Browsing by Author "London, Leslie"
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- ItemOpen AccessA case for integrating human rights in public health policy(2006) London, LeslieIn a global environment where human rights and well-being are coming under increasing threat, both from the spectre of terrorism and from the counter-reaction to it,1 and where international governance systems continue to pay lip service to poverty reduction while encouraging unbridled private accumulation of wealth resulting in huge inequalities between and within countries,2,3 the need to make human rights considerations an integral part of how public health policies are formulated cannot be overemphasised. Contestation over entitlements to socio-economic rights has troubled health care systems worldwide, from resource-poor settings in Africa, where questions have been raised as to whether human rights approaches are best suited to addressing the problem of AIDS in Africa,4,5 through to the over-consumptive USA where universal access to health care remains a policy objective doomed to unfulfilment under market-fixated economic systems.6,7
- ItemOpen AccessA descriptive study of treatment provision for problem alcohol drinking in adult males in Khayelitsha, Cape Town, South Africa(BioMed Central, 2017-12-04) Saban, Amina; Morojele, Neo; London, LeslieBackground: Poor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barriers to treatment seeking. This descriptive study examined the availability and nature of problem drinking treatment facilities in Khayelitsha, a largely poor township of Black, Xhosa-speaking Africans, on the outskirts of Cape Town. Methods: Seven treatment facilities for problem drinking in adult males were identified using data from the Department of Social Development in the City of Cape Town. Staff members were identified as key informants at each of the treatment facilities, and were interviewed using a structured questionnaire. Twelve interviews were conducted. Results: Findings indicated that the available alcohol treatment facilities were relatively new, that treatment modalities varied both across and within treatment facilities, and that treatment was provided largely by social workers. Treatment facilities did not accommodate overnight stay for patients, operated during weekday office hours, and commonly referred patients to the same psychiatric hospital. Discussion: The study provides a baseline for assessing barriers to treatment for problem drinking in Khayelitsha by highlighting the nature of available facilities as playing a predominantly screening role with associated social work services, and a point of referral for admission to a psychiatric institution for treatment. The social and financial implications of such referral are pertinent to the discussion of treatment barriers. Conclusions: Recommendations are made to inform policy towards locally-provided integrated care to improve treatment provision and access.
- ItemOpen AccessAcute pesticide poisoning amongst adolescent girls and women in northern Tanzania(2020-03-06) Lekei, Elikana; Ngowi, Aiwerasia V; Kapeleka, Jones; London, LeslieAbstract Background Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production. Methods Over the period of 12 months, health facility-based surveillance for cases of APP was implemented in 10 Tanzanian healthcare facilities in 2006. Results The study identified 108 APP cases of whom 31 (28.7%) occurred amongst adolescent girls. Suicide was the leading poisoning circumstances (60.2%) and the most vulnerable women were 20–29 years old who comprised 38.4% of all cases with suicide as circumstance. Organophosphates (OPs), zinc phosphide, paraquat and endosulfan were common amongst known reported poisoning agents. The annual APP incidence, mortality and Case Fatality Rate for women were 5.1/100,000, 0.2/100,000 and 3.7/100, respectively. Conclusion APP amongst women in Tanzania is common and this call for diverse preventive interventions to reduce poisoning incidents.
- ItemOpen AccessAdditional costs of FAS and PFAS learners in the classroom: An estimate for public primary schools in the Western Cape(2018) Makin, Emma; London, Leslie; Sinanovic, EdinaBackground: The Western Cape province of South Africa has the highest recorded prevalence rates of Fetal Alcohol Spectrum Disorders (FASD) in the world. In the last decade rates of fetal alcohol syndrome (FAS) and partial fetal alcohol syndrome (PFAS) prevalence of 68.0 - 89.2 per 1000 (May et al., 2007), 67.2 per 1000 (Urban et al., 2008), and 59.3 - 91.0 per 1000 (May et al., 2013) have been published after research was conducted in towns in the Western Cape (WC). Educating learners with FASD is a challenge as a result of the large range of cognitive impairments associated with heavy prenatal alcohol exposure. Determining a burden of cost to the education system may be one way to motivate for the development of prevention and intervention strategies. Methods: I designed questionnaires that were distributed to the educator and principal of a cohort of learners including learners with FAS and PFAS. Data were collected on educational impacts of variables associated with educator time use. Additional costs as a result of the use of educator's time by learners with FAS/PFAS were scaled up using risk differences and published statistics to reflect a cost burden to the WC Education Department. Results: The additional cost burden of disruptions caused by learners with FAS and PFAS for the WC Education Department is USD 7,010,166 in educator time for one academic year. The additional burden for learners with FAS/PFAS requiring additional assistance with lesson content to the WC is USD 5,754,885 in educator time for one academic year. The additional cost burden of public primary school learners with FAS/PFAS who had repeated a year of schooling was USD 3,876,565 in educator time based on 2012 salaries. Conclusions: These findings indicate that there is a large burden of cost to the education system when educator time is viewed as an economic input in education. Efforts need to be directed towards prevention programs to reduce the prevalence of learners with FAS/PFAS in the classroom. Educator training programs must be created to ensure that educators are equipped to manage the challenges posed by learners with FAS/PFAS in the classroom.
- ItemOpen AccessAn Equity Analysis of the Burden from Alcohol Consumption in South Africa(2020) Correia, Fontes Mayara; London, Leslie; Ataguba, John; Harker-Burnhams, NadineBackground: Alcohol consumption remains one of the leading contributors to the risk of mortality worldwide. While literature sources are clear that alcohol consumption has a major negative impact on society and which is felt more severely amongst low-socioeconomic families, the literature on alcoholrelated harm on individuals and households in South Africa, especially from different socio-economic backgrounds, is very limited. This study represents an initial attempt to assess inequalities and inequity in alcohol consumption, at the household and individual levels, in South Africa using national household data. The objectives of this study are (1) to examine the usability of existing survey data in South Africa for assessing alcohol-related expenditure and impacts; (2) to provide a detailed description of alcohol consumption patterns in South Africa at the individual level using various equity stratifiers and (3) to assess the socioeconomic distribution of expenditure on alcoholic beverages at the household level in South Africa. Methods. For objective 1, all publicly available alcohol data sources for South African populations were scanned to examine their usability. A set of qualitative interviews with 10 key researchers in the alcohol policy and economics field in South Africa were undertaken to capture their experience and perceptions of alcohol data in South Africa. The analysis involved identifying databases known to key informants, exploring challenges in using the datasets for research and further analyzing any recommendations for how routine datasets could be better used to inform policy. For Objectives 2 and 3, this study used publicly available secondary data, including the National Income Dynamics Study (NIDS) and the Income Expenditure Survey (IES). The data have been anonymized and can be accessed from the DataFirst website. Results: There are differences in alcohol consumption patterns and alcohol expenditure among equity stratifiers. The findings show that the burden of alcohol consumption is heavier on the poor. Poorer households spend a significantly larger share of their total household consumption expenditure on alcoholic beverages than richer households—a case of regressivity in spending on alcoholic beverages. Spending on alcohol beverages became less regressive (i.e. a pro-poor ‘shift') between 1995 and 2000; and between 2005/06 and 2010/11. For alcohol consumption patterns, current drinkers are more prevalent among the rich; whereas binge drinkers are more prevalent among the poor. Binge drinking is a problem among the low-income, young individuals, male and African populations. The results also show that there are significant constraints limiting the quality and usefulness of alcohol data in South Africa. These constraints are related to (a) lack of accessibility of survey data, (b) lack of systematic and standardized measurement of alcohol consumption, (c) limited geographic coverage, (d) infrequent survey timing and (e) lack of public availability of industry data on price, production, distribution and consumption of alcohol. Conclusion: This study provides evidence that alcohol consumption in South Africa may be a reflection of genuine differences in consumption patterns among socioeconomic status, and the burden falls most heavily on poorer households and individuals. Based on the results, there is an opportunity to further reduce the regressivity of alcohol expenditure by implementing comprehensive alcohol harm-reduction policies. This study supports recommendations for the South African government to continue to push for evidence-based alcohol policies aiming to decrease alcohol consumption, especially for risky drinkers. However, limited data accessibility in South Africa could potentially impact on the implementation, monitoring and evaluation of relevant policy and interventions to address alcohol-related harms. Thus, for implementing evidence-based alcohol policy in South Africa to be successful, the government must have accessible, reliable and meaningful data for stakeholders and researchers to evaluate interventions and assess whether national alcohol policies aiming to decrease alcohol consumption have achieved their intended objectives.
- ItemOpen AccessAn analysis of alcohol use and possible confounding risk factors for risky sexual behaviour amongst women in the rural Western Cape and urban Gauteng provinces(2013) Khati, Makobetsa; London, LeslieThe general aim of this thesis is therefore to analyse alcohol consumption variables and possible confounding risk factors associated with risky sexual behaviour amongst women in the urban city of Tshwane in Gauteng and the rural Western Cape sites, respectively.
- ItemOpen AccessAssessment of anthropometry, academic performance and absenteeism in a comprehensive educational programme on the Cape Flats : a cross-sectional survey with a cohort analysis(2007) Kamminga, Froukje; London, LeslieChristel House South Africa (CHSA) is an independent primary and secondary school that offers a comprehensive educational programme that includes two meals and snacks to children from disadvantaged areas known as the Cape Flats. Anthropometric measurements such as weight and height are widely recognised as a reliable way to assess growth and nutritional status of children. Underweight and wasting are indicators of recent and severe malnutrition while stunting is associated with poor socio-economic conditions. Academic performance is associated with many factors including genetics, socio-economic circumstances, parental education and ill-health. However, there is no convincing evidence supporting a direct link between improved academic performance and improvement in nutritional status. This study aims to evaluate the comprehensive programme that CHSA provides by assessing anthropometric measurements and academic performance as well as absenteeism among the learners over a two year period. In particular, to assess whether those learners who showed improved anthropometry also demonstrated improved academic performance and reduced absenteeism between 2002 and 2004. The study is a cross-sectional survey with a retrospective cohort analysis. Existing data, part of the school's routine data collection, were used. The data consisted of weight and height measurements, end-of-year grades for English and Mathematics, and absenteeism records, all for 2002 and 2004. After obtaining informed consent from parents and guardians, a sample of 175 learners was established and used for cross-sectional analyses. This represented 65% of all eligible learners in the sample population. The median age was 8.5 years. Sex and age specific anthropometric measurements, expressed as weight-for-age, height-for-age and weight-for-height Z-scores, were created using the Epi Nut software in EPilnf06. Due to age and height limits in data that can be entered in this software, a cohort sub-sample of 81 learners, median age 7.2 years, was created and used for cohort analyses. As a result of measurement error with regard to height measurements in 2002, height-for-age and weight-for-height outcomes for 2002 were rendered invalid and excluded from statistical analyses of height-for-age and weight-for-height Z-score change between 2002 and 2004. However, by creating a 'gain' variable that took account of the measurement error, selected comparisons could still be done. The study found a prevalence of underweight of 8% in 2002 and 1.7% in 2004 (n=175). The reduction in underweight was statistically significant (P<0.05). There was a significant improvement in weight-for-age, English performance and Mathematics performance between 2002 and 2004, both in the complete sample (n=175) and the cohort (n=81). These improvements were statistically significant for both sexes, except for weight-for-age among girls in the cohort. There was no significant reduction in absenteeism during this period, either in the complete sample or the cohort. For 2004, bi-variate analyses showed a modest but significant positive correlation between weight-for-age Z-score and English (r=0.21, P<0.05) and Math (r=0.25, P<0.05) performance respectively, and a significant modest negative correlation with absenteeism (r=-0.18, P<0.05) (n=175). These correlations were not apparent in 2002. Multivariate analyses using logistic regression showed no associations between weight-for-age Z-score gain or height-for-age Z-score gain and improvement in English, Math and absenteeism, respectively (n=81). A negative association (OR=0.3, 95% CI 0.11-0.76) was found between weight-for-height Z- score gain and improvement in absenteeism. All analyses were adjusted for sex, age and having failed a year in school between 2002 and 2004. No significant associations were found when assessing improvement in English, Math and absenteeism in relation to quartiles of change in weight-for-age Z-score. A modest positive correlation was found between reduction in absenteeism and improvement in English (r=0.3, P<0.05) (n=81). Limitations of the study include measurement error in height in 2002, leading to the exclusion of height-for-age and weight-for-height in most of the analyses, and eliminating stunting and wasting as indicators of malnutrition from the overall assessment. Secondly, as a result of the limitations for age and height in the EpiNut software, a cohort was created. Analysis indicated that those included in the cohort were significantly different 'from those not included in the cohort in terms of age and sex. In particular, selection bias caused the exclusion of older and taller girls from the cohort. As such, findings for the cohort may not be representative of the study population. In spite of its limitations, this study identified a number of significant findings in respect of academic performance and anthropometric outcomes, suggesting that the programmes as provided by Christel House South Africa benefit their learners. In view of future monitoring and evaluation it is recommended that a protocol for weight and height measurement taking is agreed on, that the same instruments are used consistently, and that these instruments are regularly calibrated. It is also recommended that any future research related to child growth and academic performance at CHSA include data on socio-economic circumstances and parental education. Lastly, it is recommended that CHSA makes an assessment of the quality and nutritional value of the food provided, to ensure that the meals and snacks are healthy, varied and nutritionally balanced.
- ItemOpen AccessThe association betweeen psychopathology and substance use in young people(2011) Saban, Amina; Flisher, Alan J; London, Leslie; Morojele, Neo KThe co-occurrence of problematic substance use and non-substance use psychopathology is very common in psychiatry, and is generally referred to as comorbidity. The phenomenon has been the subject of debate and widespread research, yet remains poorly understood. The thesis aimed to examine the association between psychopathology and substance use in young people in South African settings, to determine the nature and prevalence of comorbidity, and to identify sociodemographic factors that might influence the associations, as well as the influence of comorbidity on substance use treatment outcomes.
- ItemOpen AccessThe association of depression, impulsivity and suicidal ideation with organophosphate pesticide exposure amongst South African farm workers(2011) Kootbodien, Tahira; London, Leslie; Little, FrancescaThe objectives were to evaluate the validity and reliability of four neurobehavioral instruments used in the study and to test three models hypothesised as possible causal pathways between OP exposure and depression, impulsive behaviour and suicidal ideation.
- ItemOpen AccessBiological monitoring of workers exposed to pesticides - guidelines for application in field settings(2011) London, LeslieThis guideline was produced for those persons responsible for the maintenance of health and safety measures at agricultural workplaces handling potentially hazardous organophosphate and carbarnate. This guideline has been produced by the Occupational and Environmental Health Research Unit at the Department of Community Health, University of Cape Town as part of its research in the field of pesticide hazards and pesticide safety. The support of the International Development Research Centre (IDRC) in this regard is acknowledged.
- ItemOpen AccessBlackness in a predominantly white academe : a case of the University of Cape Town's Faculty of Health Sciences(2011) Serote, Abraham Chupe; Cooper, David M; London, LeslieThis study examined the lived experience of black registrars (medical residents) in a predominantly white academic medical milieu using the case of the University of Cape Town Faculty of Health Sciences, South Africa. It foregrounded this experience by demonstrating how it is circumscribed by notions of race (and racism). Given the centrality of race and thus, whiteness, a select few members of the white academic staff were included as a 'control' group. The study employed Critical Race Theory (CRT) as its overarching theoretical lens. Research confirmed CRT theoretical underpinnings that life experience in race-centred societies is, largely, circumscribed by race (and racism), it also contended that there existed no singular black experience; hence the emergence of the three narratives of black registrar experience at UCT FHS.
- ItemOpen AccessA call to advance and translate research into policy on governance, ethics, and conflicts of interest in public health: the GECI-PH network(2021-01-25) Nakkash, Rima; Mialon, Melissa; Makhoul, Jihad; Arora, Monika; Afifi, Rima; Al Halabi, Abeer; London, LeslieEfforts to adopt public health policies that would limit the consumption of unhealthy commodities, such as tobacco, alcohol and ultra-processed food products, are often undermined by private sector actors whose profits depend on the sales of such products. There is ample evidence showing that these corporations not only try to influence public health policy; they also shape research, practice and public opinion. Globalization, trade and investment agreements, and privatization, amongst other factors, have facilitated the growing influence of private sector actors on public health at both national and global levels. Protecting and promoting public health from the undue influence of private sector actors is thus an urgent task. With this backdrop in mind, we launched the “Governance, Ethics, and Conflicts of Interest in Public Health” Network (GECI-PH Network) in 2018. Our network seeks to share, collate, promote and foster knowledge on governance, ethical, and conflicts of interest that arise in the interactions between private sectors actors and those in public health, and within multi-stakeholder mechanisms where dividing lines between different actors are often blurred. We call for strong guidance to address and manage the influence of private sector actors on public health policy, research and practice, and for dialogue on this important topic. Our network recently reached 119 members. Membership is diverse in composition and expertise, location, and institutions. We invite colleagues with a common interest to join our network.
- ItemOpen AccessCase-control study of the association of use of health services by children with behavioural and developmental disorders with prenatal alcohol exposure(2010) Katwan, Elizabeth; London, LeslieBackground Prenatal alcohol exposure can result in a range of permanent birth defects known as Fetal Alcohol Spectrum Disorders (FASD). Fetal Alcohol Syndrome (FAS), which detrimentally affects the neurodevelopmental, physical, and social capabilities of children, is the most severe diagnosis on this scale of disorders. Research suggests that FASD rates exceed FAS in various populations. South Africa&acirc;s Western Cape region has one of the highest rates of FAS in the world. Hypothesis In populations where the prevalence of full-blown FAS is already known to be high, such as the Western Cape, other, less severe childhood developmental and behavioural disorders may be due to prenatal alcohol exposure. Objectives The aim of this research was to determine the odds of maternal alcohol use in children with behavioural and/or developmental disorders (BDD) in comparison to children free from behavioural disorders. This project also examined the average utilisation of health services by children with BDD as an arm of a larger study on the economic burden of FAS in South Africa. Methods Opportunistic sampling was employed to select parents or caretakers of 110 children aged 4 to 12 for interviews at a tertiary children&acirc;s public hospital in Cape Town. Health service utilization and maternal alcohol consumption habits were compared between 55 cases, children with BDD and 55 controls, children free from such disorders. Univariate analyses and logistic regression methods were used to determine these associations. Ethics The University of Cape Town Research Ethics Committee approved this study. Dr. T. Blake, Senior Medical Superintendent of Red Cross War Memorial Children&acirc;s Hospital granted access to Red Cross Hospital. Before each study interview was conducted, informed consent, which emphasized confidentiality of responses and the right to refuse to answer a question or withdraw from the interview, was taken from the adult respondent. We also explained to participants that they would remain anonymous and that their answers would not affect their child&acirc;s treatment in the clinics. Results BDD were significantly associated with current maternal alcohol consumption, maternal binge drinking in the last six months, and maternal alcohol use six months before pregnancy, but not significantly with reported maternal gestational drinking. The median number of visits to a clinic in the last six months was significantly higher for cases than for controls. Conclusions Childhood BDD among our study participants were not attributed to prenatal alcohol exposure. Current maternal alcohol consumption has a significant impact on BDD in children, possibly serving as a proxy for unstable home environments. The competing environmental factors that influence childhood BDD warrants further research.
- ItemOpen AccessChild's play: Exposure to household pesticide use among children in rural, urban and informal areas of South Africa(2009) Tolosana, Sandy; Rother, Hanna-Andrea; London, LeslieBackground. As part of a larger dermatological investigation undertaken in 1999 - 2001 involving the Department of Dermatology, Groote Schuur Hospital (Cape Town, South Africa) and Nottingham University (UK), household pesticide use was investigated among Xhosa-speaking families living in three areas in South Africa (a rural area, an urban township and an informal settlement). Objectives. The aim was to characterise pesticide use patterns and potential exposures through skin absorption, ingestion and inhalation for this group of South African children. Methods. A standardised questionnaire, which included a section investigating household pesticide use, was administered by four trained fieldworkers to the parents/ guardians of the 740 children (25%) aged between 3 and 11 years identified as having atopic dermatitis either by clinical examination or according to the UK criteria (rural N=387, urban N=292, informal N=61). Results. Of the children with atopic dermatitis, 539 (73%) had been exposed to household pesticides. Most childhood exposure (89%) occurred in the informal settlements, followed by 78% in the urban area and 63% in the rural area. Conclusions. This research highlighted considerable home environment pesticide exposure of South African children in lower socio-economic groups in rural, urban and informal areas. As children are particularly vulnerable to the short- and long-term health effects of pesticide exposure, further indepth investigation is needed to ascertain and document the health effects associated with such exposure in the home.
- ItemOpen AccessChildhood behavioral and developmental disorders : association with maternal alcohol consumption and use of health services in Cape Town, South Africa(2010) Katwan, Elizabeth; London, Leslie[Background] Prenatal alcohol exposure can result in a range of permanent birth defects known as Fetal Alcohol Spectrum Disorders (FASD). Fetal Alcohol Syndrome (FAS), which detrimentally affects the neurodevelopmental, physical, and social capabilities of children, is the most severe diagnosis on this scale of disorders. Research suggests that FASD rates exceed FAS in various populations. South Africa’s Western Cape region has one of the highest rates of FAS in the world. [Hypothesis] In populations where the prevalence of full-blown FAS is already known to be high, such as the Western Cape, other, less severe childhood developmental and behavioural disorders may be due to prenatal alcohol exposure. Objectives The aim of this research was to determine the odds of maternal alcohol use in children with behavioural and/or developmental disorders (BDD) in comparison to children free from behavioural disorders. This project also examined the average utilisation of health services by children with BDD as an arm of a larger study on the economic burden of FAS in South Africa. [Methods] Opportunistic sampling was employed to select parents or caretakers of 110 children aged 4 to 12 for interviews at a tertiary children’s public hospital in Cape Town. Health service utilization and maternal alcohol consumption habits were compared between 55 cases, children with BDD and 55 controls, children free from such disorders. Univariate analyses and logistic regression methods were used to determine these associations. [Ethics] The University of Cape Town Research Ethics Committee approved this study. Dr. T. Blake, Senior Medical Superintendent of Red Cross War Memorial Children’s Hospital granted access to Red Cross Hospital. Before each study interview was conducted, informed consent, which emphasized confidentiality of responses and the right to refuse to answer a question or withdraw from the interview, was taken from the adult respondent. We also explained to participants that they would remain anonymous and that their answers would not affect their child’s treatment in the clinics. [Results] BDD were significantly associated with current maternal alcohol consumption, maternal binge drinking in the last six months, and maternal alcohol use six months before pregnancy, but not significantly with reported maternal gestational drinking. The median number of visits to a clinic in the last six months was significantly higher for cases than for controls. [Conclusions] Childhood BDD among our study participants were not attributed to prenatal alcohol exposure. Current maternal alcohol consumption has a significant impact on BDD in children, possibly serving as a proxy for unstable home environments. The competing environmental factors that influence childhood BDD warrants further research.
- ItemOpen AccessCommunity health committees as a vehicle for participation in advancing the right to health(2010) Glattstein-Young, Gabriela S; London, Leslie; Stuttaford, MariaThe principles of Primary Health Care guided health system transformation in South Africa where community health committees represent formal structures for participation in health. While there is evidence to suggest that participation can assist the progressive realization of the right to health, this link is not well established in the literature and Southern African studies underscore a serious deficit in the implementation of meaningful community participation. The present study used multiple methods to explore the relationship between participation and the right to health and to draw lessons on best practice for community participation from three health committees in South Africa's Western Cape Province.
- ItemOpen AccessCommunity participation and the right to health for people with disability: a qualitative study into Health Committees' understanding and practise of their governance role in relation to disability(2015) Abrahams, Theodore William John; Haricharan, Hanne Jensen; London, LeslieBACKGROUND: People with disabilities encounter major barriers that prevent them realising their right to health in South Africa. Health committees are legislated structures for community participation in health at a local level. This study investigated how health committee members understand and practise their role in community participation and how this advances the right to health for persons with disability. METHODS: A qualitative study was conducted with three health committees in the Cape Town Metropole in the Western Cape province of South Africa purposively selected for the study. Three facility managers and eight health committee members took part in focus group discussions and semi-structured interviews, supplemented by participant observations of committee meetings. Additionally, semi-structured interviews were conducted with 2 disability activists. These methods were used to gain a rich understanding of health committees’ roles and practises in relation to persons with disabilities. Thematic analysis was used to analyse the data. RESULTS: The main research findings were: (i) health committees did not prioritise disability on their respective agendas; (ii) persons with disabilities were not adequately represented on health committees; (iii) health committees exhibited poor understanding of disability barriers relating to health; (iv) lack of egalitarian values led to persons with disabilities not trusting the health committee, and distrust amongst health committee members; lastly (v) health committees augment health facility operations instead of fulfilling their governance and oversight function. These factors may have contributed to health committees not helping to advance the right to health for persons with disabilities. CONCLUSIONS: Health committees should include mandated representation of persons with disabilities, whilst addressing marginalisation directed toward persons with disabilities on committees. Training of health committees, as well as networking with disabled organisations, could help improve their limited understanding of disability. Health committees should consider addressing disability a human rights issue, which critically involves community mobilisation, raising awareness around issues of disability and promoting agency amongst persons with disabilities to claim their rights.
- ItemOpen AccessCommunity systems strengthening project: the successes and challenges perceived and experienced in Gugulethu, South Africa(2022) Mautsa, Tafadzwa Forsina; London, Leslie; Olivier, JillCommunity participation is an effective strategy for strengthening health systems and progressively realising health rights. For meaningful community participation to occur, the capacity of formal or informal community organisations and mechanisms involved in addressing social determinants of health needs to be strengthened. One way of doing this is through training. There is minimal research on the efforts of community structures set up to address social determinants of health and health needs in communities, following training to strengthen their capacity. This study sought to evaluate the successes and challenges of a particular Community Systems Strengthening Project which, between 2016 and 2019, set out to train health committee members and community health activists in Gugulethu, South Africa. In so doing, it investigated whether and how the health committee members and Community Health Activists assumed an activist role in the community and are engaging in meaningful community participation. A mixed methods evaluative study was conducted in two phases during 2020-2021. The first phase was a scoping review of available literature, followed by an evaluative study including review of project documents, observation by attending events organised by the project and other community organisations, and in-depth interviews with health committee members (2), community health activists (4) and project staff (4). The training intervention was found to have influenced the health committee members and Community Health Activists thinking, understanding and practice in their community efforts to address social determinants of health. Therefore, adequate support, training, and an enabling environment can facilitate meaningful community participation in health. Ultimately, these measures will contribute to the progressive realisation of the right to health and the right to community participation, and ultimately health system transformation. The limited adaptability of the intervention, limited resources, participant perceptions and sustainability were found to be obstacles to meaningful community participation. This dissertation consists of two parts. The study protocol, Part A, outlines the rationale of undertaking this research and the proposed methods. Part B consists of the journal ready manuscript which presents the results and discussion of the research findings.
- ItemOpen AccessConceptualising the right to enjoy benefits of scientific progress and exploring its potential to enhance access to effective diagnosis and treatment of drug-resistant tuberculosis in South Africa(2019) Shawa, Remmy Malama; London, Leslie; Coomans, Fons; Cox, HelenThe lack of access to effective diagnosis and treatment of drug-resistant tuberculosis (DR-TB) remains a persistent global challenge. Human rights arguments for access to treatment mostly focus on the right to health. However, a key challenge in access to effective diagnosis and treatment is the glaring absence of scientific research in neglected diseases such as TB. This thesis sets out to elaborate the right to enjoy the benefits of scientific progress and explore its potential to increase scientific research in DR-TB and consequently enhance access to effective diagnosis and treatment in South Africa. This research project was conducted using three interrelated sub-studies; a legal analysis sub-study which examines the current conceptualisation of the REBSP in international law; a policy analysis sub-study which interrogates South Africa’s legal and policy efforts towards the realisation of the REBSP and access to diagnosis and treatment for DR-TB; and a qualitative sub-study which explores the South African context regarding research and development (R&D) in general, and in DR-TB in particular. The qualitative sub-study included 17 stakeholders who are active in TB R&D, advocacy and policy work, from human rights and research institutions, government agencies, civil society organisations, and donor agencies. This thesis finds that the REBSP essentially ensures two things, namely the production of science and access to the benefits of scientific progress. However, most countries including South Africa have systems, policies and resources aimed at advancing the production of science but lack similar systems, policies and resources to purposely ensure the enjoyment of the benefits from scientific progress. Internationally, there is no clear guidance on the interpretation of the REBSP, making it difficult for states to domesticate it in their national policies and framework laws. A General Comment by a UN human rights monitoring body is therefore urgently needed to secure global consensus on the interpretation of the REBSP. In the meanwhile, South Africa can still draw inspiration for the REBSP and together with the right to health, use it to advance access to DR-TB diagnosis and treatment alongside many other interventions. To enable better access to effective diagnosis and treatment of DR-TB, this thesis recommends that South Africa i) develops systems that would make scientific progress and results accessible, and affordable; ii) removes system and regulatory barriers that hinder the conduct of research or that delay registration of new drugs; iii) monitors and regulates the conduct of third parties and prevent them from exploiting communities; iv) encourages pharmaceutical companies to provide free access to successful treatment and tools in communities where trials are conducted; and v) mobilises financial and technical resources and allocates them to DR-TB researchfrom drug discovery through to implementation science.
- ItemOpen AccessContamination of rural surface and ground water by endosulfan in farming areas of the Western Cape, South Africa(BioMed Central Ltd, 2003) Dalvie, Mohamed; Cairncross, Eugene; Solomon, Abdullah; London, LeslieBACKGROUND:In South Africa there is little data on environmental pollution of rural water sources by agrochemicals. METHODS: This study investigated pesticide contamination of ground and surface water in three intensive agricultural areas in the Western Cape: the Hex River Valley, Grabouw and Piketberg. Monitoring for endosulfan and chlorpyrifos at low levels was conducted as well as screening for other pesticides. RESULTS: The quantification limit for endosulfan was 0.1 mug/L. Endosulfan was found to be widespread in ground water, surface water and drinking water. The contamination was mostly at low levels, but regularly exceeded the European Drinking Water Standard of 0.1 mug/L. The two most contaminated sites were a sub-surface drain in the Hex River Valley and a dam in Grabouw, with 0.83 +/- 1.0 mug/L (n = 21) and 3.16 +/- 3.5 mug/L (n = 13) average endosulfan levels respectively. Other pesticides including chlorpyrifos, azinphos-methyl, fenarimol, iprodione, deltamethrin, penconazole and prothiofos were detected. Endosulfan was most frequently detected in Grabouw (69%) followed by Hex River (46%) and Piketberg (39%). Detections were more frequent in surface water (47%) than in groundwater (32%) and coincided with irrigation, and to a lesser extent, to spraying and trigger rains. Total dietary endosulfan intake calculated from levels found in drinking water did not exceed the Joint WHO/FAO Meeting on Pesticide Residues (JMPR) criteria. CONCLUSION: The study has shown the need for monitoring of pesticide contamination in surface and groundwater, and the development of drinking water quality standards for specific pesticides in South Africa.