Browsing by Department "Unknown"

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    A cost-utility and budget impact analysis of long-acting insulin analogues, (determir, glargine and degludec) for the treatment of adults with T1DM in South Africa
    (2023) Verryn, Mark; Cleary, Susan
    Background: Type 1 Diabetes Mellitus (T1DM) is a life-threatening condition that is managed with administered insulin. Intermediate- to long-acting insulin represents the basal insulin constituent of the total insulin used in treating T1DM and has received much research and development over the years. In South Africa, intermediate-acting Neutral Protamine Hagedorn (NPH) insulin has been the mainstay basal insulin recommended in the public sector. Newer (ultra) long-acting insulin analogues, however, have subsequently been approved for use. Costutility and budget impact analyses of the newer long-acting insulin analogues detemir, glargine and degludec have yet to be performed in the South African public health sector context. Methods: A systematic search for clinical evidence was performed to inform the economic evaluation. A cost-utility analysis was carried out utilising Markov modelling. Seven comparators were modelled representing the various insulin types and treatment regimens. For each comparator, three Markov states were created, one in which no complications occurred and another two states representing nocturnal and daytime hypoglycaemic events respectively. Three scenarios were modelled in order to capture the variable rates of complications reported in the clinical evidence. Quality-Adjusted Life Years per patient year was the health outcome utilised. Costs were included as South African Rands and then converted to United States dollars. A cost-effectiveness threshold range appropriate for the South African context was used to assess value for money. Thereafter, a budget impact analysis was conducted. Results: Three systematic reviews were identified in the systematic search for inclusion in this study. Subsequently, three scenarios were modelled in order to capture the clinical significance identified in the three systematic reviews. All three models favoured NPH insulin over the alternatives, as NPH insulin dominated most other insulins, barring insulin detemir, insulin glargine-U300 and insulin degludec. Insulin detemir was the most cost-effective option of the alternatives to NPH insulin (ICER of 10,783.75 USD/QALY). However, insulin detemir was still not cost-effective in relation to South Africa's cost-effectiveness threshold (CET 1,175 - 8,909 USD/QALY). The NPH insulin twice daily regimen was also found to dominate the NPH once daily regimen. Conclusions: The status quo of NPH insulin in the management of T1DM in adults remains the most cost-effective option for the South African public health sector. Further research and consideration could be made for the use of NPH insulin twice daily, as opposed to once daily.
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    A Retrospective, Observational Study of Medico-legal Cases against Obstetricians and Gynaecologists in South Africa's Private Sector
    (2020) Taylor, Bettina; Cleary, Susan
    South Africa is experiencing a medico-legal crisis that is threatening the delivery of essential health care services, especially relating to maternal and fetal health. In the private sector, professional indemnity premiums for obstetricians to provide insurance cover in the event of medico-legal challenges have increased more than 10-fold in a 10-year period. In the State, exponential increases in contingent liabilities for claims due to alleged negligence are usurping health care budgets allocated towards the delivery of health care, with about half of these claims relating to obstetrics and gynaecology and three quarter of latter to cerebral palsy for reasons of alleged hypoxic brain injury of the newborn. Despite the ominous implications of these developments for the supply side of health care, there is a scarcity of information in terms of contributing factors. Whilst many assume that the main driving force of burgeoning professional indemnity premiums for obstetricians and gynaecologists in the private sector have also been as a result of claims for cerebral palsy, there are no empirical data to explain developments over recent years and guide risk management interventions in this regard. To understand claim trends and identify potential predictors of patient dissatisfaction that result in engagement of the regulatory and legal system in the private sector, obstetric and gynaecological medico-legal data recorded by Constantia Insurance Limited, a local professional indemnity provider, were analysed. Other than confirming a steep increase in medico-legal notifications for obstetric- and gynaecology-related complaints from about 2003 to 2012, a high proportion of number of claims and paid settlements for gynaecology relative to obstetric-related cases was noted. This is contrary to international and public sector experiences, where number of demands relating to obstetrics consistently exceed those associated with gynaecological care. This finding, together with the fact that the majority of pay-outs on behalf of doctors related to surgical complications, especially unintended intraoperative injuries to internal organs and vessels, calls for further research into the clinical outcomes of private gynaecological practice, as well as potential review of aspects of surgical training standards and accreditation in gynaecology and consideration of surgical mentorship programmes. The latter is particularly relevant in the context of surgical registrars having expressed concerns about their readiness to practice independently following specialist graduation. Whereas claims for severe neurological injury of the newborn constituted less than 15% of all claims settled on behalf of obstetricians and gynaecologists entered into the study, they accounted for about half of all known paid settlements relating to pregnancy-related care. Whilst not dominating in terms of claim frequency overall, they nevertheless are an important focus area for risk management interventions, given the high quantum of demand typically associated with these cases. In this regard, more research into the etiology of errors is required, including the contribution of nursing and other system failures that could not be quantified adequately as part of this research project. Another important finding was the disproportionate contribution of medico-legal risk by a small cohort of practitioners, which suggests a need for doctor-focused support and interventions, including effective peer review and regulatory oversight by the Health Professions Council. To reverse the high financial burden of professional indemnity fees and fear of litigation amongst private sector obstetricians and gynaecologists, multidimensional risk management interventions, which include enhancements at the point of care, are required. If medicolegal trends and their negative consequences are to be reversed, medico-legal hotspots should become an important source of information and consideration in the development of solutions aimed at preventing human error and strengthening the healthcare system in terms of improved patient safety and satisfaction.
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    An African city and the modern plague: transformations in governance at the moment of Mbabane's HIV & AIDS crisis
    (2025) Marrengane, C. Ntombini; Oldfield, Sophie
    This study examines the governance of Mbabane, Eswatini, a Southern African city, at the height of the global HIV epidemic (1995–2005), which cut through the continent like an unstoppable plague. Located at the epidemic's epicentre, the Kingdom of Eswatini held the unfortunate distinction of having the highest infection rate in the world, with one in every three adults testing positive at the end of the 20th century. Such devastating numbers required a response at every level of government. This study looks at the intersection between governance and the crises unleashed by a modern plague at an urban scale. In response to the devastating effects of the epidemic on city residents, Municipal Council of Mbabane (MCM) officials adopted innovative strategies to mitigate the epidemic's impact, extending beyond the city's legal mandate. Through a deliberate process, the council reoriented its focus away from its core mandate of command and control of urban space to engaging and experimenting with city residents, civil society organisations and, most importantly, traditional authorities who directly influenced the expansion of the city and yet remain excluded in meaningful ways from urban management. By adopting this novel approach, the MCM found ways to align its service delivery mandate with the unprecedented needs emerging at the household level because of the unfolding HIV epidemic. This study uses qualitative methods, to explore the extraordinary efforts of city officials to govern the city during crisis through ‘incremental bricolage' – a term used to define the governance processes that emerged in a complex urban setting amid a crisis. This term describes the provisional, collaborative, and collective decision-making across institutional structures in an environment of bifurcated governance. Incremental bricolage provided a pathway for the council's engagement with traditional authorities, an influential but long ignored urban stakeholder. Incremental bricolage also offered new opportunities for the council to develop partnerships to meet the changing needs of urban residents because of the deadly plague. By repurposing relationships and capacities within the council and across organisations outside the municipality, the governing body led a process of rationalising and equitability extending the reach of HIV support and care services across the city. Disrupting the notion of dysfunctional governance systems in African cities, this case draws attention to the conditions under which urban local authorities operate. This case also highlights the flexibility and innovation demonstrated by MCM officials and other key governance stakeholders to meet the iv needs of city residents in a bifurcated urban context at a moment of crisis triggered by a global epidemic.
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    Cost benefit analysis of energy efficiency in low-cost housing
    (1999) Winkler, Harald; Fecher, Randall Spalding; Tyani, Lwazikazi; Matibe, Khorommbi
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    Cost utility and budget impact analysis of bortezomib and lenalidomide for the treatment of relapsed/refractory multiple myeloma in the South African public health sector
    (2021) Matsela, Lineo Marie; Cleary, Susan; Wilkinson, Thomas
    Multiple myeloma (MM) is the second most common haematologic cancer, accounting for approximately 13% of all blood cancer cases worldwide. The global incidence rate increased by 126% from 1990 to 2016. In South Africa, multiple myeloma accounts for approximately 9% of haematological cancers and less than 1% of all cancers. Nevertheless, some studies have reported that the incidence is likely underestimated due to an underdiagnosis of the cancer. Thus, the disease could possibly be an issue of greater concern in South Africa than current statistics indicate. The nature of the MM tumour makes patients prone to resistance of chemotherapy and multiple relapses leading to the development of relapse/refractory multiple myeloma (RRMM). During the relapse/refractory period, the patient is nonresponsive to treatment and/or experiences progressive disease When a patient experiences relapse/refractory MM, their prior, (first line) treatment is readministered if it was clinically efficacious and well-tolerated. Contrarily, a change in regimen is recommended if “an insufficient response, a rapid relapse and poor tolerance” to the first-line treatment is experienced by a patient. Second-line regimens that are recommended due to their proven high clinical efficacy are lenalidomide plus low-dose dexamethasone (LEN/DEX) and bortezomib monotherapy (BORT). The clinical effectiveness of both regimens for second-line treatment of RRMM was reported in the MM009/010 and the APEX studies, respectively, where each regimen was compared against dexamethasone monotherapy. Given this proven clinical effectiveness for RRMM, lenalidomide is under consideration for inclusion in the South African Essential Medicines list. Three treatment strategies for second line RRMM treatment were modelled from a provider's perspective. These strategies were dexamethasone (standard of care), BORT and LEN/DEX. For each strategy we modelled a hypothetical cohort of relapsed/refractory multiple myeloma patients using a three-state Markov model (pre-progression, progression and dead) over a 15-year time horizon. Efficacy data was obtained from the MM009/010 and APEX trials, while utilisation rates were obtained from a European study. Other input data was sourced from local literature. Outcomes were reported in quality adjusted life years (QALYs). Incremental cost effectiveness ratios (ICERs) were calculated for BORT and LEN/DEX and compared to the local cost-effectiveness threshold to determine if the drugs are good value for money for the South African government. The total costs per patient using DEX, BORT and LEN/DEX over 15 years differed significantly resulting in estimates of R8 312.32, R234 995.50 and R1 135 323.37, respectively. The associated health benefits in terms of quality-adjusted life years gained from the treatments were 1.14, 1.49 and 2.29. Hence, for every quality adjusted life year gained from BORT relative to DEX, an additional R654 648.52 would need to be spent. In contrast, when BORT is compared to LEN/DEX, an additional R1 225 542.23 would need to be spent for an additional quality adjusted life year gained from LEN/DEX. Both the BORT and LEN/DEX treatments were not cost-effective relative to the costeffectiveness threshold of R38 500 per DALY gained. Due to the high costs, both BORT and LEN/DEX could potentially have significant economic impacts on the South African public health sector budget. The study suggests that one year of treatment for 337 RRMM patients in South Africa using the BORT and LEN/DEX would increase the budget budget-cost of RRMM treatment by 3136% and 8684%, respectively. Both BORT and LEN/DEX treatments would not be cost-effective strategies for second-line treatment of RRMM in South Africa. The results indicate that the drug prices of lenalidomide and bortezomib hinder the cost-effectiveness of BORT and LEN/DEX. Price reductions could potentially make BORT more cost-effective and allow it to be considered as an option for second-line treatment for RRMM patients.
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    Economic evaluation of cash "plus" interventions for risky sexual behaviour among adolescent girls & young women in low and middle-income countries: a systematic review
    (2025) Tibini, Vuyolwetu Thembekile; Alaba, Olufunke; Mchenga, Martina
    Background: Adolescent girls and young women (AGYW) are especially susceptible to risky sexual behaviours that increase their risk of HIV infection and other negative consequences related to their reproductive health, especially in low- and middle-income countries (LMICs). Globally, AGYW, who are between the ages of 15-24, are at risk of HIV infection at an average of 4900 every week, while in 2021 AGYW accounted for 63% of all new HIV infections. In response, cash transfer interventions have become a tool to lessen financial vulnerability and provide AGYW with the confidence to make safer decisions regarding their sexual health. However, cash transfer interventions alone might not adequately address the intricate social, biological, and economic issues that AGYW face. As a result, "cash plus" interventions which combine cash with complementary services such as training, health care, and skill development have piqued interest as potentially more effective fixes. The premise of this systematic review is to examine theeconomic evaluations of these "cash plus" programs and their effect on reducing risky sexual behaviours among AGYW in LMICs. Methods: The thesis first implemented a structured literature review. The structured literature delves into the implementation of cash transfers in LMICs and identifies any related shortcomings. Secondly, the structured literature review examines epidemiological evidence of risky sexual behaviours faced by AGYWs in LMICs; these include HIV acquisition, unplanned pregnancy, condomless sex, transactional sex, and multiple sexual partners. Finally, the structured literature review scrutinizes any cash transfer programs that have undergone economic evaluation to address the risky sexual behaviour among AGYWs in LMICs. After the structured literature review was completed, a systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed on several electronic databases, including EbscoHost, PubMed, Cochrane Library, Web of Science, and Scopus, along with relevant grey literature. The review included economic evaluations of cash "plus" interventions aimed at risky sexual behaviour among AGYW in LMICs and studies between 1 January 2000 – 31 December 2023. Studies were screened for eligibility based on pre-defined inclusion criteria, and data were extracted into a synthesis table. Costs were adjusted to 2023 U.S. dollars (USD) to standardize economic evaluations across studies. Full and partial economic evaluations, including cost effectiveness analysis (CEA), cost-utility analysis (CUA), and cost-benefit analysis (CBA), were analysed. The key gaps show how standard cash transfers for AGYW have a limited impact on complex needs, a lack of complementary support, and minimal long-term benefits. Cash Plus addresses these gaps by integrating additional components tailored to AGYW's needs, such as mentorship and skills training, which enhance resilience and support sustainable behavioural changes. However, the economic evaluation of Cash Plus interventions targeting AGYW's risky sexual behaviours in LMICs requires further work. The importance of this work is that it provides evidence of cost- effectiveness, scalability, and long-term economic impact, allowing for informed, resource- efficient decisions on implementing Cash Plus programs in LMICs. Results: This thesis' systematic review retrieved a total of 40 articles, six of which met the inclusion criteria. All these studies, conducted between 2018 and 2022, were based in Sub-Saharan Africa, specifically in Kenya, Uganda, and Liberia. The population covered in the six studies totalled 15,517 AGYW, with interventions targeting a wide age range of 12 to 24 years. The interventions included programs like DREAMS, Empowerment and Livelihood for Adolescents (ELA), Girl Empower Plus (GE+), and Bridge PLUS, among others. Economic evaluations revealed mixed results regarding the cost- effectiveness of the interventions. Five studies performed full economic evaluations using CEA and CBA. One study conducted a partial economic evaluation (cost analysis). The total unit cost for the six units was $2 446,90, but after adjusting for the 2023 value, the amount rose to $2 881,60. Conclusion: The thesis suggests that cash "plus" interventions aimed at reducing risky sexual behaviours among AGYW in Sub-Saharan Africa are cost-effective, particularly over longer time frames. The review highlights the need for further research into the long-term, non-monetary benefits of these interventions, such as improvements in health, education, and social well-being, to fully assess their value. The mixed economic evaluations and inflation-adjusted unit costs highlight the importance of ongoing research and careful resource allocation. The results underscore the importance of targeted, comprehensive strategies in addressing the complex needs of AGYW, while also pointing to the challenges of scaling such interventions in resource constrained environments.
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    Evaluation of a common method of convulsion therapy in Bantu schizophrenics
    (1955) De Wet, Jacobus Stephanus du Toit
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    Exploring the interplay of ecological and social factors in human-induced disturbance of the African Oystercatcher (Haematopus moquini): insights and management recommendations for conservation
    (2023) Keet, Taylor; Anderson, Pippin; Altwegg Andreas
    It is well-established that nature-based recreation can pose a significant threat to wildlife. However, certain activities may have greater impacts than others, such as dog walking. Estuarine and coastal ecosystems are frequented by dog walkers, and they are also home to shorebird populations that are facing mounting pressure due to human disturbance. African Oystercatchers (Haematopus moquini) are vulnerable to human disturbance because they are a ground-nesting species that breeds during the height of the South African holiday and tourist season (October-March). Domestic dogs (Canis familiaris) are heavily implicated in the lower breeding success rates evident in mainland African Oystercatcher populations. Therefore, this research focussed on both the ecological (flight initiation distances) and social dimensions (beach user surveys) of human disturbance of African Oystercatchers. The results of the ecological dimension showed that treatment type (dog vs. no dog treatment), location, incubation status, and the interaction between location and incubation status had a significant effect on African Oystercatcher flight initiation distances. Most importantly, African Oystercatchers had longer flight initiation distances on average in response to the dog treatment (a walker approaching with a leashed dog) compared to the no dog treatment. The results of the social dimension revealed ‘ambivalence' and ‘contradiction' themes. The ambivalence theme centred around the recreationists being uncertain about or disliking the majority of the hypothetical regulations aimed at protecting shorebirds, despite strongly agreeing that shorebird protection and regulations are important. The contradiction theme centred around two sub-themes. Firstly, the species literacy gap that emerged when the recreationists agreed that they were familiar with local shorebirds, while being unable to substantiate this belief by naming the species. Secondly, the cognitive dissonance displayed by the recreationists when they showed good awareness of the threats that human activities pose to shorebirds, while also strongly agreeing that their dogs pose no threat, and many also indicating that larger buffer zones are required to protect shorebirds from dog walkers. Three evidence-based management recommendations were provided, namely implementing buffer zones during the breeding season, tackling the poor leashing compliance rate, and installing signage to educate recreationists and persuade them to adopt pro-social behaviours.
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    Factors associated with partial health insurance coverage among households in Malawi
    (2025) Phiri, Jane; Alaba, Olufunke
    Health insurance has proven ideal for curbing the increase in household contribution towards health expenditure. However, despite efforts to expand health insurance in Sub-Saharan Africa, coverage has remained low and favouring higher-income groups. Malawi is among the countries that face this low uptake, with only 3% of the total population insured. Moreover, within insured households, coverage is often incomplete, leaving some members without protection. This partial insurance coverage increasingly contributes to a reliance on out-of-pocket expenditure (OOPE), a regressive and inequitable financing mechanism that disproportionately affects vulnerable households. However, there is dearth of evidence on factors associated with this phenomenon among households in Malawi, thus, understanding the dynamics of partially insured households is crucial to addressing these gaps, reducing financial barriers to healthcare, and promoting Universal Health Coverage (UHC). Methodology: This study aimed to examine the determinants associated with partially insured households in Malawi. The thesis is divided into three parts: a structured literature review, a journal manuscript and a policy brief. The literature review revealed that most studies in Africa and elsewhere have focused on individual health insurance coverage determinants and not intrahousehold health insurance coverage status determinants. In Malawi, this is coupled with a low health insurance uptake. There is also limited information on factors influencing households to insure some but not all members. This study therefore aimed to fill this gap in literature and inform health financing policies. This quantitative study used cross-sectional secondary Data from the 2019-2020 Multiple Indicator Cluster Survey (MICS). The individual health insurance status; insured and uninsured, was defined as coverage by any health insurance. Using unique identifiers (cluster number, household number and line number), every individual was grouped into their respective households. Consequently, household size was used to determine a household's health insurance coverage status where a household with all members as insured was categorized as fully insured, a household with at least one but not all members insured as partially insured and a household with no member covered as completely uninsured. A two-stage analysis approach was then utilized in this study. Firstly, descriptive statistics were used to analyse and compare fully insured households, partially insured households and completely uninsured households. Zoning into partially insured households, the second stage applied multivariate binary logistic regression to identify factors associated with health insurance coverage. Analysis was done using STATA statistical package version 18. Results: This study had 64,615 unique individuals from 22,886 households. Only 0.6% of individuals had health insurance. A higher proportion of the households were completely uninsured (22,649; 98.96%) with 228 households (1%) being partially insured and the remaining 9 households (0.04%) were fully insured. Household sizes differed significantly among fully, partially insured, and completely uninsured households (median of 1, 5, & 4 respectively; p-value=<0.001). Higher education levels of household heads were strongly associated with full and partial insurance coverage and in contrast, lower education levels, such as no education or primary education, were linked to a lack of insurance coverage (89% vs 50% vs 72%; p-value=<0.001). All fully insured households were from the richest quintile. Age of household head [AOR 1.025 (1.000-1.050);p-value=0.045], higher education level of an individual [ AOR 4.470 (1.519-13.154); p-value=0.007], an individual's access to media [AOR 2.276 (1.050-4.931); p-value=0.037] and a higher dependency ratio [AOR 1.655 (1.111-2.466);p-value=0.014] were positively associated with being an insured individual from a partially insured household with household size [AOR 0.813 (0.682-0.969); p-value=0.022] being negatively associated with the outcome. On the other hand, residential area, sex of an individual and region were not associated with health insurance ownership in partially insured households. Households, therefore, were partially insured mainly because of being with large household members (median size of 5), higher dependency ratio, media access, individuals having no or primary education and being from the poorest quintile. Conclusion: Socioeconomics and household dynamics influence health insurance coverage. This study highlights education, household size, wealth, dependency ratio, and media exposure as significant determinants influencing partial household health insurance enrolment. Partially insured households remain particularly vulnerable as they continue to face financial risks due to uninsured members, highlighting the need for targeted interventions to facilitate their transition to full coverage. The findings emphasize socioeconomic and informational disparities. Therefore, efforts to enhance health insurance enrolment should focus on improving education access, supporting larger and economically disadvantaged households, and leveraging media channels to raise awareness about the benefits of comprehensive health insurance coverage. Implementing policies that enhance affordability, and accessibility will also be essential in achieving universal coverage and reducing financial vulnerability among households. Moreover, these findings are timely given Malawi's commitment to UHC, Sustainable Development Goal 3, and regional targets such as the Abuja Declaration, reinforcing the need for equitable health financing policies that address partial household insurance coverage.
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    Farm labour on the Zebediela estates
    (1971) Stapelberg, J P M
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    Gynaecological case book.
    (1957) Du Toit, Pierre Francois Mulvihal
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    Mechanisms of Impaired Diuretic responsiveness in Chronic Heart Failure
    (1997) Salusbury-Trelawny, Joanna Mary
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    On farms and in laboratories: maize seed technologies and the unravelling of relational agroecological knowledge in South Africa
    (2021) Marshak, Maya; Wynberg, Rachel; Wickson, Fern
    When Europeans settled in South Africa in the 17th century, maize was already being grown as part of diverse and traditional cropping systems. Over centuries maize has become embedded in a web of social, ecological, economic and political relations. Since the 1900s the development of maize seed has increasingly shifted location as scientific maize breeding has come to dominate its production. In this time maize seed has changed form, from open pollinated varieties (OPVs) to hybrid seed, and most recently to genetically modified (GM) seed. While the progression of seed developments alongside their co-technologies such as pesticides, fertilizers and herbicides has greatly boosted yields, the development of maize has become increasingly generic and disconnected from the specificities of local agroecosystems. Like all technologies, maize seed technologies are not neutral but are rather deeply entangled in the history and politics of knowledge production. Commercial technologies such as hybrid and GM seeds are products of a particular lineage of thought rooted in the post-enlightenment age of modernist, dualist science. This has resulted in a conceptual dualism in which humans are seen as separate from nature. Studies on the impacts of new seed technologies have tended to replicate this dualism, focusing either on social or ecological aspects. Few investigate the effects on relationships between humans and agro-ecosystems. This thesis aims to address this knowledge gap by exploring the effects of the technification of maize seed on knowledge and practices within two sites of agricultural knowledge generation and practice in South Africa: smallholder maize agriculture and maize research and development. These offer two unique sites of knowledge creation and practice, and historically have had a turbulent relationship, rooted in colonialism and apartheid histories. Through exploring human-agroecosystem interactions, the research hopes to contribute to a broadened understanding about the impacts of maize seed technification and implications for agricultural knowledge generation and sustainability. Drawing conceptually and methodologically on posthumanist theory, this thesis investigates the changing nature of social-ecological relationships of and between smallholder farmers and scientists and the agro-ecological systems in which they work. Building on the concept of agricultural deskilling, it argues that modern seed technologies have contributed to ecological deskilling both on smallholder farms and within research and development, as seed technologies become increasingly disconnected from the environments in which they are used. 2 Increasingly, however, there is renewed interest by both farmers and scientists in ecological-reskilling as new ‘silver bullet' seed technologies reveal many setbacks. The thesis concludes that in order to rebuild displaced ecological knowledge an ontological shift is needed to move beyond dualist science-based approaches to farming and research, towards those that learn from relational ways of knowing. Approaches should be embraced that acknowledge the relational knowledge of smallholder farmers that has been displaced and devalued for centuries and that builds this relationality into research. This c could contribute to restoring cognitive justice and fostering more resilient agricultural futures.
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    Parenting for Lifelong Health program for parents and teens in Zimbabwe: cost estimation and the budget impact analysis
    (2025) Zwidza, Yolanda Rutendo; Sinanovic, Edina
    Introduction Parenting for Lifelong Health (PLH) for adolescents was initiated in 2012 to address the pervasive issue of childhood violence in low-to-middle-income countries. The intervention targets teens aged 10-17 years old and their caregivers. The program outcomes aim to increase positive parenting, reduce harsh discipline, and the reduction of behavioural problems in teenagers. Secondary outcomes include increasing the parents' self-efficacy. Methods This thesis evaluates the total and unit costs of the Parenting for Lifelong Health for Teens (PLH-Teens) program in Zimbabwe and estimates the budgetary impact of scaling up the intervention nationally. An economic cost analysis was conducted from the provider's perspective to calculate the total cost of implementing the program over one financial year, using the 2021 USD rate. The total cost of delivering the intervention to 5537 families was determined by summing capital and recurrent costs, with capital costs annuitized at a 5% discount rate. A budget impact analysis was then performed to estimate the financial implications of scaling the program to 250,000 families. Additionally, a one-way sensitivity analysis was carried out to examine potential variations in cost outcomes by making assumptions and changes to the input variables. Results The total implementation cost of the PLH-Teens program for 5537 participants in the year 2021 was US $823,704.00 The unit cost per family (completing sixteen sessions) was US $148.76, and the unit cost per session was US $9.30. Scaling the program to 250,000 families, representing an approximate increase of 96.36% of the initial target population, resulted in an estimated budget impact of US $37 190 915.00. The budget impact analysis indicated that the total cost of implementing the PLH program exceeded the national government budget allocation for programs that address violence in orphaned and vulnerable children and teens of US $27 000 000.00. Conclusion Parenting programs indicated high efficacy in the reduction of violence between caregivers and teenagers in Zimbabwe, following extensive modification of the intervention design to accommodate the context of low- to middle-income countries in their various dimensions. The socioeconomic profile of Zimbabwe has limitations in the ability to implement the intervention without donor assistance independently.
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    Personnel management in the South African Railways
    (1947) Seawright, Thelma Rosa