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- ItemOpen AccessEvaluating the alignment of the refugee status determination process with international and national human rights and refugee law: a cross-country analysis of Sweden and South Africa(2024) Aytan, Selma; Amien, WaheedaIn South Africa, the domestic refugee legislation, the Refugees Act 130 of 1998, was established in 1998.1 However, the country continues to struggle to correctly implement and apply the refugee law in a successful manner. Furthermore, outside its domestic refugee legislation, South Africa has both ratified and signed the 1951 United Nations Convention Relating to the Status of Refugees2 (1951 Convention) as well as the Organization of African Unity Convention Governing the Specific Aspects of Refugee Problems in Africa (OAU Refugee Convention).3 The country has hence committed to honoring the outlined obligations in both conventions in accordance with international law and to enact the Refugees Act.4 South Africa has further agreed to the 1967 Protocol Relating to the Status of Refugees5 and the 1948 United Nations Universal Declaration on Human Rights (UDHR).6 An important section that is outlined in all of these instruments is the right to seek and enjoy asylum. Further, the 1951 Convention was established to specifically protect people who are fleeing any form of persecution in their country of origin due to grounds such as race, religion, nationality, political opinion or membership to a particular social group.7 However, regardless of the provided grounds, South Africa has at times shown to fail to recognize such grounds during the refugee status determination process. With the country's extensive processing times as well as the hardship to receive more than a temporary residency in the country for long periods of times, many refugees and/or asylum seekers are put into uncertain circumstances which can have negative effects on both their physical and mental health. Sweden, a country on the opposite north altitude of South Africa, has traditionally had a wellestablished outwardly image of being an open and welcoming country for refugees. As a member-state of the European Union, Sweden is obliged to follow any policies that the EU develops. The European Council in 1999 began to develop the Common European Asylum System (CEAS)8, which would be foundational in the inclusive and full application of the 1951 Convention.9 This established system has undergone a couple of different developmental periods since its inception. During, what is commonly referred to as, the European influx of refugees that began in 2015, many deficiencies in the EU refugee and asylum policies and laws were exposed. Consequently, many of the member-states who were affected began to increase their engagement in terms of the future direction of the EU asylum and refugee policies and laws. Numerous countries additionally began to refuse their obligations in terms of EU policies and laws surrounding the topic. The European refugee influx also marked an important transition in Sweden's refugee and asylum policies. Prior to 2015, Sweden took pride in being a generous state in terms of their national asylum and refugee system, as well as the quality of care which refugees and asylum seekers were provided at the point of arrival. One prime example of this was in 2013 when all Syrian and stateless persons seeking asylum were guaranteed and provided permanent residency, given that they were arriving from war-torn Syria. This policy has since changed, and it is far more complicated and difficult for an asylum seeker and refugee to attain permanent residency. There has been a notable switch in Sweden's stance on accepting and receiving refugees and asylum seekers even after the 2022 election, in which a far-right majority now is politically in charge of the country. With the difficulties that asylum seekers and refugees are now facing in terms of having their refugee status determined globally, this paper seeks to first, investigate whether South Africa's refugee status determination process has ever fully been aligned with human rights and refugee law; secondly, investigate why Sweden has begun to move towards a similarly difficult refugee status determination process as South Africa. The analysis will be conducted through desk-top research comprising academic literature, international and regional treaties, legislation, government reports, policy documents, relevant case studies, academic publications, journal articles, book chapters and books. By applying desk-top research, the dissertation will attempt to provide a comprehensive understanding of the challenges and difficulties that refugees and asylum seekers face today in both countries.
- ItemOpen AccessPregnancy intendedness in a high-risk obstetric population in a regional hospital(2024) Akpakan, Akanimo; Van Der Spuy, Zephne; Kadwa, Khatija; Petro, Greg; Firmin, CarlUnintended pregnancies (UIP) are those that are mistimed, unplanned, or unwanted at the time of conception. It is estimated that, worldwide, 40% of pregnancies were unplanned in 2012 and this carries increased risks for both mothers and babies. This study was designed to utilise the London Measure of Unplanned Pregnancy (LMUP) to assess pregnancy intendedness in a high-risk obstetric population of women who were accessing care at a large regional hospital. Methods: This was a cross-sectional descriptive study. Women attending the High-Risk clinics or admitted with medical problems were recruited at George Regional Hospital. Once they consented to the study, the LMUP was administered by a single research team member. The LMUP is a psychometrically validated measure of pregnancy intention for a current or recent pregnancy. Questions enquire about the intention and timing of pregnancy, preconception behaviour, contraception usage, and partner's input and a score is obtained which indicates intendedness. It has been validated in our department in the 3 local languages. Results: A total of 200 women were recruited for the study. No potential participant declined to be interviewed. The mean age was 30.4+/- 6.3 years and the majority of participants were of mixed ancestry (n=135). HIV status was positive for 23 participants and unknown for 29. All participants completed the Perinatal Mental Health Score and 4 required referrals for supportive assistance. The LMUP indicated that 76 women had unintended pregnancies, 58 were ambivalent about their pregnancies and 66 had an intended pregnancy. Pre-pregnancy discussion and preparation were lacking for most of the participants despite pre-existing risk factors. Pregnancy intendedness was affected by several factors. Age (P = 0.02), relationship status (P = 0.001) and financial support (P = 0.005) were associated with intendedness. Employment, parity, language group, educational level, booking gestation, HIV status, and multiple comorbidities did not affect pregnancy intendedness. Other factors that had no influence were Perinatal Mental Health Score, preconceptual counselling/health improvement, and habits. Poor partner communication was common. Women at extremes of reproductive life had more unplanned pregnancies (P = 0.02). i There was good unprompted contraceptive knowledge but poor information about emergency contraception. Conclusion: In this high-risk group of obstetric patients, there was little preconception discussion or preparation and inadequate use of contraception among women who did not plan a pregnancy.
- ItemOpen AccessMulti-objective evolutionary algorithms for product design(2024) Aslan, Bilal Hasan; Nitschke, GeoffIdentifying chemical compounds with optimal properties for specific applications presents a fundamental challenge in materials science. Traditional methods, based on trialand-error, are inefficient and costly. This thesis introduces an innovative integration of Computational Chemistry and Machine Learning (ML) with Evolutionary MultiObjective Optimisation (EMOO) techniques to streamline compound design. This approach automates the design process by leveraging ML to accurately predict compound properties and using EMOO to select compounds that meet various criteria. The significance of this work lies in its potential to transform the traditional development process, facilitating the creation of chemical products that fulfill multiple objectives more efficiently. This study not only demonstrates the synergy between advanced ML and optimisation techniques but also presents a comprehensive comparison of the MultiObjective Covariance Matrix Adaptation Evolution Strategy (MO-CMA-ES) and Nondominated Sorting Genetic Algorithm II (NSGA-II), including two novel meta-heuristics for enhanced molecular exploration. Our findings reveal that MO-CMA-ES, especially when combined with an extended search meta-heuristic, excels in exploring molecular spaces, establishing it as a preferred method for compound synthesis. This research promises to accelerate compound development specifically for detergent compounds, offering significant implications for product design across various industries.
- ItemOpen AccessEffects of preterm birth on HIV acquisition risk and antiretroviral prophylaxis safety in HIV-exposed Infants in Botswana(2024) Ajibola, Gbolahan; Myer, Landon; Powis, KathleenBackground: The risk of in-utero and peripartum HIV acquisition in HIV-exposed infants born prior to 37 weeks completed gestational age (preterm), is thought to be high when compared with those delivered at term. However, limited data exist on the differential risk of HIV acquisition among infants born preterm following foetal exposure to HIV versus those born at term. With a reported increase in the prevalence of preterm delivery among infants with in-utero HIV and antiretroviral (ARV) drug exposure, it is pertinent to understand the risks associated with mother-to-child-transmission (MTCT) of HIV in infants born preterm versus those born on or after 37 weeks gestational age, as a means of identifying opportunities to eliminate MTCT (eMTCT). Furthermore, Botswana's current Prevention of Mother-to-Child Transmission of HIV (PMTCT) guidelines recommend a variety of ARV prophylaxis strategies in the first 4 – 6 weeks of life for HIV-exposed infants depending on their risk for HIV acquisition, which ranges from triple antiretroviral (ARV) prophylaxis for infants deemed to be at “high risk” for HIV-acquisition to twice-daily dosing of zidovudine for the first 4-6 weeks of life for infants deemed to have a low HIV acquisition risk. At the time of the MPEPU study (2010 – 2015), Botswana offered 4 weeks of zidovudine (ZDV) alone as post-exposure prophylaxis to all exposed infants, however, participants enrolled in the study were given the option to receive once daily Nevirapine (NVP) as prophylaxis if randomized to a breastfeeding arm for the entire duration of breastfeeding in the absence of maternal 3-drug ART. Equally important to understanding the risk of HIV acquisition among infants born preterm is an understanding of the hematologic safety of ARV prophylaxis strategies. Methods: Using data extracted from a Botswana-based placebo-controlled trial evaluating the effect of co-trimoxazole (CTX) on mortality in infants who were HIV-exposed in-utero (the Mpepu Study), we describe the prevalence, timing, and risk factors for HIV acquisition in infants born preterm versus those born at term and assessed the hematologic safety of ARV prophylaxis among HIV-exposed preterm infants in the first month of life. Fisher's exact tests were used to compare the prevalence and timing of infants seroconverting at birth or within 72 hours post-delivery (for in-utero estimates) and those testing positive at 14-34 days after an initial negative result at birth (for peripartum estimates), with prevalence ratios (PR) calculated to ascertain the magnitude and direction of observed associations. The same approach was used to compare the occurrence of severe anaemia and neutropenia between full-term and preterm infants based on ARV prophylaxis received. A multivariable logistic regression model was fit to identify risk factors for HIV acquisition and severe hematologic effects of ARV prophylaxis in the first month of life. Results: Two thousand eight hundred and sixty-six Mpepu infants, all with in-utero HIV exposure, were included in this secondary analysis. Of these, 532 (19%) were born preterm and 2334 (81%) were born at term. There was no significant difference in HIV acquisition rate between preterm and term infants overall (0.8% versus 0.6%, p=0.54, PR=1.33), at birth (0.2% versus 0.3%, p=1.00, PR=0.67) or at 14-34 days post-delivery (0.6% versus 0.3%, p=0.41, PR=2). The only significant predictor of HIV acquisition in both preterm and term infants was associated with the mother's ARV drug regimen as either treatment or prophylaxis. Triple-drug antiretroviral treatment (ART) use in women living with HIV (WLHIV) during the index pregnancy was associated with an observed decrease in odds of HIV acquisition in both preterm and term infants compared to infants born to women who received ZDV only or no ARV prophylaxis at all in the index pregnancy [adjusted Odds Ratio (aOR): 0.003; 95% Confidence Interval (CI): 0.001 – 0.02, p<0.001]. Of a total of 2746 children with haemoglobin results, 23 (0.8%), [10 preterms versus 13 born full term] infants had severe anaemia in the first month of life, while 43 (1.5%) [29 preterms versus 14 full terms] of 2733 children had severe neutropenia. Of 1524 neonates who received twice daily ZDV as prophylaxis, 17 (1.1%) [7 preterms versus 10 full term] had severe anaemia compared to 6 (0.5%) [3 preterms versus 3 full terms] of 1222 neonates who received oncedaily dosing of NVP. Twenty-eight 91.8%) [8 preterms versus 20 full term] of 1518 neonates who received twice daily ZDV as prophylaxis and 15 (1.2%) [4 preterms versus 11 full terms] of 1215 neonates who received once-daily dosing of NVP had severe neutropenia. A significantly higher proportion of preterm infants had severe anaemia when compared with those delivered at term (1.9% versus 0.6%, p=0.005, PR=3.16). A similar trend was observed with neutropenia, with a higher proportion of preterm infants with severe neutropenia when compared to term infants (2.5% versus 1.3%, p= 0.070, PR=1.92). Infants with severe anaemia were more likely to have been born preterm (aOR: 2.41; 95% C.I: 0.96 – 6.03; p=0.05) while those with severe neutropenia were more likely to have formula-fed at birth (aOR: 0.37; 95% C.I: 0.19 – 0.73; p=0.004) and younger (14-27 days) at the time of testing (aOR: 0.09; 95% C.I: 0.03 – 0.33; p=<0.001). Infant ARV prophylaxis (twice daily ZDV versus once daily NVP) and randomized treatment arm (CTX versus placebo) did not significantly contribute to the occurrence of severe anaemia and neutropenia. Conclusions: In settings with low MTCT rates attributable to widespread use of maternal ART in pregnancy, as in Botswana, infants born preterm experienced similar rates of HIV acquisition compared to those delivered at term. Reassuringly, ART use by women in pregnancy significantly reduces the risk of infant HIV acquisition. Infant post-exposure ARV prophylaxis (twice daily ZDV versus once daily NVP) appeared safe in both preterm and term infants and did not contribute to the slight increase in cases of severe hematologic adverse events observed in preterm. However, in an era where triple ARV prophylaxis is now recommended for infants at high risk of HIV acquisition, understanding the hematologic safety of this approach among preterm infants is of paramount importance.
- ItemOpen AccessExploring the lived experiences of primary caregivers of children with visual impairment from a low- and middle-income context in the Western Cape Province(2024) Abrahams, Zuleikha; Mckenzie, Judith; Freeman, NicolaFew studies explore the experiences of Primary Care Givers and families with a child with visual impairment from low-and-middle-income, and least so, from South Africa (SA). It is important to understand this phenomenon so that interventions can be tailored to suit their needs and shortcomings. Services and support for such families are difficult to access or in some cases non-existent. The main responsibility often rests on these families, and the effect of this in low and middle income contexts is complex and poorly understood. In South Africa, and more specific in the Western Cape Province, support for parents and services for children with visual impairment are limited. The aim of the study was to explore the lived experiences of primary caregivers, from Western Cape Province, after their child was diagnosed with visual impairment at a paediatric tertiary hospital. The purpose of this study was to find out the responses of the family in respect of psychosocial challenges, their needs, what support they received and accessed, as well as the efficiency and effective availability of these services. The phenomenon that involves features of the person as a psychosocial being, requires an understanding and exploration of lived experiences to facilitate the complexity of the disability conundrum. Hence, a qualitative research approach using an interpretive phenomenological design was adopted. Purposive sampling was used to select six participants from the WCP whose child was diagnosed at a paediatric tertiary hospital. Data was collected through semi-structured interviews. Interviews were digitally recorded and later transcribed verbatim. Interpretive phenomenological analysis of data involved an inductive and deductive approach, coding for themes and categories emerging from the data. The literature review explored what was found about primary caregivers, parents and families and their experiences at the diagnosis of their child with visual impairment. It showed what needs, services and supports other studies identified on parents with a child with visual impairment or disability in various income contexts globally. Information about services and support in the health and educational sectors, and at the local and national governmental institutions in South Africa was provided. The findings of the study illustrated four themes. Firstly, the experiences of primary caregivers of a child with visual impairment after diagnosis. Secondly, Expressed concerns and needs. Thirdly, Services and support accessed. Fourth, Changes and concerns for the future. The ecological framework illustrated the microsystem, mesosystem, exosystem and macrosystem where services and support were needed. These various social environments also illustrated formal and informal social services and support that eased caregiving, participation and inclusion for PCGs of children with visual impairment. The Discussion chapter interpreted the findings in terms of current literature and developed a composite of the findings to further suggestions from primary caregivers that led to the recommendations of this study. The study concluded with recommendations that Strong psychosocial support services for a primary caregiver and family whose child is diagnosed with visual impairment are needed. Referrals for ample formal and informal support services from these systems and sectors in social, economic and political environment must be an immediate response when health professionals relate the news of the visual impairment so that information, counselling and emotional support assist the primary caregiver and family through the initial trauma. Furthermore, there should be measures to monitor the well-being of these primary caregivers and their families to ensure that healthy family systems are maintained.