Rural South African Community Research Articles

Scars of disengagement: perspectives on community leadership and youth engagement in rural South Africa.

Given the emerging global youth disengagement epidemic, anticipated population growth, and the threat of continued rural-urban migration among young adults, recent research has focused on community leadership practice and the factors that influence youth engagement at the local level. Studying these practices and factors can elicit interventions that can improve youth engagement and youth health. This study engaged South African rural community leaders in interviews to collect perceptions and experiences on community leadership and factors that influence youth engagement and their health behaviors. Content analysis was used to analyze the data. Emergent themes are categorized into four domains: conceptualizations of leadership, current youth behaviors, barriers to youth engagement, and youth leadership opportunities and potential solutions. Findings demonstrate a clear grasp of the concept of community leadership among community leaders, and an awareness of the complex interplay of social, economic and environmental factors on youth disengagement and the potential interventions to promote more youth participation.

Alcohol exposure during pregnancy altered childhood developmental trajectories in a rural South African community

This study examined the effects of prenatal alcohol exposure on childhood development trajectories in a rural South African community between 2003 and 2008. We assessed 121 children at 7-12 months (year one) and 5-6 years (year five) using the Griffiths Mental Developmental Scales - Extended Revised, which measures sensorimotor, cognitive and social development, with lower scores indicating developmental delay. We also interviewed their mothers or caregivers. Three groups were identified: 29 with foetal alcohol syndrome (FAS) or partial FAS (pFAS), 57 more who had been exposed to alcohol and 35 controls who had not. The scale's total score was higher in the controls than in the FAS/pFAS group at year one and year five and in the alcohol-exposed group at year five. Many groups' trajectories declined when compared with global norms, but the trajectories in the FAS/pFAS and the alcohol-exposed groups declined more than the controls for eye-hand and performance and total score. Earlier pregnancy recognition in the FAS/pFAS group correlated strongly (r = -0.77) with higher GQ in year five. FAS/pFAS and prenatal alcohol exposure affected the Griffiths scores more than the control group. Efforts are needed to detect pregnancy early and reduce alcohol exposure.

Social Disequilibrium and the Risk of HIV Acquisition: A Multilevel Study in Rural KwaZulu-Natal Province, South Africa.

Few population-based multilevel studies have quantified the risks that social context poses in rural communities with high HIV incidence across South Africa. We investigated the individual, social, and community challenges to HIV acquisition risk in areas with high and low incidence of HIV infection (hotspots/coldspots). The cohort (N = 17,376) included all HIV-negative adults enrolled in a population-based HIV surveillance study from 2004 to 2015 in a rural South African community with large labor migrancy. Multilevel survival models were fitted to examine the social determinants (ie, neighborhood migration intensity), community traits (ie, HIV prevalence), and individual determinants of HIV acquisition risk in identified hotspots/coldspots. The HIV acquisition risk (adjusted hazard ratio [aHR] = 1.05, 95% confidence interval [CI]: 1.01 to 1.09) was greater in hotspots with higher neighborhood migration intensity among men. In women, higher neighborhood migration intensity (aHR = 1.02, 95% CI: 1.01 to 1.02) was associated with a greater HIV acquisition risk, irrespective of whether they lived in hotspot/coldspot communities. HIV acquisition risk was greater in communities with a higher prevalence of HIV in both men (aHR = 1.07, 95% CI: 1.03 to 1.12) and women (aHR = 1.03, 95% CI: 1.01 to 1.05), irrespective of hotspot/coldspot locations. HIV acquisition risk was strongly influenced by gender (ie, young women), behavior (ie, sexual debut, contraception, circumcision), and social determinants. Certain challenges (ie, community disease prevalence) for HIV acquisition risk impacted both sexes, regardless of residence in hotspot/coldspot communities, whereas social determinants (ie, neighborhood migration intensity) were pronounced in hotspots among men. Future intervention scale-up requires addressing the social context that contributes to HIV acquisition risk in rural areas with high migration.

Replication of High Fetal Alcohol Spectrum Disorders Prevalence Rates, Child Characteristics, and Maternal Risk Factors in a Second Sample of Rural Communities in South Africa.

Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 89–129 per 1000 children. Total FASD affect 196–276 per 1000 or 20–28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions.

Library and Information Services in Marginalised and Under-Resourced Communities in South Africa: Ecosystem Services and Their Implications

AbstractDaunting backlogs in terms of the library and information resource-provision in communities remain a stumbling block for all people, particularly youths, to have equitable access to information as a commodity to satisfy their dynamic and diverse ever-evolving information needs. In South Africa, the system of ruling called apartheid, also known as separate development, was officially nullified by the first democratic elections in 1994. All people including those in under-served rural communities need equitable access to information in varied formats for personal growth and development however, in the library and information services (LIS) sector, existing divisions, barriers or boundaries impede diverse users with wide-ranging information needs to fulfil them. User groups of libraries are currently divided along the still-prevailing historical divisions, an example being how university libraries are traditionally intended to cater for the information needs of their students, academics and administrative staff. Despite fulfilling their teaching needs, university libraries are also expected to cater for the research needs of students and academics to fulfil research projects, presenting university libraries as existing solely for teaching and research purposes. The key findings of the study are that most LIS are still distinctly divided with regard to their user-groups and ecosystems, with collaborations and partnerships very minimal in the LIS sector in South Africa. The study concludes that these distinct divisions deny multiple users the opportunity to equitably access information resources to meet their information needs daily. The study recommends that, based on the literature review, a holistic interconnected complex network of libraries working and existing as an ecosystem can be a viable solution to provision of LIS in resource-poor rural South African communities where there is inadequate resource-provision. The study also recommends borderless and seamless access to all libraries to enable multiple and diverse users to satisfy their dynamic and ever-changing information needs.

The development of a community reintegration outcome measure to assess people with stroke living in low socioeconomic areas

Introduction: Aims: The aim of this study was to develop and psychometrically evaluate an interview–administered questionnaire to assess community reintegration for black people with stroke in low socioeconomic rural and urban South African communities. Methods: A sequential mixed methods design was used. A qualitative approach using semi–structured interviews with adults with stroke and/or their caregivers was undertaken to conceptualize and generate community reintegration interview items. Thereafter quantitative methods including the Delphi technique, nominal groups, factor analysis and internal consistency statistics were used to test the validity and reliability of the outcome measure. Results: Thirty–two interviews (13 urban, 19 rural) generated 67 items. These were reduced to 44 categorized under eight domains during three rounds of the Delphi technique and two nominal group meetings. Factor analysis (FA) and internal consistency statistics on the remaining items, resulted in a two part outcome measure, one for a rural and the other an urban community. The internal consistency of both measures was good (alpha coefficient = 0.95). The new outcome measure, the Maleka Stroke Community Reintegration Measure (M–SCRIM) was compared to the Subjective Index of Physical and Social Outcomes to establish construct validity (urban r = 0.88, p lessthan 0.001; rural r = 0.95, p lessthan 0.001). Conclusion: The M–SCRIM is a valid, reliable interview–administered measure to assess community reintegration following stroke for people living in low socioeconomic communities in South Africa. With further refinement it could be validated for use in other developing countries with similar cultures.

The effect of geography and class on livelihoods in South Africa

Development discourse is dotted by calls to reduce poverty and inequality, yet little has been done to determine the factors perpetuating such socio-economic ills. This study investigates the effect of geography and economic class on household livelihoods in the case of selected South African rural communities. A survey was conducted with a total of 164 responses being usable, and data were subjected to analysis of covariance as well as to logistic regression. The results show that the further away a household is to an urban centre, the lower the total per capita income (well-being) and the more likely it depends on transfer income despite literature considering farming to be high value livelihood strategy. Wealth as measured through economic class and livestock show that wealthier families have access to more income generating activities. The results have implications on development policies, favouring spatial economic development strategies that seek rural-urban linkages.

Corporate Social Responsibility Intervention Of One Mining Operator: A Community Development Case In Bojanala District, South Africa

The South African economy constantly experiences work stoppages, is gradually losing its pride and currently experiences decisive anomalous moments underpinning new operational perceptions. Mining organisations seem to be blamed for not doing enough social capital development initiatives, particularly in underdeveloped communities. This study examines in depth the role of a mining company’s involvement in an identifiable community in South Africa’s Bojanala District. Specifically, the study evaluates the steps followed in identifying needs and the usefulness of a mining-project designed to enhance capacity-building opportunities for young South Africans; a sustainable development initiative. Qualitative action research was used in this study to ensure a participatory approach of the data gathering processes to personal and professional transformation. Action research phases were followed in the manner of Maree (2014). The findings suggest that expectations for community development projects are greater in rural and peri-uburban South African communities. It was found that participants had a general inability to read, write, speak, listen and apply the mathematical proficiency that is needed in order to function effectively in an employment environment. The youth unemployment rate in the Bojanala District can be attributed to the gap between their level of education and the employment requirements. The miners are deemed to have a responsibility towards their communities and it is the youth of these same communities that look towards the mines for employment. Mining companies can contribute to education, skills development and training of the youth. If community engagement is taken seriously as a CSR strategic approach, this would enhance positive inter-relations between the mining companies and their communities.

Positive Fatherhood: A Key Synergy for Functional Early Childhood Education in South Africa

AbstractThis paper presents findings from an empirical study of fathers’ involvement in the preschool education of children in one South African rural community. Both the social capital and the bio...

Psychosis and help-seeking behavior in rural KwaZulu Natal: unearthing local insights.

BackgroundGrowing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs). Nevertheless, few LMIC studies have examined individuals with psychosis in non-urban, non-hospital settings. Using the perspective of formal and informal community service providers, we aimed to uncover descriptions of people with psychosis in a rural South African community and illuminate the potential complexities of their help-seeking journeys.MethodsWe conducted a qualitative study of 40 key informant interviews and seven focus groups with stakeholders (traditional leaders, traditional healers, religious leaders, health care nurses, heads of non-governmental organizations, schoolteachers, community caregivers) in a rural Zulu community (Vulindlela). Thematic analysis of the data was performed using the inductive analysis approach.ResultsInterviewees discussed 32 individuals with probable psychosis in their community and provided rich descriptions of their symptoms. A complex picture of help-seeking behavior, primarily involving informal mental health service providers, emerged. Over half of the reported cases had no contact with formal health services in the course of their help-seeking journey; while more than two-thirds never attended a hospital and only 1 in 8 accessed a psychiatric hospital.ConclusionsOur results highlight the important role of informal care providers in LMICs as well as the need for more research on mental illness and local providers in non-hospital contexts. Community stakeholders can contribute to a fuller understanding of these issues, thereby assisting in the creation of appropriate and effective mental health interventions for rural South African communities like Vulindlela.

An in-depth study of the ICT ecosystem in a South African rural community: unveiling expenditure and communication patterns

There is no doubt of the contributions made by mobile phones and mobile network operators in increasing access to communications in rural areas of developing countries. Yet how affordable is this ubiquitous access in such an ICT ecosystem? Using data from two stratified random surveys conducted in a South African rural community, this paper provides a unique in-depth picture of the expenditure and communication patterns of its dwellers. Results show a high access ratio of people using mobile phone services weekly and a high proportion of disposable income dedicated to a very constrained set of mobile phone services. Factors such as mobile phone charging and the extra charges added by airtime resellers contribute to increase the communication costs. This data and its analysis can be used by the following: regulators and government agencies to better design their policy implementations to provide universal service and access; competing industry players to understand the dynamics within rural communities to better target their products; civil society organizations to use it as a case in their efforts to make affordable communications a constitutional right.

HIV and/or AIDS awareness among adolescents in a South African at-risk rural community.

BackgroundThe devastating effects of HIV and/or AIDS are widely documented. Despite ongoing efforts to address the challenges associated with the pandemic, the impact on children orphaned because of the disease, as well as on adolescents, remains problematic. More specifically, orphaned adolescents living in poverty are particularly vulnerable and are often exposed to, for example, emotional and physical abuse and transactional sexual exploitation. Against this background, the importance of informed awareness among adolescents is continually emphasised, yet the outcomes of awareness campaigns require ongoing research.ObjectivesThe main objective of this study was to explore HIV and/or AIDS awareness among adolescents living in a rural community in South Africa, in the Chris Hani District of the Eastern Cape Province. Sixteen adolescents (aged 12–24) who had lost one or both of their parents because of HIV and/or AIDS-related reasons were purposefully selected to participate in the study.MethodFor this qualitative investigation, we implemented a descriptive case study design. Semi-structured individual interviews, observation and field notes were used to collect and document data, and inductive thematic analysis was completed using the software programme Atlas.ti 7.ResultsThe three themes that were identified relate to HIV and/or AIDS awareness, disclosure of parents’ HIV and/or AIDS status and experiences of adolescents surrounding the death of their parents. Adolescents of the community viewed HIV and/or AIDS as an infectious disease that can lead to death; however, this can be prevented by avoiding at-risk sexual behaviour. Schools and family members were the main sources of information regarding HIV and/or AIDS to the participants. Even though parents tended not to disclose their HIV and/or AIDS status, adolescents became aware of their parents’ status when reading about this on their parents’ medical report cards or when being told about the status by others following the death of their parents. For adolescents, their parents’ deaths were associated with the parents being chronically ill or showing visible signs of deterioration such as weight loss.ConclusionThe study concludes that even though current campaigns and informative interventions have seemingly succeeded in ensuring HIV and/or AIDS awareness among adolescents – also those in remote areas – continued educational campaigns are important. Such initiatives may prove to be beneficial by focusing on ways that parents can discuss HIV and/or AIDS-related issues with their children and disclose an HIV-positive status.

Spare the rod and save the child: Assessing the impact of parenting on child behaviour and mental health

Parenting has a considerable impact on children’s behaviour and mental health. Improving child health and behaviour requires an understanding of the relationship between parenting practices; contexual factors such asparental mental health, intimate partner violence, substance abuse and poverty; and children’s behaviour. In this article the authors report the findings of a survey of parenting and child behaviour in a small rural South Africancommunity. The findings show that corporal punishment, the stress of parenting and parental mental health are significantly associated with both children’s internalising (depression and anxiety) and externalising (rulebreakingand aggression) symptoms. Intimate partner violence in the home was also associated with children’s externalising symptoms. These findings imply that parent support and training, and an increase in services to address intimate partner violence and mental health problems, should be prioritised as part of a nationalviolence reduction strategy.

HIV and/or AIDS awareness among adolescent orphans in one of the South African rural communities

HIV and/or AIDS awareness among adolescent orphans in one of the South African rural communities

Accuracy of Remote Hearing Assessment in a Rural Community.

This study determined the accuracy of pure tone air conduction (AC) thresholds obtained using a synchronous telemedicine approach without a sound booth in a rural South African community. The global need for increased hearing healthcare currently far exceeds the capacity for delivering these services, especially in developing countries. A tele-audiology approach using a portable diagnostic audiometer could provide the solution, enabling hearing assessments to be conducted remotely and without a sound booth. Hearing thresholds in a sound booth and natural environment were obtained from an initial sample of 20 adults (age range, 19-63 years; mean age, 50±13 years; 55% female), recruited from a rural agricultural community. A subgroup of 10 adults (20 ears) volunteered for the telemedicine threshold testing. AC thresholds (250-8,000 Hz) were determined and subsequently compared in these environments. Typical threshold variability was determined using test-retest correspondence as a reference for the threshold correspondence using a telemedicine mode. Test-retest threshold correspondence in the booth and natural environments was within±5 dB in 96.7% and 97.5% of comparisons, respectively. No significant differences were obtained in AC hearing thresholds determined in the telemedicine configuration compared with those recorded in the gold standard booth environment. Threshold correspondence between the telemedicine compared with booth and natural environments were within±5 dB in 82% and 85% of comparisons, respectively. The current study demonstrates the validity of using synchronous telemedicine for conducting hearing assessments in a remote rural agricultural community without a sound booth.

Disaster recovery experiences of a South African rural farming community

This study explored the bush fire disaster experiences and coping of South African farmers. Participants consisted of seven male farmers (6 = White Afrikaans-speaking; 1 = Black Tswana-speaking). Data were collected using semi-structured interviews, nine months after the disaster, and analysed thematically. The findings showed that the farmers’ recovery was characterised by three distinct, transitioning phases. The first period involved resource-maintenance coping and emotion-focused coping. The second time period was characterised by meaning making related strategies. Finally, the third time period was charactirised by anxiety over reoccurrence and resource-maintenance coping. The results also suggest that successful coping is reliant on the individual's ability to adapt coping strategies continually, in a context-appropriate manner.

Pathways to mental health care by members of a rural community in South Africa

This study explored mental health help seeking pathways followed by Black South African rural community dwellers in the Limpopo province of South Africa. Ten participants (5 females and 5 males) aged between 18 and 59 years receiving services from a rural mental health care facility in the Limpopo province were the informants. They presented with psychotic disorders = 50%, substance-use mental disorders = 20%, mood disorders = 20% and epilepsy = 10%. They completed a semi-structured one-to-one interview on their pathways to mental health care services. Data were content analysed. The results showed that help seeking pathways for mental health involve several entry points. These include the utilisation of western medicine when experiencing acute symptoms, and a preference for traditional medicine when faced with chronic but manageable symptoms. The findings suggest that families and significant others are important facilitators for individuals navigating the mental health care pathways.

Spare the rod and save the child: Assessing the impact of parenting on child behaviour and mental health

Parenting has a considerable impact on children’s behaviour and mental health. Improving child health and behaviour requires an understanding of the relationship between parenting practices; contexual factors such as parental mental health, intimate partner violence, substance abuse and poverty; and children’s behaviour. In this article the authors report the findings of a survey of parenting and child behaviour in a small rural South African community. The findings show that corporal punishment, the stress of parenting and parental mental health are significantly associated with both children’s internalising (depression and anxiety) and externalising (rulebreaking and aggression) symptoms. Intimate partner violence in the home was also associated with children’s externalising symptoms. These findings imply that parent support and training, and an increase in services to address intimate partner violence and mental health problems, should be prioritised as part of a national violence reduction strategy.

High-resolution multilocus sequence typing reveals novel urogenital Chlamydia trachomatis strains in women in Mopani district, South Africa

ObjectivesRecently, we reported a high prevalence (16%) of urogenital Chlamydia trachomatis infections among women in a rural setting in South Africa. Molecular epidemiological studies on C. trachomatis infections could provide...

Association of alcohol consumption with specific biomarkers: a cross-sectional study in South Africa.

Alcohol consumption plays an important role in the health transition associated with urbanization in developing countries. Thus, reliable tools for assessing alcohol intake levels are necessary. We compared two biological markers of alcohol consumption and self-reported alcohol intakes in participants from urban and rural South African communities. This cross-sectional epidemiological survey was part of the North West Province, South African leg of the 12-year International Prospective Urban and Rural Epidemiology (PURE) study which investigates the health transition in urban and rural subjects. A total of 2,010 apparently healthy African volunteers (35 years and older) were recruited from a sample of 6,000 randomly-selected households. Alcohol consumption was assessed through self-reports (24-hour recalls and quantitative food frequency questionnaire) and by two biological markers: percentage carbohydrate-deficient transferrin (%CDT) and gamma-glutamyl transferase (GGT). Of the 716 men and 1,192 women volunteers, 64% and 33% respectively reported regular alcohol consumption. Reported mean habitual intakes of drinker men and women were 29.9 (± 30.0) and 23.3 (± 29.1) g of pure alcohol per day. Reported habitual intake of the whole group correlated positively and significantly with both %CDT (R=0.32; p ≤ 0.01) and GGT (R=0.43; p ≤ 0.01). The correlation between the two biomarkers was low (0.211; p ≤ 0.01). GGT and %CDT values should be interpreted with care in Africans as self-reported non-drinker men and women had elevated levels of GGT (19% and 26%) and %CDT (48% and 38%). A need exists for a more specific biological marker for alcohol consumption in black Africans.