OpenUCT :: Browsing by Author "Rother, Hanna-Andrea"

Browsing by Author "Rother, Hanna-Andrea"

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Open Access
A Qualitative study of language barriers between South African health care providers and cross-border migrants
(BioMed Central, 2017-01-31) Hunter-Adams, Jo; Rother, Hanna-Andrea
Background: Communication with health care providers represents an essential part of access to health care for the over 230 million cross-border migrants around the world. In this article, we explore the complexity of health communication from the perspective of cross-border migrants seeking antenatal care in Cape Town, South Africa in order to highlight the importance of high quality medical interpretation. Methods: As part of a broader study of migrant maternal and infant nutrition, we conducted a secondary data analysis of semi-structured in-depth interviews (N = 23) with Congolese (n = 7), Somali (n = 8) and Zimbabwean (n = 8) women living in Cape Town, as well as nine focus group discussions (including men: n = 3 and women: n = 6) were conducted with migrant Somalis, Congolese, and Zimbabweans (N = 48). We first used content analysis to gather all data related to language and communication. We then analysed this data thematically. Results: Zimbabwean participants described how the inability to speak the local South African language (IsiXhosa) gave rise to labelling and stereotyping by healthcare staff. Congolese and Somali participants described medical procedures, including tubal ligation, which were performed without consent. Partners often tried to play the role of interpreter, which resulted in loss of income and non-professional medical interpretation. Participants’ highlighted fears over unwanted procedures or being unable to access care. Challenges of communication without a common language (and without professional medical interpretation), rather than outright denial of care by healthcare professionals, mediated these encounters. Conclusion: Although there are several factors impeding cross-border migrants’ access to health care, effective communication is a prerequisite for quality care. Free-to-patient professional medical interpretation would not only benefit migrant populations but would benefit the broader community where language and health literacy are barriers to accessing health care. Novel approaches to language access may include technology-enabled professional interpretation.
Open Access
The acceptability of rat trap use over pesticides for rodent control in two poor urban communities in South Africa
(BioMed Central Ltd, 2012) Roomaney, Rifqah; Ehrlich, Rodney; Rother, Hanna-Andrea
BACKGROUND: Rodent infestations are a public health problem in poor urban communities. The use of illegal street pesticides to control rodent infestations with resulting poisonings is an additional public health concern receiving limited attention in many developing countries, including South Africa. METHODS: Participants in a household intervention in two poor urban areas of Cape Town, South Africa, received two high quality rat traps. Reported in this article are the results of a follow-up survey conducted six months after distribution to assess community perceived acceptability of using rat traps instead of toxic pesticides (N=175). RESULTS: Of the 175 respondents that were followed up, 88% used the traps and only 35% continued using pesticides after the intervention. The analysis identified perceived effectiveness of the traps (prevalence odds ratio 18.00, 95% confidence interval 4.62 to 70.14), being male (prevalence odds ratio 8.86, 95% confidence interval 1.73 to 45.19), and the willingness to buy traps from an informal market (prevalence odds ratio 17.75, 95% confidence interval 4.22 to 74.57) as significantly associated with the acceptance of trap use. CONCLUSIONS: Rat traps, when introduced to poor urban communities, are acceptable as an alternative to toxic pesticides for rodent control. Sustainability of trap use, however, needs to be researched, especially cost and cost-benefit.
Open Access
Analysing the effectiveness of pictograms as a hazard communication mechanism to reduce child exposure to chemicals in South Africa
(2021) Louw, Tatum; Rother, Hanna-Andrea
Hazard communication mechanisms are essential for informing child caregivers of the dangers associated with chemical products. However, for caregivers to protect their own health and their children from the harm of toxic chemicals, it is important that they understand label information as scientifically intended. Therefore, to accommodate parts of society that have a lack of access to education, the placement of hazard communication pictograms on labels have been introduced to overcome literacy barriers. Many research studies have been conducted on the comprehensibility of pictograms and have found that many barriers exist in end-users being able to understand the intended message behind the pictogram. This study, therefore, explores further the awareness and comprehension of pictogram comprehensibility among caregivers in South Africa that have different backgrounds and living experiences. The study employed a mixed-methods cross-sectional design. The study was conducted with farmworkers from a farm in Paarl and students from the University of Cape Town. Two different data collection tools were used: a face-to-face questionnaire was administered to farmworkers (taking into account literacy barriers) and an online questionnaire to students due to unforeseen circumstances (COVID-19), that put a pause on face-to-face questionnaires being administered among UCT students. Both groups received the same questions except for small adjustments made to the online questionnaire to accommodate the platform. Data for the face-to-face questions were stored in the data collection application, CommCare, and transferred to Excel for quantitative analysis. The online questionnaire was administered through a Google form that was emailed to all students at the university by the Department of Student Affairs and data were then transferred to excel for quantitative analysis. The qualitative data were analysed using a thematic analysis approach where themes were created from theory in the literature and word repetitions that emerged from the respective group responses. Based on the overall results, comprehension of the pictograms varied greatly between caregiver groups indicating harmonization is necessary. Although beyond the scope of this study, the difference amongst the perception of danger warrants further analysis on whether age, educational level, perception of danger, lived experiences, and environmental exposure play a role in the two groups' comprehension of pictograms. The study focused on the already existing Globally Harmonized System of Classification and Labelling of Chemicals (GHS) pictograms as well as newly proposed ones to communicate the “Keep out of reach of children” message. Based on the overall results, what the pictograms represented varied greatly between the different caregiver groups, indicating that comprehension differs largely, and harmonization has not been entirely achieved as desired by the GHS. However, the study concludes that participants place responsibility on the chemical industry to make information about the harmful effects about their products more accessible to communities through educational talks, social media, experts at the point of sale to explain any potential hazards, and through the use of billboards and flyers. Though difficult to achieve, it is suggested that conversation amongst chemical legislators and industry commence on how to include the voice of end-users in the development and implementation of hazard communication strategies.
Open Access
Assessing the impact of e-learning on decision-making to reduce health risks: Perceptions from UCT's pesticide risk management cohort
(2015) Stuurman, Kenin Richard; Rother, Hanna-Andrea
There is a need to build the capacity of professionals in low- to middle- income countries (LMICs) in order to reduce pesticide risks on human and environmental health. To address these risks, the University of Cape Town (UCT) introduced the Post Graduate Diploma in Pesticide Risk Management (DPRM). This programme utilises a mixed teaching mode including an e-learning component which includes virtual seminars/discussion forums. The DPRMs' discussion forum aimed to strengthen skills in managing and reducing pesticide risks. Due to the shortage of skilled professionals in LMICs, e-learning can facilitate the on-going training and skills development in pesticide management to address pesticide related challenges. The study focus was on evaluating the impact of the DPRMs' e-learning Discussion Forum bi-monthly sessions on the decision-making processes of professionals in LMICs working in pesticide risk management. The sample for this study was obtained from a population of working professionals, who either completed or were currently enrolled for the DPRM programme (N=37). Twenty-two participants completed the online questionnaire anonymously. These participants were employed by governments, non-governmental organizations (NGOs), research institutes and private companies in Africa and Fiji. This mini-dissertation is divided into four parts. The protocol (Part A) provides the study justification and describes the methodology for collecting the data and the analysis thereof. The literature review (Part B) describes e-learning and how it relates to capacity building of pesticide risk management (PRM) professionals in LMICs countries. It looks at the challenges of implementing and maintaining successful capacity building and the role e-learning plays. The manuscript of a journal ready article (Part C) presents the research findings on the perceived effectiveness of the e-learning based DPRM discussion forum and whether it aided PRM professionals in making better decisions. There are four appendices (Part D) which include the questionnaire, consent form, ethical approval and instructions for writing the manuscript. The study found that participants reported improved application of information gained through e-learning in a practical and effective manner, thereby improving their skills for real world scenarios. Overall benefits acknowledged by participants included establishing a knowledge resource, improved communication with colleagues and stakeholders, as well as improved ability for knowledge application in their work and pesticide use in context. An important finding was that just over half of respondents (55%) felt that they were able to contribute to policy change in their countries as a result of the discussion forum. Unfortunately, no statistical significance could be established between variables due to the limited sample size. It is recommended that a follow-up study with a larger sample be conducted, to establish whether the discussion forum has a long-term and sustainable impact in decision- making processes and policy implementation.
Open Access
Assessing the role of temperature and air pollution in exacerbating childhood asthma in Cape Town, South Africa
(2022) Phakisi, Tshepo Kingsley; Rother, Hanna-Andrea; Godsmark, Christie Nicole; Weimann, Edda
Childhood asthma is one of the most common chronic diseases worldwide, including in South Africa. There has been substantial evidence on the role of air pollution in asthma exacerbation but limited research on the role of climate change and how the interaction between climate change and air pollution is affecting childhood asthma, specifically in low and middle-income countries (LMICs). Temperature changes can be used as an effect of climate change to investigate the association between climate change, air pollution and childhood asthma. This study, therefore, used a case study approach aimed at examining the interaction between air pollution and temperature in exacerbating childhood asthma focusing on clinical data obtained from Red Cross War Memorial Children's Hospital, air quality data (City of Cape Town) and temperature data (South African Weather Services) for Cape Town, South Africa for three study years (2009, 2014 and 2019). The protocol (Part A) of the mini dissertation describes childhood asthma literature globally and in LMICs and specifically in South Africa. It also discusses the increasing incidences and prevalence of the disease and possible causes such as air pollution and climate change. Furthermore, it discusses the vulnerability of children to the exposure of interest, being air pollution (PM2.5, PM10, NO2 and O3) and climate change (i.e., temperature). Subsequently, the development of air quality standards is discussed, specifically concerning whether they consider the specific children's vulnerability to exposures. The protocol then describes the study population and methodologies for conducting this study. The journal ready article (Part B) presents the findings of the study. Spearman's correlation was used to measure the degree of association between temperature variables and air pollutants. The results indicated that diurnal temperature was associated with PM2.5 (r=0.579: p< 0.01) and PM10 (r=0.505: p< 0.01). A Poisson regression analysis was applied to evaluate the relationship between asthma exacerbation with air pollutants and temperature variables. In a univariate analysis there was a statistically significant relationship between asthma exacerbation and diurnal temperature for 2019, IRR=0.98 (95% CI,0.97 – 0.99) p< 0.05, maximum temperature 2014, IRR=0.99(95% CI, 0.98 - 1.00) p< 0.05 and for 2019, IRR=0.98(95% CI, 0.97 - 0.99) p< 0.01, average temperature 2014, IRR=0.99(95% CI, 0.98 - 1.00) p< 0.05 and for 2019, IRR=0.98(95% CI, 0.97 - 0.99) p< 0.01. Using a multivariate analysis there v of 110 was no significant relationship between childhood asthma exacerbation and air pollutants (PM10, NO2 and O3) except for PM2.5 IRR=0.12(95% CI, 0.01 - 0.81) p< 0.05. Diurnal temperature statistically significant childhood asthma predictor for 2009, IRR=1.02(95% CI, 1.00 - 1.05) p< 0.05 and for 2014, IRR=0.97(95% CI, 0.96 - 0.99) p< 0.01. Temperature increase, therefore, seems to be related to asthma exacerbation. More research is needed on the relationship between diurnal temperature, childhood asthma, and air pollutants to inform adaptation strategies. The findings of this study are important for the development of climate change and health adaptation and prevention strategies in South Africa, particularly in relation to heat adaptation. These findings are also relevant for the development of air quality guidelines and guidelines to address children, as the most vulnerable population to environmental health exposures. The appendices (Part C) present the analyses that were not included in the protocol (Part A) and article (Part B). These also include documents relating to the study such as ethics approval and permission to conduct research by different entities.
Open Access
"But it's just paracetamol" : caregivers ability to administer over-the-counter painkillers to their children with the information provided
(2013) Gibson, Fiona; Rother, Hanna-Andrea
Unintentional overdose of over-the-counter (OTC) medications has become an increasing global public health concern due to the common and frequent use of painkillers among end users, to self-medicate and medicate others, without fully understanding the associated health risks. While many developed countries have started to implement measures in an attempt to reduce access to large quantities and raise awareness of the dangers of misuse of OTC medications, this is not the case in many middle and low income countries. Instead, many individuals are forced to rely on written information while faced with poor health literacy, inadequate information and limited verbal information from health professionals, all of which contribute to the increase in unsafe behaviours leading to overdosing. In South Africa, most unintentional overdoses from OTC painkillers occur in children, which can often be attributed to incorrect dosing from caregivers. With the common practice of re-packaging medications at a distribution level, individuals are often not provided with adequate information about their medication, appropriate for their level of health literacy. This study explored whether caregivers are able to make informed decisions about the correct and safe administration of popular OTC painkillers (specifically paracetamol) to their children, based on information from labels, medication inserts and/or patient information leaflets (PILs).
Open Access
Characterising the role of climate change in perpetuating Zimbabwean farmers' health risks from exposure to endocrine disrupting pesticides
(2020) Zinyemba, Cliff; Rother, Hanna-Andrea; Archer, Emma
Climate change and endocrine disrupting chemicals are currently amongst key drivers for a range of non-communicable diseases and adverse human health conditions. Pesticides constitute an important source of endocrine disrupting chemicals. A growing public health concern is the potential relationship between climate change and adaptive increases in agricultural pesticide use. Effectively, with increases in pesticide use, there may be increased potential for elevated pesticide exposures and, thus, increased endocrine disrupting health risks. The aim of this thesis was to assess whether climate change is a key risk perpetuating factor for endocrine disrupting health risks due to increased agricultural pesticide uses and exposures. The study was conducted in Zimbabwe with farmers in the cotton farming district of Rushinga. Three research methods: 1) interviews with farmers, 2) quantitative structure-activity relationship modelling and, 3) stakeholder interviews with government cotton agronomists working in Rushinga district who acted as key informants. Qualitative in-depth interviews were conducted with 50 active smallholder farmers who had grown cotton for a minimum of 30 years. The interviews gathered farmers' perceptions and observations regarding climate change, changes in pest types, pest populations, pesticide use patterns, pesticide handling practices, and adaptive practices, amongst others. Quantitative structure-activity relationship modelling was, further, applied in identifying key risk pesticides of concern. Amitraz, endosulfan, fenvalerate and lambda-cyhalothrin were determined as having a high likelihood of acting as endocrine disruptors, as validated by literature highlighting the four pesticides' hormone-related cognitive, physiological and reproductive adverse health effects. Findings indicated that a number of farmers' adaptative practices were found to be incremental and, potentially, maladaptive, thereby enhancing pesticide use and exposure. This was indicative of climate change's potential for perpetuating pesticide-related endocrine disrupting health risks. Opportunities exist, however, for farmers to reduce pesticide use, and, thus, potential endocrine disrupting health risks through certain autonomous transformational adaptive practices, such as crop switching and cotton acreage reduction. Assistance to farmers by the government and development agencies, for enhancing opportunities for transformational adaptation is therefore recommended. Furthermore, there is need, at policy level, for phasing out pesticides with endocrine disrupting properties. There is, furthermore, a clear need for enhancing farmers' access to, and comprehension of, pesticide risk information through various innovative means, including research translation to reduce exposure risks.
Open Access
Child'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, Leslie
Background. 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.
Open Access
Climate Change, Pesticides and Health: Considering the Risks and Opportunities of Adaptation for Zimbabwean Smallholder Cotton Growers
(2020-12-26) Zinyemba, Cliff; Archer, Emma; Rother, Hanna-Andrea
There is potential for increased pesticide-related adverse health outcomes in the agricultural sector linked to adaptive increases in pesticide use necessitated, in part, by climate change-related increases in pest populations. To understand the role of adaptation practices in pesticide use and health risks, this study assessed Zimbabwean smallholder cotton farmers’ adaptive responses linked to their climate change perceptions. In depth interviews were conducted with 50 farmers who had been growing cotton for at least 30 years. The study identified farmers’ adaptation practices that increased their pesticide use, as well as those that presented opportunities for reducing pesticide use through non-pesticide-dependent adaptation pathways. The findings show that due to perceived climate change impacts, such as a shorter growing season, farmers were adopting a range of adaptive practices. These included changes in pest management practices, such as increasing pesticide spraying frequencies due to keeping ratoon crops, which were increasing farmers’ overall pesticide use. Such incremental adaptive practices are potentially maladaptive, as they may increase farmers’ pesticiderelated health risks. Other practices, however, such as reducing cotton acreage and diversifying crops, resulting in transformational adaptation, suggest the existence of opportunities for decreasing overall pesticide use or totally eliminating pesticides from the farming system
Open Access
Demographic determinants of chemical safety information recall in workers and consumers in South Africa
(2015) Sathar, Farzana; Dalvie, Mohamed Aqiel; Rother, Hanna-Andrea
Chemical hazard communication is intended to alert users of the potential hazards of chemicals. Apart from the fact that hazard information should be understood, it is also important that it should be recalled. Recall of hazard communication is critical when the written form of the information is not available at the time it is required. A cross-sectional study investigating predictors of the recall of chemical safety information on labels and safety data sheets amongst 315 workers (industry, transport and agriculture sectors) and 87 consumers in two provinces of South Africa was conducted. The recall of participants was tested using two modules (module 2 which relates to the demographics, and module 3 which relates to the recall of the participants) from the Hazard Communication Comprehensibility Testing (CT) Tool developed by the Centre for Environmental and Occupational Health at the University of Cape Town. Respondents were predominantly male (67.7%), the median age was 37 years (IQR: 30-46 years) and less than half of the participants completed high school (47.5%). The majority of participants were blue collar workers outside of industry (55.5%). The skull and crossbones symbol was the label element most recalled, both unprompted (79.6%) and prompted (94.8%), and the first aid and treatment measures the least frequently recalled (6.0%-29.9%). Multivariate analysis showed the predictors that were found to increase the recall of all the label elements were, industrial sector, transport sector, agriculture sector, gender, home language English and Afrikaans, reading English and Afrikaans, completing high school and non-industry white collar occupations. The predictors that were found to decrease recall were further education, not wearing glasses and non-industry blue collar occupations. This study found demographic factors to influence the recall of hazard information. Policy should ensure the implementation of procedures that promote the recall of hazard information to protect workers from hazardous exposures.
Open Access
Environmental health recommendations for Multidrug-Resistant Tuberculosis in low- and middle-income countries: a systematic review
(2022) Nel, Amy; Rother, Hanna-Andrea; Miller, Mary E
Despite efforts towards the management and prevention of Tuberculosis (TB) having shown some success, Multidrug-Resistant Tuberculosis (MDR-TB) may potentially compromise these endeavours. MDR-TB has the potential to become the most dominant form of TB in low- and middle-income countries (LMICs). The impact of environmental health factors on the optimization of health of MDR-TB infected individuals, as well as on the prevention of transmission to household contacts, is not well documented. Current Sustainable Development Goals (SDGs) aim to achieve inclusivity, sustainability and resilience, not only through economic and social changes, but also through environmental targets in order to achieve optimal health and well-being for all. However, without appropriate acknowledgment of the environment's influence on outcomes during TB treatment, these targets are potentially unattainable. Establishing the recommendations of environmental health risk factors for individuals living at home with MDR-TB will have important policy implications as well as assist in decision making for those affected with MDR-TB in LMICs, such as South Africa. This systematic review, therefore, sought to identify the environmental health factors in LMICs that affect treatment outcomes for individuals living at home with MDR-TB, to optimize their health during completion of their treatment regimen and prevent transmission to household contacts. Part A outlines the current literature available for such a topic as well as methodology used within the systematic search and analysis of included articles. Prominent environmental health exposure variables of interest that have previously been identified as having a significant role in TB transmission or influencing the well-being of infected individuals, were identified within the literature. These included air pollution, nutrition, migration, urbanization, smoking, alcohol, other substance use and housing. Outcomes of interest included optimization of health and prevention of MDR-TB transmission to household contacts. The article (part B) represents the results from the systematic search as well as the application to current policy recommendations. After screening and reviewing the full text of potential articles for inclusion (N = 87), only thirteen articles were eligible for inclusion into the final sample. All included studies were primary observational studies, examining the relationship between MDRTB and the pre-defined exposures and outcomes in populations ≥13 years of age. Environmental risk factors for household transmission of MDR-TB potentially included malnutrition but showed no significant relationship with overcrowding. There was disagreement as to whether smoking was as a significant predictor of mortality but findings did indicate that smoking did have a negative impact on sputum culture conversion among patients receiving treatment. Other substance use was found to have a significant role in the default of treatment. The use of alcohol was associated with poor treatment outcomes, default of treatment and lack of sputum culture conversion. In terms of household conditions, an association was found between substandard housing conditions and treatment default. Formal housing was associated with a decline in treatment default but a residential address change was associated with defaulting treatment. The results of the review presented contradictory results regarding the risk of mortality and underweight/overweight BMI estimates. The review potentially highlighted vulnerable population groups including gender groups, children and HIV positive individuals. Therefore, this systematic review highlighted the potential relationship between environmental risk factors and optimising the health of individuals on treatment for MDR-TB, as well as the role that promoting environmental health may play in preventing the transmission to household contacts. In conclusion, environmental risk factors should be incorporated into local health system strategies and global policy. This includes WHO targets in TB prevention efforts, as well as in action areas for the attainment of relevant SDGs (e.g. SDG 3 and SDG 5), to address the burden of MDR-TB and decrease MDR-TB transmission in LMICs, effectively and sustainably.
Open Access
Evaluating a South African mobile application for healthcare professionals to improve diagnosis and notification of pesticide poisonings
(2017) Kabanda, Siti; Rother, Hanna-Andrea
Acute pesticide poisoning (APP) is a major global public health problem, particularly in low- and middle-income countries (LMICs) including South Africa. However, healthcare professionals (HCPs) worldwide have limited training in handling environmental health risks such as from pesticide exposures. Most HCPs lack basic training on APP and, this presents a challenge to HCPs when diagnosing and notifying pesticide-related poisonings. With a recent increase in mobile application technology, this gives a convenient platform to provide training support for HCPs in their clinical practice. An example is the integration of a South African pesticide notification guideline into an existing Emergency Medicine (EM) mobile application. This pesticide notification guideline (PNG) within the EM mobile application aims to provide an immediate point-of-care tool to help HCPs in diagnosis and notify pesticide poisoning cases. Despite this useful platform for training HCPs, there are limited studies that have evaluated mobile applications or technologies to promote HCPs training in LMICs. This study, therefore, aimed to evaluate the Centre for Environmental and Occupational Health Research (CEOHR)'s PGN adapted for the EM mobile application as a tool for improving HCP's ability to diagnose and report APPs. The protocol (Part A) provides information and a justification for the research study and, describes the methods used to gather and analyse the data. The extended literature review (Part B) provides an overview of studies assessing HCPs' knowledge of and training in pesticide poisonings and the role mobile health technologies play in improving HCPs' knowledge and training in clinical practice. Furthermore, the literature review illustrates the relevant theoretical frameworks and concepts that helps to understand HCPs' behaviour changes when using clinical guidelines or algorithms. The journal manuscript article (Part C) provides this study's research findings and how it could contribute to the body of knowledge. A total of 50 emergency medicine physicians and registrars participated in the
Open Access
Evaluating a South African mobile application for healthcare professionals to improve diagnosis and notification of pesticide poisonings
(2019-03-11) Kabanda, Siti; Rother, Hanna-Andrea
Background: Mobile health is a fast-developing field. The use of mobile health applications by healthcare professionals (HCPs) globally has increased considerably. While several studies in high income countries have investigated the use of mobile applications by HCPs in clinical practice, few have been conducted in low- and middle-income countries. The University of Cape Town developed a pesticide notification guideline which has been adapted and embedded into a South African Essential Medical Guidance mobile application. This study evaluated the usefulness of the guideline within a mobile application for improving the ability of HCPs to diagnose and notify on acute pesticide poisonings (APPs). Methods A descriptive online questionnaire, with 15 open- and 20 closed-ended questions, was completed by 50 South African emergency medicine physicians and registrars (i.e. medical doctors training as specialists) between December 2015 to February 2016. Descriptive statistics were used to calculate response frequencies and percentages using SPSS version 23. Texts from the open-ended questions were thematically analysed. Fisher’s exact test was applied to determine associations. Results A significant association was found between participants’ knowledge that APP is a notifiable condition, and ever reporting the poisoning to the National Department of Health (p = 0.005). Thirty four percent of the participants were aware of the guideline within the Essential Medical Guidance application despite only seven participants having used it. Those who used the guideline found it provided useful information for the identification of unlabelled pesticides products and promoted reporting these cases to the National Department of Health for surveillance purposes. In addition, it appeared to facilitate the prompt diagnosis and treatment of APP cases, and most intended to continue using it for training and educational purposes. Conclusions Mobile health applications appear to support overburdened medical education programmes and promote better patient care. However, since most participants were not aware of the existence of the pesticide guideline within the studied essential medicine application, there is potential for the use of healthcare applications to play a more central role in healthcare systems and medical training. Furthermore, the field of medical informatics could support HCPs through mobile applications in improving reporting of APP.
Open Access
Factors facilitating pest infestation in two low-income urban areas of Cape Town, South Africa : an urban health observation study
(2016) Mngadi, Nontokozo; Rother, Hanna-Andrea
High pest burdens in low-income urban areas pose a significant public health threat to residents due to pest-induced diseases and other negative health consequences. Furthermore, pests can also be a source of nuisance and social stigma. To ward off pests and the problems they are associated with, many residents of socioeconomically disadvantaged urban areas frequently use pesticides, including highly toxic illegal pesticides. Inappropriate and indiscriminate use of pesticide is a concern since pesticide exposures can put residents, especially children, at risk for negative health effects. While pesticide use and exposures are common in many low socioeconomic urban areas globally, pesticide-induced adverse health effects are of particular concern in developing countries, such as South Africa, where pesticide regulations and enforcement thereof is often lacking. Following the alarming rise in number of children hospitalized with pesticide poisoning in the Cape Town surrounds, researchers at the University of Cape Town conducted a study whose aim was to identify common in-home pests, pesticide use and exposure patterns, and pesticide risk perceptions in Khayelitsha and Philippi, two low socioeconomic communities of Cape Town. This study was part of the larger project and was focused on investigating factors that contribute to pest infestation in low socioeconomic urban areas. An analysis of qualitative data that examined factors in housing, environment and practices and pest control behaviours of poor urban residents that facilitate pest infestation is presented in this mini-dissertation. The protocol (Part A) describes the study population and the methods used to collect and analyse the data. The structured literature review (Part B) describes the double health burden from pests and pesticide exposure faced by low-income urban residents. It also discusses the poverty-related factors that contribute to pest infestations in impoverished urban areas. Lastly, it critically evaluates research on alternative non-toxic pest control methods relevant for low socioeconomic urban communities.
Open Access
Health risk perception of Karoo residents related to fracking, South Africa
(2015) Willems, Mieke; Dalvie, Mohamed Aqiel; Rother, Hanna-Andrea; London, Leslie
Shale gas exploration by means of Hydraulic Fracturing (fracking) has been on the South African (SA) energy agenda since 2010 as a potential alternative energy source to coalmining. Internationally, the desirability of fracking is debated due to increasing evidence of the environmental and health risks fracking poses. However, experts favouring fracking propose this technology as a greener alternative to conventional energy sources such as coal. Limited scientific evidence is available internationally related to knowledge and risk perceptions of fracking and evidence is limited to studies conducted in the United States (US). South African risk perception studies relates to mining, farming, travelling in SA as a foreigner and sexual behaviour. The president of SA called fracking a 'Game-Changer' using industry jargon in the 2014 presidential address. However, SA has failed to produce exploration regulations to date despite oil and gas companies pushing their agendas. Public participation in the process thus far has been limited. This cross sectional study explored the knowledge, health risk perceptions and information sources related to fracking amongst 102 Central Karoo residents through a household survey. Beaufort West municipality was selected as the study site as this is one of the closestareas to Cape Town demarcated for fracking exploration. This study found that 40% of Central Karoo residents do not know what fracking is or the potential risks and benefits thereof. Media is the main information source of 59% of participants. Only half of participants trust their information sources. Those with more trust in their information sources perceived fracking as posing a greater risk. In contrast those believing fracking to pose a low risk were more likely to trust the government and oil and gas companies. More than half of participants (53%) believe that fracking poses an extreme health risk and 78% thought fracking will harm their health. Most commonly listed causes why fracking will make Karoo residents sick includes water pollution (47.4%) and air pollution (19.6%). Higher education was found to have an inverse relationship with trust in the national government A limitation of this study was that farms could not be randomly selected, affecting the representativeness of the sample. There is a major lack of knowledge pertaining to fracking among those living in the Central Karoo which has important implications for managing the process of public participation in the approval of shale gas exploration.
Open Access
Investigating strategies for addressing child and adolescent mental health following exposure to extreme weather events in low- and middle-income countries: A scoping review
(2022) Kadota, Molly Kaelin; Rother, Hanna-Andrea; Jagarnath, Meryl
The inevitability of an increase in extreme weather events (EWE) due to climate change will likely influence every determinant of human health and wellbeing. Children and adolescents, defined as anyone under the age of 19, are among the most susceptible because of their unique vulnerabilities (i.e. physiologically, developmentally, biologically, and behaviourally) and lifespans. The effects on physical health are generally well documented, and many climate change adaptation strategies have begun to include them in their considerations. However, the implications of EWE exposure on mental health are less understood, particularly within low- and middle-income countries (LMICs). Populations residing in LMICs are especially vulnerable because of pre-existing conditions like already extreme weather, lack of resources, poor economic conditions, weak health systems, high burden of disease, and poor governance. Therefore, children and adolescents in LMICs maintain a heightened vulnerability to experiencing adverse effects. In Part A, a preliminary literature review determined the breadth of information documenting child and adolescent mental health outcomes following exposure to EWE. Research, mainly from high-income countries (HICs) or international organisations, demonstrating an association between mental health impacts and climate change, focused primarily on adult populations, has increased substantially over the last few years. Experiencing an EWE in childhood or adolescence likely leads to direct (e.g. anxiety, post-traumatic stress disorder, depression, behavioural disorders, and suicidal ideations), indirect (e.g. displacement, loss of sense of place, violence, malnutrition, developmental delays, and disruption of education), and overarching (e.g. general climate anxiety about impending threats) mental health impacts, presenting in both the short- and long-term. The goals of adaptation and mitigation strategies were also presented in the protocol to determine the potential for specific mental health strategies. In Part B, then, a scoping review was conducted to provide a narrative of where adaptation, resilience, and mitigation strategies in LMICs address, and where they do not, child and adolescent mental health impacts following exposures to EWE. A search conducted in June-August 2021 of 12 online databases from the Pubmed, EBSCOhost, and Scopus platforms and grey literature sites like Google Scholar, Microsoft Academic, and NGO pages identified 5,073 relevant records. Search results were limited to documents written in English and filtered by a 2000-2021 date range. In the current LMICs climate change strategies, the review highlighted a general lack of consideration for child and adolescent mental health and resilience. Therefore, eight main themes recurring in the literature were identified as integral components for including child and adolescent mental health in future national strategies and policymaking discussions. The themes provide general guidance, but their addition necessitates country-specific conceptualisation to determine technical considerations (e.g. funding and responsibility) and relevance. This review, therefore, emphasised the necessity for LMICs to begin including child and adolescent mental health in climate change strategies, highlighted key recommendations that were applicable in the LMICs context, and illuminated still existing gaps in the literature and potential areas for future research.
Open Access
Mycotoxin health risk assessment modelling among maize-subsistence farmers living in Centane, Eastern Cape Province, South Africa
(2022) Burger, Hester-Mari; Rother, Hanna-Andrea
Harmful mycotoxins such as fumonisin B (FB), deoxynivalenol (DON), and zearalenone (ZEA), produced by ubiquitous food-borne fungal species, are known to contaminate maize crops from subsistence farming areas in Centane, Eastern Cape Province (EC), South Africa. The daily consumption of home-grown maize in these areas has resulted in FB exposure of five to ten times above the recommended provisional maximum tolerable daily intake (PMTDI) of 2 µg kg-1 body weight day-1 , as set by The Joint FAO/WHO Expert Committee on Food Additives. From a public health perspective, not only can these mycotoxins cause various human diseases but also impact food security. For this purpose, mycotoxin risk assessment among maizesubsistence farmers is critical to ensure evidence-based risk management. Currently, in resources poor settings, a deterministic risk assessment approach remains the easiest and most accessible. This approach, based on epidemiological data, includes using a total mean mycotoxin level (µg kg-1 ) multiplied by the individual total mean dry/raw maize intake in g day-1 divided by body weight (kg) and expressed as a probable daily intake (PDI). The resultant PDI is thereafter compared to the relevant mycotoxin PMTDI to determine the risk. However, this type of assessment remains one-dimensional and can only quantify risk. To address this limitation, the current study was aimed at developing a mycotoxin risk assessment model that not only quantifies the risk of exposure to multi-mycotoxins (FB, DON, and ZEA) but it is also interactive. The new model was based on the Mycotoxin Risk Assessment Model (MYCORAM) that was originally developed for South African commercial maize consumers and referred to as the MYCORAM-II. The overall purpose of the MYCORAM-II is to assess the percentage of maize consumers above the relevant mycotoxins PMTDI. In the current study, a multiphase study design was used to develop and evaluate the model consisting of phase 1) dietary maize intake, body weight data collection, phase 2) the development of dietary dry maize intake per body weight categories, phases 3 and 4) mycotoxin levels data and the development of the MYCORAM-II, phase 5) evaluation of the MYCORAM-II using published mycotoxin levels in home-grown maize from Centane, and phase 6) to assess the appropriateness of the national maximum safety levels as set by the South African Department of Health for FB and DON in dry maize. The development of the model was limited to the availability of secondary data, its validity, and the type of data that has been collected and published from studies conducted over the past 10 years in rural maize-subsistence farming areas in EC, South Africa. Applying mycotoxin levels in home-grown maize from Centane to the MYCORAM-II indicated that for total FB between 80-90% of maize, consumers were above its PMTDI based on overall higher levels of FB. In comparison, DON and ZEA with their lower levels in home-grown maize resulted in a lower percentage of consumers above the respective PMTDIs. The MYCORAM-II also indicated that the South African national maximum safety levels will not protect subsistence maize consumers between (89% and 90% will be at risk). In addition, the MYCORAM-II indicated differential risk scenarios when using published data from African countries. Overall, the MYCORAM-II highlighted the distinct roles of FB levels in home-grown maize, the number of positive samples, and maize intake practices. Despite the limitation of the MYCORAM-II, its simplicity and interactive function render it useful to describe multi-mycotoxin exposure among subsistence maize farmers not only in Centane, EC, but also in Africa. Its application can also be expanded towards developing population-specific safety levels, facilitating decision-making during risk management, and the evaluation of appropriate public health interventions aimed at reducing mycotoxin exposure.
Open Access
Perceptions related to breastfeeding and the early introduction of complementary foods amongst migrants in Cape Town, South Africa
(BioMed Central, 2016-10-20) Hunter-Adams, Jo; Myer, Landon; Rother, Hanna-Andrea
Background: Infant feeding recommendations are of health importance, yet the extent to which migrant communities in low- and middle-income countries know or implement these recommendations is poorly understood. This study explores the perspectives of infant feeding amongst cross-border migrants in Cape Town, South Africa. Methods: Between February and October 2013, semi-structured in-depth interviews (n = 23) were conducted face-to-face with Congolese, Somali and Zimbabwean mothers living in Cape Town. To assess commonly identified narratives of infant feeding, nine focus group discussions (three with men and six with women) were conducted with migrant Somalis, Congolese, and Zimbabweans. Results: Three dominant themes framed infant feeding. 1) Pragmatism in feeding choices drove responses to baby’s cues, including cries, sleeping patterns, and weight gain (2). Formula feeding was normative in the South African context, whereas lack of commercial infant milk back home was described in terms of expense (3). Low rates of breastfeeding were explained in terms of work responsibilities including household work and lack of breastmilk supply resulting from stress and poor diet. However, women participants typically did not consider their feeding choices to negatively affect their baby’s health. Conclusions: The reasons for early introduction of both commercial infant milk and solid foods were complex. Breastfeeding was not prioritized despite an awareness of medical recommendations. Rather than emphasizing specific breastfeeding intentions, participants favoured an approach that reacted to their baby’s perceived changing needs. The practical challenges of breastfeeding described by cross-border migrant women reflect one way in which socio-economic and health inequalities may currently be perpetuated for marginalised populations.
Open Access
Pesticide Research on Environmental and Human Exposure and Risks in Sub-Saharan Africa: A Systematic Literature Review
(Multidisciplinary Digital Publishing Institute, 2021-12-27) Fuhrimann, Samuel; Wan, Chenjie; Blouzard, Elodie; Veludo, Adriana; Holtman, Zelda; Chetty-Mhlanga, Shala; Dalvie, Mohamed Aqiel; Atuhaire, Aggrey; Kromhout, Hans; Röösli, Martin; Rother, Hanna-Andrea
On the African continent, ongoing agriculture intensification is accompanied by the increasing use of pesticides, associated with environmental and public health concerns. Using a systematic literature review, we aimed to map current geographical research hotspots and gaps around environmental and public health risks research of agriculture pesticides in Sub-Saharan Africa (SSA). Studies were included that collected primary data on past and current-used agricultural pesticides and assessed their environmental occurrence, related knowledge, attitude and practice, human exposure, and environmental or public health risks between 2006 and 2021. We identified 391 articles covering 469 study sites in 37 countries in SSA. Five geographical research hotspots were identified: two in South Africa, two in East Africa, and one in West Africa. Despite its ban for agricultural use, organochlorine was the most studied pesticide group (60%; 86% of studies included DDT). Current-used pesticides in agriculture were studied in 54% of the study sites (including insecticides (92%), herbicides (44%), and fungicides (35%)). Environmental samples were collected in 67% of the studies (e.g., water, aquatic species, sediment, agricultural produce, and air). In 38% of the studies, human subjects were investigated. Only few studies had a longitudinal design or assessed pesticide’s environmental risks; human biomarkers; dose-response in human subjects, including children and women; and interventions to reduce pesticide exposure. We established a research database that can help stakeholders to address research gaps, foster research collaboration between environmental and health dimensions, and work towards sustainable and safe agriculture systems in SSA.
Open Access
Protected at work but not at home: para-occupational ‘take-home’ herbicide residue exposure risks amongst forestry workers families in South Africa
(2018) Pududu, Bonolo; Rother, Hanna-Andrea; Khumalo, Nanzi
Para-occupational 'take-home’ exposure amongst worker’s families in Low-and middle-income countries (LMICs) is not well characterised. This is concerning as research shows the association between long-term low-dose herbicide exposure and the development of adverse health effects. This study explored 'take-home’ herbicide residue exposure risks amongst the families of Working for Water (WfW) forestry workers in the Western Cape, South Africa using aspects of the community-based participatory research (CBPR) approach photovoice. In addition, a documentary review of the existing WfW programme policies and regulations was undertaken to assess whether required practices supported or prevented the risk of 'taking-home’ herbicide residues. The results of the documentary review revealed that workplace policies and regulations did not address 'take-home’ exposure risks. Photovoice findings highlighted low compliance to safety practices (e.g., not adhering to PPE requirements) at worksites, and this was identified as the main risk factor for 'take-home’ exposure amongst worker’s families. It was noted that the transient nature of forestry work impacted on worker’s ability to carry out hygiene practices as decontamination facilities were not available at worksites for worker’s to use before going home. As a result, all workers took their personal protective equipment (PPE) home. Worker’s after work behaviours (e.g., wearing PPE inside the home) and home hygiene practices (e.g., laundering PPE separately from household laundry) varied. That is, some worker’s carried out protective practices whilst others did not. This was largely attributed to the workplace policies and regulations which did not cover 'take-home’ exposure risks as informed by the national legislation which has not established standards and regulations related to 'take-home’ exposure risks. Evidence from this study demonstrated the existence of workers’ 'taking-home’ herbicide residue and exposing their families to potential health risks from low-dose exposures.