OpenUCT is the open access institutional repository of the University of Cape Town (UCT). It preserves and makes UCT scholarly outputs digitally and freely available, including theses and dissertations, journal articles, book chapters, technical and research reports, as well as open educational resources.
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Knowledge and perceptions of doctors in a tertiary level hospital in KwaZulu-Natal towards palliative care
(2026) Vahed, Junaid Mohamed; Krause, Rene; Walker, Louise
Background: South Africa (RSA) was a signatory to the 2014 World Health Assembly resolution that highlighted the importance of ongoing palliative care (PC) education amongst disciplines that manage patients with life-limiting illnesses. Thereafter, policies, such as the National Policy Framework and Strategy on Palliative Care, were established that advocated for the integration of PC. PC education has also been incorporated into undergraduate curricula and the training of oncology registrars. However, except for integration of PC at a few centres in RSA, a large deficit of hospital-based PC still exists. Limited previous work has been done that investigates the knowledge and perceptions that doctors at tertiary centres in RSA possess towards PC. Objective: To assess the knowledge that doctors at a tertiary level hospital have regarding PC, and to determine the perceptions of these doctors towards PC. Methods: A prospective, observational, mixed-methods study consisting of a quantitative knowledge survey (n=65, response rate 66.32%) and qualitative semi-structured interviews (n=12) was undertaken. The survey data was analysed using statistical methods with the assistance of a biostatistician whilst, for the semi-structured interviews, thematic analysis was used. Results: Participants displayed an awareness of the concept of PC and its importance. There was good awareness of the role of the inclusion of patient and family preferences in decision-making. However, several knowledge deficits regarding the timing and scope of PC still prevailed. PC was largely seen as synonymous with end-of-life care, and the roles of PC beyond the physical domain were poorly understood. Some aspects regarding futile care were poorly understood. Additionally, misconceptions regarding the use of morphine were present. The majority of the knowledge deficits and incorrect perceptions prevailed regardless of level of experience or cadre. Participants admitted to knowledge gaps and to the lack of implementation of policy that underpins the need for PC. Creation of a PC service would be well received and suggestions were given on ways to integrate PC within the hospital. Conclusion: 6 In KwaZulu-Natal, more education is required to improve knowledge surrounding matters related to PC and a formal PC service is much needed.
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Open Access
Extended cost effectiveness analysis of interventions for early detection, screening and breast cancer control: case studies of South Africa and Uganda
(2026) Abewe, Christabell; Sinanovic, Edina; Moodley, Jennifer
The global statistics for the year 2022 indicate that female breast cancer is the second leading cause of global cancer incidence with an estimated 2.3 million cases and among women, it is the most frequently diagnosed cancer and the leading cause of cancer death among women in 157 countries [1]. In the African region, breast cancer incidence and mortality are on an upward trajectory and predicted to double in Sub-Saharan African by 2050. Given the growing burden of breast cancer in low- and middle-income countries (LMICs), these countries now face the challenge of effectively detecting and treating a disease that was previously considered too uncommon to merit the allocation of finite health care resources. As such, in LMICs there is a need to scale up early detection and screening strategies that can improve on the too common pattern of disease presentation at a stage when prognosis is very poor. We constructed a dynamic state transition model to estimate the cost effectiveness of three breast cancer down-staging interventions in Uganda and South Africa. Our model is premised on a comprehensive mathematical framework that estimates the stage shifts in early versus late stages of breast cancer diagnosis based on proportional performance rates of three early detection and screening interventions (awareness raising, clinical breast examination (CBE) and mammography) spanning 40 years. This study then used the extended cost effectiveness analysis framework to assess the possible distributional impact of utilizing universal public financing as a tool to increase access and coverage of breast cancer early detection interventions in these two countries. This dissertation found that biennial CBE and awareness raising interventions are not only crucial for down-staging breast cancer diagnosis, but they are also economically attractive and viable for options for both Uganda and South Africa. Biennial CBE coupled with treatment interventions for all stages was cost-effective for South Africa with an ICER of $2,708 per healthy life year gained. Awareness raising interventions were also found to be cost effective with an ICER of 3,201 per health life year gained. Mammography screening combined with treatment for all stages was not found to be a cost-effective intervention for South Africa with an ICER of $9,491 per healthy life year gained. For Uganda, we found awareness raising interventions to be the most cost-effective interventions for breast cancer control with a dominant ICER of $-118 per healthy life year gained. Biennial CBE for women aged 40-74 combined with treatment for all stages was also cost effective with an ICER of $416 per healthy life year gained. Biennial MMG screening combined with treatment for all stages was not cost effective with an ICER of $3,110 per healthy life year gained. Further, this thesis demonstrated that publicly financing early detection and screening interventions in LMICs for breast cancer can alleviate a considerable proportion of breast cancer burden and catastrophic health expenditures benefiting the poorest wealth quintiles. In South Africa 44% of the deaths averted are in the wealthiest two quintiles while the poorest two quintiles would account for 34% of the total deaths averted. Regarding financial protection, our analysis shows that publicly financing breast cancer control interventions could avert approximately US $7.89 million over the 40years, this translates to US $197,254 annually. The distribution of catastrophic health expenditures averted is pro-poor, with the poorest wealth quintile accounting for 76% of the averted catastrophic 2 health expenditure cases, on the other hand, the wealthiest two quintiles account for approximately 1.4% of the catastrophic health expenditure cases averted. In Uganda, our analysis shows that 55% of the deaths averted are concentrated in the wealthiest two quintiles while the poorest two quintiles would account for 26% of the total deaths averted. Regarding financial protection, our analysis shows that publicly financing breast cancer control interventions could avert approximately US $29.2 million over the 40-years, this translates to US$729,098 annually. The distribution of catastrophic health expenditures averted is pro-poor, with the lowest three wealth quintiles accounting for 63% of the catastrophic cases averted while the richest two quintiles account for 37% of the cases of catastrophic expenditures averted. The findings from this thesis are notable for breast cancer policy in LMICs as the analysis demonstrated significant down-staging associated with early detection and screening interventions for breast cancer. Implementation of these interventions will require substantial additional financial investments, but our analysis shows that the health benefits will broadly outweigh these requirements for CBE and awareness raising interventions.
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Open Access
Criminalising technology-facilitated child sexual exploitation and abuse: to what extent does Namibia comply with international law?
(2026) Angula, Markus Penda Mulandula; Ally, Nurina; Lutchman, Salona
With the growth and accessibility of fast-paced internet connections and mobile devices, children are increasingly living their lives online. In Namibia, 81 per cent of children aged twelve to seventeen are internet users. While technology has been a game changer for children, it has also facilitated Online Child Sexual Exploitation and Abuse (OCSEA) through digital platforms such as chat rooms, online gaming, online forums and social media.
Despite Namibia's obligations under international conventions such as the Convention on the Rights of the Child (CRC), its Optional Protocol on the Sale of Children, Child Prostitution and Child Pornography (OPSC) and the African Charter on the Rights and Welfare of the Child (ACRWC), progress in fully domesticating and criminalising all forms of OCSEA remains slow. This research explores the extent to which Namibia's national laws on OCSEA comply with international obligations. It examines binding international conventions to establish the OCSEA conduct required for criminalisation under international law and tests national laws on OCSEA against international law requirements.
This research shows that the Child Care and Protection Act of 2015 does not comprehensively address all forms of OCSEA despite it being the primary legislation domesticating the CRC, OPSC and ACRWC. Other national laws reviewed either lack the specificity of OCSEA or are not aligned with international law requirements. Key gaps in the legal framework include the failure to criminalise all forms of OCSEA, the absence of clear definitions of the different forms of OCSEA, and inadequate criminal penalties for violations that are proportionate to the gravity and magnitude of OCSEA.
This research identifies the draft Cybercrime Bill and draft Sexual Exploitation Bill as opportunities to address these gaps. It recommends strengthening and consolidating the OCSEA-related provisions in both Bills into a single law with stronger and consistent legal provisions aligned with international law. It argues that the consolidated provisions should be placed in the Cybercrime Bill, which has better prospects of being enacted, as it is referenced in national plans. It recommends accelerating the enactment of the revised Cybercrime Bill.
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Open Access
(En)Gendering the mineral supply chain: women's work and livelihoods in 3T extractivism in Africa's Great Lakes region
(2026) Furniss, Allison; Ross, Fiona
This dissertation examines the everyday working context of women along the 3T mineral supply chain in Africa's Great Lakes region. 3T's (tin, tungsten and tantalum) are collectively known as “digital minerals” and classified as critical minerals, central to the production of digital technologies. Using a broad definition of extractivism, this research focuses on women who work in artisanal and small-scale mines (ASM), as well as women in downstream production roles along the supply chain. This includes female mineral traders, transporters, mine owners and women working along the export route. As a multi-sited ethnography, this study uses participant observation, interview and focus group methodologies. The androcentrism of extractivism creates a working context with significant gendered divisions of labour, gendered vulnerabilities and barriers to work. Due to these factors, women experience various extractive violences in gendered ways. These include subtle violences that are material and embodied, premised on disposability. Nevertheless, within the overall working context for women, I argue that women's everyday actions, how they narrate their everyday working context and their “ways of operating” all show that women seek to reframe and insert themselves into dominant narratives, reject victimisation and reappropriate space and place in extractivism. These combined factors contribute to a slow acceptance of their participation. Lastly, I show that as one follows the chain of production, women's participation in extractivism decreases as economic opportunities increase, in an inverse relationship. By focusing on women who put the 3T mineral supply chain in motion and whose labour contributes to the manufacturing of digital technologies, this dissertation (en)genders a global supply chain. This research is based on 13 months of ethnographic fieldwork conducted in 2022-2023 in eastern Democratic Republic of the Congo, Rwanda and Tanzania.
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Open Access
Transgender men and mental healthcare services in South Africa
(2026) Daya, Jude Anjuli; Boonzaier, Floretta
The mental healthcare needs of transgender men in South Africa are not being met. Transgender people face disproportionately high rates of mental illness, yet struggle to find mental healthcare that is sensitive to their needs. Transgender men remain an unseen, underserved subset of this already marginalised group. This research aimed to provide a platform for trans men to share their narratives about accessing mental healthcare. The researcher, a trans man, brings an insider perspective to trans mental health. Individual semistructured interviews were conducted with 17 adult transgender men and transmasculine individuals who had used mental healthcare services in South Africa. The interview transcripts were analysed using thematic narrative analysis, informed by queer theory and gender minority stress theory. Participants described ongoing challenges, which included everyday and medical discrimination, feelings of invisibility, imposed expectations of transness and masculinity, and the distress of gender dysphoria. This study highlights the significant maltreatment and transphobia that trans men experience from most mental healthcare services. Participant narratives indicate that most healthcare providers were misinformed about transness and treated patients as educators. This research provides insights into the challenges trans men navigate with mental healthcare, and offers recommendations for appropriate, sensitive care for this population.