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
Development of a context-appropriate emergency care short course competency framework for Saudi Armed Forces medics
(2026) Alshaabani, Tariq; Saunders, Colleen; Wallis, Lee
Background Saudi Armed Forces medics require specialised emergency care training tailored to conflict-zone conditions. Existing trauma programs, such as International Trauma Life Support, do not fully address their unique needs. This doctoral programme of work aimed to develop a context-appropriate short course competency framework to enhance their preparedness Methods A multi-method approach was used. A scoping review examined the epidemiology of injuries in Middle Eastern conflict zones. A quantitative survey identified training priorities from military medical experts. Qualitative focus groups with trainees and instructors explored gaps in existing training. Batt's six-step model was then used to develop a competency framework for military medics in conflict settings. Results This study combined insights from a wide range of research methods to uncover areas where current training for Saudi Armed Forces medics could be improved. The scoping review shed light on the frequency and severity of extremity and thoracic injuries in regional conflict zones. Expert surveys highlighted top-priority skills like bleeding control, chest trauma management, and shock intervention. Meanwhile, qualitative findings revealed training challenges such as a lack of contextual relevance, limited psychological preparation, and insufficient scenario-based learning. These findings were integrated to develop a proposed competency framework designed using Batt's six-step model. Discussion Findings highlight the need for a tailored competency framework that integrates evidence-based trauma care with operational realities. Strategies for skill retention, competency-based assessments, and faculty training are essential for long-term effectiveness. Additionally, psychological preparedness and decision-making under pressure emerged as critical components. Implementing ongoing mentorship and simulation-based learning may further enhance medics' ability to apply skills in high-stress environments. Conclusion This thesis proposes a practical and context-specific competency framework tailored to the needs of Saudi military medics. Grounded in educational theory and real-world evidence, it lays the foundation for future piloting and evaluation, with the goal of improving emergency care training in military settings.
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Open Access
Regional dust emission thresholds from croplands in central South Africa
(2026) Adesuyi, Ayodeji; Eckardt, Frank
The continuous, pronounced supply of fine dust material originating from extensive agricultural farmland poses a major threat to topsoil quantity, quality, and sustainable food production, as well as other impacts on Earth's systems. The increase in dust emission in these agricultural areas is primarily attributed to surface dryness resulting from rising temperatures caused by climate change, global warming, and land degradation. The need to account for the surface variability is crucial to our comprehension of dust emission processes. The Free State and North West provinces have been identified as significant sources of agricultural dust in South Africa. This study uses an observation approach to characterise and examine physical surface controls (drought, soil moisture, vegetation, and surface roughness) that promote dust emission, using satellite remote sensing data, as well as to establish the dust event observations on eight 1-degree tiles of agricultural farmland, also referred to as the Main Emission Region (MER). Time series data for drought, soil moisture, vegetation, crop type data and surface roughness data were generated and examined over 11 years from 2006 to 2016, to analyse the spatial-temporal variation of the datasets, which corresponds to the dust event observation available. The study employed a descriptive statistical method to examine the temporal variations of the datasets as indicators of the likelihood of potential dust emissions. From the drought and soil moisture dataset, the monthly Standardised Precipitation Index (SPI), Standardised Precipitation Evapotranspiration Index (SPEI) and soil moisture index (SMI) were generated. The surface roughness data (Albedo: MCD43A1) was analysed and modelled using Chappell's “Albedo approach”, to obtain the best aerodynamic roughness (uS*/Uh). A supervised decision tree land cover classification technique was used to extract the land cover classes, while the vegetation crop type data was already classified. Findings from the study indicate that dry conditions for SPI, SPEI and SMI are highest in October and November, while surface roughness is lowest in August in the MER. The months of August, September, October, and November were identified as high dust emission months. The seasonal variation indicates dry conditions in most seasons, which corresponds with dust seasons, except for a slightly insignificant wet condition observed in summer and the prolonged drought or dry condition years matched with high to medium dust emission years. During these latter years, it was discovered that there was a decline in maize cover (1.2–0.6 million hectares) and an increase in fallow land (140–790 thousand hectares), especially between 2015 and 2016. This study created a combined threshold that categorised the indicators into low, medium, and high dust emission thresholds. Individual thresholds for dust production were also established. Should we have these values, the likelihood of dust emission increases with the availability of dust.
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Open Access
Beyond the incision: What preoperative and intraoperative data could inform us on the outcomes of acute appendicitis
(2026) Aboo, Fatima Bibi; Moloi, Lebohang
Background Acute appendicitis is one of the most common surgical emergencies worldwide, with significant morbidity and mortality, particularly in low- and middle-income countries (LMICs). Its management often serves as a proxy for the efficiency of surgical services, yet South African data remain limited, largely from single-centre retrospective studies. Standardised intraoperative grading systems can help assess severity, guide management, and predict outcomes, but interobserver variability and its impact on reproducibility are not well defined. This study therefore evaluated the Gomes grading system in the South African context, focusing on its reproducibility and prognostic utility in resource-limited settings. Methods A prospective cohort study was conducted across four hospitals in the Western Cape Metro. Patients aged 18 years and older who underwent surgical intervention for acute appendicitis between 1 February, and 31 July 2025 were enrolled. Demographic, intraoperative, and outcome data were collected anonymously and analysed in R (v4.5.0) using descriptive statistics, Wilcoxon rank-sum, Chi-square, and Fisher's Exact tests (p <0.05). All surgical units received training on the Gomes et al. (2015) grading system, which was used to capture intraoperative findings with photographic evidence, as videography was not feasible. Ethical approval was obtained and patient confidentiality was maintained. Results Ninety-eight patients were included, 46% male and 54% female, with a median age of 32 years. Patients with comorbidities were disproportionately represented in higher-grade disease. Preoperative predictors of complications included right iliac fossa tenderness (p <0.001), diffuse abdominal pain (OR 4.33, p <0.001), diarrhoea (OR 4.50, p =0.047), peritonitis (p =0.04), and elevated serum creatinine (p <0.001). White cell count and C-reactive protein were not predictive. Imaging was limited, with sonography performed in 25.5% and CT in 38.8%, neither yielding statistically significant findings. Intraoperative grading ranged from simple inflammation (24.5%) to perforated diffuse peritonitis (32.7%). Higher grades were strongly associated with complications (p <0.001), longer hospital stays (median 3-5.5 days), and open or converted procedures. Postoperative complications included deep surgical site infection (17.3%), superficial infection (11.2%), renal failure (6.1%), wound dehiscence (5.1%), nosocomial infection (4.1%), and fistula formation (1%). Mortality was 3.1%, occurring in patients with comorbidities, advanced intraoperative grades, elevated creatinine, and open laparotomy. ICU admission was required in 7.1%, predominantly for grade 4 disease. Interobserver agreement for intraoperative grading was fair (κ≈0.3), with consensus highest in lower grades and variability in transitional categories. The use of still images rather than videography limited reproducibility, contributing to variability in grading. Conclusion In this setting, preoperative clinical features and intraoperative severity were the strongest predictors of postoperative complications. The Gomes classification demonstrated strong prognostic value for complications and hospital stay, supporting its integration into routine documentation to guide escalation of care, rationalise resource use, and benchmark outcomes. Although interobserver agreement was only moderate, constrained by image quality, the study highlights the need for enhanced training and standardised visual aids in LMICs. Overall, the prognostic utility of intraoperative grading systems such as Gomes is reaffirmed, underscoring their potential to guide resource allocation and facilitate integration of LMICs into global outcome reporting.
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Open Access
The influence of perceived neuro-inclusivity and employer brand on organisation attraction
(2026) Jenkins, Robyn; Schlechter, Anton
Background. Organisations are increasingly recognising Diversity, Equity, and Inclusion (DEI) as essential for fostering supportive and innovative workplaces. However, within this context, neurodiversity—natural variation in human neurological development—remains a critical yet often overlooked dimension of workforce diversity. Neurodivergent individuals, such as those with autism, ADHD, dyslexia, or dyspraxia, bring unique skills and perspectives in the workplace but remain underrepresented in organisations due to stigma, misperceptions, and limited accommodations. Cultivating a strong employer brand and inclusive total rewards strategies may enhance the attraction of talent, yet research on perceived neuro-inclusivity and organisation attraction remains limited. Purpose of the Research. The purpose of the current research study was to 1) investigate how perceived neuro-inclusivity and employer brand influence organisation attraction, and 2) to determine the relative importance of neuro-inclusivity and employer brand compared to traditional total rewards typically offered to prospective employees. Specifically, the study aimed to examine the main and interaction effects of perceived neuro-inclusivity (NI) and employer brand (EB) on organisation attraction and assess the relative importance of NI and EB compared to other reward factors typically offered by organisations. Rationale for the Study. Understanding how perceived neuro-inclusivity and employer brand influence organisation attraction can help organisations design more effective DEI initiatives and recruitment strategies to attract and retain talented employees. Despite evidence that diversity and inclusive practices enhance organisation attraction, the specific impact of neuroinclusivity on organisation attraction remains underexplored. Investigating the relationship between NI, EB, and OA addresses both a practical and academic gap and offers insights that may help organisations gain a competitive advantage in attracting top-performing personnel. Research Design. A quantitative research approach guided by a positivist epistemology was employed to examine the causal relationships between perceived neuro-inclusivity, employer brand, and organisation attraction, as well as the relative importance of these attributes compared to other total rewards. Two experimental studies were conducted. Study 1 used a 2×2 full-factorial experiment in which participants were randomly assigned to one of five fictitious recruitment poster conditions varying in neuro-inclusivity and employer brand; responses were measured using an Organisation Attraction Scale (OAS) to test main and interaction effects. Study 2 employed a fractional experiment utilising Choice-Based Conjoint analysis, where participants evaluated hypothetical employer profiles combining support for neurodiversity, neuro-inclusive accommodations, employer brand, and five other total reward attributes, to determine their relative importance. Sampling & Realised Sample. The current research study used a non-probability sampling approach, specifically a purposive and snowball sampling procedure. The target population for the current research study were people who were able to provide informed consent and were currently employed or to be employed soon. The realised sample was predominantly white (86.3%), female (63.7%) and employed full-time (66.44%). Most respondents held a tertiary qualification (78.08%), with 16.44% possessing a master's or doctorate degree. Therefore, this sample underrepresents people of colour, males, and people without tertiary education. Main Findings. Employer brand (EB) was found to have a significant positive main effect on organisation attraction (OA), consistent with prior research and explained through Social Identity Theory, where affiliation with reputable organisations enhances pride and self-worth. Neuro-inclusivity (NI) also had a significant positive main effect on OA, though its impact was weaker and more variable than EB, likely due to lower visibility and awareness compared to employer brand cues. Choice-Based Conjoint analysis revealed that while compensation, career development, and work–life balance were top priorities, neuro-inclusive accommodations were rated higher than performance management and employer brand. This suggests that tangible neuro-inclusive practices may be perceived as more valuable than reputational signals alone, highlighting the growing importance of neuro-inclusivity in shaping prospective employees' organisation attraction. Contribution of the Study. The current research study demonstrates that employer brand (EB) and neuro-inclusivity significantly influences organisation attraction (OA) and that neuroinclusive (NI) accommodations enhance an organisation's Employee Value Proposition (EVP). NI accommodations were often ranked relatively more important than traditional rewards, highlighting the value of tangible, actionable practices over abstract signals. Findings advance research on neuro-inclusivity by showing that inclusive practices support Person Organisation Fit and position neuro-inclusivity as a strategic factor in talent attraction. Practically, embedding neuro-inclusive cues in recruitment materials and HR strategies can increase OA and guide evidence-based DEI initiatives to attract and retain diverse talent. Significance of the Study. The current research study contributes to the field of human resource management, particularly in the area of talent acquisition and Diversity, Equity and Inclusion (DEI) initiatives. By investigating the causal relationships between perceived neuroinclusivity, employer brand, and organisation attraction, the current research study provides valuable insights into aspects that may attract and retain talent in an organisation. The findings have implications for both academic research and practical application in industry. Managerial Implications. The current study highlights the importance of embedding neuroinclusivity into recruitment, HR policies, and organisational culture. To improve workplace neuro-inclusivity, organisations should provide mandatory neurodiversity training, implement tangible accommodations (e.g., alternative assessments, assistive technology, flexible work arrangements), and explicitly signal inclusive practices in job postings to attract neurodiverse talent and other prospective employees who value DEI. Performance management systems should be adapted to recognise diverse cognitive styles, while inclusion must be authentic rather than symbolic to prevent marginalisation. By fostering psychological safety, practical support, and a culture of understanding, organisations can enhance attraction, integration, disclosure, and performance among neurodivergent employees, reinforcing the strategic value of neuro-inclusivity.
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Open Access
Eating for Brain Health: Exploring barriers and facilitators of diet adherence in a dementia-risk sample in South Africa
(2026) Steenkamp, Kirsten; Joska, John; Rabie , Stephan
Background: The prevalence of dementia is increasing in low-and-middle-income countries, including in South Africa. It is driven by population ageing, with contributions from several noncommunicable diseases and lifestyle factors, including diet. The influential 2024 Lancet Commission suggests that modifiable risk factors across the lifespan may account for almost half of dementia cases. These risk factors include mid-life hypertension, diabetes mellitus, and dyslipidaemia. A significant proportion of the burden caused by these risk factors may be mitigated by diet. In addition, there is evidence that a brain-healthy diet may be part of a care package that could improve dementia outcomes once confirmed. The role of a healthy diet in reducing dementia risk and progression could be an important modifiable intervention. In South Africa, low-income households experience pervasive structural and psychosocial barriers to healthy eating, which result in chronic food insecurity and low dietary diversity. Additionally, reported adherence to national eating guidelines is low. Socio-cultural studies have shown that perceptions of health strongly influence dietary behaviour. There are currently no behavioural interventions to improve diet adherence in dementia-risk South Africans. The development of contextually informed interventions to improve diet adherence may significantly help reduce the burden of dementia. This includes an in-depth understanding of socio-cultural perceptions of healthy eating, which could facilitate dietary behaviour change for improved brain health.
Aims: To explore contextually relevant factors influencing adherence to the South African FoodBased Dietary Guidelines (SA-FBDG). Specifically, readiness to change, food insecurity, and barriers to healthy eating were examined. In addition, this study aimed to explore, using in-depth interviews, how barriers and facilitators to a healthy diet might be mitigated and strengthened, respectively. Methodology: A cross-sectional, mixed-methods approach was used to measure SA-FBDG diet adherence and potential variables that are associated with adherence. The study recruited 120 dementia-risk persons from two primary healthcare facilities in Khayelitsha, Cape Town. In line with current evidence, dementia-risk was defined as persons over the age of 60 who were diagnosed with a chronic condition of either/and diabetes, hypertension or high cholesterol. Hereafter, qualitative semi-structured interviews were conducted with 13 subsampled participants to explore dietary behaviour and eating-related perceptions.
Key findings: 1. Adherence to the Elderly SA-FBDG was moderate. 2. Diet adherence was significantly positively correlated with dietary readiness to change and negatively correlated with barriers to healthy eating. Results showed that diet adherence was not significantly associated with food insecurity. However, in the qualitative subsample, financial deprivation was reported as a key barrier to healthy eating. Additional barriers to healthy eating included limited food literacy and poor health awareness. Facilitators to healthy eating included having your own food garden, positive self-talk, a supportive community, and responsibilities towards family. 3. The data suggested that diet adherence was dependent on the monthly Older Person's Grant. Diet adherence was higher in the period after grant payment and lower for the remainder of the month, which is consistent with a pattern of food insecurity linked to income.
Conclusions: In addition to strengthening interdisciplinary research and promoting clinical nutrition, the research will advance efforts towards achieving the Sustainable Development Goals by reducing food insecurity and the burden of nutrition-related non-communicable diseases in South Africa. Potential intervention targets are recommended to inform the development of dementia-informed dietary interventions and align future research with Africa's 6x5 dementia plan.