Browsing by Subject "Western Cape"

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    A situational analysis of child and adolescent mental health services and systems in the Western Cape Province of South Africa
    (BioMed Central, 2022-01-25) Mokitimi, Stella; Schneider, Marguerite; de Vries, Petrus J
    Background Even though child and adolescent mental health is a global health priority, services are very limited, particularly in low- and middle-income countries (LMIC), and therefore need comprehensive strengthening. This requires knowledge of the hardware elements of the system (human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems). This study sought to examine these elements of child and adolescent mental health (CAMH) services and systems in the Western Cape Province of South Africa. Methods The World Health Organization Assessment Instrument of Mental Health Systems (WHO-AIMS) version 2.2 of 2005 was adapted to identify key variables of interest in CAMH. Data were collected for the calendar year 2016 and focused on the public health sector. We outlined findings based on best available data across the six domains of the WHO-AIMS. Results In domain 1, we found no provincial CAMH policy or implementation plans to support the national CAMH policy and were unable to identify a CAMH-specific budget. In domain 2, there was no dedicated provincial leadership structure for CAMH, and no dedicated or ‘child- and adolescent-friendly’ mental health services at primary or secondary care levels. At tertiary level, there were only three specialist CAMH teams. The majority of CAMH resources were based in the City of Cape Town, with limited resources in the rural districts. Essential medicines were available in all facilities, and the majority of children and adolescents had access to free services. In domain 3, data were limited about the extent of training offered to primary healthcare staff, and little or no psychosocial interventions were available in primary care. Domain 4 identified a small and variable CAMH workforce across all levels of care. In domain 5, few public health campaigns focused on CAMH, and little evidence of formal intersectoral collaboration on CAMH was identified. Domain 6 identified significant limitations in health information systems for CAMH, including lack of child- and adolescent-specific and disaggregated data to establish baselines for policy development, monitoring, evaluation and CAMH research. Conclusions This study identified significant structural weaknesses in CAMH and presents a clear call for action to strengthen services and systems in the province and in South Africa. it would be important to expand research also to include provider and user perspectives for service strengthening.
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    A study of the computations done by grade 9 learners in a Western Cape high school when simplifying algebraic expressions involving the negative symbol
    (2025) Brink, Hestia; Jaffer, Shaheeda; Davis, Zain
    The computations that learners do when simplifying algebraic expressions are multiple and diverse, with some determined by reasoning aligned with mathematics whilst others rely on idiosyncratic constructs like mnemonics or solution templates. Research in mathematics education highlights symbol sense and negative number concepts as persistent difficulties in learning algebra and categorises learners' errors, but it is wanting in explanations of learners' computations and how they might relate to the way learners think. This study identifies, describes and offers possible explanations for some of the computations that learners did when attempting to simplify algebraic expressions involving the negative symbol. Grade 9 learners from one class in a Western Cape high school were given a set of algebraic expressions to simplify after which interviews were conducted with some learners to discuss their solutions. In the computational analysis of the data, cognitive science and universal algebra were used as lenses for a deeper understanding of learners' mathematical (and non-mathematical) thinking. The data indicates learners' tendency to read algebraic expressions as strings of characters constituting different types of objects, classified in this study as operators, signs, numerals, letters, and superscripts. As suggested by the literature, the negative symbol presented learners with additional challenges, given its polysemic nature in mathematics. Many learners resorted to replacing standard mathematical operations with various operation-like manipulations taking different types of objects as arguments. Plausible reasons for learners' type-sensitivity and idiosyncratic computations offered by this study include: humans' innate capacity for recognising and categorising different objects and symbols; the biases produced from language; and the reliance on existing mental structures for the assimilation of new knowledge. In considering learners' computations at a fundamental level, this study contributes to a more complete view of what learners do computationally and, importantly, why.
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    An audit of the prevalence of abnormal fasting blood glucose levels in patients presenting for elective surgery at a selection of Western Cape government hospitals
    (2019) Biesman-Simons, Tessa; Nejthardt, Marcin; Biccard, Bruce; Roodt, Francois
    Background. Diabetes mellitus (DM) is a common condition. The high burden of undiagnosed DM and lack of large population studies make accurate prevalence estimations difficult, especially in the surgical environment. Furthermore, poorly controlled DM is associated with an increased risk of perioperative complications and mortality. Objectives. The primary objective was to establish the prevalence of DM in elective adult non-cardiac, non-obstetric surgical patients in Western Cape hospitals. The secondary objectives were to assess the glycaemic control and compliance with treatment of known diabetics. Methods. This was a five-day, multicentre, prospective observational study performed at six government-funded hospitals in the Western Cape. Screening for DM was done using fingerprick capillary blood glucose (CBG) testing. Patients found to have a CBG of ≥ 6.5 mmol/L had an HbA1c level done. DM was diagnosed based on the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) diagnostic criteria. Patients known with DM had an HbA1c performed and Morisky Medication Adherence Scale (MMAS-4) questionnaires completed, to assess glycaemic control and compliance with treatment. Results. Of the 379 participants, 61 were known diabetics (16.15%; 95% CI 12.4-19.8%). After exclusion of eight patients with incomplete results, a new diagnosis of DM was made in five out of 310 patients (1.6%; 95% CI 0.2-3.0%). Overall prevalence of DM was 17.8% (66/371; 95% CI 13.9-21.7%). HbA1c results were available in 57 (93.4%) of the 61 known diabetics. Of these 27 (47.4%; 95% CI 34.4-60.3%) had an HbA1c level≥8.5% and 14 (24.6%; 95% CI 13.4 - 35.8%) had an HbA1c ≤7%. Based on positive responses to two or more questions on their MMAS-4 questionnaires, 12 out of 60 participants (20%) were deemed non-compliant. Conclusion. There is a low rate of undiagnosed DM in our elective surgical population; however there is a large proportion of poorly controlled DM. Since poorly controlled DM is known to increase postoperative complications, this likely increases the burden of perioperative care. Resources should be focused on improvement of long-term glycaemic control in patients presenting for elective surgery.
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    Assessing the sensitivity to climate change of the Berg River Voelvlei abstraction system, Western Cape Province, South Africa
    (2025) Rabakali, Takalani; New, Mark; Cullis, James
    There is increasing evidence that climate change (CC) will negatively impact the water sector in many regions of the world, including South Africa, by reducing the availability of water resources in both dams and rivers, changing streamflow patterns, and disrupting aquatic biodiversity. The water resources of the southwest region of the Western Cape Province are particularly sensitive to anthropogenic CC, because the entire Western Cape Water Supply System (WCWSS) relies on rainfall-runoff to fill the main six renowned reservoirs, especially during the winter season. During the 2015-2018 drought event that occurred in the southwestern Cape (SWC) region around Cape Town, which ultimately lasted three consecutive years, these six reservors declined due to a shortage of rainfall that was exacerbated by anthropic factors associated with the growth of the urban population, as well as largely unabated demand amongst local water users. The records showed that rainfall in 2017 was the lowest since the 1880s, and subsequent analysis showed that human influence on climate had increased the likelihood of a drought of this magnitude in the SWC by a factor of three. Several options for augmenting supply in the WCWSS have been proposed, including the Berg River Vöelvlei Abstraction System (BRVAS), which will draw water from the Berg River (BR) in winter and pump it into the Vöelvlei dam (VD). However, there has been no analysis to date of the reliability of the BRVAS scheme under river flow conditions experienced in the recent 2015-2018 drought, or under projected climate change. This study aims to assess the reliability of the BRVAS to climate change. The two research questions for this study were as follows: (1) Given that the previous BRVAS reliability calculations made use of abstraction simulations using the earlier dry period of 1968-1972, would simulations using a period that spans the more severe 2015-2018 drought have the potential to alter the calculated reliability of the scheme? (2) How will the water available for abstraction change in the future under CC scenarios, and what are the implications of these changes for the reliability of the BRVAS? An abstraction model was set up in Excel that used historical streamflow (G1H020-Daljosafat streamflow gauge) and projected river flow data as input. The observed, extending from 1965 to 2021 were retrieved from the Department of Water and Sanitation (DWS) website. The CC model-driven runoff data came from an existing study on the future of water resources in South Africa for three different periods, the recent past (or baseline) from 1961-1990, the near future from 2015-2044, and the distant future from 2070-2099. For the observed period, analysis of the data using the G1H020 Daljosafat streamflow gauge historical data showed that the simulated abstraction amounts and estimates are reduced if one considers the recent drought of 2015-2018 that happened in the SWC region of South Africa. Similarly, for the near and far future, it was found that the water abstraction amounts available were reduced quite dramatically across a large majority of hydrological flows simulated using the six different climate change model outputs. The minimum annual abstraction amount in 2015-2018/19 was found to be 33% lower than the earlier period, while the median annual abstraction amount was 75% different. Similarly, for projections, the frequency of flows below the 25th percentile (Q1) in all models ranged from 1% to -13% in the near future of 2015-2044, and from -1% to -39% in the distant future of 2070-2099, whereas the median annual abstraction differences for the near future ranged from 0% to -6% and 0% to -29% for the far future. The abstraction of 95% of the time (FDCs) exceeded during the observational record and the range across the models in differences between the far future and the recent past was noted to be from -50% to -83 percent.
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    Avian malaria prevalence and mosquito abundance in the Western Cape, South Africa
    (BioMed Central Ltd, 2013) Okanga, Sharon; Cumming, Graeme; Hockey, Phillip
    BACKGROUND:The close relationship between vector-borne diseases and their environment is well documented, especially for diseases with water-dependent vectors such as avian malaria. Mosquitoes are the primary vectors of avian malaria and also the definitive hosts in the disease life cycle. Factors pertinent to mosquito ecology are likely to be influential to observed infection patterns; such factors include rainfall, season, temperature, and water quality. METHODS: The influence of mosquito abundance and occurrence on the prevalence of Plasmodium spp. in the Ploceidae family (weavers) was examined, taking into account factors with an indirect influence upon mosquito ecology. Mosquitoes and weaver blood samples were simultaneously collected in the Western Cape, South Africa over a two-year period, and patterns of vector abundance and infection prevalence were compared. Dissolved oxygen, pH, temperature and salinity measurements were taken at 20 permanent waterbodies. Rainfall during this period was also quantified using remotely sensed data from up to 6months prior to sampling months. RESULTS: Sixteen wetlands had weavers infected with avian malaria. More than half of the mosquitoes caught were trapped at one site; when this site was excluded, the number of mosquitoes trapped did not vary significantly between sites. The majority of mosquitoes collected belonged to the predominant vector species group for avian malaria (Culex culex species complex). Seasonal variation occurred in infection and mosquito prevalence, water pH and water temperature, with greater variability observed in summer than in winter. There was a significant correlation of infection prevalence with rainfall two months prior to sampling months. Mosquito prevalence patterns across the landscape also showed a close relationship to patterns of rainfall. Contrary to predictions, a pattern of asynchronous co-variation occurred between mosquito prevalence and infection prevalence. CONCLUSION: Overall, salinity, rainfall, and mosquito prevalence and season were the most influential vector-related factors on infection prevalence. After comparison with related studies, the tentative conclusion drawn was that patterns of asynchronous variation between malaria prevalence and mosquito abundance were concurrent with those reported in lag response patterns.
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    Changing the game: public education and the discourses and practices of privatisation in educational technology policy and intervention
    (2020) Staschen, Orrie; Kell, Catherine
    Privatisation in education is a contentious issue, inseparable from the shift in focus from community-based education initiatives to individualistic and economically driven ones (Ball and Youdell, 2007). This raises ethical issues with initiatives like the Western Cape Government's Game Changer initiatives, given the range of access issues that learners experience in the pervasive social inequity of South Africa. There is a lack of existing research on privatisation practices in public education in the Western Cape, specifically what linguistic strategies are utilized in the official texts promoting it. The Game Changer initiatives and their associated ‘Roadmaps' promote non-state collaboration in extra- curricular eLearning classes and broader technology rollout in under resourced public schools. Analysis of the Roadmap policy reveals discourses of fast capitalism, skills talk, datafication and digital nativism. These discourses were mirrored in the practices, text and talk generated in an after-school mathematics intervention run by an EdTech company, which I have called ZipEd, in a Cape Flats school between 2017-2018. The company prioritized their funder's mandate and to prove their software's efficacy, spun data to reflect largely positive results. In the rush to provide this data, ZipEd entered several schools without fulfilling ethical clearance requirements. Obtaining access to Game Changer pilot sites ensured ZipEd's product rollout, continued growth, and financial success, revealing the neoliberal approaches which dominate ZipEd's practices. The Game Changer policy texts and the intervention observed, treated languages as silo-ed entities, ignoring family or community approaches to literacy initiatives, curricular reform, trans-languaging strategies and inclusive language learning. While EdTech is a useful teaching tool, this promotion of “exogenous” (Ball and Youdell, 2007) privatisation in the Western Cape, blurs the lines between state and non-state involvement, ultimately resulting in the commodification of public schooling.
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    Child and adolescent mental health services in the Western Cape Province of South Africa: the perspectives of service providers
    (2022-07-14) Mokitimi, Stella; Jonas, Kim; Schneider, Marguerite; de Vries, Petrus J
    Background Current work in the field point to the need to strengthen child and adolescent mental health services (CAMHS) globally, and especially in low- and middle-income countries (LMICs). Policy development, planning and service provision must be relevant to the needs of stakeholders at grassroots level, and should include their perspectives. This study set out to explore the perspectives and lived experiences of service providers, including their recommendations to strengthen CAMHS in South Africa. Methods Using focus group discussions (FGDs) and semi-structured individual interviews (SSIIs), qualitative data were collected from 46 purposefully selected multidisciplinary health service providers across the Western Cape, one of the nine provinces of South Africa. Audio-recorded data were entered into NVivo 11 (QSR), and thematic analysis was performed by two independent raters. Results Results highlighted a significant lack of CAMH resources, poor intersectoral collaboration, limited access to training, absence of consistency and uniformity in service delivery, weak support for staff, and high rates of negative attitudes of staff. External factors contributing to poor CAMHS identified by service providers included poor socioeconomic circumstances, high rates of HIV/AIDS, substance use and stigma. The eight recommendations to strengthen CAMHS included a need to (1) increase CAMH staffing, (2) provide dedicated CAMHS at secondary care and child-friendly infrastructure at primary care, (3) review current service focus on number of patients seen versus quality of care provided to children, (4) formalise intersectoral collaborations, (5) increase learning opportunities for trainees, (6) employ a lead professional for CAMHS in the province, (7) increase support for staff, and (8) acknowledge staff initiatives. Conclusions Findings underlined the need for quality improvement, standardisation and scale-up of mental health services for children and adolescents in South Africa. Whilst we used the Western Cape as a ‘case study’, we propose that our findings may also be relevant to other LMICs. We recommend that the perspectives of service users, including children and adolescents, be sought to inform service transformation.
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    Condom use and HIV testing behaviours of men working in the construction industry in Western Cape, South Africa
    (2025) Kweku Yakubu, Kamaluddin; Govender, Rajendran
    In 2017, UNAIDS published a report titled “Blind Spot: Reaching Out to Men and Boys”, which highlighted a global pattern where men experience worse outcomes than women in the HIV prevention and treatment cascade. This issue is particularly evident in South Africa, where men have been found to be less engaged in HIV prevention and treatment services compared to women. To address this disparity, targeted interventions are urgently needed to improve HIV- related health outcomes for men. However, many such interventions lack a clear theoretical foundation, making it difficult to replicate or assess their effectiveness. This study addresses this gap by empirically testing the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) within a purposive sample of men who are at high risk for HIV/AIDS and hard-to-reach through traditional health facility-based interventions, male construction workers. The study found that an integrated model combining HBM and TPB constructs provided a statistically significant explanation of HIV testing and condom use. Key findings include the direct influence of perceived threat of HIV/AIDS, attitudes and subjective norms on HIV testing, and the significant role of self-efficacy and attitudes towards condom use on condom use intention. In addition to socio-demographic factors such as age and education, experiential factors associated with the impact of someday antiretroviral (ARV) therapy initiation under Universal Test and Treatment (UTT), such as knowledge of where to obtain ARVs, were also found to directly influence the HBM and the TPB, underscoring the importance of the evolving social context of HIV prevention and treatment in understanding HIV-related health outcomes. Finally, the study offers a structured approach for assessing and documenting theory-based interventions, facilitating systematic investigation and replication across different settings.
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    Development and validation of an inventory for Western Cape primary science teachers' conceptions of formative assessment
    (2024) Ghorpade, Aparna Sandeep; Laugksch, Rudiger
    Across many nations worldwide, formative assessment has become an increasingly important component of education policies. Adopting a formative assessment approach in education can improve learners' academic performance, ultimately leading to enhanced educational outcomes. The current South African assessment policy (DBE, 2011) emphasises using formative assessment in primary schools, highlighting its importance in the educational process. However, studies exploring South African teachers' formative assessment practices have shown the need to improve teachers' understanding and use of formative assessments in classrooms. Therefore, it is important to make South African teachers' conceptions of assessment explicit in order to determine their current understanding of formative assessment and to move them towards implementing appropriate approaches to formative assessment. In South Africa, limited research has been conducted exploring teachers' conceptions of assessment, especially in Natural Sciences and Technology at the Intermediate Phase (Grades 4-6) level. Consequently, this study has four objectives - a) to develop an instrument suitable for use with primary school science teachers in the Western Cape, b) to identify practicing primary school science teachers' conceptions of formative assessment, c) to identify the demographic factor(s) that influence the conception of formative assessment of primary school science teachers, and d) to identify the preferred formative assessment practices of such primary school science teachers. Data were collected using a quantitative research design. The survey instrument used was developed by adapting Brown's (2006) Abridged Teachers' Conceptions of Assessment (TCoA-IIIA) inventory for the Western Cape context. Relevant science education stakeholders from the Western Cape province evaluated the content validity of the TCoA-IIIA questionnaire by providing feedback on the clarity of instructions and items of the questionnaire. The modifications and adaptation of TCoA-IIIA resulted in the “Teachers' Conceptions of Assessment - Western Cape (TCoA-WC)” questionnaire. To adapt the TCoA-IIIA for use in the Western Cape, rigorous cross-cultural adaptation and back-translation methods were followed. English, Afrikaans, and isiXhosa are the most commonly spoken languages in the Western Cape province. Hence, a pilot test of the TCoA-WC was conducted with a group of English, Afrikaans, and isiXhosa teachers. The TCoA-WC was then administered online to teachers in 65 schools across four Metro Education districts in the Western Cape. A stratified random sampling method was used as a method of sampling. The selected districts for the study included Metro Central, Metro North, Metro East, and Metro South, which collectively 64% of the province's teacher population. The data collection stage of the present study coincided with the first year of the COVID-19 pandemic, resulting in a limited response of 157 primary science teachers. These 157 responses were analysed by conducting three types of statistical analyses. The confirmatory factor analysis (CFA) analysis of data collected using TCoA-WC revealed the same factor structure as that of the TCoA-IIIA model, confirming the presence of four main conceptions of assessment (i.e., Improvement, School Accountability, Learner Accountability, and Irrelevance) and associated 27 items in the thinking of Western Cape primary science teachers. The TCoA-WC model also exhibited well-fitted psychometric properties. The reliability analysis and CFA analysis confirmed that TCoA-WC is a valid and reliable measure of Western Cape primary science teachers' conceptions of formative assessment. Thus, this study resulted in the development of the TCoA-WC inventory, which is conceptually, linguistically, and culturally appropriate for use with the teachers in the Western Cape province. The study participants did not explicitly endorse any specific assessment concept identified by the TCoA-WC inventory. However, the CFA analysis confirmed that all four conceptions of assessment, that is, Improvement, School Accountability, Learner Accountability, and Irrelevance, are present in the thinking of Western Cape primary school science teachers. It is hoped that the skillful integration of the findings of this study into teacher professional development initiatives will result in the implementation of formative assessment practices in the Western Cape primary classroom as outlined in the Curriculum and Assessment Policy Statement (DBE, 2011), which will lead to significant improvement in the performance of learners
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    Exploring the influence of funding sources on business incubation in the Western Cape
    (2020) Milne, James; Dhlamini, Xolisa
    The topic of business incubation has been the subject of considerable academic research, and a focal point in entrepreneurship support ecosystems. Business incubators provide entrepreneurs and start-up businesses with a shared space (either physical or virtual). The incubator offers a systematic shared support structure that enhances businesses' chances of succeeding and growing into entities that eventually graduate to a location beyond the ‘safety net' of the incubator. Academic research in the field of incubation has predominantly focused on (i) understanding business incubation models that are most effective within particular operating environments; and (ii) understanding support services that are most useful to incubatees of the incubator. This research instead explores the influence that funding sources have on business incubators, with a focus on understanding how incubators in turn assist their incubatees in accessing finance. Research focusing on funder influence on incubators, and support provided to incubatees to assist with access to finance, is at a nascent stage within the South African business incubation landscape. The research was undertaken utilising a multiple case study approach, with individual business incubators constituting a case. Incubators were classified into three case typologies, depending on their predominant funding source: mixed; private; or public funded. From the population of business incubators in South Africa, a sample of 8 incubators within the Western Cape Province were selected. Semi-structured interviews with participants were undertaken over a three month period and involved undertaking interviews with 8 incubator managers, and 10 current or former incubatees. Qualitative data from participant interviews were analysed using a combination of NVivo12 and MS Excel, in order to determine responses relevant to the research question and subquestions. The information collected was categorised into themes of relevance using initial and pattern coding methodologies. The research suggests that funders influence the work of incubators through driving their own objectives, utilising the incubator as a tool. Public sector funders set objectives for incubators that were linked to achieving socioeconomic goals (poverty alleviation and economic redress). Public sector funders were found to be strongly focused on achieving their own performance indicator goals, even if these did not align to the work of the incubators. Private sector funders set objectives for incubators that were linked to achieving the goals of their organisation or fund mandate. Private sector funders were found to lack long-term commitment to funding incubators. Communication between public and private sector funders was found to be, in general, poorly co-ordinated. Lack of co-ordination between funders negatively affected the impact of incubators. The cross-case multiple case study methodology revealed that in the Western Cape, similarities exist in the channels of support provided by incubators to assist their incubatees in accessing funding, regardless of the funding structure of the business incubator. However, heterogeneous priorities exist in funding support services provided to incubatees. Bias was identified in the process of sourcing of funding for incubatees. Incubators pursued a blend of proactive and reactive approaches to accessing funding for their incubatees, depending on their relationship with funder(s). The researcher recommends a strengthening of efforts to co-ordinate objectives across the two broad spheres of incubator funding sources (public and private) in order to build effective and sustainable business incubators in South Africa. Financiers of incubators should review stakeholders and other financiers involved in the incubator to clarify policy, commitments and performance metrics. Emphasis must be placed on ensuring alignment (i) between incubator financiers; (ii) between the objectives of the financier(s) and the incubator. The current study is well suited to being expanded in future, both in terms of: (i) widening the interview participant base to include incubator financiers; (ii) a geographic expansion to focus on South Africa as a whole.
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    Impact of air connectivity on tourism, FDI and trade: insight from the Western Cape
    (2020) Nonyati, Sibusiso; Alhassan, Abdul Latif
    This study investigated the impact of air connectivity on macroeconomic factors, specifically tourism, FDI and trade in the Western Cape, based on quarterly data from 2010 to 2018. The Autoregressive Distributed Lag (ARDL) bounds approach for cointegration was used to assess whether long-run relationships existed between air connectivity and tourism, FDI and trade. The ARDL bounds test found a cointegrated relationship between air connectivity and tourism, FDI and trade respectively. Air connectivity was found to have a positive and significant long-run relationship with tourism This also supports the literature findings that air connectivity improves countries' accessibility and increases tourist arrivals from various markets. This confirms that air connectivity leads to an increase in the number of international tourists visiting the Western Cape, which contributes significantly to the tourism industry and the Western Cape economy. In addition, air connectivity was observed to have a positive but statistically insignificant long-run relationship with FDI and trade respectively. Therefore, this study concludes that air connectivity plays a key role in the economy, specifically regarding tourism through the facilitation of more tourists into the Western Cape. Furthermore, although the study showed positive and insignificant relationships between air connectivity and FDI and trade respectively, air connectivity is related to FDI and trade and these relationships require further investigation. Therefore, it is recommended that policymakers and decisionmakers on the African continent need to have initiatives that support the improvement of air connectivity, especially given that Africa has only a 2.2% market share of global air passengers and less than 10% of the continent's population uses air transport. Other African countries and regions should use a similar approach to what the Western Cape has done to improve the air connectivity between Cape Town and the rest of the world. In addition, investment in airports and airport-related infrastructure is critical and necessary, as poor airport infrastructure has been cited to be one of the obstacles in improving air connectivity in the continent. Furthermore, the development of an air connectivity index for the continent is required. This index will have to take into account the availability of data and the African context. Where data does not exist, a robust plan for the collection of data will also have to be developed. Lastly, the regulation of the aviation market needs urgent attention, starting with an Open Skies policy. The deregulation of air access could play a significant role in improving the African Continent's air connectivity.
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    Implementing family strengthening policy: an assessment of NGO experiences in the Western Cape, South Africa
    (2024) Katzef, Carly; Naidoo, Vinothan
    Mutually reinforcing health, education, and social development outcomes are rooted in the quality of children's relationships with primary caregivers in the home environment; yet multiple, compounding stressors make parenting a difficult task. Government policies that aim to support families do so through committing to provide an ‘enabling environment' for caregivers to fulfil this central role. The South African Revised White Paper on Families represents one such commitment. A key lever of support is family strengthening, which includes the provision of parenting support programmes to enhance caregiver-child relationships, and contribute to family and community safety and wellbeing. These programmes are largely delivered by non-governmental organisations (NGOs). However, as they are mandated, funded, and to some extent, regulated, by national policy frameworks, NGOs face several challenges. This qualitative study investigated the implementation of parenting support programmes by documenting the experiences of frontline NGO providers. Conducted in the Western Cape, it employed a semi-structured survey of NGOs, supplemented by key informant interviews with provincial government officials overseeing family strengthening in the province. The literature on parenting programmes highlights four interlinked factors which shape implementation outcomes, namely, availability of human and financial resources; co ordinating multiple institutions to support interventions in this joined-up policy area; and adopting evidence-based coupled with monitoring and evaluation practices to enhance programme design. Findings were generally consistent with the key implementation drivers in the existing literature: that government and NGOs alike lack the human and financial resources to execute a coordinated response to the family strengthening mandate. This limitation is partly attributed to the White Paper's siloed approach to family services, as well as a preference for statutory cases (such as foster care placement, and child abuse and neglect) over preventative support, such as parenting programmes. Monitoring and evaluation efforts are also hindered by resource constraints, which is compounded by governments' narrow quantitative reporting indicators that struggle to measure programme impact. However, there is an apparent effort in the sector to balance insights from both academic research and organisations' practice generated learnings in an attempt to define ‘evidence' usefully and realistically. Overall, this study identified the most prominent factors influencing the implementation of family strengthening policies, with a focus on the White Paper on Families, and drew out implications for improving policy design. Addressing family strengthening is a significant, yet complex, policy area that this research shed further light on by adding the experiences in the Western Cape province of South Africa as an additional piece of evidence to the existing literature. Future research avenues could explore the perspectives of both facilitators as well as beneficiaries (parents/caregivers) to contribute to a more comprehensive understanding of this little-known policy area.
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    Investigating the clinicopathological spectrum and associated genetics of colorectal carcinoma in young (<60 years of age) patients in the Western Cape Province
    (2025) Aldera, Alessandro; Ramesar, Rajkumar; Boutall, Adam
    The incidence of colorectal carcinoma (CRC) in young patients is rising in sub-Saharan Africa, and is set to become a major public health problem within the next decade. Despite this, there is a paucity of large-scale genomic studies in the subregion. To investigate driver genes, oncogenic signalling pathways and spectrum of pathogenic variants, we retrospectively identified 197 CRC cases over a 5 year period. Thirty-two mismatch repair deficient (dMMR) cases, without known germline variants, were investigated with amplicon-based panel next generation sequencing (NGS). Pathogenic or likely pathogenic variants were detected in the corresponding MMR gene in 14 of 18 (78%) MLH1/PMS2-deficient tumours, 5 of 8 (63%) MSH2/MSH6-deficient tumours, 1 of 4 (25%) tumours with isolated MSH6 loss, and 0 of 2 tumours with isolated PMS2 loss. Cases with a variant allele frequency suggesting a germline mutation were identified in MLH1 (eight), MSH2 (two) and MSH6 (one). NGS-based strategies for Lynch syndrome screening are advised to detect the broad spectrum of disease-causing MMR gene variants in our population. Resource constraints prohibit the rollout of universal MMR screening in sub-Saharan Africa. We sought to determine the performance of a deep learning model in our ethnically heterogeneous cohort. Our model yielded an AUROC of 0.91 (±0.02). Calibrating the classification threshold to 0.15, the overall sensitivity achieved in our cohort was optimised to 96% (95% CI 90-100) with a specificity of 60% (95% CI 52-82). This model could therefore be employed to accurately pre-screen for dMMR cases, thereby reducing the burden of downstream immunohistochemical and molecular testing in our resource limited setting. Whole exome sequencing was performed on a subset of the research cohort. Eighty-three cases were included in the analysis (77 MSS, 4 MSI, 2 POL). APC, TP53 and KRAS were among the most frequently mutated driver genes, although at a lower frequency than described in the literature. BRAF V600E mutations were absent. Although there were differences in the frequencies of mutations in the major driver genes, the frequencies of oncogenic pathway alterations were similar. FAT4 (26%) and TET2 (15%) have emerged as important novel driver genes in left-sided tumours, and potential therapeutic targets for further investigation.
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    'It’s not just the learner, it's the system!' Teachers’ perspectives on written language difficulties: Implications for speech-language therapy
    (OASIS Publishing, 2011) Navsaria, Indira; Pascoe, Michelle; Kathard, Harsha
    The failure to achieve academic outcomes in linguistically diverse classrooms in poor areas of the Western Cape, South Africa, is well documented. A major contributing factor is the written language communication difficulties experienced in these classrooms. This paper describes the views of intermediate-phase teachers on why written language difficulties are experienced by learners and ways in which these difficulties might be overcome. A series of interviews were conducted with two class teachers in one urban school from which there had been a high number of referrals for speech-language therapy. The teachers were individually interviewed using an in-depth, semi-structured format. Teachers reported that 50 - 70% of learners in their classes were not meeting grade level academic outcomes. They were asked to explain the difficulties experienced with regard to written language, and the challenges and solutions linked to these. The findings suggest that there are barriers and opportunities at the school system, individual learner and home/social community levels. Major challenges identified at the school system level included limited training and lack of support for teachers, poor foundation skills in learners and difficulties with language. The current opportunities for the development of written language were insufficient and teachers identified further opportunities to promote the learners’ written language development. These included training and support for teachers, clear and consistent assessment guidelines, remedial assistance for learners and safe, nurturing home environments. There is a need to look beyond the learner as the site of the problem; a systemic approach is essential. In the light of these findings, suggestions are made for the role of the speech-language therapist.
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    Local government policy in South Africa 1980-1989 (with specific reference to the Western Cape) : devolution, delegation, deconcentration or centralisation?
    (1991) Cameron, Robert; Welsh, David; Bekker, Simon
    This thesis is an examination of the National Party's policy of decentralisation of powers to local authorities in the 1980s. The thesis concentrates primarily on urban local government and its objectives are: 1. To trace the evolution of the south African state's policy of devolution of powers to local authorities in the 1980s; 2. To examine critically the main features of new local government legislation in this period, with particular reference to the devolution of powers policy; 3. To apply a normative framework for analysis, which can help serve as a heuristic device, in determining the extent of decentralisation that has occurred, to selected local authorities in the western Cape. The primary sources of research material that were consulted were Hansard, Acts of parliament, government commissions and gazettes, year books, provincial debates, ordinances, gazettes, circulars and local authorities' minutes and publications. Approximately 50 qualitative interviews were also conducted. The framework of analysis utilised certain indices, namely personnel, access, functions, party politics, finance and hierarchical relations, to measure the extent of decentralisation that has occurred in three local authorities in the Western Cape. This framework helped determine that limited devolution of powers had occurred. There were four major reasons for the reluctance of the National Party to devolve extensive powers to local authorities. First and foremost, reform policy was made in an elitist, top-down manner by a small group of reformers in order to ensure that the government could share power without losing control. The corollary of this centralised policy-making was the tendency of centr.al and provincial authorities not to devolve extensive powers to local authorities. Secondly, there was the viewpoint of the central government that the local government development process had to be controlled from the top because of the lack of sufficient skills, experience and finance at local level. Thirdly, the need for macro-economic financial control was· also a brake on the devolution process. Fourthly, the government believed that, in a unitary state, central government should always have a relative degree of control over local authorities' activities.
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    Medicine and the Arts Week 2 - Me and TB: children's accounts of tuberculosis and the clinic
    (2015-01-21) Abney, Kate
    In this video, medical anthropologist Kate Abney shares some of the stories told by young patients in the tuberculosis (TB) wards of hospitals across South Africa’s Western Cape where she worked. She describes how she has helped to facilitate storytelling among young TB patients through art. This is the third video in Week 2 of the Medicine and the Arts Massive Open Online Course.
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    Neurocognitive disorders in young adults commencing highly active antiretroviral treatment in the Western Cape
    (2010) Joska, John Anton; Flisher, Alan; Stein, Dan
    Background: HIV-associated neurocognitive disorders (HAND) remain prevalent in the era of highly active anti-retroviral therapy (HAART). It is not known whether HAND are as prevalent in South Africa as in other regions, and whether individuals with HAND in South Africa will respond to HAART. Methods: The published literature was reviewed to elucidate potential mechanisms of the development of HIV-associated dementia (HAD)- the most severe form of HAND- and to establish the effect that HAART has exerted on HAND across diverse studies. A prospective clinical cohort study was initiated in Cape Town, in which 170 participants completed baseline clinical and neuropsychological assessments. Laboratory investigations included apolipoprotein E (APOE) genotyping. The performance of the International HIV Dementia Scale (IHDS) as a brief screening tool was analysed using a receiver operating characteristic (ROC). At one-year, 105 participants were re-assessed for neuropsychological change. Results: The reviewed literature suggests that HAD is likely mediated by a range of HIV-related factors (including possible difference in HIV sub-type) and host-related factors. In addition, while neurocognitive improvements are reported in most prospective studies, these are dogged by differences in methodology and approach. In this study, 25.4% of participants met criteria for HAD at baseline and this was associated with lower levels of education and male gender. The APOE4 allelic variant was not associated with those who had developed HAD, despite this variant being common in Cape Town. The IHDS performed reasonably well on ROC analysis, detecting 86% of dementia cases using a cut-off score of ≤11. At one-year follow-up, participants had improved significantly on neuropsychological assessment, including a small sub-sample who had not initiated HAART. Significant associated factors were male gender, the use of HAART and worse baseline neuropsychological test performance. Conclusion: HAND- including HAD- are common conditions in South Africa, where HIV clade C is predominant. Further work to identify cases and delineate mechanisms of disease and treatment response is needed. This might take the form of larger prospective studies, incorporating control groups. Such studies could better elucidate disease mechanisms with a view to developing targets for therapeutic interventions.
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    Pattern of recovery and outcome after stroke in patients accessing a Western Cape rehabilitation facility
    (2007) Rouillard, Susan; Jelsma, Jennifer; De Weerdt, Willy
    Background: Stroke is a growing healthcare problem in South Africa, and contributes significantly to theburden of disease. Rehabilitation is thought to improve recovery and outcome, but little is known about current rehabilitation practices and outcomes in the South African setting. Aims and Objectives: The primary aim was to describe pattern of recovery and outcome after stroke in first ever stroke patients at a Western Cape Rehabilitation Facility. The secondary aim was to explore factors that may influence outcome after stroke. Objectives included describing characteristics of stroke patients the rehabii itation process, and certain aspects of the environment. Study Design: The study was a prospective, longitudinal, descriptive study of first ever stroke patients admitted to the Western Cape Rehabilitation Centre between 22 June 2005 and 28 March 2006. Instrumentation: The ational Institute of Health Stroke Scale IHSS) was used to describe severity on admission. The Barthel Index (BI) and Rivermead Motor Assessment (RMA) were used to describe functional and motor recovery respectively. The main outcome measure at six months was the Modified Rankin Scale (MRS), with secondary outcomes including the ottingham Extended Activities of Daily Living Scale, the Caregiver Strain Jndex and the EQ-5D, a measure of health related quality of life. Questionnaires drawn up for use in the study collected further information on patient characteristics, residential and work status at six months, as well as environmental features. Procedure: Patients who met the eligibility criteria were assessed at admission discharge and six months post stroke. Data Analysis: Summary statistics were used to present descriptive data. Friedmans analysis of variance and Wilcoxons matched pairs test were used to assess the significance of change across the selected measurement points. A repeated measures A OYA was used to investigate differences in pattern of recovery between sub-groups. Bivariate analysis and logistic regression were used to analyse the influence of certain factors on MRS scores at six months. Results: Participants were noted to be younger (average age of 51.3 ± I 4.4 SD) than those in overseas rehabilitation studies with a high proportion of haemorrhagic strokes and infective aetiologies. Participants were mostly from low income homes although the majority lived in formal housing (86.3%) with access to services. The rehabilitation process was characterised by early admission after stroke (74.5% within 30 days), and an average length of rehabilitation stay of approximately 60 days. Four participants were readmitted for further rehabilitation stays within the six month follow up period. Of the remaining patients, fewer than I 0% had received any substantial rehabilitation input after discharge, although most had been seen at least once by a health professional (89.4%). The overall pattern of recovery showed change between all three time points with most change occurring between admission and discharge (median Bl change of 25, p<0.017). However, clinically significant change (defined by> 15% of total scores) was seen between discharge and six months in terms of Bl scores in 55.3% and RMA Gross Sub-scale scores in 45.5% of participants. Mobility items reflected the most change with 81.8% of participants independently mobile at six months compared to 54.5% at discharge. The pattern of recovery over time did not appear to be influenced by severity of stroke (F=2.29, p>0.05) or early/late admission to rehabilitation (F=0.51, p>0.05). Only one participant was living in an institution at six months, despite the fact that more than 20% of participants required constant care. The majority of participants (59.6%) were independent in self-care but many required assistance for extended activities of daily living such as housework, meal preparation, using public transport and shopping. Of interest were difficulties experienced with community mobility, a high prevalence of depression or anxiety (50%) as well as problems with relationships or feelings of isolation (82.6%). High levels of caregiver strain were reported in 55.8% of caregivers. Only 10% of those working prior to their stroke had returned to work at six months. Severity of stroke (fHSS) emerged as the clearest predictor of outcome (OR 0.70, CJ 0.53-0.94), but environmental factors were also seen to be significant. Income group affected outcome (adj z=-2.08, p<0.05), and the presence of at least one reported environmental barrier reduced the odds of favourable recovery according to the MRS (OR 0.18 Cl 0.03-0.98). Lack of transport and financial problems were highlighted by participants as major barriers affecting participation. Discussion and Conclusions: Pattern of recovery followed a more or less expected course over time with greater change between admission and discharge, than between discharge and six months. The high percentage of participants improving between admission and discharge suggests appropriate selection of rehabilitation candidates and effectiveness of the rehabilitation programme. Clinically significant change occurring between discharge and six months particularly with regard to higher mobility, implies that patients may benefit from follow up after discharge in order to optimize outcomes, especially as many participants were discharged fairly early after their strokes while recovery may still be ongoing. In terms of outcomes, BJ scores at six months were comparable to other studies, with most patients functionally independent or requiring only minimal assistance with activities of daily living (ADL). However, a higher prevalence of difficulties was seen in more complex extended ADL and at the level participation restrictions than in studies in developed countries. In particular, there were higher levels of depression, social isolation and caregiver strain, and only a small percentage of those previously working had returned to work at six months. Lack of community mobility and difficulties with transport may have contributed to restrictions in participating in activities outside of the home. These difficulties are most likely to arise after discharge from rehabilitation, as the patient tries to resume pre-stroke roles in the community. Further research is recommended to determine whether provision of follow up after discharge from rehabilitation will improve outcomes. Research is also recommended to explore how caregivers can be best supported to reduce levels of caregiver strain. Although the severity of stroke at admission was found to be the clearest predictor of outcome, the influence of adverse environmental factors on outcome was also apparent. Other characteristics of the study sample such as the young age distribution and medical profile may also have contributed to differences in recovery and outcome.
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    Potential impacts of climate change and land-use change on hydrological drought in the Western Cape (South Africa)
    (2022) Naik, Myra; Abiodun, Babatunde
    The Western Cape (South Africa) recently witnessed the most severe drought on record. The meteorological drought, which was characterised by below-normal rainfall for three consecutive years (2015 – 2017), cascaded to agricultural and then hydrological drought, resulting in devastating socio-economic consequences. While some studies indicate that climate change may increase the severity and frequency of droughts in the Western Cape in the future, there is a lack of information on how to mitigate the effects of future climate change on hydrological drought. This dissertation therefore investigated the extent to which land-use changes could be applied to reduce climate change impacts on future hydrological drought in this region. For the study, the revised Soil Water Assessment Tool (SWAT+) was calibrated and evaluated over four river basins in the Western Cape, and the climate simulation dataset from the COordinated Regional Downscaling EXperiment (CORDEX) was bias-corrected. Using the bias-corrected climate data as a forcing, the SWAT+ was used to project the impacts of future climate change on water yield and hydrological drought in the four basins and to quantify the sensitivity of the projection to four feasible land-use change scenarios in these basins. The relevant land-use scenarios are the expansion of mixed forests (FrLand), the restoration of grassland (GrLand), the restoration of shrubland (SrLand), and the expansion of cropland (CrLand). The model evaluation shows good agreement between the simulated and observed monthly streamflow at hydrological stations, and the bias correction of the CORDEX datasets improved the quality of the SWAT+ hydrological simulations in the four basins. The climate change projection depicts an increase in temperature and potential evapotranspiration but a decrease in precipitation and all the hydrological variables. Drying is projected across the Western Cape, and the magnitude of such drying increases with higher global warming levels (GWLs). The land-use changes alter the impacts of climate change by influencing the hydrological balance. While FrLand mitigates the impacts of climate change on the frequency of hydrological drought by increasing streamflow, soil water and percolation, CrLand mitigates the impacts by increasing surface runoff. However, the magnitudes of these land-use change impacts are very small compared to the climate change impacts. Hence, the results suggest that land-use changes may not be an efficient strategy for mitigating the climate change impacts on hydrological drought over the region. The findings obtained from this 2 research provide relevant information towards mitigating the severity of future droughts and improving water security in Western Cape River Basins.
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    Quality of asthma care: Western Cape Province, South Africa
    (2009)
    Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care. Methods. The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. Results. Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. Conclusion. The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care.