OpenUCT is the open access institutional repository of the University of Cape Town (UCT). It preserves and makes UCT scholarly outputs digitally and freely available, including theses and dissertations, journal articles, book chapters, technical and research reports, as well as open educational resources.
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Open Access
The prevalence of health conditions and levels of physical activity of older people in South Africa: an intervention study
(2026) Naidoo, Shane; Naidoo, Nirmala
Background: South Africa has a rapidly growing aging population, shaped by interwoven biological, economic and social determinants, that is anticipated to place substantial strain on healthcare systems due to the high prevalence of multimorbid non-communicable diseases (NCDs). Although physical activity (PA) is proven to mitigate age-related NCD risks, 81.70% of older South Africans remain insufficiently active, with limited research that address these challenges. Objective: This study aimed to develop and evaluate an evidence-based PA intervention, underpinned by the Active Aging Framework, to mitigate NCDs and associated risk factors among older people residing in South African old age homes. Methods: The study followed a four-phase approach. Phase 1: A scoping review was conducted of randomised controlled trials on PA interventions targeting NCDs and their risk factors among older people in Sub-Saharan Africa. Phase 2: A cross-sectional analysis of 396 residents from 17 urban and rural old age homes was utilised to assess NCD prevalence and risk factors. Phase 3: Intervention mapping was employed to design a tailored PA programme incorporating aerobic and resistance training principles derived from the previous phases. Phase 4: The programme was piloted through a randomised controlled trial conducted in four facilities, two urban and two rural, with 80 participants evenly distributed between the experimental and control groups. Statistical analyses included t-tests, ANOVA, Mann-Whitney U, Kruskal-Wallis H, chi-squared tests, regression models, and Generalised Estimating Equations. Results: Phase 1 identified that a structured 12-week PA intervention combining aerobic activity (60–79% maximum heart rate) and resistance training as effective in reducing risks factors associated with NCDs. Phase 2 revealed critical issues, with 83.08 % engaging in insufficient PA, 31.82% classified as obese, and 35.10% exhibiting depressive symptoms. Phase 4 results demonstrated significant health improvements, including Time X Group interactions for body mass index (F (2,144) = 85.51, p < .001), systolic blood pressure (Waldχ² (3) = 35.43, p < .001), and Short Physical Performance Battery scores (Waldχ² (3) = 103.34, p < .001). Discussion: Phase 1: The scoping review demonstrated that PA interventions in Sub-Saharan Africa aligns well with international standards in promoting health and well-being among older people.
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Open Access
In Christ, there is neither male nor female: the trajectories of women's leadership in the Ghana Baptist Convention (GBC)
(2026) Owusu, Felix; Ukah, Asonzeh
This study explores the trajectories of women's leadership within the Ghana Baptist Convention (GBC). Historically, the GBC and its leadership have defined leadership predominantly through traditional masculine traits and characteristics. This perspective has resulted in the systemic exclusion of women from significant positions of authority within the local churches associated with the GBC. The study employed a qualitative and cross-sectional research design, separating it from the more commonly utilized quantitative methodologies. Thirty-eight (38) participants, comprising fifteen (15) males and twenty-three (23) females, were selected for this investigation to ensure a diverse gender representation within the sample. This study, which offers an in-depth analysis of women's leadership within the GBC, is organized into six chapters. The chapters are organized to meticulously and systematically address the research questions posed in the study: how did the GBC come to accept women's pastoral leadership, and in what ways did this acceptance evolve with time? The research identified three barriers hindering female pastoral leadership in the GBC. First, doctrinal and social barriers have shaped societal perceptions and expectations regarding women's roles in the denomination, stemming from deeply ingrained cultural norms. Second, institutional barriers exist within the structures and policies of the GBC itself, and these limit opportunities for women to attain leadership positions. Finally, the attitudes of women within the GBC have also played a crucial role. Together, these elements have created a challenging environment for women aspiring to pastoral leadership. These factors have led to the persistent underrepresentation of women in leadership roles, marginalizing female voices and their contributions to the GBC. This disparity restricts the influx of diverse perspectives and impedes the GBC's overall growth and inclusivity.
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Open Access
Using the Montreal Cognitive Assessment Test (MoCa) to screen for low cognitive performance in HIV positive heavy episodic alcohol users
(2026) Ori, Rasmita; Joska, John; Ipser, Jonathan
Background South Africa faces a dual public health crisis: concurrent HIV and high-risk alcohol consumption epidemics. Cognitive impairment in individuals with HIV (PLWH) is multifaceted, influenced by comorbidities and lifestyle factors. HIV infection correlates with increased alcohol use, potentially compromising treatment adherence and health outcomes. Globally, data on cognitive performance in PLWH with heavy episodic alcohol use are limited. Optimal assessment involves comprehensive neurocognitive testing with appropriate normative data; however, in resource-constrained settings, a concise, accessible screening tool administered by clinic staff is desirable. Early identification of at-risk individuals could enhance treatment outcomes and access to care. Given South Africa's resource limitations, this study investigates the utility of the Montreal Cognitive Assessment (MoCA) as a screening tool for detecting cognitive impairment in PLWH with heavy episodic drinking (HED) in Cape Town. Method: Sixty-six outpatients at Nolungile Clinic in Khayelitsha, Cape Town, underwent assessment encompassing sociodemographic data, MoCA and neuropsychological test battery scores, quantitative alcohol use, and clinical parameters. Participants were categorized into four groups based on HIV status and heavy alcohol consumption. Nonparametric Receiver Operating Characteristic (ROC) analysis determined the sensitivity and specificity of various MoCA cutoff scores against a gold-standard neurocognitive battery. Neurocognitive impairment was evaluated using the Global Deficit Score (GDS) and a novel multivariate method (NMM). Bivariate and chi-square tests identified associations between clinical variables and low cognitive performance. Results: The MoCA demonstrated high accuracy in differentiating participants with low cognitive performance, utilizing either the GDS (GDS; AUC = 0.901, 95% CI = 0.8090.992) or the NMM (NMM; AUC = 0.868, 95% CI = 0.766–0.969) to define low cognitive performance. Optimal MoCA cutoff scores were 19 (GDS) and 20 (NMM) with slightly lower specificity for the NMM (Sp = 0.661) compared to the GDS (Sp = 0.768), resulting in 19 false positives for the NMM and 13 for the GDS. At the standard MoCA cutoff of 26, 57 subjects (86.4%) were classified as having low cognitive performance. Using cutoff of 19 from ROC analysis, only 18 subjects (27.2%) were classified as impaired. Between group comparisons of low cognitive performance (HIV-/HED- = 5/19, HIV+/HED- = 6/18, HIV-/HED+ = 2/16, HIV+/HED+ = 5/13) revealed no significant difference (χ² = 2.923, df = 3, p = 0.404). MoCA cutoff scores showed no association with years of education or total socioeconomic status (SES) score. Similarly, no association was found between MoCA impairment and drinking score or HIV severity measures. Correlational analyses revealed a significant association between total MoCA score, SES, and NP domain scores (t = 2.436, df = 64, p = 0.01764). Significant associations were also observed for individual MoCA domains of naming and language with SES score. Low cognitive performance was significantly more prevalent in females (15/38 = 39.5%) than males (3/28 = 10.7%). Conclusion: This study demonstrates an association between lower cognitive performance and HIV, particularly among individuals with comorbid heavy alcohol use. This at-risk population would benefit from targeted screening to optimise treatment outcomes and access to dual diagnosis services. The MoCA maybe a valuable screening tool in resource constrained settings. Lowering the MoCA cutoff score further mitigates the overestimation of low cognitive performance. This research contributes to existing literature, showing a statistically significant association between SES score and both total MoCA score and specific cognitive domain impairment.
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Open Access
Life history and population dynamics of the African Pygmy Falcon - an obligate associate of the Sociable Weaver
(2026) Olubodun, Olufemi; Thomson, Robert
Raptors play key roles in nature from providing key ecosystem services to serving as flagship species for conservation initiatives. As apex predators and scavengers, raptors can control prey populations directly and indirectly thus maintaining delicate ecosystem balance, potentially controlling pest and disease spread. Raptors have a slow life history and are long-lived hence are more sensitive and reflective of long-term anthropogenic-driven changes than other avian groups. Desert-living raptors are even more prone to anthropogenic changes, particularly climate change as they already exist in environments that often nearly reach their ecological thresholds. These make raptors key conservation flagship species and important surrogates for studying the effects of changing climate. Despite these roles and their vulnerability to environmental pressures, research into the life-history and ecology of this avian group is limited, notably for African species inhabiting arid environments. Existing knowledge often focused on large charismatic species, with little research on small-sized species. I aim to understand and unravel the life history and ecology of a desert-dwelling raptor and how these are impacted by meteorological variables. In this thesis, I focus on the ecology of the African pygmy falcon (Polihierax semitorquatus) – Africa's smallest diurnal raptor, for which until now little information exists. This desert-dwelling species inhabits the Kalahari Desert of southern Africa where the weather is already at extreme levels and predicted to become more severe due to climate change. As a predator and obligate nesting associate of sociable weaver (Philetairus socius) colonies which serve as a microecosystem for fauna and flora interaction, the falcon can potentially structure the local ecosystem. Previous study on pygmy falcons show that they induce direct and indirect impact on their nest host and other associates of the nest. An initial study on their breeding biology was descriptive and a more recent study have established their cooperative breeding strategy. The main aim of this PhD was to investigate the life history and population dynamics of pygmy falcons and how these respond to metrological variables using long-term life history and demographic data collected from 2011 – 2024. I began by exploring the annual population density and variation in the reproductive traits of pygmy falcons. I found significant annual variation in clutch size, number of fledglings produced and likelihood of successful breeding. Second, I aimed to understand the breeding phenology of the falcons and the relationship with rainfall and temperature. I found strong negative association between clutch initiation date, and body condition of chicks with temperature. However, rainfall was more important for breeding success, and these followed a positive association. Third, relying on initial studies on population abundance of the pygmy falcons and effect of group living on their fledging conditions, I investigated the effect of rainfall, temperature, and group living on the survival of pygmy falcons. The results indicated no annual variation in survival, weak effects of winter and summer temperatures on adult survival, and no weather signals for juvenile survival. Finally, I considered delineating the home range size and explore the daily activity patterns of pygmy falcons. I investigated the latter in relation to time of day and temperature. I achieved this by attaching miniaturized GPS tags as backpacks on the falcons for a two-week duration during their chick-rearing phase. I found temperature thresholds important for limiting pygmy falcons' activities. Clearly, temperature at certain thresholds imposed limits on the activities of pygmy falcons prompting behavioural changes to optimize thermoregulation. I concluded that the year-to-year variation in the breeding parameters of pygmy falcon in my study population is likely linked to the high annual environmental stochasticity. Weather variables were more important for phenological traits, and daily activities, than for vital rates like survival, suggesting differential vulnerability of life stages to environmental pressures. As climate change is predicted to become more severe, with desert temperatures expected to become more extreme, pygmy falcons could experience severe phenological limitations. Moreso, the lack of effect of weather on survival may suggest that they are driven by other anthropogenic changes or intrinsic traits not considered in this thesis.
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Open Access
Determinants of public debt in South Africa
(2026) Odhiambo, Mark; Nikolaidou, Eftychia
Public debt, including both domestic and foreign obligations, poses significant risk to economic stability, particularly in developing countries such as South Africa. Public debt has been increasing in developing countries. The debt-to-GDP ratio in South Africa has been increasing in recent years, with total gross loan debt of national government debt reaching 73,4% of GDP by the end of 2023, this highlights the need for a deep understanding of the factors contributing to debt accumulation. Despite this need, this area of study has received limited attention in existing literature for South Africa. This study seeks to fill the gap in literature by examining the determinants of public debt in South Africa using quarterly data from 1990Q1 to 2023Q4, focusing on both the total debt and its domestic and foreign components. In addition to this, the study specifically focuses on fiscal variables as to ascertain how government policymakers can control debt accumulation and strengthen debt management strategies. Using the Autoregressive Distributed Lag (ARDL) approach to cointegration, this research explores the relationship between public debt and key fiscal and macroeconomic variables. The study also incorporates the effects of major global events, such as the 2008 Global Financial Crisis (GFC) and the Covid-19 pandemic. The findings indicate that government revenue plays a crucial role in reducing both total and domestic debt, while increased government expenditure is associated with higher levels of debt, particularly in the same categories. Government deposits are found to have a long-term negative relationship with foreign debt. The relationship between inflation and domestic debt is shown to be complex, with both positive and negative impacts. The analysis further reveals that the Global Financial Crisis increased domestic debt, and the Covid-19 pandemic has exacerbated foreign debt through lagged effects. This paper not only contributes to the limited literature on the determinants of public debt in South Africa but also provides policy recommendations. These policy recommendations underscore the importance of enhancing revenue collection and prudent expenditure management among other insights.