Browsing by Subject "abuse"

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    Do South African mothers shake their babies? incidence and risk factors for infant abuse in Cape Town
    (2019) Nefdt, Kirsten C; Ward, Catherine L
    Abusive head trauma from shaking is a recognised common cause of fatal head injury in young children globally, although there is little evidence of its occurrence in South Africa. This is perplexing given that the country has amongst the highest reported under-five child mortality and infanticide rates worldwide. To determine whether infants under one-year are violently shaken, a cross-sectional study was conducted with 385 mothers and other primary female caregivers (ages 18 to 60 years; mean age = 27 years) from three high-risk communities in Cape Town. Semi-structured interviews were used to examine: (1) the incidence of shaking, (2) the triggers for shaking, (3) the risk factors for shaking, thoughts of shaking, and knowledge of the dangers of shaking, and (4) the methods used to console crying infants. Results showed that 13.2% (n = 51) of all participants self-reported violent shaking, and 20% (n = 77) had thoughts of shaking their infants. Following a content analysis, three primary triggers for shaking were identified, these were: inconsolable infant crying, feeling angry or frustrated, and being stressed. Findings from a thematic analysis also showed that shaking occurred during a momentary loss of control, and participants seemed to have limited support at the time. The results from three hierarchical logistic regression analyses showed that (1) alcohol use, infant age, a lower knowledge of the dangers of shaking, inconsolable crying, and having thoughts of shaking, predicted shaking, (2) caregiver age, infant age, knowledge of the dangers of shaking, and caregiver responses to infant crying, predicted having thoughts of shaking, and (3) social support, caregiver history of childhood abuse, and having thoughts of shaking, predicted knowledge of the dangers of shaking. Finally, a content analysis revealed three protective factors for infant crying, these were: (1) having easy, contented children, (2) not feeling stressed in response to infant crying, and (3) leaving an infant alone to self-soothe. Taken together, the current findings have programmatic implications that may help prevent the violent shaking of young children in South Africa.
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    Elder abuse in South Africa: measurement, prevalence and risk
    (2023) Jacobs, Roxanne; Schneider, Marguerite; Farina, Nicolas
    Abuse towards older people is a global public health and human rights concern and considered a hidden pandemic due to underreporting. It has been estimated that 1 in 6 people aged 60 and older have experienced abuse at some point, with World Health Organization estimating that only 4% of cases are reported. Often older adults do not recognise their situation as an abusive one or may be reluctant to disclose because the abuser is a family member, often an adult child for which the older person feels responsible for. People living with dementia and older persons with significant health concerns are especially vulnerable to elder abuse, with estimates showing that 2 in every 3 people living with dementia have experienced some form of abuse. Rigorous data on the extent of the problem globally is limited, with studies often excluding the self-report of older adults with cognitive impairment, such as dementia. Lack of disclosure may therefore be amplified in people living with dementia with limitations in insight, recall or communication skills. These realities keep elder abuse hidden, while often relying on the self-report of perpetrators to disclose abuse. Screening and identifying elder abuse, especially amongst people with cognitive impairments, are complex. Very little research is published on elder abuse in South Africa, with a complete absence of prevalence estimates, routine reporting, or monitoring and surveillance of issues relating to elder abuse. From the limited data available, elder abuse in South Africa is a serious concern. In South Africa older persons are now, more than ever, expected to manage households, rear children, and financially support their entire household with their pensions. This shift in role makes them especially vulnerable to the impact of the country's high rates of poverty, unemployment, and crime, especially within the home environment. These structural and social determinants of violence are poorly understood in the context of elder abuse. In particular, there is a serious lack of local evidence that supports the understanding, risk, and measurement of elder abuse in South Africa. This study therefore proposed to address these gaps through four sub-studies designed to describe the landscape of elder abuse in South Africa. These sub-studies had the following aims: 1. To provide a situational analysis on current service provisions for dementia and elder abuse for older adults, including people living with dementia and their families (sub-study 1). 2. To cross-culturally adapt the Elder Abuse Screening Tool (EAST) and the Caregiver Abuse Screen (CASE) in South Africa, to detect self-reported abuse and risk of abusing from older persons' and potential perpetrators' perspectives (sub-study 2). 3. To examine the nature of self-reported elder abuse using the Elder Abuse Screening Tool (EAST) to generate evidence on the prevalence, predictors, and perpetrators of abuse (substudy 3). 4. To estimate the prevalence and predictors of risk of abusing using the Caregiver Abuse Screen (CASE) amongst household informants, including carers for people living with dementia (sub-study 4). Sub-study 1: “Dementia in South Africa: a situational analysis” This study comprises of two parts. Part I presents a situational analysis that was conducted in three phases: (1) a desk review guided by a comprehensive topic guide which included the World Health Organization's (WHO) Global Dementia Observatory indicators; (2) multi-sectoral stakeholder interviews to verify the secondary sources used in the desk review, as well as identify gaps and opportunities in policy and service provisions and (3) a SWOT-analysis examining the strengths, weaknesses, opportunities and threats in current care and support provisions in South Africa. Findings highlight the gaps and opportunities with current service provisions and show how structural factors create barriers to diagnosis, support and care. These barriers to diagnosis, care and support create risk for elder abuse and neglect as families and people living with dementia are largely unsupported by formal, community-based services. Part II expands this analysis and provides a closer look at the insights gained from stakeholders interviewed and reports on the status of elder abuse support provisions in South Africa. We found that, like in the case of dementia services, support provisions for elder abuse are poor. While there is a lack of data on the nature and extent of the problem, experts agree that underreporting is a big problem, and that people living with dementia are at greater risk of elder abuse that may include extreme forms of violence. Sub-study 2: “Cross-cultural adaptation of the EAST and CASE screening tools for elder abuse in South Africa” We tested the cultural appropriateness of the EAST (Elder Abuse Screening Tool) and the CASE (Caregiver Abuse Screen) in two regions (Western Cape and Limpopo) and four languages in South Africa (English, Afrikaans, isiXhosa and Northern Sotho (Sepedi)), using a cognitive interviewing methodology. Findings show that questions in the EAST and CASE are generally well understood, but that adaptations of both tools are necessary for use within South Africa. Older persons' fear, knowledge and experience of crime also showed that strangers may deliberately use deception to build trust and abuse. Further validation is needed to determine suitable scoring and use by health and social care practitioners. Sub-study 3: “Prevalence, perpetrators, and predictors of self-reported elder abuse in South Africa: findings from a household survey” Informed by the cognitive interviews in sub-study 2, the adapted EAST was used in a household survey to screen 490 older people for self-reported elder abuse across two areas, Cape Town (Western Cape) and Dikgale (Limpopo). One in ten older adults screened positive for abuse, of which financial abuse was most common. Perpetrators of elder abuse were most often a non-family member with whom the older adult had a relationship with. Higher prevalence of self-reported abuse was strongly predicted by higher levels of the respondent's own functional impairment. This is one of the first studies that explore the relationship between dementia, functional impairment, and elder abuse at a community level in South Africa. Sub-study 4: “Risk of elder abuse in South Africa: a survey of household informants” Within the same household survey, we screened informants of the older adults using the CASE. We found that risk of elder abuse was very high, with half of participants screening positive for abusive dispositions toward an older person. Carers of people living with dementia were four times more likely to be at risk of abusing compared to carers of people free of dementia. However, our multivariate model showed that more severe psychological and behavioural symptoms and increased carer burden are the main associations with elder abuse in this population. Supporting carers to manage stress and reduce burden includes the effective management of neuropsychiatric symptoms and has potential to reduce risk for elder abuse. Overall, the findings of this study showed that elder abuse and risk of abusing is high in South Africa, with perpetrators often being a non-family member with whom the older person has a personal relationship with, or a family member. It provides an important contribution to the available evidence base on elder abuse in a low-or-middle-income country like South Africa and gave insight into understanding elder abuse in context to support targeted efforts to reduce risk of abuse and provide adequate services for older adults, including people living with dementia.
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    Enhancing professionalism: human rights & me @ the University of Cape Town
    (2012) Mitchell, Veronica
    This handout aims to promote professionalism and social accountability in health care. Human Rights Education has become an integral part of the curricula in the Health Sciences Faculty at the University of Cape Town. As students develop their knowledge and skills to promote respect for human rights and quality health care they learn to be advocates for social justice, valuing the link between human rights and health. However students frequently report witnessing disturbing situations in their clinical encounters where the disjuncture between the theory and practice is challenging. They find themselves faced with dissonance, uncertain how to react towards positive change.
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    Moving beyond excuses: Confronting disrespect in Obstetrics
    (2016-09-27) Mitchell, Veronica
    This teaching and learning resource aims to promote a socially just pedagogy in Obstetrics. It provides a collection of images, videos and tools to acknowledge different practices. The intention is to illustrate the value of engaging with affect/effect in an affirmative manner as a response to the pervasive and prevailing disrespect and abuse in birthing facilities.