and Methods: Anthropometric and home environment data were collected from 152 perinatally HIV‑infected children on antiretroviral therapy who lived with their primary caregivers in a rural Eastern Cape community. Results: More than half of the sample of children had inadequate nutritional status. The prevalence of stunting particularly was high (36.2%), while 12% were underweight and only 2.7% presented with wasting. Coexisting poor quality home‑environment (P < 0.01) added to this burden. Younger age children who lived with a younger biological caregiver were found to present more with stunting than older age children (e­™2 [n = 152] = 14.79, P = 0.005), but no significant differences were observed for underweight or wasting. Conclusion: It is important in a context such as South Africa, with the double burden of HIV infection and poverty, that all efforts be directed at alleviating undernutrition. Early pediatric HIV management should not only focus on the provision of treatment but should also prioritize the quality of care of HIV‑positive children in the home to improve on their nutritional health. Key words: HIV/AIDS, nutritional status, pediatrics, resource‑poor setting, stunting, underweight, wasting.

Influences on Exclusive Breastfeeding Among Rural HIV-Infected South African Women: A Cluster Randomized Control Trial.

South African guidelines for prevention-of-mother-to-child-transmission (PMTCT) of HIV emphasize exclusive breastfeeding (EBF). This study examined the impact of a PMTCT intervention and male involvement on EBF. In a two-phase cluster-randomized trial, rural South African community health centers were randomized to offer HIV-infected pregnant women PMTCT standard of care plus either: a behavioral PMTCT intervention, or a time-equivalent attention-control condition. Phase 1 women had non-participating male partners; Phase 2 women had participating partners. Pregnant women (n = 1398) were assessed on HIV stigma, disclosure of HIV status to partner, male involvement, and family planning knowledge. Feeding practices were assessed 6 weeks postpartum (56% retained). Reduced depressive symptomatology predicted EBF 6weeks postpartum, adjusting for attrition (AOR = 0.954, p = 0.001). Neither male involvement in antenatal care, phase, HIV stigma, disclosure, nor family planning knowledge predicted EBF. Future studies and perinatal care should address depression, which has important implications for infant health.

HIV Treatment Substantially Decreases Hospitalization Rates: Evidence From Rural South Africa.

The effect of HIV treatment on hospitalization rates for HIV-infected people has never been established. We quantified this effect in a rural South African community for the period 2009-13. We linked clinical data on HIV treatment start dates for more than 2,000 patients receiving care in the public-sector treatment program with five years of longitudinal data on self-reported hospitalizations from a community-based population cohort of more than 100,000 adults. Hospitalization rates peaked during the first year of treatment and were about five times higher, compared to hospitalization rates after four years on treatment. Earlier treatment initiation could save more than US$300,000 per 1,000 patients over the first four years of HIV treatment, freeing up scarce resources. Future studies on the cost-effectiveness of HIV treatment should include these effects.

Interpreting Food Security Research Findings With Rural South African Communities

INTRODUCTION: The presence of concurrent childhood stunting and adult obesity observed in poor, rural, former homeland communities in South Africa appears to be explained by nutrition transition, but the factors shaping rural food security are still poorly understood. Localized constraints and capabilities are often overlooked by food security policies, strategies and programs. Grounding food security data in local contexts is often a missing step in the diagnosis of food insecurity.AIMS: This qualitative study aimed to engage members of poor rural communities in generating a more grounded, localized understanding of food insecurity.METHOD: Members of South Africa’s poorest rural communities were asked to validate and interpret food production, consumption and nutrition data from a three-year, multidisciplinary food security study, with the aid of graphic presentations to overcome literacy barriers.RESULTS: Interpretations of food security research findings by communities revealed unique local experiences and understandings of food insecurity.CONCLUSION: Engaging people in the joint diagnosis of their food security challenges generates information on the environmental, economic and cultural conditions that shape experiences of hunger and influence nutrition outcomes, which are not always captured by conventional food security analyses. More inclusive and participatory research could support the design of more effective food security interventions in marginalized rural communities.

The development of a family resilience-strengthening programme for families in a South African rural community.

The aim of this study was to develop a contextually based family resilience program. Also presented here is a literature review of family resilience interventions suggesting that these 3 processes are the basis for effective family functioning. A close collaboration with the community ensured an adequate understanding of the presenting family challenges and this article describes the process in developing a program based on these challenges. A 3-round Delphi design was used for the study with international and local experts (n=10) in the field of family and resilience studies and community stakeholders (n=5). The program has three main aims: to increase family connectedness, family communication processes and social and economic resources. Based on the findings of this study, 4 modules will be presented to participants, "about family," "talking together," "close together," and "working together." A description is provided of the program content and decisions regarding logistical program concerns.

Understanding Goal Motivations in Deprived Contexts: Perspectives of Adults in Two Rural South African Communities

The aim of the present study was to explore and describe the goals and motivations underlying them for adults living in rural African contexts using an inductive approach. Seventy participants (n = 25 males, n = 45 females) between 43 and 89 years (mean age 60.85 years) were selected from a total of N = 537 residing in the rural Ganyesa and Tlakgameng communities in South Africa. Participants were asked to indicate the three most important goals in their present lives and then provide reasons why each of these goals was important to them. Themes emerging from the data analysis referred to financial security, meeting social needs, environmental considerations, generative caring, and relational goals. Goal motivations were not mere intrinsic processes aimed at personal need satisfaction, but had a strong interdependent focus embedded in existing relational ties. Based on the findings we conceptualise an integration of key constructs found in diverse perspectives used in goal research and emphasise the unique role of contextual factors in the understanding of goals and motivations underlying them. These findings highlight important considerations in the enhancement of the quality of life of rural residents of Ganyesa and Tlakgameng.

Evidence for sample selection effect and Hawthorne effect in behavioural HIV prevention trial among young women in a rural South African community

ObjectivesWe examined the potential influence of both sample selection effects and Hawthorne effects in the behavioural HIV Prevention Trial Network 068 study, designed to examine whether cash transfers conditional on...

Understanding the role played by parents, culture and the school curriculum in socializing young women on sexual health issues in rural South African communities

Background: the decline in South Africa’s HIV infection rates especially among young women is encouraging. However, studies show that the 15–24-year-old cohort remains vulnerable. As they still report early sexual debut, being involved in sexual partnerships with older men as well as having unprotected sex. These risky sexual behaviors may be linked to factors such as the parent–child sexual health communication and the timing of the first talk. The quality of sexual health information received in school may also be important for enhancing healthier sexual behaviors. Aims and Objectives: to investigate the what, when and how sexual health communication occurs in rural South African families and to determine whether such communication patterns have changed over time. We also wanted to get an in-depth understanding of the roles played by culture, sexual health education and peers in the socialization of young women on sexual matters. Methods: a purposive sample of (n = 55) women who were 18–35 years old was selected and interviewed in focus group discussions (FGDs). Results: the FGD findings show that parent–child communication on sexual matters in rural communities is limited to messages that warn against pregnancy. It is also laden with cultural idioms that are not well explained. The school sexual health curriculum also fails to adequately equip adolescents to make informed decisions regarding sexual matters. All this seems to leave room for reception of misguided information from peers. Conclusions: findings highlight a need for designing interventions that can create awareness for parents on the current developmental needs and sexual behavior of adolescents. For adolescents programs would need to focus on providing skills on personal responsibility, and how to change behavior to enhance sexual health.

Motivational Interviewing for Poorly Controlled Type 2 Diabetics in a Rural South African Community

Difficulty adhering to lifestyle changes required for effective management is rife among patients with Type 2 Diabetes Mellitus (T2DM). Motivational interviewing may prove a useful tool for healthcare providers when supporting patients. Thirteen poorly controlled T2DM patients, 11 females and 2 males, took part in the study. A qualitative design with semi-structured interviews was used and the data was analysed by means of thematic analysis. Themes explored included Stumbling blocks to change, awareness of difficulties, making changes, and the role of motivational interviewing. Motivational Interviewing was received positively and provided useful information, which will help to understand the needs of the diabetic in a rural community as well as suggest recommendations for improving future clinic care.