Browsing by Subject "Eastern Cape"

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    A functional balance profile of school aged children and adolescents diagnosed with Down Syndrome, schooled in the Eastern Cape province of South Africa: a pilot study.
    (2025) Nolte, Cilje; Rogers, Christine
    Children and adolescents with Down Syndrome (DS) are at a higher risk of falls due to impaired balance and gait patterns, which complicates their ability to safely engage in daily activities (Jung, Chung & Lee, 2017). Assessing balance function in children is not only important for identifying balance deficits, but also to inform and highlight integral areas of balance function that should be addressed during rehabilitation. Although various outcome measures have demonstrated acceptable reliability and validity in typically developing children, the applicability of outcome measures in children with DS has not been fully established. This pilot study aimed to evaluate the clinimetric properties, including reliability, validity, and practicality, of four functional balance outcome measures: the Paediatric Balance Scale (PBS), the second edition of the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2, Subtest 5), the full Children's Balance Evaluation Systems Test (Kids- BESTest), and its shortened version (Kids Mini-BESTest). To contextualise the results, a control group of age- and sex-matched typically developing peers was included for comparison. The primary objectives were to assess reliability (inter-rater and test-retest), known-groups validity, criterion validity (via correlations with Timed Up & Go (TUG) scores), and internal consistency (using Cronbach's alpha) of each measure. Outcome measures used in real-world settings like schools and clinics require qualities beyond being clinimetrially sound. Aspects regarding the practical applicability of these outcome measures should also be considered. Thus, this study evaluated the accessibility, safety, and practicality of administering these tests in a DS population, including time requirements, cost-effectiveness, and participant acceptability. The secondary objectives were to describe the balance profile of the DS group and explore the effects of potential confounders, including middle ear function, cochlear outer hair cell function, and Body Mass Index (BMI), on balance performance and test outcomes. Children from the Merryvale School for Special Education in Gqeberha, Eastern Cape (EC), South Africa (SA), participated in this study, while typically developing controls were sourced from local schools in the same area. Safety measures, such as gait belts and close guarding, were implemented to ensure participant safety and minimise fall risk during assessments. Data confidentiality and participant welfare were prioritised throughout the study. The results demonstrated significant differences in balance performance between children with DS and typically developing peers across all four assessment tools. The DS group exhibited lower mean scores and shorter durations for balance tasks, with notable floor effects in specific items, particularly within the Kids-BESTest and PBS. Independent t-tests revealed statistically significant group differences (p < 0.001), with large effect sizes (e.g., Cohen's d = 3.94 for BOT-2 Subtest 5). Reliability analysis showed good inter-rater and test-retest reliability for all tools, with Cronbach's alpha values ranging from 0.867 to 0.971, indicating strong internal consistency. Validity testing confirmed known-groups validity, with balance assessments effectively differentiating between DS and typically developing groups, while criterion validity demonstrated a significant association between balance test scores and TUG performance (e.g., Kids-BESTest R² = 0.536, p < 0.001). Health-related variables, such as BMI and middle ear status, significantly correlated with poorer balance outcomes. This correlation further emphasises the multifactorial nature of balance impairments in children with DS. This study offers initial insights into effective, safe balance assessment methods which audiologists can use for DS populations. These insights ultimately pave the way for future research to support balance related interventions.
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    Analysing fuel transactions of government vehicles in the Eastern Cape, South Africa
    (2025) Tavares, Jared; Silal, Sheetal
    Fuel management and fraud detection in government fleets are critical issues that have far-reaching financial and operational implications. To address these challenges, an investigation of fuel usage patterns and anomalies in the Eastern Cape Province government fleet in South Africa from April 2021 to January 2022 was conducted. Through the application of exploratory data analysis, clustering techniques, and predictive modelling, the research uncovers valuable insights that can be used to optimise fuel consumption and detect fraudulent activities within the fleet. Univariate and bivariate analyses reveal distinct patterns in fleet composition, transaction volumes, and fuel eJiciency across various vehicle makes, model derivatives, and departments. The use of clustering techniques enables the identification of distinct vehicle segments and transaction patterns, emphasising the importance of considering contextual factors when analysing fuel usage. To detect potential fraud, three key indicators are developed: abnormally large transactions, frequent transactions, and fuel price diJerences. Predictive models, including XGBoost, Multi-layer Perceptron, and Random Forest, are employed to automate the classification of transactions based on these fraud indicators. The Multi-layer Perceptron demonstrates the best performance, achieving an accuracy of 87% on the test set. The dissertation acknowledges limitations due to the scope of the data and missing information for certain geographic variables such as district and site. Future research could expand the geographical and temporal range, incorporate qualitative data, explore real-time monitoring systems, and investigate vehicle maintenance and fuel eJiciency. The present research makes a noteworthy contribution to the knowledge of fuel management and fraud detection in government fleets by oJering a data-driven approach to expose ineJiciencies and anomalies. The insights and methodologies presented serve as a foundation for future research and practical applications, ultimately leading to more eJicient, cost-eJective, and transparent fleet operations.
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    ART adherence trajectories and correlates of treatment outcomes among adolescents in the Eastern Cape Province of South Africa
    (2025) Zhou, Siyanai; Knight, Lucia; Toska, Elona
    Background: Sustained adherence to antiretroviral treatment (ART) is essential for viral suppression among adolescents living with HIV. In turn, suppressed viral load reduces the risk of onward transmission, HIV-related morbidity, and mortality, optimising overall health and well-being. Yet, adherence to ART among adolescents living with HIV (ALHIV) remains suboptimal compared to children and adults. Adherence measurement varies widely with no gold standard, and composite assessments such as longitudinal self-reported adherence have not been thoroughly evaluated among ALHIV in low-resource settings. In sub-Saharan Africa, evidence on longitudinal sustained ART adherence and its impacts on subsequent HIV treatment outcomes for ALHIV remains scarce. Prior studies on ART adherence—largely cross-sectional—have relied on traditional aggregate methods, dichotomising adolescents as adherent versus non-adherent which is insufficient to capture variations in adherence over time. Longitudinal ART adherence trajectories may aid the assessment of sustained long-term adherence and its impact on HIV treatment outcomes among ALHIV. To address these gaps, this PhD examined the validity of longitudinal self-reported measures of ART adherence among ALHIV in South Africa. It used group-based trajectory models (GBTMs) to identify ART adherence trajectories and examined their association with HIV treatment outcomes—viral suppression and mortality. It further explored factors contributing to distinct adherence trajectories, and the impact of psychosocial and structural provisions on long-term HIV treatment outcomes among ALHIV in South Africa. Methods: This PhD is an analysis of a three-wave longitudinal cohort study of 1046 ALHIV and 473 HIV-negative peers aged 10-19 years at baseline, in the Eastern Cape province of South Africa. From 2014 to 2018, participants completed questionnaires that included their socio-demographic information and self-reported adherence at all three visits. All participants and their caregivers gave informed consent to participate. In parallel, routine viral load data were extracted from physical and electronic patient files in health facilities, and the National Health Laboratory Services (NHLS) of South Africa (2014-2019). Viral load laboratory test results for 75.2% of the participants were obtained. Mortality was ascertained through community tracing and reporting from 2016 to 2022. All analyses in this thesis used the longitudinal cohort data to address the specific objectives. Statistical analyses included mixed effects logistic regression, group-based trajectory modelling, and path analysis. Findings: The first analysis (Chapter 4) explored the validity of five longitudinal self-reported adherence measures to screen for non-adherence and identify ALHIV with elevated viral load (>1000 copies/mL). Self-report measures included any missed dose in the past 3-days, past-week, past-month, days missed in the past-month, and any past-year missed clinic appointment and were all significantly associated with elevated viral load. The individual sensitivity of each measure varied from 79.5% to 91.6%, and positive predictive values were above 75%. Using the five self-reported adherence measures and group-based trajectory modelling, four adolescent adherence trajectories were identified (Chapter 5), namely ‘consistent (49.8%), ‘low start and increasing' (20.8%); ‘gradually decreasing' (23.5%), and ‘low and decreasing (5.9%) adherence. Compared to the consistent adherence trajectory, membership in each of the three inconsistent adherence trajectories was significantly associated with lower adjusted odds of durable viral suppression—having suppressed viral load (<1000 copies/ml) at two or more consecutive study waves. Complementary mortality analysis (Chapter 6) showed that all-cause mortality rates differ across the four adherence trajectories, and sustained adherence to ART was associated with lower rates of mortality among ALHIV. The analysis found that ALHIV experience higher all-cause mortality than their HIV-negative peers, despite ART rollout in South Africa. Guided by the socio-ecological model (Chapter 7), pathways linking barriers contributing to the distinct longitudinal adherence trajectories were established using path analysis. Experiencing mental health symptoms, medication side effects, internalised HIV stigma, food insecurity, longer clinic travel time (>1 hour), and witnessing domestic violence or conflict were associated with inconsistent adherence trajectories relative to the ‘consistent adherence' trajectory. More importantly, the pathways linking co-occurring barriers, and mental health symptoms to longitudinal adherence were unique for each trajectory or ALHIV sub-group. The final analysis (Chapter 8) revealed that access to government-provided social protection and family psychosocial support was associated with greater improvements in long-term ART adherence and viral load outcomes. Conclusions: This PhD documents multiple ART adherence trajectories, low rates of viral suppression, and high all-cause mortality among ALHIV in South Africa. Self-reported adherence shows promise for low-cost and relatively easy-to-administer alternative measures to ensure timely identification of poor adherence to ART among adolescents, particularly in settings where virologic monitoring is limited. ALHIV displayed distinct adherence behaviour patterns over time, which provides an opportunity to identify and target specific sub-groups of ALHIV in need of adherence support interventions. The multiple barriers identified and their pathways to longitudinal adherence trajectories present another opportunity to tailor care to specific groups of ALHIV, possibly informing differentiated service delivery to different sub-groups of ALHIV. Government-provided social protection and strategies to address psychological well-being can be key add-on support provisions to enhance the effectiveness of ART treatment among ALHIV in low-resource settings. Overall, this PhD demonstrates the need to shift from a one-size-fits-all model of care to customised HIV care and combine biomedical with psychosocial and structural interventions to address the needs of distinct groups of ALHIV.
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    Decolonising and Africanising the Further Education And Training (FET) history curriculum in South Africa (Grades 10-12): integration of heritage sites and institutions of memory in the Western and Eastern Cape
    (2025) Phunguza, Sibongiseni; Bam-Hutchison, June
    The politics of heritage have progressively played a critical role in South African socio-political life since 1994. As an example, heritage institutions have played a major role in re-centring histories that were pushed to the periphery within the decolonisation discourse in post-Apartheid South Africa. Heritage has therefore also been seriously considered in the decolonisation of education in South Africa, especially in teaching History as a subject. This thesis critically analyses the integration of heritage sites and institutions of memory into the FET (grades 10-12) history curriculum, and how this integrated process of knowledge production could contribute towards building an Africa-centric curriculum. It argues that by centering African heritage sites and institutions of memory in knowledge production and education, the FET history curriculum can be radically decolonised and shifted towards indigenous knowledge prioritisation. The thesis explores two aspects in this argument: (1) How could we integrate heritage sites and institutions of memory into the FET history curriculum and (2) how could we teach topics that are covered in the curriculum by using African-informed foundations of research and knowledge production. The thesis argues that these two processes are interdependent and intersectional in nature.
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    The dynamics of household formation and composition in the rural Eastern Cape.
    (2008) Neves, David; Du Toit, Andries
    Focusing on a specific impoverished region of rural Eastern Cape, this paper examines the dynamics of household formation and composition within postapartheid migratory networks. While the fluidity, contingency and spatially extended nature of African households is generally understood, the paper focuses on the social relationships that both buttress and flow from these qualities. In conceptualising the notion of the household, the paper also suggests the rubric of the ‘household’ can be a powerful, cultural narrative for constituting practices of domesticity. Five detailed case studies are presented and the dynamics of household-making explicated in terms of three distinct levels of analysis. The first is the overarching macro-structural context which includes kinship practices, cultural mores, rural governance and the changing political economy of South Africa’s former homelands. The paper argues that the altered material base of rural livelihoods in the last two decades has seen traditional patterns of male circular migration and trajectories of household formation eclipsed by large numbers of economically marginalised workseekers who precariously churn between both urban-rural and within rural areas. These changes have undercut the prospects for traditional forms of household formation and reconfigured the nature of the contemporary conjugal contract.
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    The impact of illness and death on migration back to the Eastern Cape.
    (2008) Neves, David
    This paper examines the impact of HIV/AIDS related morbidity and mortality on return migration to the rural Eastern Cape. The paper begins by discussing the interrelation between population mobility and HIV and grounds these dynamics within the structural context of underdevelopment in a former homeland region of South Africa. The changing migratory regimes of the post-apartheid era, which have seen formal male labour migration supplanted by increasingly informal and feminized migratory trajectories, between both rural-urban and intra-rural locales, are described. Five case studies are presented, and the multiplicity of factors associated with rural return migration in the face of HIV/AIDS related illness delineated. The empirical material suggests illness-induced back migration is driven not only by the search for health and succour, but also by complex amalgams of shifting entitlement and obligation. Understanding the dynamics of rural return requires attention not only to the highly variegated position that urban returnees potentially assume within receiving households, but also the effects of their return on these households. Even within the relatively limited number of case studies presented, rural returnees are variously subjects or dispensers of care, either relatively peripheral or crucially central members of receiving households. The evidence simply belies any notion of unidirectional rural return, driven by a universal set of imperatives in response to illness.
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    Policy implementation and coordination capacity: a case study of the state s capacity to implement the National Integrated Early Childhood Development policy in a district in the Eastern Cape, South Africa
    (2024) Parenzee, Penelope; Lopes, Carlos; Leibbrandt, Murray
    Early childhood Development (ECD) refers to the suite of interventions – provided to a child from conception until the transition into school, which nurtures and enables the child to thrive and reach their full potential. Of the policy responses directed at addressing inequality, ECD is identified as pivotal in increasing equality in a society and disrupting cycles of poverty across generations (Paananen et al., 2018; Irwin et al., 2007). In the South African context, where inequality and poverty persisted even with the transition to democracy, the prominence of ECD has evolved, culminating in the establishment of a National Integrated ECD Policy (2015). Despite the policy, the provision of integrated, quality ECD services for all children is yet to be realised. Across the country, varying degrees of implementation failures prevail, with devastating consequences for those residing within the poorest areas of the country. The coronavirus 2019 (COVID-19) crisis compounded the urgency to address the ECD policy implementation challenges, with research illustrating how the failure of government to coordinate the implementation of ECD has brought the sector to the brink of collapse (Wills et al., 2020). The emphasis on coordination structures, that are envisaged to oversee streamlined technical solutions, continues to dominate, shaping and re-shaping the implementation landscape. This research study set out to understand the state's capacity to coordinate the implementation of the NIECD policy. Through the use of case study methodology, the research delves into the implementation of ECD in a district in the Eastern Cape province. Howlett's (2018) multiple streams/critical junctures policy framework was applied to make sense of the implementation realities that plague the ECD sector. To deepen the understanding of coordination capacity – aspirational and existing - Wu et al's (2015) policy capacity matrix provided a complementary analytical framework. Based on the findings from this research study, there is a need to reconsider the focus on coordination structures for the ECD sector to challenge the perception that coordination constitutes structures as a way of dealing with the challenges of ECD policy implementation. Instead, a shift towards far more inclusive local level engagement may contribute to a renewed consideration of coordination as that of working within the complexities of diverse contexts. The focus of this research study is opportune, as it can contribute to the current debates on coordination capacity for the implementation of ECD services in South Africa.
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    Psoralea margaretiflora (Psoraleeae, Fabaceae): A new species from the Sneeuberg Centre of Floristic Endemism, Eastern Cape, South Africa
    (2011) Stirton, Charles; Clark, Vincent; Barker, Nigel; Muasya, Muthama
    AbstractA new species of Psoralea is described. Psoralea margaretiflora C.H. Stirton & V.R. Clark is endemic to the Sneeuberg Centre of Floristic Endemism, Eastern Cape, South Africa. This resprouter is characterised by its small greenish-white flowers with a small trifid purple nectar patch and translucent veins; 5(–7)-pinnate leaflets; multi-branching erect short seasonal flowering shoots; and tall habit of many stiff bare stems with the seasonal shoots massed at the apex. It is most similar to Psoralea oligophylla Eckl. & Zeyh., a widespread species found in the Eastern Cape. The reseeder Psoralea oligophylla differs in its lax virgate spreading habit with numerous long glaucous seasonal shoots; single stem, 1(–3)- glaucous leaflets; more numerous white flowers; and standard petals with a purple ring surrounding a bright yellow nectar patch.
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    Steve Biko in the intellectual history of the Eastern Cape
    (2013) Mangcu, Xolela
    This audio lecture locates the ideas of the late Black Consciousness leader, Steve Biko, within a long trajectory beginning with the Khoi-Khoi and San wars of resistance in the Northern Cape. For anyone with an interest in the life of Steve Biko and SA history.
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    The impact of industrial agrarian policies on soils: experiences of small-scale farmers in the rural Eastern Cape
    (2023) Phakisi, Nteboheng Portas; Green, Lesley
    After the end of legislated apartheid, the South African government changed old policies that had been driven by segregation against the black majority. Black small-scale farmers in rural areas were encouraged to join commercial agriculture to capitalise on state subsidies and support. Municipalities including Buffalo City Metropolitan, Great Kei, Amathole and others in the Eastern Cape, in collaboration with the Eastern Cape Department of Agriculture and agro industry, introduced programmes such as the Massive Food Production Programme and the current Cropping Project to support rural farmers and to reduce poverty in the province. The initiatives included the introduction of genetically modified maize seeds, chemical fertilisers, chemical herbicides, and pesticides, as well as herbicide-resistant and pest-resistant crops. However, joining state-funded initiatives meant farmers had to give up the farming practices and knowledge systems that had sustained them for years, and they lost the kinship they had built with the local soil and its organisms. By kinship I am referring to a symbiotic relationship that does not separate nature from society, a relationship that is mutualistic and in which there is no mastery of one party over the other. Working with rural Eastern Cape small-scale farmers who participated in these programmes, this study employs a multidisciplinary approach to understand the changing agricultural landscape in rural South Africa, focusing on the consequences of state-funded programmes on local soil knowledge in the context of current Eastern Cape industrial agrarian policies. Navigating from small-scale farmers' voices, remote sensing technology, history, African environmentalism, soil science and the human psyche, the study examines what happens when corporations and the government encroach on traditional and small-scale agriculture. This integrative research methodology of the Environmental Humanities, framed from the Global South, compels us to reconceptualise our relationship with nature. The study argues that while agro-industrial technologies can be used with existing local practices to assist farmers, they should never be introduced as a replacement for existing local knowledge of soil fertility. Moreover, where policies focus on the financialisation of the agrarian economy, such policies risk benefitting agrobusinesses instead of poor, small-scale farmers. If policies intended to stimulate rural development are to be effective, the needs of rural small-scale farmers must be taken into consideration when such policies are initiated.
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    Understanding the burden of HIV-related cancers in South Africa's Eastern Cape Province: A 2002-2017 retrospective study
    (2025) Ncinitwa, Akhona; Myer, London; Mabunda, Sikhumbuzo
    Background: The Human Immunodeficiency Virus (HIV)-related cancers in South Africa are a critical public health issue that echoes trends seen across other low-middle income countries (LMICs). These cancers include Kaposi sarcoma, non-Hodgkin's lymphoma, and cervical cancer. Understanding the HIV-related cancer trends and incidence is crucial for achieving improved health outcomes. Therefore, this study aims to understand the HIV- related cancers in the Eastern Cape province of South Africa Methods: This retrospective study used secondary analysis of data generated by the Eastern Cape Cancer Registry linked to the HIV database from the National Health Laboratory Services through probabilistic record linkage to identify and characterise cancer among people living with HIV. Included were cancer cases reported between 1st January 2002 and 31st December 2017 of adult men and women diagnosed with HIV-related cancers. Statistical analysis was done using STATA18.0. A join-point regression model was used to characterise the cancer trends. The Kaplan-Meier curve was used for survival analysis. Results: The sample comprised 1183 eligible cancer patient records, with 1044 (88.3%) females. The HIV prevalence among cancer patients was 74.5%. Specifically, 75.5% of males and 74.3% of females were living with HIV. The trends of Kaposi sarcoma showed an increase between 2002 and 2015 with an annual percentage change (APC) of 17.4%, and between 2015 and 2017, trends decreased with an APC of 22.6%. Cervical cancer trends decreased between 2002 and 2004 with an APC of 14.4%; from 2004 to 2017, there was a sharp increase of 33.2% APC. Kaposi sarcoma had the highest survival median of 3.1 years (p=0.06) for people living with HIV, followed by non-Hodgkin's lymphoma with 2.9 years (p=0.96), and lastly cervical cancer with 2.5 years (p=0.73). Conclusion: The growing burden of cervical cancer and Kaposi sarcoma among people living with HIV remains a problem in the Eastern Cape. Therefore, targeted interventions such as regular screening, early diagnosis, access to appropriate treatment, a system to track treatment adherence and survival rates, appropriate resource allocation, and targeted educational programmes are needed to address the burden.
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    Unravelling the palaeobiology of the dinosaurian post crania and associated carnivore teeth from the early jurassic, Elliot formation in the Eastern Cape
    (2025) Lee Logie, Jessica; Chinsamy-Turan, Anusuya; Krupandan, Emil
    The Elliot Formation of the Stormberg Group of South Africa ranges in age from the Late Triassic to the Early Jurassic. This stratigraphic unit bears a varied dinosaur assemblage, among which sauropodomorph dinosaurs are the most abundant. Sauropodomorpha are particularly well documented in the Upper Elliot Formation and are morphologically and taxonomically diverse. Specimen AM 6147, a large basal sauropodomorph, was excavated from the Barkley Pass, Eastern Cape, Elliot Formation of South Africa in 2013 by a joint team from the Albany Museum and the University of the Witwatersrand led by Dr Billy de Klerk. The specimen comprises post cranial material including ribs, gastralia, vertebrae of the mid-posterior section of the tail, and a complete left pes. Associated with the specimen are three teeth of contemporaneous carnivores. Here, we describe the skeletal anatomy of AM 6147 and assess its phylogenetic affinities by scoring our findings in a phylogenetic data matrix. We also attempt to identify the carnivorous taxa to which the associated teeth may have belonged, and the nature of the relationship between them and AM 6147. Our phylogenetic analyses reveal that this specimen belongs to the Massospondylidae and that it is recovered as a new taxon, Enkulusaura deklerki, based on a unique combination of plesiomorphic and derived features. Our findings suggests that the three associated carnivore teeth could possibly belong to two different theropod dinosaur, while the third tooth is likely from a crocodylomorph. In conclusion, this study of AM 6147 shows that it is a new large bodied Massospondylid from the Elliot Formation and provides a better understanding of the diversity of basal Sauropodomorpha in the Early Jurassic of South Africa. Furthermore, the associated teeth contribute insight into the ecological relationships between these contemporaneous taxa.