Rural South African Community Research Articles

Transitioning to a life with disability in rural South Africa: A qualitative study.

BackgroundAdjustment to the onset of disability has complex reverberations relating to both socially engendered disadvantage and the realities of functional limitation. Pre-existing ways of understanding disability can meaningfully shape this experience.ObjectiveThis study aimed to provide an exploratory understanding of the experience of becoming disabled in a low-income, under-served, rural South African community. In particular, it was interested in how people with disabilities constructed their struggle within the conceptual split between disadvantage caused by ‘malfunctioning’ bodies (a ‘medical model’ view) and that caused by social organisation (a ‘social model’ view).MethodsSeven people between the ages of 39 and 47 who had acquired a physical disability within the last 4 years were recruited in a rural area of Limpopo province, South Africa. Semi-structured face-to-face interviews were conducted, and the resulting data were thematically analysed. The authors were positioned as both ‘insiders’ and ‘outsiders’ to the participants and sought to use this orientation to best understand and stay faithful to participants’ views while simultaneously applying participant’s experiences to conceptual knowledge in disability studies.ResultsFour themes emerged: (1) emotional impact of onset of disability, (2) being introduced to disablist prejudice, (3) being required to take on a ‘disabled’ identity and (4) socio-economic implications of becoming disabled. The findings reflected a complex set of adverse experiences in the lives of the participants, spanning disadvantages based on embodied, cultural, relational and environmental factors, which were superimposed on existing, generalised poverty in their local communities. Participants made sense of their predicament in multiple, evolving ways.ConclusionThis study contributes to the understanding of the complex predicaments, and sense-making, of persons who have acquired a disability in a rural, impoverished Global South environment.

Usefulness of the English version of the Stress Overload Scale in a sample of employed South Africans

Amidst reports of high levels of stress in South Africa, it remained difficult to quantify psychological stress in the absence of locally validated measures. This study explored the English version of the Stress Overload Scale (SOS) in a South African sample. The first aim was to replicate the basic psychometric analysis of the original English version used in American samples, as well as the Setswana version used in a South African rural community setting. The second aim was to investigate criterion validity to determine its appropriateness for use in South Africa. A total of 2136 employed South Africans with at least 9 years of schooling participated in this study. Participants completed a range of mental health and well-being measures, both clinical and dispositional. Responses were analysed to examine both scale characteristics and validity indices related to the SOS. Little sociodemographic influence (age, gender and first language) was found, with analyses supporting validity across most indices. Furthermore, good predictive ability for mental (ill-) health was observed. This study, for the most part, replicated previous validation findings of the SOS. Validity was further confirmed by correlating the scale with measures of clinical mental health and dispositional well-being. Given the positive support to its validity, when used amongst employed South Africans with at least 9 years of education, the scale holds promise for application in local health-related research, for triage in primary healthcare contexts and for measuring outcomes of mental health interventions in therapeutic settings.

An Assessment of the Energy Poverty and Gender Nexus towards Clean Energy Adoption in Rural South Africa

South Africa has about 2.5 million households without electricity access, most of which are located in rural areas and urban informal settlements. The nexus of energy poverty and gender is at play in the affected communities, as women and girls are culturally stereotyped with the task of collecting unclean fuels (e.g., firewood) and using these for their households’ energy demands. Therefore, this study prioritized rural women and girls as respondents in the provinces most affected by gendered energy poverty (GEP) in the country. The study was carried out in selected rural unelectrified areas of Limpopo, Mpumalanga, and KwaZulu-Natal provinces using structured interviews. The study revealed that GEP in the rural areas has exposed women and girls living there to security concerns, health hazards, premature death, domestic fire accidents, time poverty, income poverty, illiteracy, drudgery in households and farm tasks, etc., at different levels of severity. It also showed the effects of perceptions, age, income, and culture on the choice of energy use among the respondents. Mitigation strategies against GEP in rural South African communities through clean energy adoption are also proposed in this paper.

Chronic diseases of lifestyle risk factor profiles of a South African rural community.

Globally, chronic diseases of lifestyle account for millions of dollars spent annually on health. These diseases share similar risk factors including: physical inactivity, obesity, cigarette smoking, and hypertension among others. This study sought to assess risk factors for chronic diseases of lifestyle of a rural community in South Africa. This study used a survey design with data randomly collected using the WHO STEPS Instrument for Chronic Disease Risk Factor Surveillance from participants who attended routine checks from February to October 2018 from a trained healthcare practitioner. Informed consent was sought from all participants before the administration of the instrument. The research setting was the community Primary Health Center. About 54.0% of participants presented with no family history of hypertension but 19.7% had a family history of type II diabetes mellitus. More women were found to be hypertensive, with the majority (93.4%) monitoring their blood pressure. The study revealed that more men were current smokers. A large number of participants were engaged in a sedentary lifestyle with about one-third of the participants reported being obese. Physical inactivity, sedentary lifestyle, and hypertension were among the lifestyle-related risk factors for chronic diseases among residents of this rural community.

Deliberative engagement methods on health care priority-setting in a rural South African community.

Public engagement in priority-setting for health is increasingly recognized as a means to ensure more ethical, inclusive and legitimate decision-making processes, especially in the context of Universal Health Coverage where demands outweigh the available resources and difficult decisions need to be made. Deliberative approaches are often viewed as especially useful in considering social values and balancing trade-offs, however, implementation of deliberative engagement tools for priority-setting is scant, especially in low- and middle-income settings. In order to address this gap, we implemented a context-specific public deliberation tool in a rural community in South Africa to determine priorities for a health services package. Qualitative data were analysed from seven group deliberations using the engagement tool. The analysis focused on understanding the deliberative process, what the participants prioritized, the reasons for these selections and how negotiations took place within the groups. The deliberations demonstrated that the groups often considered curative services to be more important than primary prevention which related to the perceived lack of efficacy of existing health education and prevention programmes in leading to behaviour change. The groups engaged deeply with trade-offs between costly treatment options for HIV/AIDS and those for non-communicable disease. Barriers to healthcare access were considered especially important by all groups and some priorities included investing in more mobile clinics. This study demonstrates that deliberative engagement methods can be successful in helping communities balance trade-offs and in eliciting social values around health priorities. The findings from such deliberations, alongside other evidence and broader ethical considerations, have the potential to inform decision-making with regard to health policy design and implementation.

A qualitative exploration of psychosocial well-being experiences in a South African rural community.

The aim of this study was to explore and describe the psychosocial well-being experiences of a South African rural community. The study employed a qualitative explorative-descriptive research design in which participants (n = 20) were sampled through purposive sampling and participated in a world café session. Data were analyzed thematically. The findings identify three main themes with subthemes, namely contributing factors to psychosocial well-being (such as spirituality/religion and community cohesion), hindering factors to psychosocial well-being (such as crime and unemployment), and means to promote psychosocial well-being (such as provision of infrastructure). The findings provide insight into the psychosocial well-being experiences of an understudied and vulnerable South African rural community and makes recommendations for future research.

Off-grid hybrid renewable energy system with hydrogen storage for South African rural community health clinic

Most inhabitants of rural communities in Africa lack access to clean and reliable electricity. This has deprived the rural dwellers access to modern healthcare delivery. In this paper, an off-grid renewable energy system consisting of solar PV and wind turbine with hydrogen storage scheme has been explored to meet the electrical energy demands of a health clinic. The health clinic proposed is a group II with 10 beds located in a typical village in South Africa. First, the wind and solar energy resources of the village were analysed. Thereafter, the microgrid architecture that would meet the energy demand of the clinic (18.67 kWh/day) was determined. Some of the key results reveal that the average annual wind speed at 60 m anemometer height and solar irradiation of the village are 7.9 m/s and 4.779 kWh/m2/day, respectively. The required architecture for the clinic composes of 40 kW solar PV system, 3 numbers of 10 kW wind turbines, 8.6 kW fuel cell, 25 kW electrolyser and 40 kg hydrogen tank capacity. The capital cost of the microgrid was found to be $177,600 with a net present cost of $206,323. The levelised cost of energy of the system was determined to be 2.34 $/kWh. The project has a breakeven grid extension distance of 8.81 km. Since this distance is less than the nearest grid extension distance of 21.35 km, it is established that the proposed renewable energy microgrid with a hydrogen storage system is a viable option for the rural community health clinic.

Health Risk Assessment of PM2.5 and PM2.5-Bound Trace Elements in Thohoyandou, South Africa.

We assessed the health risks of fine particulate matter (PM2.5) ambient air pollution and its trace elemental components in a rural South African community. Air pollution is the largest environmental cause of disease and disproportionately affects low- and middle-income countries. PM2.5 samples were previously collected, April 2017 to April 2018, and PM2.5 mass determined. The filters were analyzed for chemical composition. The United States Environmental Protection Agency’s (US EPA) health risk assessment method was applied. Reference doses were calculated from the World Health Organization (WHO) guidelines, South African National Ambient Air Quality Standards (NAAQS), and US EPA reference concentrations. Despite relatively moderate levels of PM2.5 the health risks were substantial, especially for infants and children. The average annual PM2.5 concentration was 11 µg/m3, which is above WHO guidelines, but below South African NAAQS. Adults were exposed to health risks from PM2.5 during May to October, whereas infants and children were exposed to risk throughout the year. Particle-bound nickel posed both non-cancer and cancer risks. We conclude that PM2.5 poses health risks in Thohoyandou, despite levels being compliant with yearly South African NAAQS. The results indicate that air quality standards need to be tightened and PM2.5 levels lowered in South Africa.

United in diversity? Digital differences and inequalities within a South African rural community

ABSTRACT Digital inequalities in Africa have been explored in terms of dimensions such as gender, age, education, socio-economic status, language, ability/disability etc. In the present study, we draw on qualitative research emphasising digital differences within Dwesa, a rural community on the Wild Coast of the Eastern Cape Province of South Africa. For the past decade and a half, this has been the site of extensive ethnographic and ICT-for-development research highlighting complex and nuanced social arrangements, social stratification and local power dynamics. Mobile communication and media appear to either entrench or challenge the status quo, e.g., by strengthening the bond with community members who migrated to urban areas, by disrupting cultural norms or by opening up work and education opportunities. Mobile digital access, use and benefits are unevenly distributed within the community. Teachers and local business people tend to be early adopters and use phones extensively for work-related purposes and to maintain contacts outside the community. The youth appear to be the most sophisticated and frequent users of social media to organise events and meet new people. Somewhat surprisingly, mature women provide some of the most innovative examples of collaboration and empowerment. People of all ages, genders and socio-economic backgrounds recognise the disruptive potential, costs and limitations of digital technology and some deliberately limit themselves to voice calls. Our findings problematise a view of rural African communities as digitally homogeneous and provide some examples of how actual experiences in the Global South challenge expectations based on research from the Global North.

Comparison of the prevalence of non-communicable diseases and traditional herbal medicine use in urban and rural communities in South Africa

BackgroundTo quantify the use of traditional herbal medicines (THM), we documented the prevalence of specific health conditions, the use of THM and the influences and reasons for using indigenous treatment practices. MethodsA cross-sectional descriptive study using a homogenous purposive sampling among 721 South Africans living in rural and urban black South African communities. A structured questionnaire was used to collect data between April–October 2014 on clinical/medical history, health-seeking behavior, and Traditional Herbal Medicine (THM) use. Descriptive, bivariate and multivariable analyses was done using R. ResultsMajority of participants (77.5%) were from the urban area. More than (90%) had no health insurance, and 80% had monthly income of< R2000 (equivalent to $ 126) in both urban and rural areas. Most participants had NCD irrespective of location, but prevalence was higher amongst urban dwellers (61%). Hypertension was found to be the most dominant cardiovascular disease risk factor. Rural participants had statistically significant higher rates of hypertension (67.1%) and diabetes (32.1%). Use of THM was significantly associated with recommendations by family or colleagues. Participants who reported poorer health status in rural areas used THM more than those in urban areas. Using multiple logistic regression, rural participants have greater than 12-to-1 odds of being THM users than urban participants (odds ratio [OR]=12.62; 95% confidence interval [CI]=(4.09, 55.34)). ConclusionsNCDs were more prevalent in urban communities with hypertension being the most prevalent. There is widespread use of THM across South Africa. Rural residents and individuals of low social economic status rely more on THM. These findings suggest a need for systematic and larger studies to understand the magnitude and predictors of variation in access to and use of healthcare services, as these are critical to developing effective culturally appropriate interventions for approaching hard-to-reach patients. Helping patients navigate the complex healthcare system is the hallmark of a responsive system of care.

Osteoporosis, Rather Than Sarcopenia, Is the Predominant Musculoskeletal Disease in a Rural South African Community Where Human Immunodeficiency Virus Prevalence Is High: A Cross-Sectional Study.

The rollout of antiretroviral therapy globally has increased life expectancy across Southern Africa, where 20.6 million people now live with human immunodeficiency virus (HIV). We aimed to determine the prevalence of age-related osteoporosis and sarcopenia, and investigate the association between HIV, bone mineral density (BMD), muscle strength and lean mass, and gait speed. A cross-sectional community-based study of individuals aged 20-80 years in rural South Africa collected demographic and clinical data, including HIV status, grip strength, gait speed, body composition, and BMD. Sarcopenia was defined by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines, and osteoporosis as BMD T-score ≤ -2.5 (if age ≥50 years). The mean ± standard deviation (SD) age of 805 black South African participants was 44.6 ± 14.8 years, 547 (68.2%) were female; 34 (13.2%) were men, and 129 (23.6%) women had HIV, with 88% overall taking anti-retroviral therapy. A femoral neck T-score ≤ -2.5, seen in four of 95 (4.2%) men and 39 of 201 (19.4%) women age ≥50 years, was more common in women with than without HIV (13/35 [37.1%] versus 26/166 [15.7%]; p=0.003). Although no participant had confirmed sarcopenia, probable sarcopenia affected more men than women (30/258 [11.6%] versus 24/547 [4.4%]; p=.001]. Although appendicular lean mass (ALM)/height2 index was lower in both men and women with HIV, there were no differences in grip strength, gait speed, or probable sarcopenia by HIV status. Older age, female sex, lower ALM/height2 index, slower gait speed, and HIV infection were all independently associated with lower femoral neck BMD. In conclusion, osteoporosis rather than sarcopenia is the common musculoskeletal disease of aging in rural South Africa; older women with HIV may experience greater bone losses than women without HIV. Findings raise concerns over future fracture risk in Southern Africa, where HIV clinics should consider routine bone health assessment, particularly in aging women. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

The Viability and Potential of Smallholder Sweet Potato Enterprises as a Food Security Measure in Rural Communities of South Africa

The Agricultural Research Council in partnership with the Department of Rural Development and Land Reform are engaged in promoting the establishment of sustainable Sweet Potato Enterprise projects in South Africa. This study sought to investigate the viability of smallholder sweet potato enterprises for the South African rural communities. Formal market surveys and Gross margin analysis were utilised in addressing the research questions. Results of the study indicate that both the sweet potato vine nurseries and growers stand a significant chance to gain considerable amount of income from sweet potato enterprises. Sweet potato vines had a gross margin of between R219,000.00 and R226,000.00 while the sweet potatoes attracted an average gross margin of R47,000.00/ha. Coupled with the potential to create employment and provide access to the nutritious sweet potato cultivars, sweet potato enterprises can potentially improve food security among the rural poor in South Africa, indirectly extending benefits even to those who are not directly involved in production. This study recommends support of smallholder farmers through training and infrastructure development, as well as creation of awareness among rural people of the benefits of sweet potatoes.

Reimagining Community Schools as Beacons of Hope and Possibility in the South African Context

South African schools in poor communities are facing a crisis of inefficiency and inequality. The failure of the present education schooling system to address the needs of the majority of local communities requires a reimagining of the concept and function of schools. We posit that to adequately address the current education realities in the country, stakeholders in schools need to re-evaluate their role within communities, and how they can best serve these communities by opening up possibilities for a better future for all. Using findings from our respective studies with members of both rural and urban South African communities, we reflect on how fostering mutually beneficial partnerships between a school and its community can contribute towards the holistic development and well-being of all school stakeholders. The article advances an argument for the need to start a process of reimagining school as not only a space for pursuing academic outcomes for the learners, but as an evolving site of possibility of betterment of the community that it serves. As such, the aim of the article is to challenge the present deficit definitions of the “community school” in South African education discourses and to present a progressive reimagining of community schools. We further offer three propositions for enabling such community schools to become beacons of hope and possibility in socio-economically challenged South African communities.

Herbal-Based Cosmeceuticals and Economic Sustainability among Women in South African Rural Communities

Access to natural resources in the immediate environment is an essential factor that contributes to livelihood in many rural areas. In the current study, we explored the economic potential(s) of the natural herbal-based cosmetic and cosmeceutical enterprise for the welfare of the Vhavenda women. A purposive sampling technique was used to collect data from 79 Vhavenda women and analysed with descriptive and inferential statistics (Tobit regression) as well as budgeting analysis. The majority (61%) of the participants were married with an average household size of five members. Additionally, 39% of the participants were already ageing with an average age-group of 56–70 years. The majority (44%) of the participants were not formally employed while the monthly average total income of R1841.01 (107.37 USD) was recorded with an average per capital expenditure of R1438.42 (83.89 USD). A budgeting cost ratio of 1.28 was recorded, which indicates that for every R1.00 (0.057 USD) invested in the herbal-based cosmetic and cosmeceutical production, an expected return of R1.28 (0.073 USD) was forecasted. Tobit regression results indicated that the determinants of the income of participants were experience level (p &lt; 0.01), religion affiliation (p &lt; 0.05) and consumption expenditure (p &lt; 0.01) among others. Thus, a conscious, introspective and intentional look into this marginalised herbal-based cosmetic and cosmeceutical enterprise as a panacea for improved income and welfare of rural South Africans should be considered.

The Potential Therapeutic Value of Medicinal Plants in the Management of Metabolic Disorders.

Metabolic syndrome (MetS) is a prevalent, multifactorial and complex disease that is associated with an increased risk of developing diabetes and other major cardiovascular complications. The rise in the global prevalence of MetS has been attributed to genetic, epigenetic, and environmental factors. The adoption of sedentary lifestyles that are characterized by low physical activity and the consumption of high-energy diets contributes to MetS development. Current management criteria for MetS risk factors involve changes in lifestyle and the use of pharmacological agents that target specific biochemical pathways involved in the metabolism of nutrients. Pharmaceutical drugs are usually expensive and are associated with several undesirable side effects. Alternative management strategies of MetS risk factors involve the use of medicinal plants that are considered to have multiple therapeutic targets and are easily accessible. Medicinal plants contain several different biologically active compounds that provide health benefits. The impact of phytochemicals present in local medicinal plants on sustainable health and well-being of individuals has been studied for many years and found to involve a plethora of complex biochemical, metabolic, and physiological mechanisms. While some of these phytochemicals are the basis of mainstream prescribed drugs (e.g., metformin, reserpine, quinine, and salicin), there is a need to identify more medicinal plants that can be used for the management of components of MetS and to describe their possible mechanisms of action. In this review, we assess the potential health benefits of South African ethnomedicinal plants in protecting against the development of health outcomes associated with MetS. We aim to provide the state of the current knowledge on the use of medicinal plants and their therapeutically important phytochemicals by discussing the current trends, with critical examples from recent primary references of how medicinal plants are being used in South African rural and urban communities.

Life-Course Trauma and Later Life Mental, Physical, and Cognitive Health in a Postapartheid South African Population: Findings From the HAALSI study.

Objective: To investigate the relationships between exposure to life-course traumatic events (TEs) and later life mental, physical, and cognitive health outcomes in the older population of a rural South African community. Method: Data were from baseline interviews with 2,473 adults aged ≥40 years in the population-representative Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) study, conducted in 2015. We assessed exposure to 16 TEs, and used logistic regression models to estimate associations with depression, post-traumatic stress disorder (PTSD), activities of daily living disability, and cognitive impairment. Results: Participants reported an average of 5 (SD = 2.4) TEs over their lifetimes. Exposure was ubiquitous across sociodemographic and socioeconomic groups. Trauma exposure was associated with higher odds of depression, PTSD, and disability, but not with cognitive health. Discussion: Results suggest that TEs experienced in earlier life continue to reverberate today in terms of mental health and physical disability outcomes in an older population in rural South Africa.

The relationships between cognitive function, literacy and HIV status knowledge among older adults in rural South Africa.

IntroductionAlthough HIV prevalence is exceptionally high in South Africa, HIV testing rates remain below targeted guidelines. Older adults living with HIV are substantially more likely to remain undiagnosed than younger people. Cognitive function and literacy could play key roles in HIV status knowledge due to the decision‐making processes required around weighing the costs and benefits of testing, navigating testing logistics and processing results. We aimed to assess the independent relationships among each of cognitive function, literacy and education with HIV status knowledge in a population‐based sample of older adults living in a rural South African community with high HIV prevalence.MethodsWe analyzed data from a population‐based study of 5059 men and women aged 40 years and older in rural South Africa (Health and Aging in Africa: A Longitudinal Study of an INDEPTH community (HAALSI)). HAALSI surveys, conducted between 2014 and 2015, queried self‐reported literacy, educational attainment and HIV status knowledge. Laboratory tests were conducted to assess true HIV sero‐status. Cognitive function was assessed with a battery of cognitive tests measuring time orientation, immediate and delayed recall, and numeracy and coded using confirmatory factor analysis as a z‐standardized latent variable. We estimated the relationship between the outcome of HIV status knowledge and each of three exposures: (1) latent cognitive z‐score, (2) literacy and (3) education, using confounder‐adjusted modified Poisson regression models in the study population overall and stratified by HIV sero‐status.ResultsWe found that HIV status knowledge was higher among those with higher cognitive z‐scores (adjusted Prevalence Ratio (aPR) (95% CI): 1.18 (1.14, 1.21) per standard deviation unit), and among literate participants (aPR (95% CI): 1.24 (1.16, 1.32) vs. non‐literate participants). Taken together, the associations with literacy and cognitive function completely attenuated the otherwise positive association between educational attainment and HIV status knowledge. The magnitudes of effect were generally similar among laboratory‐confirmed HIV‐negative and HIV‐positive participants.ConclusionsCampaigns that target older adults in rural South Africa with HIV testing messages should carefully consider the cognitive and literacy levels of the intended audience. Innovations to ease the cognitive load associated with HIV testing could prove fruitful to increase HIV status knowledge.

Opinion piece: People need nature to thrive – a case for inclusion of environmental sustainability in occupational therapy practice in rural South Africa

ABSTRACT Access to household amenities such as potable water, sanitation and electricity remains a challenge affecting many rural South African communities. These inequities, coupled with high levels of poverty, have resulted in heavy reliance on natural resources for survival and livelihoods making these rural communities highly vulnerable to climate change. The present and evolving impact of climate change on rural occupations and the need for occupational therapists (OTs) to be aware of this dynamic is crucial in building resilience and allowing for adaptation to ensure sustainability for these communities. Inclusion of environmental sustainability in occupational therapy (OT) practice is explored through a reflection on the work of a conservation non-governmental organisation in rural South Africa. The authors recommend that South African OTs take up the challenges presented by climate change as outlined in the WFOT Position Paper and Guidelines on Sustainability.

The use of rights-based discourses in the narrative construction of identity by disabled adults in rural South Africa

There has been an increasing focus on developing a human rights approach to ensure that disabled people have equitable access to their rights. A number of policies have been developed, which are intended to meet the needs of disabled people and to provide frameworks within which services should be rendered. This article explores the narratives of disabled adults living in a rural South African community, with a specific focus on the ways in which rights-based discourses are internalized and used in the construction of identity. A total of 103 references to rights emerged within 22 of the interviews. Eight of the interviews did not include rights-based discourses, yet this was juxtaposed by observations of extreme violations of human rights. Suggestions are made for adopting an ethic of care approach to policy implementation and evaluation, with the need for context specific adaptations to be made.

Physical activity in early childhood education and care settings in a low-income, rural South African community: an observational study.

Research has not been conducted on physical activity in early child education and care (ECEC) settings in low-income, rural communities in South Africa. This study aimed to describe the physical activity environment of these settings and identify child and contextual factors associated with physical activity in these settings. By understanding physical activity in this environment, it will be possible to identify context-specific opportunities, including with teachers, to overcome potential challenges and maximise physical activity in a low- and middle-income country setting. The study was conducted in rural Bushbuckridge, Mpumalanga in 2014. Preschool-aged children (n=55) were recruited from five ECEC settings, including three preschools and two primary schools, where preschool-aged children are in their reception year, grade R. Preschool environment characteristics were assessed using an observational tool adapted from existing tools. Children's physical activity was assessed using the Observational System for Recording Physical Activity in Children - Preschool Version. Differences between preschool and grade R settings were assessed using χ2 analyses, and multinomial logistic regression analysis was used to determine factors associated with physical activity in the ECEC settings. The physical activity environment differed between preschool and grade R ECEC settings in terms of space (preschoolpgrade R, p<0.001). On average, children spent 28.7% of their day in the ECEC settings engaged in physical activity, of which 22.3% was moderate- to vigorous-intensity physical activity (MVPA). Children spent the greatest proportion of the day in sedentary activities (69.9%) and this differed significantly between preschool (63.2%) and grade R children (81.3%, p<0.001). Preschool children were significantly more active than grade R children, and spent greater proportions of time in light-intensity physical activity (8.6% v 2.7%, p<0.001) and MVPA (25.4% v 15.3%, p<0.001). Irrespective of ECEC setting, children were significantly more likely to participate in MVPA if they were outdoors (p=0.001), and significantly less likely to do MVPA if they were overweight/obese (p=0.006). These findings provide insight into child-level and contextual factors associated with preschool-aged children's physical activity within ECEC settings in a low-income, rural community in South Africa. Particularly, the physical and social features of ECEC settings are important in the promotion of physical activity. Findings from this study suggest that it is necessary to upskill and encourage teachers in ECEC settings to maximise opportunities for physical activity in rural low-income communities in South Africa.