Innovation
Research
SDG1
SDG2
SDG3
SDG4
SDG5
SDG6
SDG7
SDG8
SDG9
SDG10
SDG11
SDG12
SDG13
SDG14
SDG15
SDG16
SDG17
The ability of genetically modified (GM) crops to increase yields and reduce use of pesticidesis well established. Based on food security needs and the central role of agriculture, Africa may stand to benefit from green biotechnology given the low agricultural productivity and the looming food crises in most urban areas. However, the adoption of GM crops in Africa has been slow and limited to a handful of countries. The primary objective of this paper is to evaluate the impact of GM maize adoption in South Africa by looking at wholesale spot prices. We apply a threshold autoregressive model to time series data on the price of maize and GM adoption rates in South Africa to address the following questions: (1) Does the adoption of GM maize excite the growth rate of price of maize in South Africa; (2) Does the error variance of the maize price growth rate exhibit regime-switching behaviour to impact the volatility? The results show evidence that the adoption of GM maize influences the dynamics of the maize price growth rate in South Africa. Further, there is strong evidence that the error variance exhibits regime-switching behaviour with the posterior mean for the error variance in the first regime about twice as large as that of the second regime.
SDG2—Research
Agenda 2063: A1
Keywords: agricultural productivity, food security, genetically modified crops, maize, sustainable agriculture
Background: Reviews of perinatal deaths are mostly facility based. Given the number of women who, globally, deliver outside of facilities, this data may be biased against total population data. We aimed to analyse population based perinatal mortality data from a LMIC setting (Mpumalanga, South Africa) to determine the causes of perinatal death and the rate of maternal complications in the setting of a perinatal death. Methods: A secondary analysis of the South African Perinatal Problems Identification Program (PPIP) database for the Province of Mpumalanga was undertaken for the period October 2013 to January 2014, inclusive. Data on each individual late perinatal death was reviewed. We examined the frequencies of maternal and fetal or neonatal characteristics in late fetal deaths and analysed the relationships between maternal condition and fetal and/or neonatal outcomes. IBM SPSS Statistics 22.0 was used for data analysis. Results: There were 23503 births and 687 late perinatal deaths (stillbirths of ? 1000gr or ? 28 weeks gestation and early neonatal deaths up to day 7 of neonatal life) in the study period. The rate of maternal complication in macerated stillbirths, fresh stillbirths and early neonatal deaths was 50.4%, 50.7% and 25.8% respectively. Mothers in the other late perinatal deaths were healthy. Maternal hypertension and obstetric haemorrhage were more likely in stillbirths (p = < 0.01). The main causes of neonatal death were related to immaturity (48.7%) and hypoxia (40.6%). 173 (25.2%) of all late perinatal deaths had a birth weight less than the 10th centile for gestational age. Conclusion: A significant proportion of women have no recognisable obstetric or medical condition at the time of a late perinatal death; we may be limited in our ability to predict poor perinatal outcome if emphasis is put on detecting maternal complications prior to a perinatal death. Intrapartum care and hypertensive disease remain high priority areas for addressing perinatal mortality. Consideration needs to be given to novel ways of detecting growth restriction in a LMIC setting.
SDG3—Research
Agenda 2063: A1
Keywords: maternal mortality, Mpumalanga, South Africa
Background. This cross-sectional study examined respiratory health outcomes and associated risk factors in children living in a part of South Africa characterised by high levels of air pollution. Methods. A questionnaire was used to collect self-reported respiratory health and risk factor data from the parents/guardians of children between the ages of 9 and 11 years attending primary schools in the study area. Six government schools were selected based on their location, class size and willingness to participate. Univariate and bivariate analyses as well as logistic regression analysis were performed on the data, using a p-value of 0.25 and biological plausibility. Results. The overall prevalence of respiratory ill-health symptoms was 34.1%. The prevalence of respiratory ill-health conditions was significantly elevated among children from households using non-electrical fuels v. electricity for cooking (43.9% v. 31.6%; adjusted p-value 0.005). The same was noted among those using non-electrical fuels for heating (37.8% v. 29.0%). Conclusion. The elevated prevalence of some respiratory health outcomes among schoolchildren, especially in conjunction with domestic fossil fuel burning, is of concern. The data collected in this study may be used to complement or form a basis for future policy regarding indoor or ambient air quality in the area.
SDG11, SDG12, SDG3—Research
Agenda 2063:
Keywords: air contamination, air pollution, air quality, eMalahleni, Mpumalanga

Co-benefits of addressing climate change can motivate action around the world

Authors: Paul G Bain, Taciano L. Milfont, Yoshihisa Kashima, Micha? Bilewicz, Guy Doron, Ragna B. Gararsdo?ttir, Valdiney V. Gouveia, Yanjun Guan, Lars-Olof Johansson, Carlota Pasquali, Victor Corral-Verdugo, Juan Ignacio Aragones, Akira Utsugi, Christophe Demarque, Siegmar Otto, Joonha Park, Martin Soland, Linda Steg, Roberto Gonza?lez, Nadezhda Lebedeva, Ole Jacob Madsen, Claire Wagner, Charity S. Akotia, Tim Kurz, Jose Luis Saiz, P. Wesley Schultz, Gro? Einarsdo?ttir, Nina M. Saviolidis
Personal and political action on climate change is traditionally thought to be motivated by people accepting its reality and importance. However, convincing the public that climate change is real faces powerful ideological obstacles1-4, and climate change is slipping in public importance in many countries5,6. Here we investigate a different approach, identifying whether potential co-benefits of addressing climate change7 could motivate pro-environmental behavior around the world for both those convinced and unconvinced that climate change is real. We describe an integrated framework for assessing beliefs about co-benefits8 , distinguishing social conditions (e.g., pollution, disease, economic development), and community character (e.g., benevolence, competence). Data from all inhabited continents (24 countries; 6196 participants) showed that two co-benefit types, Development (economic and scientific advancement) and Benevolence (a more moral and caring community), motivated public, private, and financial actions to address climate change to a similar degree as believing climate change is important. Critically, relationships were similar for both convinced and unconvinced participants, showing that co-benefits can motivate action across ideological divides. These relationships were also independent of perceived climate change importance, and could not be explained by political ideology, age, or gender. Communicating co-benefits could motivate action on climate change where traditional approaches have stalled.
SDG13, SDG4—Research
Agenda 2063: A1
Keywords: sustainability education, sustainable development education

Medical education and the quality improvement spiral: A case study from Mpumalanga, South Africa

Authors: Martin Bac, Anne-Marie Bergh, Mama E. Etsane & Jannie Hugo
Background:The short timeframe of medical students rotations is not always conducive to successful, in-depth quality-improvement projects requiring a more longitudinal approach.Aim:To describe the process of inducting students into a longitudinal quality-improvement project,using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies. Setting:Mpumalanga clinical learning centres, where University of Pretoria medical students did their district health rotations. Method:Consecutive student groups had to engage with a hospitals compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n= 42), a written group report (n= 42) and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n= 139). Results:Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator, health advocate, scholar, communicator, manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students, who also acted as catalysts for transforming practice. Conclusion:Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert.More studies could provide insight into the potential of this approach in transforming institutions and student learning.
SDG3—Research
Agenda 2063:
Keywords: health education, health training, medical training, Mpumalanga, South Africa
Professional accountants need to retain and maintain a broad skills set. In response to this need, the South African Institute of Chartered Accountants (SAICA) emphasises the mastering of pervasive skills in its competency framework and expects South African universities offering its accredited programmes to produce graduates able to demonstrate such skills at acceptable levels of competence upon entry into the workplace. This study investigates the manner in which SAICA-accredited South African universities offer and teach pervasive skills, and attempts to determine whether heads of departments have identified the teaching of these skills as being the responsibility of the university, or not. These views were solicited through an e-mailed questionnaire. The study found that although the development of pervasive skills is an outcome largely included in these accredited undergraduate programmes, their presentation and integration into the courses vary considerably, and more integration of pervasive skills into course majors should be considered. Teaching methods and practices followed by the universities show significant diversity, and this result corresponds with those reported elsewhere in the literature. It is a concern that there is only limited use of research-based projects in these undergraduate programmes. An interesting finding of the study was that heads of departments perceive the acquisition of some pervasive skills to be best achieved in the real-world, practical workplace, rather than in the theoretical confines of the universities' lectures and tutorials.
SDG4—Research
Agenda 2063: A6
Keywords: relevant skills, skills development, South Africa
Science and conservation are often driven by different agendas, partly because many researchers are reluctant to tackle applied topics perceived to be less competitive for publishing or too impractical to study. Consequently, research often fails to contribute meaningfully to conservation outcomes. We use leopards Panthera pardus in South Africa to illustrate this mismatch between research and conservation priorities. A review of the scientific literature showed that leopard studies in South Africa focused disproportionately on basic research, particularly on leopard feeding ecology inside protected areas. Academics were responsible for most articles but avoided applied studies, even though they were published in higher impact journals and took less time to undertake. An assessment of active leopard projects further demonstrated that studies were clumped in areas of low conservation concern and most failed to publish their findings. Many projects were also funded by commercial volunteer programs with financial incentives for conducting research. We recommend that leopard researchers in South Africa and carnivore researchers more widely engage with practitioners to ensure the most pressing issues are addressed. Scientists must also situate their research in a broader conservation context and evaluate the outcomes of management decisions. Finally, continued funding and permissions for research should at a minimum be contingent on research outputs being published in the peer-reviewed literature.
SDG15—Research
Agenda 2063: A1
Keywords: conservation, extinction, South Africa, threatened species

Time-varying linkages between tourism receipts and economic growth in South Africa

Authors: Mehmet Balcilar, Rene van Eyden, Roula Inglesi-Lotz & Rangan Gupta
The causal link between tourism receipts and GDP has recently become a major focus in the tourism economics literature. Results obtained in recent studies about the causal link appear to be sensitive with respect to the countries analysed, sample period and methodology employed. Considering the sensitivity of the causal link, we use the rolling window and time-varying coefficient estimation methods to analyse the parameter stability and Granger causality based on a vector error correction model (VECM). When applied to South Africa for the 1960-2011 periods, the findings are as follows: results from the full sample VECM indicate that there is no Granger-causality between the tourism receipts and GDP, while the findings from the time-varying coefficients model based on the state-space representation and rolling window estimation technique show that GDP has no predictive power for tourism receipts; however, tourism receipts have positive-predictive content for GDP for the entire period, with the exception of the period between 1985 and 1990.
SDG12, SDG8—Research
Agenda 2063: A1
Keywords: economic growth, South Africa, sustainable tourism
In recent years, governments in Africa have been under increasing pressure to demonstrate their relevance as citizens demand delivery of better public services. To respond to the numerous calls for efficiency improvements in service delivery governments design and implement a number of public policies that address service delivery problems. The question of how gender dynamics is used to shape public policy management is, though, less understood and has not been subject to enough scholarly attention among policy analysts. The challenges faced by different gender categories differ and ought to be considered in public policy formulation, implementation and review. While a significant amount of scholarly work has been directed at the broad subject of gender in Africa, there remains a dearth of research on gender dynamics specifically relating to public policy management. Also, studies that take a comparative angle on the subject are not a common feature on the continent. In this article, the authors interrogate through a comparative approach the gender dynamics in the public policy management of the water sector policies in South Africa and Uganda. It addresses certain policy and management implications, aiming at bringing to the fore issues of gender as specifically applied to the subject of public policy.
SDG16, SDG5—Research
Agenda 2063: A6
Keywords: gender equality, South Africa, women in leadership
SDG5—Research
Agenda 2063: A6
Keywords: gender equality, non-discrimination, South Africa
Reliability and accessibility of public transportation are major concerns. ICT based demand responsive schemes can be the ultimate solution to these problems. Even though Demand Responsive Transportation solutions have always been conventional for cabs to meet individual travellers needs, they have not been used for buses and mini-bus taxis in the Free State. Therefore, they can be considered to provide reliable and flexible transportation to meet the publics momentary transportation needs at affordable rates using taxis and buses. Current accessibility problems like long walking distance to bus stops and long waiting times can be solved using demand responsive schemes and cheaper demand based minibus taxi or bus services would reduce the use of expensive cabs. This would reduce public transportation reliability, accessibility, affordability and efficiency problems, but might not have the same impact on operators and public transportation users. The benefits they might have on public transportation users could lead to immediate or long-term consequences for the operators. This paper aims at evaluating the possible impacts of using ICT based technologies and applications for demand responsive public transportation in the Free State province and how they may impact public transportation operators and users in terms of dead mileage, travel times, intensity of demand in different areas and acceptance of these schemes by the public and operators.
SDG11—Research
Agenda 2063:
Keywords: access to transport, affordable transport, public transport, safe transport, South Africa

Implementing facility-based kangaroo mother care services: Lessons from a multi-country study in Africa

Authors: Anne-Marie Bergh, Kate Kerber, Stella Abwao, Joseph de-Graft Johnson, Patrick Aliganyira, Karen Davy, Nathalie Gamache, Modibo Kante, Reuben Ligowe, Richard Luhanga, Be?ata Mukarugwiro, Fide?le Ngabo, Barbara Rawlins, Felix Sayinzoga, Naamala Hanifah Sengendo, Mariam Sylla, Rachel Taylor, Elise van Rooyen & Jeremie Zoungrana
BACKGROUND: Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda. METHODS: A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress. RESULTS: Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care. CONCLUSION: The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems.
SDG3—Research
Agenda 2063:
Keywords: child mortality, infant mortality, neonatal mortality, under-five mortality
Although national Human Rights Commissions (NHRCs) are institutional mechanisms suitable for advancing the domestic implementation of socioeconomic rights, traditional approaches to the advancement of these rights have more readily focused on the role of courts. This process has witnessed the prioritisation of the justiciability of these rights above other non- and quasi-judicial means for their realisation. As a result, contemporary scholarship has barely noticed the role and practical efforts of NHRCs in this regard. To fill this gap, this article evaluates the mandate, activities, and effectiveness of NHRCs in three selected Commonwealth African countries Nigeria, South Africa and Uganda and identifies four factors which either impair or enhance their effective performance of this role: the explicit provision of socio-economic rights as justiciable guarantees in the constitutional framework of states; the granting of an explicit legal or constitutional mandate on socio-economic rights to NHRCs; the provision of adequate institutional, functional, and financial independence for NHRCs; and a high level of institutional support from other institutions that ensure states accountability for human rights.
SDG16—Research
Agenda 2063: A3
Keywords: protection of fundamental rights, protection of human rights, South Africa

Potential of polycyclic aromatic hydrocarbon-degrading bacterial isolates to contribute to soil fertility

Authors: Maryam Bello-Akinosho, Rosina Makofane, Rasheed Adeleke, Mapitsi Thantsha, Michael Pillay & George Johannes Chirima
Restoration of polycyclic aromatic hydrocarbon- (PAH-) polluted sites is presently amajor challenge in agroforestry. Consequently, microorganisms with PAH-degradation ability and soil fertility improvement attributes are sought after in order to achieve sustainable remediation of polluted sites. This study isolated PAH-degrading bacteria from enriched cultures of spent automobile engine-oil polluted soil. Isolates partial 16S rRNA genes were sequenced and taxonomically classified. Isolates were further screened for their soil fertility attributes such as phosphate solubilization, atmospheric nitrogen fixation, and indoleacetic acid (IAA) production. A total of 44 isolates were obtained and belong to the genera Acinetobacter, Arthrobacter, Bacillus, Flavobacterium, Microbacterium, Ochrobactrum, Pseudomonas, Pseudoxanthomonas, Rhodococcus, and Stenotrophomonas. Data analysed by principal component analysis showed the Bacillus and Ochrobactrum isolates displayed outstanding IAA production. Generalized linear modelling statistical approaches were applied to evaluate the contribution of the four most represented genera (Pseudomonas, Acinetobacter, Arthrobacter, and Rhodococcus) to soil fertility. The Pseudomonas isolates were the most promising in all three soil fertility enhancement traits evaluated and all isolates showed potential for one or more of the attributes evaluated. These findings demonstrate a clear potential of the isolates to participate in restorative bioremediation of polluted soil, which will enhance sustainable agricultural production and environmental protection.
SDG15—Research
Agenda 2063:
Keywords: degraded soil, land degradation, soil restoration

What is needed for taking emergency obstetric and neonatal programmes to scale?

Authors: Anne-Marie Bergh, Emma Allanson & Robert C Pattinson
Scaling up an emergency obstetric and neonatal care (EmONC) programme entails reaching a larger number of people in a potentially broader geographical area. Multiple strategies requiring simultaneous attention should be deployed. This paper provides a framework for understanding the implementation, scale-up and sustainability of such programmes. We reviewed the existing literature and drew on our experience in scaling up the Essential Steps in the Management of Obstetric Emergencies (ESMOE) programme in South Africa. We explore the non-linear change process and conditions to be met for taking an existing EmONC programme to scale. Important concepts cutting across all components of a programme are equity, quality and leadership. Conditions to be met include appropriate awareness across the board and a policy environment that leads to the following: commitment, health systems-strengthening actions, allocation of resources (human, financial and capital/material), dissemination and training, supportive supervision and monitoring and evaluation.
SDG3—Research
Agenda 2063: A1
Keywords: child mortality, maternal mortality, neonatal mortality, South Africa, under-five mortality

South African Futures 2035

Authors: Jakkie Cilliers
Using updated population forecasts, this paper presents alternative growth scenarios for South Africa up to 2035, and their implications for employment, politics and poverty. Bafana Bafana Redux is the expected current trajectory. This scenario takes into account the impact of policy incoherence and the electricity supply crisis on South Africas long-term prospects. With concerted effort and much greater focus, an improved future, dubbed Mandela Magic Lite, is possible but neither scenario has a significant impact on structural unemployment. South Africa will only achieve long-term stability and prosperity with a leadership committed to inclusive political and economic practices.
SDG1, SDG8—Research
Agenda 2063: A1
Keywords: economic growth, job creation, poverty, South Africa, unemployment
Despite the urgent need for local economic development in South Africa, Local Economic Development (LED) as area of professional endeavour/activity has largely failed to live up to this need. In this article, an alternative method for approaching urban planning, by focusing on the bottom-up approach and urban renewal was explored. The urban renewal work of the Mandela Bay Development Agency (MBDA) in the Nelson Mandela Bay Metropolitan Municipality is used as a case study of a successful example of an LED-initiative. By taking into account the needs of the customer (or local community), a respect for difference, a conscious drive to ensure participation of, and benefit for all affected parties, keeping the eye on the ball, a desire to learn and innovate, and a pragmatic actionorientation, the MBDA achieved success in its local economic development initiatives. The value of this article lies in the experience of lessons learned, the overall understanding of urban planning, and the necessity for urban planning to respond to the local economy of a particular city.
SDG1, SDG11—Research
Agenda 2063: A1
Keywords: cities, human settlement planning, poverty, spatial planning, urbanisation
In this article it is recommended that the DSD develops a strategy on alternative service delivery mechanisms to guide activities in the context of collaborative public management. This can be achieved using two alternatives: a policy splitting and a linear policy succession. Policy splitting is recommended to implement the Non-Profit Organisations Act, Act 71 of 1997, distinguishing between Non-Profit Organisations (NPOs) requiring registration status to undertake NPO work, and NGOs collaborating with the DSD to deliver social welfare services. Linear policy succession implies replacing the Policy on Financial Awards to Service Providers with a new policy with the same purpose, but incorporating other elements required for the management of collaborative partnerships between the DSD and NGOs.
SDG1—Research
Agenda 2063: A1, A3
Keywords: poverty, social grant, social protection, South Africa
The majority of migrant workers target those countries in southern Africa that have stronger economies. Irregular migrants are in a particularly vulnerable position, and this article discusses the protection that this category of persons may expect to experience in the southern African region. It traverses the international, continental and regional instruments providing protection to irregular migrants, and considers the constitutional and legislative frameworks in relation to social protection in Botswana and South Africa. The article concludes by recommending that the broader notion of social protection, rather than the narrower concept of social security, should be emphasized. Job creation programmes are essential. It suggests that the advantages of the free movement of people in the region should be explored and encouraged. The article also supports the notion that a regional policy that seeks to balance the flow of migrants in the Southern African Development Community should be adopted.
SDG1, SDG10, SDG8—Research
Agenda 2063: A1, A2
Keywords: job creation, migrant workers, social grant, social protection, South Africa
The eradication of extreme poverty is a key component in the post-2015 Millennium Development Goals process and the African Unions Agenda 2063. This paper uses the International Futures forecasting system to explore this goal and finds that many African states are unlikely to make this target by 2030, even when modelling a package of aggressive poverty reduction interventions. In addition to country-level targets the authors also argue in favour of a goal that would see Africa as a whole reducing extreme poverty to below 15% by 2030, and below 4% by 2045.
SDG1, SDG8—Research
Agenda 2063: A1
Keywords: economic growth, job creation, poverty, unemployment
Since the first fully democratic elections in 1994, poverty alleviation has been a central issue for the South African government (May 2010:4). Poverty in South Africa can be largely attributed to the extreme inequalities of the past. It has been addressed through a number of developmental initiatives; for example, the government has implemented social grants to help to eradicate poverty. This article investigates how the administration of one of these social grants, the Old Age Grant, influences the livelihoods of the intended beneficiaries in the Kgautswane rural community in the Limpopo Province of South Africa. Unless a policy is implemented effectively, efficiently and ethically, it is of little use to those meant to benefit from it. Social welfare is essential for South Africa as a developmental state, but it requires a concerted effort by government to ensure the appropriate administration of this system to benefit particularly the rural poor. When the beneficiaries remain dependent on the system for their continued livelihood, only effective, efficient and ethical administration of the system will contribute to the development of a state capable of sustaining the social contract with its citizens.
SDG1—Research
Agenda 2063: A1
Keywords: poverty, social grant, social protection, South Africa
The client assumes centre stage in managing the services encounter, both in terms of service expectations and the service experience itself, aspects that in practice are complex to manage as they entail a human dimension of subjectivity. The literature tends to adopt a more traditional recipe-based scientific management approach, while in practice it would appear that a complex adaptive systems (CAS) approach may be more effective in managing the services encounter. It is an approach that embodies a multidisciplinary systems perspective that focuses not only on the on-stage encounters but also on the backstage support systems that play a key role in ensuring client satisfaction. The research consequently adopts a multi-disciplinary review of the literature relating to the management of service encounters to gain an insight into the two contrasting approaches. An important finding that emerges from the research is that the service encounter is emergent in nature and thus extremely complex to manage in practice, while the back and front stage systemic integration and management appear to adopt a more contemporary management approach.
SDG1, SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, responsive institutions, service delivery, transparent institutions
This article argues that social innovation (SI) for delivering and improving local government services is already used with much success in European and Asian countries as well as in the United States of America. However, it appears as if in South Africa, the use of SI for improving service delivery is not receiving the attention policymakers have hoped for. This statement is based on the fact that although SI is addressed in many policy documents, it is still not sufficiently integrated in the National System of Innovation. Against the backdrop of a decline in key economic indicators and inadequate basic service delivery by local government, there has been a concomitant rise in municipal and labour protests and unnecessary turbulence in South Africa. The aim of this article is therefore to elucidate the role that local government could (and needs to) play when using SI for improved service delivery.
SDG1—Research
Agenda 2063: A3
Keywords: service delivery, South Africa
Flash floods are some of the most devastating weather-related hazards in South Africa. The South African Flash Flood Guidance (SAFFG) system is a hydro-meteorological modelling system that provides forecasts for the next 1 to 6 h of potential flash floods in support of the flash flood warning system of the South African Weather Service (SAWS). The aim of this paper is to investigate the increase in the lead-time of flash flood warnings of the SAFFG using probabilistic precipitation forecasts generated by the deterministic Unified Model (UM) from the United Kingdom Met Office and run by the South African Weather Service (SAWS). As a first step, calculations of bias-corrected, basin-averaged rainfall from the UM model are provided. An ensemble set of 30 adjacent basins is then identified as ensemble members for each basin (the target basin), from which probabilistic rainfall information is calculated for the target basin covering the extended forecast period. By comparing this probabilistic rainfall forecast with the expected Flash Flood Guidance (FFG) of each basin, an outlook of potential flash flooding is provided. The procedure is applied to a real flash flood event and the ensemble-based rainfall forecasts are verified against rainfall estimated by the SAFFG system. The approach described here is shown to be able to deal with the uncertainties associated with UM rainfall forecasts, particularly regarding location and onset-time of convection. The flash flood outlook for the 18-h extended forecast period investigated was also able to capture the location of the flash flood event and showed its ability to provide additional lead-time for flash flood warnings to disaster managers.
SDG1, SDG11—Research
Agenda 2063: A1
Keywords: disaster, resilient human settlements, South Africa, vulnerability
In this paper, outcomes from an investigation of plausible climate futures over the next century, and the potential impacts on water services including water resource management and disaster risk reduction, such as flash flooding in Ekurhuleni (EMM), are presented. Four key aspects are examined: (i) the extent to which the frequency of extreme rainfall events may change in South Africa as a result of climate change; (ii) the identification of some of the implications of extreme rainfall events for local government (iii) the identification of some of the challenges communities most at risk of flooding as a result of extreme rainfall events face, finally, (iv) the opportunities for future co-production of design methods and approaches to reduce current and future climate risks in EMM and elsewhere. Climate modelling conducted for this research indicates that it is plausible for an increase in the number of extreme rainfall events to occur over central and eastern South Africa over the next century. Over EMM, for example, an increase in extreme rainfall events is likely to be accompanied by flash flooding and a range of deleterious impacts, if planning and maintenance of the water services infrastructure is not improved a result that is likely to be valid for all large metropolitan municipalities in the country. The paper provides some lessons learnt when trying to include a climate risk reduction approach into the planning of urban development.
SDG11, SDG9—Research
Agenda 2063: A1
Keywords: cities, climate change, human settlement planning, human settlements, infrastructure
South Africa was one of the last African states to obtain a fully democratic government with its first general election in April 1994. Democratising the system of government required a total transformation of all public institutions and the services provided by the state. The popular view was that this could be achieved by decentralising powers and functions to other spheres of government. The South African Constitution, 1996 established three separate, interdependent and interrelated spheres of governments, namely national government, nine provincial governments and 283 (now 278) municipalities. Each sphere is assigned its own powers, functions and responsibilities. Decentralisation has important advantages since it ensures public accountability and responsibility to a greater extent than centralisation. Moreover there is direct contact between voters and political representatives and offi ce bearers in the provincial and local spheres. The success of decentralisation reforms also depends on consistent and coherent national policies, sound legislative and regulatory frameworks for decentralisation, and effective review mechanisms to resolve disputes among all spheres of government. This article argues that in South Africa service provision and good governance can best be achieved through decentralisation. Decentralisation has also been associated with democratisation. It is argued that municipalities as constituents of local government are more likely to be accountable to its constituency. The major priority of the South African government, as set out in the Bill of Rights, is to ensure the provision of a range of services to meet socio-economic challenges, within the constraints of available resources. Local government is the sphere of government that is closest to the people and is best positioned to identify and respond to local issues. This article supports the view that service provision in South Africa can be achieved effectively through decentralisation. Decentralisation and devolution have been pursued to improve the working environment and to encourage innovative ways to increase efficiency and improve service delivery.
SDG1, SDG6—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, participatory institutions, service delivery, South Africa
A methodology for the assessment of the probable maximum loss associated with an earthquake is described and applied to the Cape Town central business district. The calculations are based on the effect of the two largest earthquakes that occurred in Milnerton in 1809 and CeresTulbagh in 1969. The investigation concludes that if buildings and infrastructure in an area follow the SANS Standard 10160 for seismic loading of 0.1 g, they are exposed to significant seismic risk. The main purpose of this research is not the accurate quantification of expected losses to Cape Towns infrastructure, but to raise awareness between civil engineers, the insurance industry and disaster management agencies that seismic hazard is an issue in South Africa and must be considered as a potential threat to its residents and infrastructure.
SDG1, SDG11—Research
Agenda 2063:
Keywords: Cape Town, disaster, earthquakes, resilient human settlements, vulnerability

Climate and southern Africas waterenergyfood nexus

Authors: Declan Conway, Emma Archer van Garderen, Delphine Deryng, Steve Dorling, Tobias Krueger, Willem Landman, Bruce Lankford, Karen Lebek, Tim Osborn, Claudia Ringler, James Thurlow, Tingju Zhu & Carole Dalin
In southern Africa, the connections between climate and the waterenergyfood nexus are strong. Physical and socioeconomic exposure to climate is high in many areas and in crucial economic sectors. Spatial interdependence is also high, driven, for example, by the regional extent of many climate anomalies and river basins and aquifers that span national boundaries. There is now strong evidence of the effects of individual climate anomalies, but associations between national rainfall and gross domes-tic product and crop production remain relatively weak. The majority of climate models project decreases in annual precipita-tion for southern Africa, typically by as much as 20% by the 2080s. Impact models suggest these changes would propagate into reduced water availability and crop yields. Recognition of spatial and sectoral interdependencies should inform policies, institutions and investments for enhancing water, energy and food security. Three key political and economic instruments could be strengthened for this purpose: the Southern African Development Community, the Southern African Power Pool and trade of agricultural products amounting to significant transfers of embedded water.
SDG2, SDG6, SDG7—Research
Agenda 2063: A1
Keywords: access to water, drinking water, food security, South Africa, sustainable energy

An evaluation of CORDEX regional climate models in simulating precipitation over Southern Africa

Authors: Mxolisi E. Shongwe, Chris Lennard, Brant Liebmann, Evangelia-Anna Kalognomou, Lucky Ntsangwane1 & Izidine Pinto
This article evaluates the ability of the Coordinated Regional Downscaling Experiment (CORDEX) regional climate models (RCMs) in simulating monthly rainfall variation during the austral summer half year (October to March) over southern Africa, the timing of the rainy season and the relative frequencies of rainfall events of varying intensities. The phasing and amplitude of monthly rainfall evolution and the spatial progression of the wet season onset are well simulated by the models. Notwithstanding some systematic biases in a few models, the simulated onset and end of the rainy season and their interannual variability are highly correlated with those computed from the reference data. The strongest agreements between the reference and modelled precipitation patterns are found north of about 20?S in the vicinity of the Inter Tropical Convergence Zone. A majority of the RCMs adequately capture the reference precipitation probability density functions, with a few showing a bias towards excessive light rainfall events.
SDG1, SDG13—Research
Agenda 2063: A1
Keywords: climate change resilience

A snow forecasting decision tree for significant snowfall over the interior of South Africa

Authors: Jan Hendrik Stander, Liesl Dyson & Christien J. Engelbrecht
Snowfall occurs every winter over the mountains of South Africa but is rare over the highly populated metropolises over the interior of South Africa. When snowfall does occur over highly populated areas, it causes widespread disruption to infrastructure and even loss of life. Because of the rarity of snow over the interior of South Africa, inexperienced weather forecasters often miss these events. We propose a five-step snow forecasting decision tree in which all five criteria must be met to forecast snowfall. The decision tree comprises physical attributes that are necessary for snowfall to occur. The first step recognises the synoptic circulation patterns associated with snow and the second step detects whether precipitation is likely in an area. The remaining steps all deal with identifying the presence of a snowflake in a cloud and determining that the snowflake will not melt on the way to the ground. The decision tree is especially useful to forecast the very rare snow events that develop from relatively dry and warmer surface conditions. We propose operational implementation of the decision tree in the weather forecasting offices of South Africa, as it is foreseen that this approach could significantly contribute to accurately forecasting snow over the interior of South Africa. SIGNIFICANCE : A method for forecasting disruptive snowfall is provided. It is envisaged that this method will contribute to the improved forecasting of these severe weather events over South Africa. Weather systems responsible for snowfall are documented and the cloud microphysical aspects important for the growth and melting of a snowflake are discussed. Forecasting methods are proposed for the very rare events when snow occurs over the interior of South Africa when the air is relatively dry and somewhat warmer.
SDG1, SDG11—Research
Agenda 2063:
Keywords: disaster, resilient human settlements, snow, South Africa
In South Africa, the right to access to adequate food is entrenched in the Bill of Rights of the Constitution of the Republic of South Africa, 1996. The government of South Africa has committed itself to promote and protect the right to access to adequate food, and to directly afford this right to people who are unable to enjoy it for reasons they cannot control. Access to adequate food is one of the pillars of food security, interrelated with food availability, food utilisation and stability of food supply. The approval of the National Policy on Food and Nutrition Security and the Household Food and Nutrition Security Strategy in 2013 by the cabinet indicates a commitment by government to promote the eradication of hunger and the achievement of food security. There is however fragmentation in the current and proposed institutional arrangements applicable to food security in the Policy and the Strategy. This article advocates for a coordinated approach in the implementation of the National Policy on Food and Nutrition Security, as the guiding framework for maximising synergy between government departments and civil society. The article recommends strategies to promote the coordination and collaboration of the various government departments that are responsible for implementing programmes that have an impact on the four pillars of food security.
SDG2—Research
Agenda 2063: A1
Keywords: food security, South Africa
This article discusses the impact of the Integrated Food and Nutrition Programme (IFNP) in light of collaborative partnerships for poverty reduction in a developing municipal area in South Africa. The programme aimed to develop home, community and school food gardens to meet the daily nutritional needs of poor households and the process was then to be broadened into marketing surplus garden produce, providing employment and income-generating opportunities. The programme thus aimed to address more than just basic food and nutrition. The purpose of the research was to obtain data through participant observation, focus group discussions and extended household interviews. Drawing on the qualitative interviews conducted with the beneficiaries of the IFNP, the article describes the manner in which poverty can continue to entrench the social exclusion of the poor (despite a specific policy intervention to improve their circumstances) when appropriate stakeholder collaboration is not fully developed and harnessed. The research recommendations include improving weak institutional environments, which may hinder effective service delivery, identifying appropriate skills development for the poor, ensuring community involvement in policy processes, maintaining efficient communication in collaborative partnerships, and maintaining personnel training on policy development and in project management skills.
SDG2—Research
Agenda 2063: A1
Keywords: food security, hunger, Kungwini, malnutrition, South Africa
Indigenous plant foods play a major nutritional and cultural role in the diets of rural people in Africa. However, they can contain high levels of antinutrients, which may exacerbate nutritional and health problems in young children consuming nutrient deficient diets. Also, the rapid increase in urbanization in Africa has led to the need for convenience type meals. This study investigated the potential of micronization (infrared treatment) in combination with extrusion cooking in developing a ready-to-eat sorghum and cowpea based porridge supplemented with cooked cowpea leaves for young child-feeding. Micronization not only inactivated the trypsin inhibitors in cowpea, it also produced an instantized product with excellent hydration properties. When served as a stiff porridge with cooked cowpea leaves in the recommended portion sizes for children aged 2e5 years, one daily serving would meet 40% of the children's protein and lysine requirements. Further, the calculated Protein Digestibility Corrected Amino Acid Score would be comparable to commercial maize-soy instant products. This is notwithstanding that the cowpea leaves had a negative effect on protein digestibility due to their high tannin content. This nutritious ready-to-eat meal from locally available plant foods could contribute substantially to food security in both urban and rural communities in Africa.
SDG2—Research
Agenda 2063: A1
Keywords: child nutrition, food security, nutrition
Malnutrition remains a global health concern and contributes significantly to childhood mortality. Nearly half of all deaths in children <5 years of age are attributed to undernutrition, especially in developing countries. It is important to differentiate between acute and chronic malnutrition, as the management and mortality for these two conditions differ. Management should follow integrative management protocols to ensure that mortality and morbidity are minimised. General principles for inpatient management of acute malnutrition can be divided into two phases, i.e. the initial stabilisation phase (usually in the first week) for acute complications, and the much longer rehabilitation phase. The initial phase lasts approximately 1 week and involves intensive monitoring and treatment. Severe acute malnutrition remains a problem in public health, especially in developing countries. Adhering to programmatic approaches for diagnosis and management ensures lower mortality rates and better outcomes.
SDG2—Research
Agenda 2063: A1
Keywords: malnutrition

Nutrient content of eight African leafy vegetables and their potential contribution to dietary reference intakes

Authors: Paul van Jaarsveld, Mieke Faber, Ina van Heerden, Friede Wenhold, Willem Jansen van Rensburg & Wim van Averbekee
Nutrient content and potential contribution of one average portion towards nutritional requirements (recommended dietary allowance; RDA) of eight African leafy vegetables (ALVs) was determined. Compared to dark-green leafy vegetables (DGLVs) as sub-group, calcium and magnesium content were similar or considerably higher, vitamin C content was considerably lower, while pigweed had higher potassium content and spider flower similar folate content. All ALVs, except Chinese cabbage, had higher iron content. Black nightshade, pigweed, cowpea and spider flower leaves had higher b-carotene content than DGLVs. For children, pigweed and cowpea leaves emerged as good sources of vitamin A (>75% RDA), followed by spider flower, black nightshade, tsamma melon, Jews mallow and pumpkin leaves (5075% RDA). For iron, pumpkin leaves provided 5075% RDA. Black nightshade, tsamma melon, pigweed and cowpea leaves contributed 2550% RDA, with Jews mallow, spider flower and Chinese cabbage providing <25% RDA. The ALVs were not a good source of zinc. Most ALVs were nutritionally similar to DGLVs. For most nutrients Chinese cabbage had considerably lower values than the other ALVs. Most of the ALVs can considerably contribute to requirements of vitamin A and, to a lesser extent, iron, both critical nutrients for developing countries.
SDG2—Research
Agenda 2063: A1
Keywords: nutrition
Through a European Union funded project called JOLISAA (Joint Learning in Innovation Systems in African Agriculture), the nature of smallholder oriented innovation systems have been explored in terms of partnerships, triggers that have given rise to them and the nature of the innovations themselves. The main objective was to analyse a broad diversity of multi-stakeholder agricultural innovation processes involving smallholders. The analysis of 11 cases documented comprises innovation bundles composed of technical, organisational and institutional innovations. The eleven cases documented showed that six exhibited non-technical innovation processes frequently related to market access as well as to inputs and services. Triggers that drive smallholders and other stakeholders to initiate innovation processes include environment stress, introduction of new technologies, identification of market change as well as policy or regulatory changes. The cases that have been documented show a variation of stakeholders responsible for initiating the process. In some cases it was smallholders approaching other stakeholders for assistance with addressing a challenge, while in other cases it was researchers or extensionists who undertook to develop an innovation to address a challenge that they had encountered through their interaction with smallholders. All documented cases have involved the contribution of ideas, knowledge and skills by at least three different types of stakeholders and the role of local knowledge has been acknowledge through the study. Out of the eleven cases three cases have been selected for a collaborative case assessment which strives to assess further key issues such as actual roles and contributions of various role-players, the dynamics of the innovation process and outcome. Several opportunities arise for joint learning with small scale farmers.
SDG2—Research
Agenda 2063: A1
Keywords: agricultural productivity, small-scale farmers, small-scale food producers, sustainable agriculture

Optimal feeding systems for small-scale dairy herds in the North West Province, South Africa

Authors: N Patience Manzana, Cheryl M E McCrindle, P Julius Sebei & Leon Prozesky
Land redistribution was legislated in 1994; it was designed to resolve historical imbalances inland ownership in South Africa. Between 2002 and 2006, a longitudinal observational studywas conducted with 15 purposively selected small-scale dairy farmers in a land redistributionproject in Central North West Province. Four farmers left the project over the period. For thepurposes of this study, a small-scale dairy farm was defined as a farm that produces less than500 L of milk a day, irrespective of the number of cows or size of the farm. The study wasconducted in three phases. In the first phase, situational analysis using participatory ruralappraisal (PRA) and observation was used to outline the extent of the constraints and designappropriate interventions. Feeds that were used were tested and evaluated. In the secondphase, three different feeding systems were designed from the data obtained from PRA. Thesewere: (1) A semi-intensive farm-based ration using available crops, pastures and crop residueswith minimal rations purchased. (2) An intensive, zero-grazing dairy system using a totalmixed ration. (3) A traditional, extensive or dual-purpose system, where the calf drank fromthe cow until weaning and milking was done only once a day. In the third phase, adoptionwas monitored. By July 2006, all remaining farmers had changed to commercially formulatedrations or licks and the body condition score of the cows had improved. It was concluded thatveterinary extension based on PRA and a holistic systems approach was a good option forsuch complex problems. Mentoring by commercial dairy farmers, veterinary and extensionservices appeared to be viable. Further research should be done to optimise the traditionalmodel of dairy farming, as this was relatively profitable, had a lower risk and was less labour intensive.
SDG2—Research
Agenda 2063: A1
Keywords: agricultural productivity, North West, small-scale farmers, small-scale food producers, South Africa
Background.Globally, in children the prevalence of overweight and obesity is increasing, and this is associated with an increased risk of noncommunicable diseases in adulthood. There is a need to examine the growing trends of overweight and obesity in children and their consequences in low and middleincome countries.Objectives.To describe the prevalence of, and determine the relationship between, stunting and overweight among children in two provinces of South Africa. Methods.Secondary data analysis was conducted on anthropometric measurements of 36 119monthold children from Gauteng and Mpumalanga provinces (N=519) participating in the South African National Food Consumption Survey Fortification Baseline I (2005). The International Obesity Task Force (IOTF) body mass index (BMI) reference percentiles were used to determine overweight and obesity. The World Health Organization standards were used to derive zscores. Results.The prevalence of overweight was 12.0% (IOTF BMI ?25 kg/m2), including 3.7% obesity (IOTF BMI ?30 kg/m2). The predominantly urban Gauteng Province had a significantly higher prevalence of overweight children (14.1%) compared with Mpumalanga (6.3%) (p=0.0277). The prevalence of stunting was 17.0% (16.5% Gauteng, 18.2% Mpumalanga; p>0.05). There was a significant correlation (r=?0.32) between BMI and heightforage zscores (p<0.0001). In the obese group, 68.4% were stunted, while in the normal and underweight group only 13.6% were stunted. Conclusions.Stunted children were more likely to be obese. Further research is necessary for clarity on the physiological mechanisms of this relationship. In the interim, prevention of stunting requires priority.
SDG2—Research
Agenda 2063: A1
Keywords: hunger, nutrition, South Africa, stunting
The main objective of the NWGA is to improve both the quality and quantity of wool produced in the communal wool sheep farming areas of South Africa. Shearing sheds in the communal area were divided into three performance categories namely top, average and bottom sheds. This finding has led to two questions: Why and where do they differ? Can something be done to improve the performance of the sheds? A total of five (5) top, five (5) average and seven (7) bottom sheds were selected to collect data from 179 respondents. The socio-economic data is always important to indicate clearly who the respondents are. The average age of respondents is 59.46 and 64% male and 36% females. There are more members in the top sheds than in the other two categories. Although a large number of respondents can read and write, the majority do have only a qualification at the lower level. A total of 83% of the respondents do have some years of experience in sheep farming. Respondents in the top shed have significantly more sheep, cattle and goats than respondents in the average and bottom sheds. Significantly more farmers attend the top shed meetings than farmer members in the other two categories. A total of 39% respondents indicated that good sheep health control will lead to higher wool production and the most common diseases as perceived by respondents are Sheep scab, Blue tongue and internal parasites. Burr/weeds and paints are the two most important objects of wool contamination. Significantly more sheep are sheared in the top sheds, they pack more bales and the weight of the bales is higher than in the average and bottom sheds. Farmers most important needs are financial issues, farm infrastructure and they need more land. To improve the profitability and productivity of wool sheep farming at all shearing sheds within the communal farming area. A specific extension program addressing the specific needs will be presented to farmers in each of the three shearing shed groups.
SDG2—Research
Agenda 2063: A1
Keywords: agricultural productivity, Eastern Cape, small-scale farmers, small-scale food producers, sustainable agriculture

Genomic technologies for food security: A review of challenges and opportunities in Southern Africa

Authors: Este van Marle-Kster, Carina Visser, Mahlako Makgahlela & Schalk WP Cloete
The Southern African Development Community (SADC) region includes 15 member states which all face growing population numbers and a possible protein shortage within the next 20 years. Although these countries have a wealth of livestock genetic resources and mostly are quite agriculturally dependent, there exist clear limitations and challenges regarding animal recording, genetic improvement, production efficiency and the implementation of new technologies, such as genomic selection (GS). Genomic selection incorporates genomic information with phenotypic information (breeding values) to derive genomic estimated breeding values (GEBV) and leads to an increased rate of genetic improvement. The countries within the SADC region are in several stages of development with regard to agriculture and infrastructural development and this limits the implementation of advanced technologies. The establishing of reference populations seems beyond the capacity of most of these countries at present, mainly in terms of financial viability, infrastructural support and national cohesion. Genomic technology however holds potential for the introgression of favourable genes in resource-poor livestock production systems and traceability of livestock products. Furthermore,identification of traits associated with adaptability and disease resistance and unique products would contribute to food security on various levels. This review discusses interventions that may mitigate constraints, and proposes key research areas needed for addressing the limitations mentioned.
SDG2—Research
Agenda 2063: A1
Keywords: food security, South Africa
The JOLISAA project analysed a number of multi-stakeholder innovation cases in smallholder agriculture in Benin, Kenya and South Africa through a Collaborative Case Assessment process. The overriding assumption was that a comparative analysis of wide ranging innovation experiences may provide useful insights into the way that innovation processes are triggered and unfold in smallholder agricultural systems. One of the cases investigated in South Africa was from Limpopo Province. This was a project-based innovation processes, initiated to redress how agricultural and social development in rural communities should be addressed through the adoption of the Participatory Extension Approach (PEA). The approach focused on the reorientation of mindsets in Limpopo Department of Agricultural, which were still founded on the teaching of linear transfer of technology models, and where farmers were approached with a believe that extension have all the answers to farmer problems. Participatory Rural Appraisal methodologies were used to interview smallholder farmers and key informants. It was revealed that this was a case of an innovation bundle where the main innovation was an institutional innovation, with the introduction of PEA through the GTZ/BASED program. The aim was to broaden agricultural service and extension delivery to smallholder farmers in the Vhembe district. In the unpacking of the soil fertility management innovation it was revealed that the innovation consists of a number of innovations, which include technical and organisation innovations. The GTZ/BASED program trained some 700 extensionists in the PEA methodology, capacitating them to facilitate technical innovations amongst smallholders in one of four technical areas. A total of 397 villages were eventually served. The extensionists specialising in soil fertility management teamed up with a local university to redress a severe decline in soil fertility in two smallholder irrigation schemes, Rammbuda and Mphaila. Together with farmers they experimented with innovative ways like green manuring with forage legumes. These technical innovation processes created capacity amongst smallholders that triggered spontaneous farmer-initiated experimentation and innovation processes to improve smallholder farming systems and livelihoods. The key challenge identified was that decisive institutional ownership is required to sustain an enabling environment allowing innovation processes to continue beyond the project phase. The key lesson was that project initiated innovations could trigger farmer innovations and that developmental change strategies should explore such opportunities.
SDG2—Research
Agenda 2063: A1
Keywords: agricultural productivity, Limpopo, small-scale farmers, small-scale food producers, South Africa
Although the term itself was only developed in the 1970s, food security has played a central role in policies that have shaped the history of South Africa from the 17th century. As with the changing international interpretation of food security over the past four decades, South African food security determinants have been interpreted differently by different ruling authorities and governments over three centuries. The Natives Land Act of 1913 played a significant role in determining the food security context of the country in terms of the character, composition and contribution of the agricultural sector, shaped consumption patterns and determined rural livelihoods. While food security is expressed as a national objective in a plethora of strategies and programmes, no formal evaluation has been carried out of the food security impact of these programmes, and there is a dire lack of coordination and no enforceable policy to ensure food security. Any national food security policy will need a framework of enforceable legislative measures and statutory coordination and reporting. This article explores the current national and household food security and nutrition situation in South Africa, and it offers recommendations for a comprehensive food security policy.
SDG2—Research
Agenda 2063: A1
Keywords: food security, South Africa

Identifying strategic markets for South Africas citrus exports

Authors: Tinashe Kapuya, Evans K Chinembiri & Mmatlou W Kalaba
SDG8—Research
Agenda 2063: A1
Keywords: economic growth, job creation, South Africa

Understanding of the farmers privilege concept by smallholder farmers in South Africa

Authors: Noluthando C Netnou-Nkoana, Julian B Jaftha, Mabjang A Dibiloane &Jacobus Eloff
Legislation on plant breeders rights the Plant Breeders Rights Act, 1976 (Act No. 15 of 1976) currently is being reviewed by the Department of Agriculture, Forestry and Fisheries. This legislation provides for farmers privilege, which is one of the exceptions to plant breeders rights. It allows farmers to save seed of protected varieties for their own use. Farmers privilege, and particularly its impact on smallholder farmers in developing countries, is a widely debated issue. During the public consultation process, several comments proposing amendments to the farmers privilege provision were received from various stakeholders. However, no comments were received from the smallholder farmers who may be directly impacted by this provision. This pilot study was undertaken to assess the understanding of the farmers privilege concept by smallholder farmers from the historically disadvantaged communities and their current practices with regard to seed saving. The results showed that the majority of the smallholder farmers were not aware of the existence of the legislation on plant breeders rights and therefore do not understand the farmers privilege concept and its implications. They also did not know whether the varieties they were using were protected by plant breeders rights or not. Little information has been published on the impact of plant breeders rights in South Africa in general. We hope that this study might inform policy decisions on matters related to plant breeders rights and the farmers privilege.
SDG15, SDG2—Research
Agenda 2063: A1
Keywords: access to genetic resources, agricultural productivity, sharing of genetic resources
Climate change represents a feedback-loop in which livestock production both contributes to the problem and suffers from the consequences. The impact of global warming and continued, uncontrolled release of greenhouse gasses (GHG) has twofold implications for the livestock industry, and consequently food security. Firstly, the continuous increase in ambient temperature is predicted to have a direct effect on the animal, as well as on food and nutrition security, due to changes associated with temperature itself, relative humidity, rainfall distribution in time and space, altered disease distribution, changes in the ecosystem and biome composition. Secondly, the responsibility of livestock production is to limit the release of greenhouse gases (GHG) or the carbon footprint, in order to ensure future sustainability. This can be done by implementing new or adapted climate-smart production systems, the use of known and new technologies to turn waste into assets, and by promoting sustainable human diets with low environmental impacts. The following elements, which are related to livestock production and climate change, are discussed in this paper: (1) restoring the value of grasslands/rangelands, (2) pastoral risk management and decision support systems, (3) improved production efficiency, (4) global warming and sustainable livestock production, (5) the disentanglement between food and nutritional needs, focusing on nutrient rich core foods, (6) GHG from livestock and carbon sequestration, and (7) water and waste management. No single organization (or industry) within South Africa can perform this research and the implementation thereof on its own. The establishment of a (virtual) centre of excellence in climate-smart livestock production and the environment for the livestock industries, with the objective to share research expertise and information, build capacity and conduct research and development studies, should be a priority.
SDG2—Research
Agenda 2063: A1
Keywords: agricultural productivity, climate change, food security, South Africa
Reliable predictions of climate change impacts on water use, irrigation requirements and yields of irrigated sugarcane in South Africa (a water-scarce country) are necessary to plan adaptation strategies. Although previous work has been done in this regard, methodologies and results vary considerably. The objectives were (1) to estimate likely impacts of climate change on sugarcane yields, water use and irrigation demand at three irrigated sugarcane production sites in South Africa (Malelane, Pongola and LaMercy) for current (19802010) and future (20702100) climate scenarios, using an approach based on the Agricultural Model Intercomparison and Improvement Project (AgMIP) protocols; and (2) to assess the suitability of this methodology for investigating climate change impacts on sugarcane production. Future climate datasets were generated using the Delta downscaling method and three Global Circulation Models (GCMs) assuming atmospheric CO2 concentration [CO2] of 734 ppm (A2 emissions scenario). Yield and water use were simulated using the DSSAT-Canegro v4.5 model. Irrigated cane yields are expected to increase at all three sites (between 11 and 14%), primarily due to increased interception of radiation as a result of accelerated canopy development. Evapotranspiration and irrigation requirements increased by 11% due to increased canopy cover and evaporative demand. Sucrose yields are expected to decline because of increased consumption of photo-assimilate for structural growth and maintenance respiration. Crop responses in canopy development and yield formation differed markedly between the crop cycles investigated. Possible agronomic implications of these results include reduced weed control costs due to shortened periods of partial canopy, a need for improved efficiency of irrigation to counter increased demands, and adjustments to ripening and harvest practices to counter decreased cane quality and optimise productivity. Although the Delta climate data downscaling method is considered robust, accurate and easily-understood, it does not change the future number of rain-days per month. The impacts of this and other climate data simplifications ought to be explored in future work. Shortcomings of the DSSAT-Canegro model include the simulated responses of phenological development, photosynthesis and respiration processes to high temperatures, and the disconnect between simulated biomass accumulation and expansive growth. Proposed methodology refinements should improve the reliability of predicted climate change impacts on sugarcane yield.
SDG13, SDG2—Research
Agenda 2063: A1
Keywords: agricultural productivity, climate change adaptation, South Africa, sustainable agriculture

Performance of simple irrigation scheduling calendars based on average weather data for annual ryegrass

Authors: Melake K Fessehazion, John G Annandale, Colin S Everson, Richard J Stirzaker, Michael van der Laan, Wayne F Truter & Amanuel B Abraha
Poor irrigation management in pastures can lead to yield and quality reduction as well as loss of income through extra pumping and leaching of nitrate fertiliser. A number of irrigation scheduling techniques of varying levels of sophistication have been developed over the years to address limited irrigation water availability and maximise productivity. Despite this, the adoption of irrigation scheduling tools by farmers remains low. The objective of this study was to assess the use of simple irrigation scheduling calendars based on average weather data to improve irrigation management in ryegrass. The calibrated Soil Water Balance (SWB) model was used to generate simple irrigation calendars and assess effectiveness for different scenarios by mechanistically simulating water dynamics and pasture growth. Scheduling irrigation using the calendars gave similar irrigation applications, water losses and yields compared to a more scientific real-time scheduling (in response to soil water depletion by the crop). While site-specific irrigation scheduling calendars can easily be generated by consultants and irrigators, even simpler monthly estimates of average daily water use can also be useful. Application of calendars by farmers is encouraged to improve water and nutrient use efficiency of irrigated pastures, if real-time irrigation scheduling is not employed.
SDG2—Research
Agenda 2063:
Keywords: agricultural productivity, sustainable agriculture
A clear tomato yield gap exists in Southern Africa. Understanding the economic crop production factors is a necessary prelude to any discussion of ecological sustainability. The objective of this study was to evaluate the economic factors that influence the sustainability of open field tomato production. We compared detailed tomato production costs from six international studies to data from the largest commercial tomato producer in South Africa. The Environmental Impact Quotient (EIQ) was used to demonstrate the interactions between economic and agro-ecological constraints. Economic pressures are forcing tomato producers to intensify production, which underscores the need for the continued development of ecologically sustainable tomato production systems. The findings of this study will benefit policy development in support of sustainable food security in the rural areas of Southern Africa and beyond.
SDG2—Research
Agenda 2063: A1
Keywords: agricultural productivity, food security, South Africa

Challenges experienced by South Africa in a aining Millennium Development Goals 4, 5 and 6

Authors: Fhumulani M Mulaudzi; Seepaneng S Phiri; Doriccah M Peu; Mmamakwa L S Mataboge; Nkhensani R Ngunyulu & Ramadimetja S Mogale
Background: Despite progress made by other countries worldwide in achieving Millennium Development Goals (MDGs) 4, 5 and 6, South Africa is experiencing a challenge in attaining positive outcomes for these goals. Objective and setting: To describe the challenges experienced by South Africa regarding the successful implementation of MDGs 4, 5 and 6. Methods: An integrative literature review was used to identify and synthesise various streams of literature on the challenges experienced by South Africa in attaining MDGs 4, 5 and 6. Results: The integrative review revealed the following themes: (1) interventions related to child mortality reduction, (2) implementation of maternal mortality reduction strategies, and (3) identified barriers to zero HIV and TB infections and management. Conclusion: It is recommended that poverty relief mechanisms be intensified to improve the socio-economic status of women. There is a need for sectoral planning towards maternal health, and training of healthcare workers should emphasise the reduction of maternal deaths. Programmes addressing the reduction of maternal and child mortality rates, HIV, STIs and TB need to be put in place.
SDG3—Research
Agenda 2063: A1
Keywords: child mortality, HIV, maternal mortality, South Africa, TB
There is an urgent need for human societies to become environmentally sustainable. Because public policy is largely driven by economic processes, quantifications of the relationship between market prices and environmental values can provide important information for developing strategies towards sustainability. Wildlife in southern Africa is often privately owned and traded at game auctions to be utilized for commercial purposes mostly related to tourism. This market offers an interesting opportunity to evaluate how market prices relate to biologically meaningful species characteristics. In this market, prices were not correlated with species contributions to either phylogenetic or functional diversity, and species contributions to phylogenetic or functional diversity did not influence the trends in prices over time for the past 20 years. Since this economic market did not seem to appreciate evolutionary or ecologically relevant characteristics, we question if the game tourism market may contribute towards biodiversity conservation in southern Africa. We suggest that market prices in general may have limited values as guides for directing conservation and environmental management. We further suggest that there is a need to evaluate what humans value in biological organisms, and how potentially necessary shifts in such values can be instigated.
SDG15—Research
Agenda 2063:
Keywords: biodiversity, conservation
Introduction: Despite having access to several clinics and health centres in their local communities, numerous patients opt to go directly to hospitals for non-emergencies and minor ailments. Reasons for this include their perceptions of the quality of primary health care services, the attitudes and perceptions of health workers, opening hours of clinics, community involvement and participation, and drug and equipment availability as well as the quality of infrastructure. Perceptions of size, a lack of specialty care and limited services were most frequently mentioned as reasons why patients bypassed their local primary health care facilities. Aim: This study aimed to identify the reasons given by patients presenting with minor ailments, for bypassing their local primary health care facilities in the Greater Tzaneen municipal area to Letaba Hospital. Methods: A cross-sectional descriptive study was performed at Letaba Hospital over a three-month period, from 23 June 2008 to 15 August 2008, in which non-referred patients presenting with minor ailments were randomised and entered into the study on a voluntary basis. A preset questionnaire was utilised for data-collection purposes. A total of 293 participants were included in the study. The questionnaire aimed to determine the demographic profile of patients who present with minor ailments at hospital, to explore the reasons why these patients bypass their local clinics and to evaluate their knowledge, perceptions and attitudes regarding their local clinics. Results: Most patients indicated that they came to the hospital because they wanted to be seen by a doctor, followed by the request to see a dentist. The study identified that patients expressed both positive and negative opinions concerning their local clinics. Conclusion: Numerous factors influence the service-seeking behaviour of rural patients. Patients bypass their local clinics due to perceptions regarding the quality of health care services at the hospital. Improving the quality aspects of clinics and enhancing the services rendered will not only increase the utilisation of clinic services, but also reduce hospital overcrowding.
SDG3—Research
Agenda 2063:
Keywords: access to health care, South Africa, Tzaneen
Aims: Cardiac disease is emerging as an important contributor to maternal deaths in both lower-to-middle and higherincome countries. There has been a steady increase in the overall institutional maternal mortality rate in South Africa over the last decade. The objectives of this study were to determine the cardiovascular causes and contributing factors of maternal death in South Africa, and identify avoidable factors, and thus improve the quality of care provided. Methods: Data collected via the South African National Confidential Enquiry into Maternal Deaths (NCCEMD) for the period 20112013 for cardiovascular disease (CVD) reported as the primary pathology was analysed. Only data for maternal deaths within 42 days post-delivery were recorded, as per statutory requirement. One hundred and sixty-nine cases were reported for this period, with 118 complete hospital case files available for assessment and data analysis. Results: Peripartum cardiomyopathy (PPCM) (34%) and complications of rheumatic heart disease (RHD) (25.3%) were the most important causes of maternal death. Hypertensive disorders of pregnancy, HIV disease infection and anaemia were important contributing factors identified in women who died of peripartum cardiomyopathy. Mitral stenosis was the most important contributor to death in RHD cases. Of children born alive, 71.8% were born preterm and 64.5% had low birth weight. Seventy-eight per cent of patients received antenatal care, however only 33.7% had a specialist as an antenatal care provider. Avoidable factors contributing to death included delay in patients seeking help (41.5%), lack of expertise of medical staff managing the case (29.7%), delay in referral to the appropriate level of care (26.3%), and delay in appropriate action (36.4%). Conclusion: The pattern of CVD contributing to maternal death in South Africa was dominated by PPCM and complications of RHD, which could, to a large extent, have been avoided. It is likely that there were many CVD deaths that were not reported, such as late maternal mortality (up to one year postpartum). Infrastructural changes, use of appropriate referral algorithm and training of primary, secondary and tertiary staff in CVD complicating pregnancy is likely to improve the outcome. The use of simple screening equipment and point-of-care testing for early-onset heart failure should be explored via research projects.
SDG3—Research
Agenda 2063: A1
Keywords: maternal mortality, South Africa
Maternal mortality ratio in low- to middle-income countries (LMIC) is 14 times higher than in high-income countries. This is partially due to lack of antenatal care, unmet needs for family planning and education, as well as low rates of birth managed by skilled attendants. While direct causes of maternal death such as complications of hypertension, obstetric haemorrhage and sepsis remain the largest cause of maternal death in LMICs, cardiovascular disease emerges as an important contributor to maternal mortality in both developing countries and the developed world, hampering the achievement of the millennium development goal 5, which aimed at reducing by three-quarters the maternal mortality ratio until the end of 2015. Systematic search for cardiac disease is usually not performed during pregnancy in LMICs despite hypertensive disease, rheumatic heart disease and cardiomyopathies being recognised as major health problems in these settings. New concern has been rising due to both the HIV/AIDS epidemic and the introduction of highly active antiretroviral therapy. Undetected or untreated congenital heart defects, undiagnosed pulmonary hypertension, uncontrolled heart failure and complications of sickle cell disease may also be important challenges. This article discusses issues related to the role of cardiovascular disease in determining a substantial portion of maternal morbidity and mortality. It also presents an algorhitm to be used for suspected and previously known cardiac disease in pregnancy in the context of LIMCs.
SDG3—Research
Agenda 2063: A1
Keywords: maternal mortality, South Africa

Climate change is catchy but when will it really hurt?

Authors: N A Sweijd, C Y Wright, A Westwood, M Rouault, W A Landman, M L MacKenzie, J J C Nuttall, H Mahomed, T Cousins, K Winter, F Berhoozi, B Kalule, P Kruger, T Govender & N Minakawa
Concern and general awareness about the impacts of climate change in all sectors of the social-ecological-economic system is growing as a result of improved climate science products and information, as well as increased media coverage of the apparent manifestations of the phenomenon in our society. However, scales of climate variability and change, in space and time, are often confused and so attribution of impacts on various sectors, including the health sector, can be misunderstood and misrepresented. In this review, we assess the mechanistic links between climate and infectious diseases in particular, and consider how this relationship varies, and may vary according to different time scales, especially for aetiologically climate-linked diseases. While climate varies in the medium (inter-annual) time frame, this variability itself may be oscillating and/or trending on cyclical and long-term (climate change) scales because of regional and global scale climate phenomena such as the El-Nio southern oscillation coupled with global-warming drivers of climate change. As several studies have shown, quantifying and modelling these linkages and associations at appropriate time and space scales is both necessary and increasingly feasible with improved climate science products and better epidemiological data. The application of this approach is considered for South Africa, and the need for a more concerted effort in this regard is supported.
SDG3—Research
Agenda 2063: A1
Keywords: climate change
BACKGROUND. Identification and prevention of any avoidable factor (AVF) associated with pregnancy may reduce critical illnesses and the need for intensive care unit (ICU) admission. OBJECTIVES. To determine AVFs that occurred prior to the admission of pregnant and postpartum patients to two ICUs in South Africa (SA) and the resulting maternal outcomes. METHODS. The hospital records of all pregnant and postpartum patients in two public hospital ICUs in Pietermaritzburg, SA, between 1 July 2010 and 30 April 2011 were assessed to identify pre-ICU AVFs. Each patient was followed up until the 7th day after ICU discharge or until hospital discharge (whichever came first), to observe maternal outcomes: survival, death or hypoxic ischaemic brain injury (HIBI). RESULTS. Of 84 patients assessed, 41 (48.8%) had ?1 AVF. Patient-related, administrative and health-worker-related AVFs were identified in 32.1% (27/84), 19.0% (16/84) and 7.1% (6/84) of patients, respectively. The most common patient-related AVF was the commencement of antenatal care after 20 weeks gestation. Unavailability of ICU beds was the most common administrative AVF. Iatrogenic pulmonary oedema associated with intravenous fluid resuscitation was the most frequent health-worker-related AVF. Of women who had AVFs, 9 (22.0%) died, 2 (4.9%) had HIBI and 30 (73.2%) suurvived. The relative risk of death or HIBI among patients with AVF/s was 1.2 (p=0.7). CONCLUSIONS. The principal interventions that may prevent AVFs are ongoing community health promotion, strengthening of obstetric skills training on fluid resuscitation and expansion of critical care services.
SDG3—Research
Agenda 2063: A1
Keywords: maternal mortality, Pietermaritzburg, South Africa

Maternal deaths from bleeding associated with caesarean delivery: A national emergency

Authors: S Fawcus, R C Pattinson, J Moodley, N F Moran, M G Schoon, R E Mhlanga, S Baloyi & E Bekker
Maternal deaths associated with caesarean deliveries (CDs) have been increasing in South Africa over the past decade. The objective of this report is to bring national attention to this increasing epidemic of maternal deaths due to bleeding associated with CD in the majority of provinces of the country. Individual chart reviews of women who died from bleeding at or after CD show that 71% had avoidable factors. Among the steps we can take are to improve surgical skills and experience, especially in rural hospitals; to improve clinical observations in the immediate postoperative period and in the postnatal wards; and to ensure that appropriate oxytocic agents are given to prevent postpartum haemorrhage. CEOs and medical managers of health facilities, district clinical specialists, heads of obstetrics and gynaecology, and midwifery training institutions must show leadership and accountability in providing an appropriate environment to ensure that women who require CD receive the procedure for the correct indications and in a safe manner to minimise risks.
SDG3—Research
Agenda 2063: A1
Keywords: maternal mortality, South Africa
BACKGROUND. Diabetes in pregnancy is associated with both accelerated fetal growth and intrauterine growth restriction. OBJECTIVE. To compare the difference in occurrence of large-for-gestational-age (LGA) and small-for-gestational-age (SGA) fetuses in a pregnant diabetic population using population-based growth charts and customised growth charts. METHODS. Retrospective observational study at Steve Biko Academic and Kalafong hospitals, Pretoria, South Africa. Information from an electronic database was used to retrospectively generate customised centiles using a web-based tool (www.gestation.net). The first fetal growth scan of the third trimester, as determined by ultrasound, was plotted for each patient on both the population-based and customised growth charts. We compared the growth category on the population-based growth chart with that on the customised growth chart. RESULTS. Of the patients, 44 had type 1, 66 type 2 and 173 gestational diabetes. The growth of 79/283 fetuses would have been reclassified had customised growth charts been used. Of cases in which fetal growth was classified as appropriate for gestation on the populationbased growth charts, 58 fetuses would have been LGA and 14 SGA had customised growth charts been used. Four of the fetuses that were SGA and three that were LGA on the population-based growth charts would have been classified as appropriately grown on the customised growth charts. This was a statistically significant difference (p<0.001), with a Cohens kappa of 0.45 indicating moderate agreement. CONCLUSIONS. Customised growth charts identified more babies with aberrations of growth, who may need vigilant antenatal care and elective delivery and may be at increased health risk in the future.
SDG3—Research
Agenda 2063: A1
Keywords: diabetes, infant mortality, neonatal mortality, South Africa, under-five mortality
BACKGROUND : Septic incomplete miscarriages remain a cause of maternal deaths in South Africa. There was an initial decline in mortality when a strict protocol based approach and the Choice of Termination of Pregnancy Act in South Africa were implemented in this country. However, a recent unpublished audit at the Pretoria Academic Complex (Kalafong and Steve Biko Academic Hospitals) suggested that maternal mortality due to this condition is increasing. The objective of this investigation is to do a retrospective audit with the purpose of identifying the reasons for the deteriorating mortality index attributed to septic incomplete miscarriage at Steve Biko Academic Hospital. METHODS : A retrospective audit was performed on all patients who presented to Steve Biko Academic Hospital with a septic incomplete miscarriage from 1st January 2008 to 31st December 2010. Data regarding patient demographics, initial presentation, resuscitation and disease severity was collected from the maternal near-miss/ SAMM database and the patients medical record. The shock index was calculated for each patient retrospectively. RESULTS : There were 38 SAMM and 9 maternal deaths during the study period. In the SAMM group 86.8% and in the maternal death group 77.8% had 2 intravenous lines for resuscitation. There was no significant improvement in the mean blood pressure following resuscitation in the SAMM group (p 0.67), nor in the maternal death group (p 0.883). The shock index before resuscitation was similar in the two groups but improved significantly following resuscitation in the SAMM group (p 0.002). Only 31.6% in the SAMM group and 11.1% in the maternal death group had a complete clinical examination, including a speculum examination of the cervix on admission. No antibiotics were administered to 21.1% in the SAMM group and to 33.3% in the maternal death group. CONCLUSION : The strict protocol management for patients with septic incomplete miscarriage was not adhered to. Physicians should be trained to recognise and react to the seriously ill patient. The use of the shock index in the identification and management of the critically ill pregnant patient needs to be investigated.
SDG3—Research
Agenda 2063: A1
Keywords: maternal mortality, Pretoria, South Africa, Tshwane

Basic and comprehensive emergency obstetric and neonatal care in 12 South African health districts

Authors: R C Pattinson, J D Makin, Y Pillay, N van den Broek & J Moodley
AIM. To assess the functionality of healthcare facilities with respect to providing the signal functions of basic and comprehensive emergency obstetric care in 12 districts. SETTING. Twelve districts were selected from the 52 districts in South Africa, based on the number of maternal deaths, the institutional maternal mortality ratio and the stillbirth rate for the district. METHODS. All community health centres (CHCs) and district, regional and tertiary hospitals were visited and detailed information was obtained on the ability of the facility to perform the basic (BEmONC) and comprehensive (CEmONC) emergency obstetric and neonatal care signal functions. RESULTS. Fifty-three CHCs, 63 district hospitals (DHs), 13 regional hospitals and 4 tertiary hospitals were assessed. None of the CHCs could perform all seven BEmONC signal functions; the majority could not give parenteral antibiotics (68%), perform manual removal of the placenta (58%), do an assisted delivery (98%) or perform manual vacuum aspiration of the uterus in a woman with an uncomplicated incomplete miscarriage (96%). Seventeen per cent of CHCs could not bag-and-mask ventilate a neonate. Less than half (48%) of the DHs could perform all nine CEmONC signal functions (81% could perform eight of the nine functions), 24% could not perform caesarean sections, and 30% could not perform assisted deliveries. CONCLUSIONS. The ability of the CHCs and district hospitals to perform the signal functions (lifesaving services) of basic and comprehensive emergency obstetric care was poor in many of the districts studied. This implies that safe maternity care was not consistently available at many facilities conducting births.
SDG3—Research
Agenda 2063: A1
Keywords: infant mortality, maternal mortality, neonatal mortality, South Africa

Maternal near miss and maternal death in the Pretoria Academic Complex, South Africa: A population-based study

Authors: P Soma-Pillay, R C Pattinson, L Langa-Mlambo, B S S Nkosi & A P Macdonald
BACKGROUND. In order to reduce maternal mortality in South Africa (SA), it is important to understand the process of obstetric care, identify weaknesses within the system, and implement interventions for improving care. OBJECTIVE. To determine the spectrum of maternal morbidity and mortality in the Pretoria Academic Complex (PAC), SA. METHODS. A descriptive population-based study that included all women delivering in the PAC. The World Health Organization definition, criteria and indicators of near miss and maternal death were used to identify women with severe complications in pregnancy. RESULTS. Between 1 August 2013 and 31 July 2014, there were 26 614 deliveries in the PAC. The institutional maternal mortality ratio was 71.4/100 000 live births. The HIV infection rate was 19.9%, and 2.7% of women had unknown HIV status. Of the women, 1 120 (4.2%) developed potentially life-threatening conditions and 136 (0.5%) life-threatening conditions. The mortality index was 14.0% overall, 30.0% for non-pregnancy-related infections, 2.0% for obstetric haemorrhage and 13.6% for hypertension. Of the women with life-threatening conditions, 39.3% were referred from the primary level of care. Vascular, uterine and coagulation dysfunctions were the most frequent organ dysfunctions in women with life-threatening conditions. The perinatal mortality rate was 26.9/1 000 births overall, 23.1/1 000 for women with non-life-threatening conditions, and 198.0/1 000 for women with life-threatening conditions. CONCLUSION. About one in 20 pregnant women in the PAC had a potentially life-threatening condition; 39.3% of women presented to a primary level facility as an acute emergency and had to be transferred for tertiary care. All healthcare professionals involved in maternity care must have knowledge and skills that equip them to manage obstetric emergencies. Review of the basic antenatal care protocol may be necessary.
SDG3—Research
Agenda 2063: A1
Keywords: maternal mortality, Pretoria, South Africa, Tshwane
This article adds to the debate on appropriate staffing in maternity units. My starting point for assessing staffing norms is the staff required to provide a safe maternity unit. A survey in 12 districts showed that their health facilities were not adequately prepared to perform all the essential emergency services required. Lack of staff was often cited as a reason. To test this notion, two norms (World Health Organization (WHO) and Greenfield) giving the minimum staff required for the provision of safe maternity services were applied to the 12 districts. Assuming the appropriate equipment is available and the facility is open 24 hours a day 7 days a week, at a minimum there need to be ten professional nurses with midwifery/advanced midwives to ensure safety for mother and baby in every maternity unit. The norms indicate that the units should do a minimum of 500 - 1 200 deliveries per year to be cost-effective. All 12 districts had sufficient staff according to the WHO. When the numbers of facilities with maternity units were compared with Council for Scientific and Industrial Research and WHO norms for number of health facilities per population, a large excess of facilities was found. Per district there were sufficient personnel to perform the number of deliveries for that district using the WHO or Greenfield formulas, but per site there were insufficient personnel. In my view there are sufficient personnel to provide safe maternity services, but too many units are performing deliveries, leading to dilution of staff and unsafe services. A realignment of maternity units must be undertaken to provide safe services, even at the expense of accessibility.
SDG3—Research
Agenda 2063: A1
Keywords: infant mortality, maternal mortality, neonatal mortality

What is the impact of multi-professional emergency obstetric and neonatal care training?

Authors: Anne-Marie Bergh, Shisana Baloyi & Robert C Pattinson
This paper reviews evidence regarding change in health-care provider behaviour and maternal and neonatal outcomes as a result of emergency obstetric and neonatal care (EmONC) training. A refined version of the Kirkpatrick classification for programme evaluation was used to focus on change in efficiency and impact of training (levels 3 and 4). Twenty-three studies were reviewed e five randomised controlled trials, two quasi-experimental studies and 16 before-and-after observational studies. Training programmes had all been developed in high-income countries and adapted for use in low- and middle-income countries. Nine studies reported on behaviour change and 13 on process and patient outcomes. Most showed positive results. Every maternity unit should provide EmONC teamwork training, mandatory for all health-care providers. The challenges are as follows: scaling up such training to all institutions, sustaining regular in-service training, integrating training into institutional and health-system patient safety initiatives and thinking out of the box in evaluation research.
SDG3—Research
Agenda 2063:
Keywords: infant mortality, maternal mortality, neonatal mortality, South Africa

Triple return on investment: The cost and impact of 13 interventions that could prevent stillbirths and save the lives of mothers and babies in South Africa

Authors: Julia Michalow, Lumbwe Chola, Shelley McGee, Aviva Tugendhaft, Robert Pattinson, Kate Kerber & Karen Hofman
BACKGROUND : The time of labor, birth and the first days of life are the most vulnerable period for mothers and children. Despite significant global advocacy, there is insufficient understanding of the investment required to save additional lives. In particular, stillbirths have been neglected. Over 20 000 stillbirths are recorded annually in South Africa, many of which could be averted. This analysis examines available South Africa specific stillbirth data and evaluates the impact and cost-effectiveness of 13 interventions acknowledged to prevent stillbirths and maternal and newborn mortality. METHODS : Multiple data sources were reviewed to evaluate changes in stillbirth rates since 2000. The intervention analysis used the Lives Saved tool (LiST) and the Family Planning module (FamPlan) in Spectrum. LiST was used to determine the number of stillbirths and maternal and neonatal deaths that could be averted by scaling up the interventions to full coverage (99%) in 2030. The impact of family planning was assessed by increasing FamPlans default 70% coverage of modern contraception to 75% and 80% coverage. Total and incremental costs were determined in the LiST costing module. Cost-effectiveness measured incremental cost effectiveness ratios per potential life years gained. RESULTS: Significant variability exists in national stillbirth data. Using the international stillbirth definition, the SBR was 17.6 per 1 000 births in 2013. Full coverage of the 13 interventions in 2030 could reduce the SBR by 30% to 12.4 per 1 000 births, leading to an MMR of 132 per 100 000 and an NMR of 7 per 1 000 live births. Increased family planning coverage reduces the number of deaths significantly. The full intervention package, with 80% family planning coverage in 2030, would require US$420 million (US$7.8 per capita) annually, which is less than baseline costs of US$550 million (US$10.2 per capita). All interventions were highly cost-effective. CONCLUSION : This is the first analysis in South Africa to assess the impact of scaling up interventions to avert stillbirths. Improved coverage of 13 interventions that are already recommended could significantly impact the rates of stillbirth and maternal and neonatal mortality. Family planning should also be prioritized to reduce mortality and overall costs.
SDG3—Research
Agenda 2063: A1
Keywords: infant mortality, maternal mortality, neonatal mortality, South Africa

Strategies to sustain a quality improvement initiative in neonatal resuscitation

Authors: Carlien van Heerden, Carin Maree & Elsie S Janse van Rensburg
BACKGROUND : Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SAs district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4. AIM : The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated. SETTING : A maternity section of a district hospital in South Africa. METHODS : The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly. RESULTS : The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting. CONCLUSION : These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africas drive to attain the MDG4.
SDG3—Research
Agenda 2063: A1
Keywords: infant mortality, neonatal mortality

Increased risk and mortality of invasive pneumococcal disease in HIV-exposed-uninfected infants <1 year of age in South Africa, 2009-2013

Authors: Claire von Mollendorf, Anne von Gottberg, Stefano Tempia, Susan Meiring, Linda de Gouveia, Vanessa Quan, Sarona Lengana, Theunis Avenant, Nicolette du Plessis, Brian Eley, Heather Finlayson, Gary Reubenson, Mamokgethi Moshe, Katherine L OBrien, Keith P Klugman, Cynthia G Whitney & Cheryl Cohen
BACKGROUND : High antenatal HIV seroprevalence rates (?30%) with low perinatal HIV transmission rates (2.5%) due to HIV prevention of mother-to-child transmission program improvements in South Africa, has resulted in increasing numbers of HIV-exposed-uninfected (HEU) children. We aimed to describe the epidemiology of invasive pneumococcal disease (IPD) in HEU infants. METHODS : We conducted a cross-sectional study of infants aged <1 year with IPD enrolled in a national, laboratory-based surveillance program for incidence estimations. Incidence was reported for two time points, 2009 and 2013. At enhanced sites we collected additional data including HIV status and in-hospital outcome. RESULTS : We identified 2099 IPD cases in infants from 2009-2013 from all sites. In infants from enhanced sites (n=1015), 92% had known HIV exposure status and 86% had known outcomes. IPD incidence was highest in HIV-infected infants, ranging from 272-654/100,000 population between time points (2013 and 2009), followed by HEU (33-88/100,000) and HIV-unexposed-uninfected (HUU) infants (18-28/100,000). Case fatality rate in HEU (29%, 74/253) was intermediate between HUU (25%, 94/377) and HIV-infected infants (34%, 81/242). When restricted to cases <6 months of age, HEU infants (37%, 59/175) were at significantly higher risk of dying than HUU infants (32%, 51/228; Adjusted relative risk ratio = 1.76 [95% confidence interval 1.09-2.85]). DISCUSSION : HEU infants are at increased risk of IPD and mortality from IPD compared with HUU children, especially as young infants. HEU infants, whose numbers will likely continue to increase, should be prioritized for interventions such as pneumococcal vaccination along with HIV-infected infants and children.
SDG3—Research
Agenda 2063: A1
Keywords: HIV, infant mortality, neonatal mortality, South Africa, under-five mortality

Severe events in the first 6 months of life in a cohort of HIV-unexposed infants from South Africa: Effects of low birthweight and breastfeeding status

Authors: Tanya Doherty, Debra Jackson, Sonja Swanevelder, Carl Lombard, Ingunn M S Engebretsen, Thorkild Tylleskr, Ameena Goga, Eva-Charlotte Ekstrm & David Sanders
OBJECTIVE : To report on risk factors for severe events (hospitalisation or infant death) within the first half of infancy amongst HIV-unexposed infants in South Africa. methods South African data from the multisite community-based cluster-randomised trial PROMISE EBF promoting exclusive breastfeeding in three sub-Saharan countries from 2006 to 2008 were used. The South African sites were Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal. This analysis included 964 HIV-negative mother infant pairs. Data on severe events and infant feeding practices were collected at 3, 6, 12 and 24 weeks post-partum. We used a stratified extended Cox model to examine the association between the time to the severe event and covariates including birthweight, with breastfeeding status as a time-dependent covariate. RESULTS : Seventy infants (7%) experienced a severe event. The median age at first hospitalisation was 8 weeks, and the two main reasons for hospitalisation were cough and difficult breathing followed by diarrhoea. Stopping breastfeeding before 6 months (HR 2.4; 95% CI 1.25.1) and low birthweight (HR 2.4; 95% CI 1.34.3) were found to increase the risk of a severe event, whilst maternal completion of high school education was protective (HR 0.3; 95% CI 0.10.7). CONCLUSIONS : A strengthened primary healthcare system incorporating promotion of breastfeeding and appropriate caring practices for low birthweight infants (such as kangaroo mother care) are critical. Given the leading reasons for hospitalisation, early administration of oral rehydration therapy and treatment of suspected pneumonia are key interventions needed to prevent hospitalisation in young infants.
SDG3—Research
Agenda 2063: A1
Keywords: HIV, infant mortality, South Africa, under-five mortality
BACKGROUND. Early infant diagnosis with rapid access to treatment has been found to reduce HIV-associated infant mortality and morbidity considerably. In line with international standards, current South African guidelines advocate routine HIV-1 polymerase chain reaction (PCR) testing at 6 weeks of age for all HIV-exposed infants and fast-track entry into the HIV treatment programme for those who test positive. Importantly, testing occurs within the context of increasing efforts at prevention of mother-to-child transmission (PMTCT) by means of maternal and infant antiretroviral therapy (ART). In addition, infants already initiated on combination ART (cART) may be retested with PCR assays for confirmatory purposes, including assessment prior to adoption. The potential for cART to compromise the sensitivity of HIV-1 PCR assays has been described, although there are limited and conflicting data regarding the effect of PMTCT regimens on HIV-1 PCR diagnostic sensitivity. METHODS. We describe a case series of three infants with different ART exposures in whom HIV diagnosis, confirmation or the result of retesting for adoption purposes were uncertain. RESULTS. These cases demonstrate that ART can be associated with a loss of detectability of HIV, leading to false-negative HIV-1 PCR results in infants on cART. Furthermore, current PMTCT practices may lead to repeatedly indeterminate results with a subsequent delay in initiation of cART. CONCLUSION. The sensitivity of HIV-1 PCR assays needs to be re-evaluated within the context of different ART exposures, and diagnostic algorithms should be reviewed accordingly.
SDG3—Research
Agenda 2063: A1
Keywords: HIV, infant mortality, South Africa, under-five mortality
BACKGROUND : The time from birth to the first paediatric surgical consultation of neonates with gastroschisis is a predictor of mortality in developing countries. This is contrary to findings in the developed world. We set out to document this relationship within our population. METHODS : Neonates with gastroschisis who were transferred to Steve Biko Academic Hospital within the study period were included. The association between mortality and demographic, clinical and biochemical variables was assessed. Significant variables after univariate analysis were subjected to multivariate regression. RESULTS : Sixty patients were included. The mortality rate was 65%. Mean transfer time and distance were 14.9 hours and 225km. Forty-eight per cent of the neonates were either dehydrated or in hypovolaemic shock clinically on arrival. Eight neonates arrived hypothermic. It was shown through univariate analysis that female sex, appropriate weight for gestational age, hydration status, gestation, transfer time, serum urea, base deficit and serum bicarbonate (HCO3) were significant predictors of mortality. Only female sex, appropriate weight for gestational age and serum HC03 were shown to be significant using ultivariate analysis. CONCLUSION : Our high mortality rate was not due to lengthy transfer times. The poor clinical condition of the patients on arrival at our hospital, which relates to deficiencies in the neonatal transfer system, had a direct impact on the survival of neonates with gastroschisis.
SDG3—Research
Agenda 2063:
Keywords: infant mortality, neonatal mortality, South Africa

Missed opportunities for early infant HIV diagnosis: Results of a national study in South Africa

Authors: Selamawit A Woldesenbet, Debra Jackson, Ameena E Goga, Siobhan Crowley, Tanya Doherty, Mary M Mogashoa, Thu-Ha Dinh & Gayle G Sherman
BACKGROUND : Services to diagnose early infant HIV infection should be offered at the 6-week immunization visit. Despite high 6-week immunization attendance, the coverage of early infant diagnosis (EID) is low in many sub-Saharan countries. We explored reasons for such missed opportunities at 6-week immunization visits. METHODS : We used data from 2 cross-sectional surveys conducted in 2010 in South Africa. A national assessment was undertaken among randomly selected public facilities (n = 625) to ascertain procedures for EID. A subsample of these facilities (n = 565) was revisited to assess the HIV status of 4- to 8-week-old infants receiving 6-week immunization. We examined potential missed opportunities for EID. We used logistic regression to assess factors influencing maternal intention to report for EID at 6-week immunization visits.RESULTS : EID services were available in .95% of facilities and 72% of immunization service points (ISPs). The majority (68%) of ISPs provide EID for infants with reported or documented (on infants Road-to-Health Chart/bookletiRtHC) HIV exposure. Only 9% of ISPs offered provider-initiated counseling and testing for infants of undocumented/unknown HIV exposure. Interviews with selfreported HIV-positive mothers at ISPs revealed that only 55% had their HIV status documented on their iRtHC and 35% intended to request EID during 6-week immunization. Maternal nonreporting for EID was associated with fear of discrimination, poor adherence to antiretrovirals, and inadequate knowledge about mother-to-child HIV transmission. CONCLUSIONS : Missed opportunities for EID were attributed to poor documentation of HIV status on iRtHC, inadequate maternal knowledge about mother-to-child HIV transmission, fear of discrimination, and the lack of provider-initiated counseling and testing service for undocumented, unknown, or undeclared HIV-exposed infants.
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa

Factors associated with the development of drug resistance mutations in HIV-1 infected children failing protease inhibitor-based antiretroviral therapy in South Africa

Authors: Theresa M Rossouw, Ute D Feucht, George Melikian, Gisela van Dyk, Winifred Thomas, Nicolette M du Plessis & Theunis Avenant
OBJECTIVE Limited data are available from the developing world on antiretroviral drug resistance in HIV-1 infected children failing protease inhibitor-based antiretroviral therapy, especially in the context of a high tuberculosis burden. We describe the proportion of children with drug resistance mutations after failed protease inhibitor-based antiretroviral therapy as well as associated factors. METHODS Data from children initiated on protease inhibitor-based antiretroviral therapy with subsequent virological failure referred for genotypic drug resistance testing between 2008 and 2012 were retrospectively analysed. Frequencies of drug resistance mutations were determined and associations with these mutations identified through logistic regression analysis. RESULTS The study included 65 young children (median age 16.8 months [IQR 7.8; 23.3]) with mostly advanced clinical disease (88.5% WHO stage 3 or 4 disease), severe malnutrition (median weight-for-age Z-score -2.4 [IQR -3.7;-1.5]; median height-for-age Z-score -3.1 [IQR -4.3;- 2.4]), high baseline HIV viral load (median 6.04 log10, IQR 5.34;6.47) and frequent tuberculosis co-infection (66%) at antiretroviral therapy initiation. Major protease inhibitor mutations were found in 49% of children and associated with low weight-for-age and height-for-age (p = 0.039; p = 0.05); longer duration of protease inhibitor regimens and virological failure (p = 0.001; p = 0.005); unsuppressed HIV viral load at 12 months of antiretroviral therapy (p = 0.001); tuberculosis treatment at antiretroviral therapy initiation (p = 0.048) and use of ritonavir as single protease inhibitor (p = 0.038). On multivariate analysis, cumulative months on protease inhibitor regimens and use of ritonavir as single protease inhibitor remained significant (p = 0.008; p = 0.033). CONCLUSION Major protease inhibitor resistance mutations were common in this study of HIV-1-infected children, with the timing of tuberculosis treatment and subsequent protease inhibitor dosing strategy proving to be important associated factors. There is an urgent need for safe, effective, and practicable HIV/tuberculosis co-treatment in young children and the optimal timing of treatment, optimal dosing of antiretroviral therapy, and alternative tuberculosis treatment strategies should be urgently addressed.
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa

Successfully controlling malaria in South Africa

Authors: L Blumberg, J Frean & D Moonasar
SDG3—Research
Agenda 2063: A1
Keywords: malaria, South Africa
HIV-infected children require early initiation of antiretroviral therapy (ART) to ensure good outcomes. The aim was to investigate missed opportunities in childhood HIV diagnosis leading to delayed ART initiation. Baseline data was reviewed of all children aged <15 years referred over a one-year period for ART initiation to the Kalafong Hospital HIV services in Gauteng, South Africa. Of the 250 children, one quarter (24.5%) were of school-going age, 34.5% in the preschool group, 18% between 6-12 months old and 23% below six months of age (median age=1.5 years [IQR 0.5- 4.8]). Most children (82%) presented with advanced/severe HIV disease, particularly those aged 6-12 months (95%). Malnutrition was prominent and referrals were mostly from hospital inpatient services (61%). A structured caregiver interview was conducted in a subgroup, with detailed review of medical records and HIV results. The majority (?89%) of the 65 interviewed caregivers reported good access to routine healthcare, except for postnatal care (26%). Maternal HIV-testing was mostly done during the 2nd & 3rd pregnancy trimesters (69%). Maternal non-disclosure of HIV status was common (63%) and 83% of mothers reported a lack of psychosocial support. Routine infant HIV-testing was not done in 66%, and inadequate reporting on patient-held records (Road-to- Health Cards/Booklets) occurred frequently (74%). Children with symptomatic HIV disease were not investigated at primary healthcare in 53%, and in 68% of families the siblings were not tested. One-third of children (35%) had a previous HIV diagnosis, with 77% of caregivers aware of these prior results, while 50% acknowledged failing to attend ART-services despite referral. In conclusion, a clear strategy on paediatric HIV case finding, especially at primary healthcare, is vital. Multiple barriers need to be overcome in the HIV care pathway to reach high uptake of services, of which especially maternal reasons for not attending paediatric ART services need further exploration.
SDG3—Research
Agenda 2063: A1
Keywords: Gauteng, HIV, Pretoria, South Africa, Tshwane
The CYP450 and UGT enzymes are involved in phase I and phase II metabolism of the majority of clinically prescribed drugs, including the non-nucleoside reverse transcriptase inhibitors, efavirenz and nevirapine, used in the treatment of HIV/AIDS. Variations in the activity of these enzymes due to gene polymorphisms can affect an individuals drug response or may lead to adverse drug reactions. There is an inter-ethnic distribution in the frequency of these polymorphisms, with African populations exhibiting higher genetic diversity compared to other populations. African specific alleles with clinical relevance have also emerged. Given the high prevalence of HIV/AIDS in sub- Saharan Africa, understanding the frequency of pharmacogen-etically relevant alleles in populations of African origin, and their impact on efavirenz and nevirapine metabolism, is becoming increasingly critical. This review aims to investigate ethnic variation of CYP2B6, CYP2A6 and UGT2B7, and to understand the pharmacogenetic relevance when comparing frequencies in African populations to other populations worldwide.
SDG3—Research
Agenda 2063: A1
Keywords: HIV
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, South Africa

Detection of acute and early HIV-1 infections in an HIV hyper-endemic area with limited resources

Authors: Simnikiwe H Mayaphi, Desmond J Martin, Thomas C Quinn, Oliver Laeyendecker, Steve A S Olorunju, Gregory R Tintinger & Anton C Stoltz
BACKGROUND: Two thirds of the world's new HIV infections are in sub-Saharan Africa. Acute HIV infection (AHI) is the time of virus acquisition until the appearance of HIV antibodies. Early HIV infection, which includes AHI, is the interval between virus acquisition and establishment of viral load set-point. This study aimed to detect acute and early HIV infections in a hyper-endemic setting. METHODS: This was a cross-sectional diagnostic study that enrolled individuals who had negative rapid HIV results in five clinics in South Africa. Pooled nucleic acid amplification testing (NAAT) was performed, followed by individual sample testing in positive pools. NAAT-positive participants were recalled to the clinics for confirmatory testing and appropriate management. HIV antibody, p24 antigen, Western Blot and avidity tests were performed for characterization of NAAT-positive samples. RESULTS: The study enrolled 6910 individuals with negative rapid HIV results. Median age was 27 years (interquartile range {IQR}: 23-31). NAAT was positive in 55 samples, resulting in 0.8% newly diagnosed HIV-infected individuals (95% confidence interval {CI}: 0.6-1.0). The negative predictive value for rapid HIV testing was 99.2% (95% CI: 99.0-99.4). Characterization of NAAT-positive samples revealed that 0.04% (95% CI: 0.000-0.001) had AHI, 0.3% (95% CI: 0.1-0.4) had early HIV infection, and 0.5% (95% CI: 0.5-0.7) had chronic HIV infection. Forty-seven (86%) of NAAT-positive participants returned for follow-up at a median of 4 weeks (IQR: 2-8). Follow-up rapid tests were positive in 96% of these participants. CONCLUSIONS: NAAT demonstrated that a substantial number of HIV-infected individuals are misdiagnosed at South African points-of-care. Follow-up rapid tests done within a 4 week interval detected early and chronic HIV infections initially missed by rapid HIV testing. This may be a practical and affordable strategy for earlier detection of these infections in resource-constrained settings. Newer molecular tests that can be used at the points-of-care should be evaluated for routine diagnosis of HIV in hyper-endemic settings.
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa

Enhancing HIV treatment access and outcomes amongst HIV infected children and adolescents in resource limited settings

Authors: Ameena Ebrahim Goga, Yagespari Singh, Michelle Singh, Nobuntu Noveve, Vuyolwethu Magasana, Trisha Ramraj, Fareed Abdullah, Ashraf H Coovadia, Sanjana Bhardwaj & Gayle G Sherman
INTRODUCTION : Increasing access to HIV-related care and treatment for children aged 018 years in resource-limited settings is an urgent global priority. In 20112012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. METHODS : Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. RESULTS : To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of results to facilities; (6) community leader and health worker advocacy at creches, schools, religious centres to increase uptake of HIV testing and dispel fatalistic beliefs about HIV; (7) use of mobile communication technology (m-health) and peer/community supporters to maintain contact with patients. DISCUSSION AND CONCLUSION : We propose that this package of facility,community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free survival.
SDG3—Research
Agenda 2063: A1, A6
Keywords: HIV

First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa

Authors: Ameena E Goga, Thu-Ha Dinh, Debra J Jackson, Carl Lombard, Kevin P Delaney, Adrian Puren, Gayle Sherman, Selamawit Woldesenbet, Vundli Ramokolo, Siobhan Crowley, Tanya Doherty, Mickey Chopra, Nathan Shaffer & Yogan Pillay
BACKGROUND : There is a paucity of data on the national population-level effectiveness of preventing mother-tochild transmission (PMTCT) programmes in high-HIVprevalence, resource-limited settings. We assessed national PMTCT impact in South Africa (SA), 2010. METHODS : A facility-based survey was conducted using a stratified multistage, cluster sampling design. A nationally representative sample of 10 178 infants aged 48 weeks was recruited from 565 clinics. Data collection included caregiver interviews, record reviews and infant dried blood spots to identify HIV-exposed infants (HEI) and HIV-infected infants. During analysis, self-reported antiretroviral (ARV) use was categorised: 1a: triple ARV treatment; 1b: azidothymidine >10 weeks; 2a: azidothymidine ?10 weeks; 2b: incomplete ARV prophylaxis; 3a: no antenatal ARV and 3b: missing ARV information. Findings were adjusted for non-response, survey design and weighted for live-birth distributions. RESULTS : Nationally, 32% of live infants were HEI; early mother-to-child transmission (MTCT) was 3.5% (95% CI 2.9% to 4.1%). In total 29.4% HEI were born to mothers on triple ARV treatment (category 1a) 55.6% on prophylaxis (1b, 2a, 2b), 9.5% received no antenatal ARV (3a) and 5.5% had missing ARV information (3b). Controlling for other factors groups, 1b and 2a had similar MTCT to 1a (Ref; adjusted OR (AOR) for 1b, 0.98, 0.52 to 1.83; and 2a, 1.31, 0.69 to 2.48). MTCT was higher in group 2b (AOR 3.68, 1.69 to 7.97). Within group 3a, early MTCT was highest among breastfeeding mothers 11.50% (4.67% to 18.33%) for exclusive breast feeding, 11.90% (7.45% to 16.35%) for mixed breast feeding, and 3.45% (0.53% to 6.35%) for no breast feeding). Antiretroviral therapy or >10 weeks prophylaxis negated this difference (MTCT 3.94%, 1.98% to 5.90%; 2.07%, 0.55% to 3.60% and 2.11%, 1.28% to 2.95%, respectively). CONCLUSIONS : SA, a high-HIV-prevalence middle income country achieved <5% MTCT by 48 weeks post partum. The long-term impact on PMTCT on HIV-free survival needs urgent assessment.
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa

Marginal structural models to assess delays in second-line HIV treatment initiation in South Africa

Authors: Julia K Rohr, Prudence Ive, C Robert Horsburgh, Rebecca Berhanu, Kate Shearer, Mhairi Maskew, Lawrence Long, Ian Sanne, Jean Bassett, Osman Ebrahim & Matthew P Fox
BACKGROUND South African HIV treatment guidelines call for patients who fail first-line antiretroviral therapy (ART) to be switched to second-line ART, yet logistical issues, clinician decisions and patient preferences make delay in switching to second-line likely. We explore the impact of delaying second-line ART after first-line treatment failure on rates of death and virologic failure. METHODS We include patients with documented virologic failure on first-line ART from an observational cohort of 9 South African clinics. We explored predictors of delayed second-line switch and used marginal structural models to analyze rates of death following first-line failure by categorical time to switch to second-line. Cox proportional hazards models were used to examine virologic failure on second-line ART among patients who switched to second- line. RESULTS 5895 patients failed first-line ART, and 63% switched to second-line. Among patients who switched, median time to switch was 3.4 months (IQR: 1.18.7 months). Longer time to switch was associated with higher CD4 counts, lower viral loads and more missed visits prior to first-line failure. Worse outcomes were associated with delay in second-line switch among patients with a peak CD4 count on first-line treatment 100 cells/mm3. Among these patients, marginal structural models showed increased risk of death (adjusted HR for switch in 612 months vs. 01.5 months = 1.47 (95% CI: 0.942.29), and Cox models showed increased rates of second-line virologic failure despite the presence of survivor bias (adjusted HR for switch in 36 months vs. 01.5 months = 2.13 (95% CI: 1.014.47)). CONCLUSIONS Even small delays in switch to second-line ART were associated with increased death and second-line failure among patients with low CD4 counts on first-line. There is opportunity for healthcare providers to switch patients to second-line more quickly.
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa

Molecular detection of Mycobacterium tuberculosis from sputum transported in PrimeStore from rural settings

Authors: L T Daum, R P H Peters, P B Fourie, K Jonkman, S A Worthy, J D Rodriguez, N A Ismail, S V Omar & G W Fischer
SETTING : Mopani District, South Africa. OBJECTIVE : To explore remote, molecular detection of Mycobacterium tuberculosis from sputum transported using PrimeStorew Molecular Transport Medium (PSMTM) compared to settings where microscopy or Xpertw MTB/RIF is used as the baseline test. DESIGN : Two sputum specimens were collected from patients with cough of72 weeks at clinics in rural South Africa. Shortly after expectoration and before processing using Xpert, microscopy and liquid culture, a flocked swab was swirled in each of these specimens and placed in PS-MTM. Swabs were stored and transported to the United States at ambient temperature for real-time PrimeMixw polymerase chain reaction (PM-PCR). RESULTS : Of 132 patients, 23 (17%) were positive on microscopy, 39 (30%) on Xpert and 44 (33%) by PSMTM/PSMTM/ PM-PCR. Concordance of PS-MTM/PM-PCR with positive microscopy and Xpert was respectively 96% and 85%. Of 107 microscopy-negative samples, 22 (21%) were positive using PS-MTM/PM-PCR, while 11/91 (12%) Xpert-negative samples were PS-MTM/ PM-PCR-positive. PS-MTM/PM-PCR positivity was significantly higher than smear microscopy positivity (P , 0.001), but similar to Xpert (P 0.33). CONCLUSION: PCR testing of specimens transported in PS-MTM would enhance TB diagnosis in settings where smear microscopy is the baseline diagnostic test, and could provide an alternative in settings where Xpert testing is not available.
SDG3—Research
Agenda 2063:
Keywords: Mopani, South Africa, TB, tuberculosis

Performance of a novel algorithm using automated digital microscopy for diagnosing tuberculosis

Authors: Nazir A Ismail1, Shaheed V Omar1, James J Lewis, David W Dowdy, Andries W Dreyer, Hermina van der Meulen, George Nconjana, David A Clark & Gavin J Churchyard
RATIONALE :TBDx automated microscopy is a novel technology that processes digital microscopic images to identify acid-fast bacilli (AFB). Use of TBDx as part of a diagnostic algorithm could improve the diagnosis of tuberculosis (TB), but its performance characteristics have not yet been formally tested. OBJECTIVES : To evaluate the performance of the TBDx automated microscopy system in algorithms for diagnosis of TB. METHODS : Prospective samples from patients with presumed TB were processed in parallel with conventional smear microscopy, TBDx microscopy, and liquid culture. All TBDx-positive specimens were also tested with the Xpert MTB/RIF (GXP) assay. We evaluated the sensitivity and specificity of two algorithms-(1) TBDx-GXP (TBDx with positive specimens tested by Xpert MTB/RIF) and (2) TBDx alone-against the gold standard liquid media culture. MEASUREMENTS AND MAIN RESULTS : Of 1,210 samples, 1,009 were eligible for evaluation, of which 109 were culture positive for Mycobacterium tuberculosis. The TBDx system identified 70 specimens (68 culture positive) as having 10 or more putative AFB (high positive) and 207 (19 culture positive) as having 1-9 putative AFB (low positive). An algorithm in which "low-positive" results on TBDx were confirmed by GXP had 78% sensitivity (85 of 109) and 99.8% specificity (889 of 900), requiring 21% (207 of 1,009) specimens to be processed by GXP. As a stand-alone test, a "high-positive" result on TBDx had 62% sensitivity and 99.7% specificity. CONCLUSIONS : TBDx used in diagnostic algorithms with GXP provided reasonable sensitivity and high specificity for active TB while dramatically reducing the number GXP tests performed. As a stand-alone microscopy system, its performance was equivalent to that of a highly experienced TB microscopist.
SDG3—Research
Agenda 2063: A1
Keywords: TB, tuberculosis
BACKGROUND AND AIMS : Tuberculosis (TB) patients who smoke risk adverse TB outcomes and other long-term health effects of smoking. This study aimed to determine the efficacy of brief motivational interviewing by lay health-care workers (LHCWs) in assisting TB patients to quit smoking. DESIGN : Multi-centre two-group parallel individual randomized controlled trial. SETTING : Six primary care tuberculosis clinics in a South African township. PARTICIPANTS : Newly diagnosed adult TB patients identified as current smokers were randomized to brief motivational interviewing by a LHCW (intervention group, n = 205) or brief smoking cessation advice from a TB nurse (control group, n = 204). MEASUREMENTS : The primary outcome was self-reported sustained 6-month smoking abstinence. Exhaled carbon monoxide (CO) testing was offered to about half the participants. Secondary outcomes were sustained abstinence at 3 months; 7-day point prevalence abstinence at 1, 3 and 6 months; and quit attempts. Allocation was concealed. Primary analysis relied on intention to treat. Multi-level analysis accounted for site heterogeneity of effect. FINDINGS : Self-reported 6-month sustained abstinence was 21.5% for the intervention group versus 9.3% for the control group [relative risk (RR) = 2.29, 95% confidence interval (CI) = 1.34, 3.92]. Biochemically verified 6-month sustained abstinence was also higher in the intervention group (RR 2.21, 95% CI = 1.08, 4.51) for the 166 participants who were offered carbon monoxide testing. Self-reported 3-month sustained abstinence was 25.4% for the intervention group and 12.8% for the control group (RR = 1.98, 95% CI = 1.24, 3.18). CONCLUSIONS : Motivational interviewing by lay counsellors to promote smoking cessation in tuberculosis patients in South Africa approximately doubled sustained smoking abstinence for at least 6 months compared with brief advice alone.
SDG3—Research
Agenda 2063:
Keywords:

Sustaining control: Lessons from the Lubombo spatial development initiative in southern Africa

Authors: Rajendra Maharaj, Devanand Moonasar, Candrinho Baltazar, Simon Kunene & Natashia Morris
BACKGROUND : The Lubombo Spatial Development Initiative (LSDI) was a tri-country project between South Africa, Swaziland and Mozambique with the aim of accelerating socio-economic development in the region. The malaria component of the project was introduced to decrease the transmission of malaria in the region. This goal was met but with termination of this project resulted in an upsurge of malaria cases in the sub-region mainly as a result of migration from high transmission areas to low transmission ones. The movement of people across borders in southern Africa remains a challenge in sustaining malaria control and elimination. METHODS : Malaria case data for Swaziland and South Africa were obtained from their respective national Malaria Information Systems. Data for Mozambique was obtained from the Mozambican Ministry of Health. Data obtained during the course of the LSDI project was compared to the case data post the termination of the LSDI. RESULTS : The 12-year period of the LSDI showed a substantial decrease in disease burden amongst the three countries involved when compared to the baseline year of 2000. The decrease in malaria cases was 99 % in South Africa and 98 % in Swaziland. Malaria prevalence in Mozambique decreased by 85 % over the same period. However, after the LSDI ended, between 2012 and 2014, there was an upward trend in case data that was counter to the goal of elimination. CONCLUSION : South Africa and Swaziland benefitted from the LSDI and were able to sustain malaria control and progress to the stage of elimination. Mozambique could not sustain the gains made during the LSDI and case numbers increased. Technical and financial resources are key challenges for malaria control and elimination interventions.
SDG3—Research
Agenda 2063: A2
Keywords: malaria

Reviewing South Africas malaria elimination strategy (20122018): Progress, challenges and priorities

Authors: Jaishree Raman, Natashia Morris, John Frean, Basil Brooke, Lucille Blumberg, Philip Kruger, Aaron Mabusa, Eric Raswiswi, Bridget Shandukani, Eunice Misani, Mary-Anne Groepe & Devanand Moonasar
BACKGROUND : With a sustained national malaria incidence of fewer than one case per 1000 population at risk, in 2012 South Africa officially transitioned from controlling malaria to the ambitious goal of eliminating malaria within its borders by 2018. This review assesses the progress made in the 3 years since programme re-orientation while highlighting challenges and suggesting priorities for moving the malaria programme towards elimination. METHODS : National malaria case data and annual spray coverage data from 2010 until 2014 were assessed for trends. Information on surveillance, monitoring and evaluation systems, human and infrastructure needs and community malaria knowledge was sourced from the national programme mid-term review. RESULTS : Malaria cases increased markedly from 6811 in 2013 to 11,711 in 2014, with Mpumalanga and Limpopo provinces most affected. Enhanced local transmission appeared to drive malaria transmission in Limpopo Province, while imported malaria cases accounted for the majority of cases reported in Mpumalanga Province. Despite these increases only Vhembe and Mopani districts in Limpopo Province reported malaria incidences more than one case per 1000 population at risk by 2014. Over the review period annual spray coverage did not reach the recommended target of 90 % coverage, with information gaps identified in parasite prevalence, artemether-lumefantrine therapeutic utilization, asymptomatic/sub-patent carriage, drug efficacy, vector distribution and insecticide resistance. CONCLUSIONS : Although South Africa has made steady progress since adopting an elimination agenda, a number of challenges have been identified. The heterogeneity of malaria transmission suggests interventions in Vhembe and Mopani districts should focus on control, while in KwaZulu-Natal Province eliminating transmission foci should be prioritized. Cross-border initiatives with neighbouring countries should be established/strengthened as a matter of urgency since malaria importation poses a real threat to the countrys elimination efforts. It is also critical that provincial programmes are adequately resourced to effectively conduct the necessary targeted elimination activities, informed by current vector/parasite distribution and resistance data. More sensitive methods to detect sub-patent infections, primaquine as a transmission-blocking drug, and alternative vector control methods need to be investigated. Knowledge gaps among malaria health workers and affected communities should be identified and addressed.
SDG3—Research
Agenda 2063: A1
Keywords: malaria, South Africa

Natural products as leads to potential mosquitocides

Authors: Navneet Kishore, Bhuwan B Mishra, Vinod K Tiwari, Vyasji Tripathi, & Namrita Lall
Mosquitoes are the crucial vectors for a number of mosquito-borne infectious diseases i.e. dengue, yellow fever, chikungunya, malaria, Rift Valley fever, elephantiasis, Japanese Encephalitis, and Murray Valley encephalitis etc. Besides, they also transmit numerous arboviruses (arthropod-borne viruses) for example West Nile virus, Saint Louis encephalitis virus, Eastern equine encephalomyelitis virus, Everglades virus, Highlands J virus, and La Crosse Encephalitis virus. The emergence of widespread insecticide resistance and the potential environmental issues associated with some synthetic insecticides (such as DDT) has indicated that additional approaches to control the proliferation of mosquito population would be an urgent priority research. The present review highlights some natural product mosquitocides that are target-specific, biodegradable, environmentally safe, and botanicals in origin.
SDG3—Research
Agenda 2063: A1
Keywords: malaria

mSpray: A mobile phone technology to improve malaria control efforts and monitor human exposure to malaria control pesticides in Limpopo, South Africa

Authors: Brenda Eskenazi, Lesliam Quiro?s-Alcala?, Jonah M Lipsitt, Lemuel D Wua, Philip Kruger, Tzundzukani Ntimbane, John Burns Nawn, M S Riana Bornman & Edmund Seto
Recent estimates indicate thatmalaria has led to over half amillion deathsworldwide,mostly to African children. Indoor residual spraying (IRS) of insecticides is one of the primary vector control interventions. However, current reporting systems do not obtain precise location of IRS events in relation tomalaria cases,which poses challenges for effective and efficient malaria control. This information is also critical to avoid unnecessary human exposure to IRS insecticides. We developed and piloted a mobile-based application (mSpray) to collect comprehensive information on IRS spray events. We assessed the utility, acceptability and feasibility of using mSpray to gather improved homestead- and chemical-level IRS coverage data. We installed mSpray on 10 cell phones with data bundles, and pilot tested it with 13 users in Limpopo, South Africa. Users completed basic information (number of rooms/shelters sprayed; chemical used, etc.) on spray events. Upon submission, this information as well as geographic positioning system coordinates and time/date stamp were uploaded to a Google Drive Spreadsheet to be viewed in real time. We administered questionnaires, conducted focus groups, and interviewed key informants to evaluate the utility of the app. The low-cost, cell phone-based mSpray app was learned quickly by users, well accepted and preferred to the current paper-based method. We recorded 2865 entries (99.1% had a GPS accuracy of 20 m or less) and identified areas of improvement including increased battery life. We also identified a number of logistic and user problems (e.g., cost of cell phones and cellular bundles, battery life, obtaining accurate GPS measures, user errors, etc.) that would need to be overcome before full deployment. Use of cell phone technology could increase the efficiency of IRSmalaria control efforts by mapping spray events in relation to malaria cases, resulting in more judicious use of chemicals that are potentially harmful to humans and the environment.
SDG3—Research
Agenda 2063: A1
Keywords: Limpopo, malaria, South Africa

Successfully controlling malaria in South Africa

Authors: L Blumberg, J Frean & D Moonasar
Following major successes in malaria control over the past 75 years, South Africa is now embarking on a malaria elimination campaign with the goal of zero local transmission by the year 2018. The key control elements have been intensive vector control, primarily through indoor residual spraying, case management based on parasitological diagnosis using evidence-based drug policies with artemisinin-based combination therapy since 2001, active health promotion in partnership with communities living in the malaria transmission areas, and cross-border collaborations. Political commitment and long-term funding for the malaria control programme have been a critical component of the programmes success. Breaking the cycle of transmission through strengthening of active surveillance using sensitive molecular tests and field treatment of asymptomatic persons, monitoring for antimalarial drug resistance and insecticide resistance, strengthening cross-border initiatives, and ongoing programme advocacy in the face of a significant decrease in disease burden are key priorities for achieving the elimination goal.
SDG3—Research
Agenda 2063: A1
Keywords: malaria, South Africa

Linalool oxide: Generalist plant based lure for mosquito disease vectors

Authors: Vincent O Nyasembe, David P Tchouassi, Charles M Mbogo, Catherine L Sole, Christian Pirk & Baldwyn Torto
BACKGROUND : Lack of effective vaccines and therapeutics for important arboviral diseases such as Rift Valley fever (RVF) and dengue, necessitates continuous monitoring of vector populations for infections in them. Plant-based lures as surveillance tools has the potential of targeting mosquitoes of both sexes and females of varied physiological states; yet such lures are lacking for vectors of these diseases. Here, we present evidence of the effectiveness of linalool oxide (LO), a single plant-based lure previously developed for malaria vectors in trapping RVF vectors, Aedes mcintoshi and Aedes ochraceus, and dengue vector, Aedes aegypti. METHODS : For RVF vectors, we used CDC traps to evaluate the performance of LO against three vertebrate-based lures: CO2 (dry ice), BioGent (BG) lure, and HONAD (a blend of aldehydes) in 2 experiments with Completely Randomized design: 1) using unlit CDC traps baited separately with LO, HONAD and BG-lure, and unlit CDC trap + CO2 and lit CDC trap as controls, 2) similar treatments but with inclusion of CO2 to all the traps. For dengue vectors, LO was evaluated against BG lure using BG sentinel traps, in a 3 6 Latin Square design, first as single lures and then combined with CO2 and traps baited with CO2 included as controls. Trap captures were compared between the treatments using Chi square and GLM. RESULTS : Low captures of RVF vectors were recorded for all lures in the absence of CO2 with no significant difference between them. When combined with CO2, LO performance in trapping these vectors was comparable to BG-lure and HONAD but it was less effective than the lit CDC trap. In the absence of CO2, LO performed comparably with the BGlure in trapping female Ae. aegypti, but with significantly higher males recorded in traps baited with the plant-based lure. When CO2 was added, LO was significantly better than the BG-lure with a 2.8- fold increase in captures of male Ae. aegypti. CONCLUSIONS : These results highlight the potential of LO as a generalist plant-based lure for mosquito disease vectors, pending further assessment of possible specificity in their response profile to the different stereoisomers of this compound.
SDG3—Research
Agenda 2063: A1
Keywords: malaria
BACKGROUND. Despite enormous strides in preventing hepatitis B virus (HBV) infection, perinatal transmission still contributes significantly to HBV epidemiology worldwide; this could account for approximately 50% of chronically infected individuals. OBJECTIVE. To assess the need for HBV screening in antenatal clinics in the HIV/AIDS era. METHODS. This was a retrospective study conducted at the antenatal clinic of 1 Military Hospital, Tshwane, South Africa. Laboratory data for HBV, HIV and CD4 count were obtained and analysed for the period January 2008 - December 2013. RESULTS. A total of 2 513 patients results were retrieved and 2 368 patients were enrolled as both their HBV and HIV serology results were available. The mean age of participants was 29 years (range 14 - 46). HIV prevalence in this study was 20.5% (95% confidence interval (CI) 0.189 - 0.222). The median CD4 count in HIV-infected patients was 522 cells/?L (interquartile range 370 - 711). There was an overall HBV prevalence of 0.8% (95% CI 0.005 - 0.011). The hepatitis B surface antigen (HBsAg) prevalence was significantly higher (2.1%) among HIV co-infected compared with HIV-uninfected patients (0.4%) (p=0.0001). Hepatitis e antigen (HBeAg) positivity was 30% in the HIV co-infected compared with 37.6% in the HIV-uninfected individuals (p=0.7400). CONCLUSION. This study showed a significantly higher HBV prevalence in HIV-infected compared with HIV-uninfected patients. The comparable HBeAg prevalence between the two groups indicates that both were at an increased risk of vertical transmission, therefore demonstrating a need for antenatal screening for HBV. Since antenatal screening is often not affordable in low-income countries, administration of HBV vaccine at birth is needed for prevention of vertical transmission.
SDG3—Research
Agenda 2063: A1
Keywords: hepatitis, Pretoria, South Africa, Tshwane
Cervical cancer remains an important cause of morbidity and mortality in South Africa (SA). A national cervical cancer prevention programme exists that offers three cervical cytology smears per lifetime, starting after the age of 30 at 10-year intervals. Despite this programme the incidence remains unacceptably high, cases are often diagnosed late, and many patients have poor response to treatment. Primary healthcare systems in many areas are poorly developed, and uptake of cytological screening is generally poor, with some metropolitan areas and regions doing slightly better. Health systems interventions are necessary to improve the quality of screening. In addition, there is often significant loss to follow-up after the initial screening test among women identified with abnormal cytology. Determinants of the high cervical cancer rate and poor outcome of treatment are similar to those in other developing countries and include a low doctor/population ratio, a high prevalence of HIV infections, and competing healthcare needs. A lack of consumer (patient) knowledge and empowerment leads to a low degree of health-seeking behaviour.
SDG3—Research
Agenda 2063: A1
Keywords: cancer, South Africa

Establishment of a cancer surveillance programme: The South African experience

Authors: Elvira Singh, Paul Ruff, Chantal Babb, Mazvita Sengayi, Moira Beery, Lerato Khoali, Patricia Kellett & J Michael
Cancer is projected to become a leading cause of morbidity and mortality in low-income and middle-income countries in the future. However, cancer incidence in South Africa is largely under-reported because of a lack of nationwide cancer surveillance networks. We describe present cancer surveillance activities in South Africa, and use the International Agency for Research on Cancer framework to propose the development of four population-based cancer registries in South Africa. These registries will represent the ethnic and geographical diversity of the country. We also provide an update on a cancer surveillance pilot programme in the Ekurhuleni Metropolitan District, and the successes and challenges in the implementation of the IARC framework in a local context. We examine the development of a comprehensive cancer surveillance system in a middle-income country, which might serve to assist other countries in establishing population-based cancer registries in a resource-constrained environment.
SDG3—Research
Agenda 2063: A1
Keywords: cancer, South Africa
Background. Despite the availability of international guidelines for the treatment of type 1 diabetes mellitus (T1DM) in children, important aspects of treatment are not accessible to all young patients in South Africa (SA). Objective. To investigate factors in diabetes management strategies that are associated with poor glycaemic control and decreased quality of life (QoL) in SA children with T1DM. Methods. Eighty children (mean (standard deviation) age 12.9 (2.7) years) with T1DM were asked to answer standardised questionnaires on demographics, management techniques used and perceptions of diabetes. The height and weight of each child was recorded and glycosylated haemoglobin (HbA1c) measured. Informed consent and assent for each participant was obtained before enrolment. Results. A total of 51.4% of the participants had poor metabolic control, with an HbA1c level >10.0% (86 mmol/mol). Factors in clinical practice found to have a significant association with decreased HbA1c and/or QoL were healthcare system (p<0.001), insulin administration (p=0.001), correction dose (p=0.002), carbohydrate counting (p<0.001) and number of severe hyperglycaemic events (p=0.048). Regular exercise did not show any association with HbA1c classification or QoL. Children from single-parent households were prone to unsuccessful diabetes management regardless of treatment techniques used (p=0.002). Conclusions. The use of premixed insulin without access to rapid-acting insulin, absence of correction doses for hyperglycaemia and lack of carbohydrate counting showed significant association with poor diabetes management. Some recommendations regarding the adoption of more effective diabetes management strategies in the public healthcare system are suggested.
SDG3—Research
Agenda 2063: A1
Keywords: diabetes, South Africa
OBJECTIVE : To evaluate the effect of a nutrition education (NE) programme on diabetes knowledge and attitudes of adults with type 2 diabetes mellitus (T2DM). METHODS : Eighty-two adults (4070 years) with poorly controlled T2DM (HbA1c ? 8%) and attending two community health centres in Moretele, North West Province (South Africa) participated in a one-year randomised controlled trial. Participants were randomised to the intervention group (n = 41; 8 weekly group education (22.5 hours); follow-up meetings and education materials) or control group (education materials only). Diabetes Knowledge Form B assessed knowledge about diabetes. Diabetes Attitudes Scale-III assessed the attitudes towards diabetes and treatment. Assessments were done at 6 and 12 months. Analysis of co-variance compared the groups (baseline, age, gender and clinic adjustments). An intention-to-treat analysis was employed. RESULTS : The intervention group had higher mean diabetes knowledge scores + 0.95 (p = 0.033) and + 2.05 (p < 0.001) at 6 and 12 months respectively. However, the scores were below 50%. Patient autonomy for diabetes attitudes was the only score significantly higher in the intervention group + 0.27 (p = 0.028) at 12 months. CONCLUSION : NE significantly improved diabetes knowledge in the intervention group, though not satisfactorily, but had limited effects on the attitudes towards diabetes.
SDG3—Research
Agenda 2063: A1
Keywords: diabetes, South Africa
Most information on the harmful health effects of solar ultraviolet radiation (UVR) has been obtained in populations in which the majority has fair skin. Here a systematic review of evidence on diseases related to solar UVR in Africa was undertaken, and the appropriateness of effective photoprotection for these people considered. There are few population-based studies on UV-induced skin cancers (melanoma, squamous and basal cell carcinomas) in Africa, although limited reports indicated that they occur, even in people with deeply pigmented skin. The incidence of melanoma is particularly high in the white population living in the Western Cape of South Africa and has increased significantly in recent years. Cataract is extremely common in people of all skin colours and is a frequent cause of blindness, particularly in the elderly. For both skin cancer and cataract, the proportion of the disease risk that is attributable to exposure to solar UVR in African populations, and therefore the health burden caused by UV irradiation is unclear. There was little published information on the use of sun protection in Africa. The potential disease burden attributable to solar UVR exposure of Africans is high, although accurate data to quantify this are sparse. Information is required on the incidence, prevalence and mortality for the range of UVrelated diseases in different populations living throughout Africa. Photoprotection is clearly required, at least for those subpopulations at particularly high risk, but may be limited by cost and cultural acceptability.
SDG3—Research
Agenda 2063:
Keywords: cancer
OBJECTIVES : Type 2 diabetes patients (T2D) have a considerably higher cardiovascular risk, which is closely associated with systemic inflammation, and an accompanying pathologic coagulation system. Due to the complexity of the diabetic profile, we suggest that we need to look at each patient individually and particularly at his or her clotting profile; as the healthiness of the coagulation system gives us an indication of the success of clinical intervention. RESULTS : T2D coagulability varied markedly, although there were no clear difference in medication use and the standards of HbA1c levels. RESEARCH DESIGN AND METHODS : Our sample consisted of 90 poorly controlled T2D and 71 healthy individuals. We investigated the medication use and standards of HbA1c levels of T2D and we used thromboelastography (TEG) and scanning electron microscopy (SEM) to study their clot formation. CONCLUSION : The latest NIH guidelines suggest that clinical medicine should focus on precision medicine, and the current broad understanding is that precision medicine may in future, provide personalized targets for preventative and therapeutic interventions. Here we suggest a practical example where TEG can be used as an easily accessible point-of-care tool to establish a comprehensive clotting profile analysis for T2D patients ; and additionally may provide valuable information that may be used in the envisaged precision medicine approach. Only by closely following each individual patients progress and healthiness and thereby managing systemic inflammation, will we be able to reduce this pandemic.
SDG3—Research
Agenda 2063: A1
Keywords: diabetes

Liquor outlet density, deprivation and implications for foetal alcohol syndrome prevention in the Bergriver municipality in the Western Cape, South Africa

Authors: Yasmin Bowers, Kirstie Rendall-Mkosi, Adlai Davids, Elmarie Nel,Nontobeko Jacobs & Leslie London
Foetal alcohol syndrome (FAS) is the most common preventable birth defect in the world, and some South African communities have amongst the highest reported rates. In August 2008, global positioning systems and geographic information systems (GIS) were used to collect data on legal and illegal alcohol outlets in the Bergriver municipality. A total of 112 outlets were recorded and towns with the densest distributions (outlet/km2) were Piketberg and Eendekuil. Spearman coefficients were used to estimate the relationship between alcohol outlet distributions within the study area and the South African Index of Multiple Deprivation. Although not statistically significant, the data are suggestive of an inverse relationship between legal alcohol outlets and deprivation less deprived areas had higher density of legal alcohol outlets while the opposite relationship applied for illegal alcohol outlets. GIS provides spatial documentation of determinants of FAS risks amenable to geographically based prevention strategies, as well as providing baseline data to evaluate the effectiveness of liquor legislation aimed at controlling access to alcohol. Results are being repurposed into health education materials that encourage community action to address the social determinants of health outcomes such as FAS.
SDG3—Research
Agenda 2063:
Keywords: South Africa, substance abuse, Western Cape
Suicides occur in correctional centres even though the behaviour of offenders is supposed to be closely monitored and regulated. The present study set out to identify and describe the risk factors and circumstances surrounding suicides in selected correctional centres in Gauteng (Johannesburg, Zonderwater, Boksburg and Kgosi Mampuru II). Qualitative methods, in particular semi-structured interview and focus group strategies, were followed to obtain data from two psychologists, two social workers, nine case management officers and twelve offenders. In addition, the case files of eight offenders who committed suicide in a correctional centre were scrutinised for information regarding their backgrounds, mental health, contact with their families, sentences and parole applications. The study identified an array of risk factors associated with suicide in correctional centres that can be categorised in terms of individual, interpersonal and structural contributors. Important risk factors include contact with families, mental health, type of cell accommodated in, access to prescription medication and overcrowding. The general strain and escape theories are used to explain the phenomenon of suicide in correctional centres.
SDG3—Research
Agenda 2063:
Keywords: Gauteng, South Africa, suicide
The misuse of alcohol has a particularly detrimental effect and is one of the most significant public health problems in South Africa and it also has an impact on the criminal justice system with evidence of association between high levels of alcohol and risk-taking behaviour, committing crimes, or being a victim of crime. A global trend has been set worldwide with alcohol being one of the most common drugs found in post mortem specimens and especially with regard to cases admitted for medico-legal autopsies. The influence of alcohol on the cause of death is either a contributory or an underlying factor in a substantial number of violent deaths. We retrospectively reviewed 1455 cases, in which alcohol was taken, of 2344 medico-legal autopsies done in 2009. We found that 47% of the cases tested positive for alcohol, with the reported blood alcohol concentrations varying from 0.01 to 0.95 g per 100 ml (mean = 0.16 0.11 g per 100 ml) with the highest proportion being in the 0.100.19 g per 100 ml range. A breakdown of the results showed that road traffic accidents, assaults and firearm-related deaths predominated the alcohol-positive cases. The results showed that there was a definite correlation between alcohol consumption and the incidence of other that natural deaths.
SDG3—Research
Agenda 2063:
Keywords: Pretoria, South Africa, substance abuse, Tshwane

Severe neuropathy due to inhalant abuse in adolescents from Pretoria

Authors: Clara Maria Schutte, Jayendra Naidoo, Mandisa Kakaza, Manesh Pillay & Juliane Hiesgen
Inhalation of volatile agents, or solvent abuse, is a dangerous pastime practised by many young adolescents in various parts of the world. Benzine, a distillate of petroleum, is a cheap and readily available solvent that is often inhaled or sniffed to produce a short-lived feeling of euphoria or disorientation. The aim of this report is to describe four adolescents with severe polyneuropathies secondary to chronic benzine inhalation who were seen at the Steve Biko Academic Hospital in Pretorias Neurology Department. Methods and patients: Four adolescent boys aged 1518 years presented to the Department of Neurology from 2011 to 2013 with progressive weakness and muscle atrophy. Results: On examination all patients showed signs of a severe motor and sensory neuropathy. Two were wheelchair bound at the time of presentation and an initial diagnosis of Guillain-Barr syndrome was considered. Cerebrospinal fluid analysis was normal and electromyography showed severe mixed motor and sensory mainly axonal polyneuropathies in all patients. All investigations for causes of neuropathies were normal, but all patients eventually admitted that they had been abusing benzine by inhaling it for a period of at least six months. The inhalation occurred as a group activity, involving many children. Conclusion: Inhalant abuse appears to be a common practice amongst adolescents from Pretoria. It can lead to a catastrophic polyneuropathy, which should be considered in the differential diagnosis of a young patient presenting with a Guillain-Barr syndrome-type of clinical picture. Awareness amongst schools and drug programmes should be raised to prevent this tragic and highly disabling condition.
SDG3—Research
Agenda 2063: A6
Keywords: Pretoria, South Africa, substance abuse, Tshwane
Internationally the relapse-rates following treatment are high. Relapse is a breakdown in a persons attempt to change or modify any target behaviour (Marlatt & Donovan, 2005:ix). According to Adinoff, Talmadge, Williams, Schreffer, Jackley and Krebaum (2010:140), relapse to substance abuse following treatment typically reaches 75% in the 3- to 6-month period following treatment. Focusing on national data it is evident that relapse is also prevalent in South Africa following treatment for drug abuse. In this article drugs refers specifically to illicit drugs such as dagga, heroin, LSD, ecstasy, cocaine and methamphetamine (Benavie, 2009:8). Alcohol, nicotine and prescription medication are excluded. The South African Community Epidemiology Network on Drug Use (SACENDU) (2008) indicated that 24% of the intakes into treatment centres in the Gauteng Province, 22% in Cape Town, 20% in the Northern Region and 32% in Port Elizabeth are not first-time admissions. SACENDU (2014) furthermore found that in Gauteng Africans made up 60% of the total admissions from January to June 2013, showing an increase of 12% from SACENDU statistics in 2010. From these admissions young adults seem to be a vulnerable group with 23% of the individuals aged 20-24 years, 17% aged 25-29 years, 11% aged 30-34 years and 7% aged 35-39 years (SACENDU, 2014). Based on these statistics it becomes clear that young African adults in the Gauteng Province often present with relapse after initial treatment for drug abuse. For the purpose of this article an African refers to a South African citizen of Black South African descent, excluding Coloured and Asian people.
SDG3—Research
Agenda 2063:
Keywords: Gauteng, South Africa, substance abuse
The World Health Organization (2009) indicates that the African region has some of the worlds highest road traffic fatalities globally making it the 9th leading cause of death in the region. Data shows that the risk of dying, as a result of a road traffic collision, is highest in the African region at 24.1/100 000 population (the global rate is 18/100 000). Nigeria and South Africa have the highest road traffic fatality rates (33.7 and 31.9/100 000, respectively) and, together with the Democratic Republic of Congo, Ethiopia, Kenya, Tanzania and Uganda, account for 64% of all road traffic deaths in the region (Peden et al., 2013). There is consensus in the literature that the provision of appropriate medical care following a road accident is a critical determinant of both the chance of survival and, on survival, the quality of life (ETSC, 1999; OECD, 1999). The potential to reduce fatalities by means of early and appropriate medical treatment is associated with the so called golden hour (the time to access a trauma care facility). This paper identifies the accessibility of trauma care facilities in the Western Cape.
SDG3—Research
Agenda 2063:
Keywords: road deaths, road fatalities, South Africa, traffic accidents, Western Cape
Traffic safety is a major challenge in most of cities in South Africa particularly on the arterial roads passing through the sub urban areas. The major contributing reasons for the occurrence of traffic accidents emphasized include human related factors, road related factors and vehicle related factors. However, the influence of the urban development related factors such as, land use and urban functions, urban form, urban pattern, accessibility, and density on the occurrence of traffic accidents have been least explored, particularly in the sub urban residential areas of the cities of South Africa. Therefore, this paper pertains to investigate the influence of various urban related factors on the occurrence of vehicular traffic accidents on the sub urban arterial roads of a South African city. The investigation was conducted by considering Bloemfontein City as the study area and by employing survey research methodologies, statistical analyses, development and consequent application of empirical regression models. It was revealed that level of accessibility (number of accessible roads) from residential areas to arterial roads is the major variable, which causes traffic accidents. Road geometry variables like median and road width influence the occurrence of traffic accidents to a certain extent. However, variables belonging to land use and urban functions, urban form, urban pattern, location of important urban functions in convoluted areas, and density of population have relatively lesser impact. Reduction in the number of access roads from the sub-urban residential areas to the arterial roads, provision of adequate medians in roads with no divided facility along with urban planning interventions, such as, appropriate urban pattern, and avoidance of location of urban functions in convoluted areas will enable reduction in the occurrence of traffic accidents and improve road safety in the cities of South Africa.
SDG11—Research
Agenda 2063:
Keywords: Bloemfontein, road deaths, road safety, South Africa, traffic accidents
The need to improve road safety remains a global challenge particularly in developing regions. In fact, despite a relatively low vehicle population, underdeveloped and developing countries account for 90% of road transport related fatalities and injuries globally. To date, solutions implemented have not been effective enough given the high incidences and crashes that still frequently occur and sometimes with devastating effects showing that effective solutions remain elusive. Various dimensions and approaches can be pursued and/or deployed towards addressing safety on the road network, particularly those focusing on road infrastructure, vehicular and human behaviour safety. However, what matters most is the impact that will be derived thereof towards addressing safety. This paper focuses on one of the dimensions: road user behaviour changing interventions towards improving road safety. The qualitative research method was applied towards the development of this paper. It was established that among many possible interventions that can be deployed to improve road safety in South Africa, road user behaviour changing interventions have a substantial impact on overall safety improvement. The major reason being that these interventions are proactive in nature, hence road users are capacitated to be able to take a proactive approach rather than being reactionary to possible incidences and crashes on the road. However, the effectiveness of road user behaviour focused interventions has its own challenges that will need to be addressed. This paper identifies the challenges and opportunities that can be explored to improve road safety in South Africa focusing on pedestrians, passengers, drivers, transport companies or operators and regulatory authorities.
SDG11, SDG3—Research
Agenda 2063:
Keywords: road deaths, road fatalities, road safety, traffic accidents
The objective of the paper is to explore the relationship between crime and road safety as well as the impact of criminal activities on the road environment in South Africa. These relationships have not been fully explored in the South African context, with its high road accident and fatality rates, and high levels of exposure to crime. The paper shows that criminal activities in the road environment extend significantly beyond the mere committing of road traffic offences and may have a negative impact on the safe operation of the road network and broader road environment, in addition to endangering the lives of road users and innocent bystanders. The impact of crime on road safety can be considered from various angles, the paper therefore uses a multidisciplinary approach to analyse the extent of the problem more comprehensively. A multi-disciplinary approach to analyse the safety and security of the road environment includes the potential role of sciences such as town-planning, transportation planning, information technology, ITS and traffic engineering, criminology, social psychology and road traffic management. Firstly, the paper provides an overview of research findings and practices regarding the relationship between crime and road safety, through the inputs from different disciplines. Secondly, the paper describes the criminal activities in South Africa that may have a negative impact on road safety. This includes a wide range of activities within the road environment, vehicle related crimes and road user behaviour. Other crime related incidences include the mugging of pedestrians and cyclists, taxi violence and conflict between taxi associations endangering both drivers and commuters, etc. Thirdly, the paper highlights some of the crime prevention and road safety interventions prevalent locally and internationally. Shortcomings and challenges associated with gaining more effective control over criminal activities in the road environment in South Africa are also mentioned. The paper concludes that a more focused operational approach and research are required to determine the impact of crime on road safety in South Africa. In addition, an extensive scoping of international best practices could assist in a better understanding of the impact of the phenomenon, and to develop appropriate countermeasures to effectively deal with it.
SDG11—Research
Agenda 2063:
Keywords: road safety, South Africa, traffic accidents
Pedestrian behaviour is influenced by many factors which may result in pedestrians being involved in accidents and could increase the risk and vulnerability of pedestrians. There is no simple universal solution that will reduce pedestrian accidents or the severity thereof. Pedestrian safety is everybodys concern and we should all work together to find solutions to the problem. A systems approach to improving human behaviour suggests that we need to address the problem at different levels by simultaneously implementing engineering, enforcement, education and encouragement interventions. This paper consists of a literature review of pedestrian behavioural studies carried out internationally and outlines a longitudinal study that consists of three phases, namely: 1. a before-study; 2. a phase where community pedestrian safety projects are implemented (including a community road safety forum and community road safety officers that will educate learners and either start a walking school bus or scholar patrol, improvement of pedestrian facilities and increased enforcement); and 3. An after-study. Each phase consists of four aspects namely: Engineering, Education, Law enforcement, and Encouragement. The before study includes a road safety assessment of the pedestrian facilities, pedestrian accident statistics for the last three years, and a human behaviour before questionnaire. The questionnaire was used to test the knowledge and attitude of pedestrians. The after-study consists of a review of the pedestrian facilities and pedestrian statistics, and a post-project questionnaire conducted on the same respondents, in order to determine if there was a measurable change in behaviour of pedestrians and an increase in road safety knowledge. This paper also reports on the implementation of the above proposed methodology as part of the Olifants River-Water-Resources-Development-Project: Phase 2. The Olifants River-Community-Road-Safety-Project consists of road safety education at seven schools over a 12 month period, pedestrian safety audits and pre- and post-implementation questionnaires. The paper concludes by summarizing strengths and weaknesses of the project and highlighting lessons learnt to be implemented in future projects.
SDG11—Research
Agenda 2063:
Keywords: road deaths, road fatalities, road safety, traffic accidents
Road traffic safety is no longer the issue of only one discipline but rather requires a multi-faceted approach targeting law enforcement; education and communication; data and intelligence; engineering and legislation. The Western Cape Government took cognizance of this, and guided by its Provincial Strategic Objectives, established the Provincial Road Traffic Management Coordinating Committee (PRTMCC) in order to achieve its primary road traffic safety objective of reducing road crash fatalities by 50% by 2014. The PRTMCC serves as the case study in order to illustrate the benefits of institutionalising structures whilst highlighting the inefficiencies that arise as a result of bureaucratic issues that ensue, particularly in the public sector. Both qualitative and quantitative research methodologies, through a public perception survey, as well as an analysis of an international best practice model, serves to support this claim. This paper explores and interrogates how institutionalising these structures within the public; private and civil society sphere could promote road traffic safety.
SDG11—Research
Agenda 2063:
Keywords: road deaths, road fatalities, road safety, traffic accidents, Western Cape
The freight industry is one of the major players that contribute to the development of the economy of South Africa. About 80% of freight in South Africa is transported by road. As a result, heavy vehicle crashes occurring on South Africa?s roads are becoming a far too familiar sight. In addition to loss of life, heavy vehicle crashes causes a great deal of damage to property, the environment, and the economy. Part of the problem might be a lack of experience and training for truck drivers. The study compares education and training levels, the amount of time spent on education, the quality of available training and education facilities in South Africa, Africa and the rest of the world. Findings indicate that currently very few formal education and training facilities for heavy vehicle driver are available in SA. Most drivers receive in-house training at the operators where they are employed. Recommendations pertain to the fact that heavy vehicle driver education needs to take place on a formal basis and the age and experience of the drivers considered before a Professional Drivers Permit (PrDP) license issued to the driver. Formal institutions such as Further Education and Training (FET) colleges needs to, in future play a bigger role in the issuing of qualifications for drivers.
SDG11—Research
Agenda 2063:
Keywords: road safety, South Africa, traffic accidents
SDG11—Research
Agenda 2063:
Keywords: road safety, South Africa, traffic accidents
The risk of experiencing an unintended pregnancy, STIs, HIV and AIDS is exacerbated when low literacy level, low functional health literacy level and misconceptions prevail as barriers to accessing primary health care services and learning about the correct use of and adherence to medicine regimens. Sometimes the source of misconception on the risks regarding unintended pregnancy, STIs, HIV and AIDS are low literacy and health literacy. This study explored the experiences of females who utilise reproductive health promotion services and the experiences of reproductive health care providers regarding the provision of reproductive health services in a primary health care setting. A qualitative, descriptive phenomenological design was used. A sample of 36 participants (11 health care providers and 25 females) who utilise the primary health care facility, was drawn through purposive sampling. Individual and focus group interviews were conducted. Teschs data analysis method was used. Ethical principles were observed and trustworthiness was ensured. The themes that emerged confirmed that low health literacy levels were related to unsafe sex practices, specifically, unprotected sex. It is recommended that a health literacy assessment tool for reproductive health be developed to reduce reproductive health problems associated with low health literacy levels.
SDG3—Research
Agenda 2063:
Keywords: family planning, reproductive health, sexual health

Freeway management and the impact on response and clearance times

Authors: C Krogscheepers, R Cable & M Coetsee
The first Freeway Management System (FMS) was launched as a pilot along the Ben Schoeman Freeway in Gauteng during 2007/2008. Since, then complete systems were rolled out in the larger Gauteng Area, the Western Cape and KwaZulu-Natal for the 2010 Soccer World Cup. These systems are currently being expanded in all three these areas to cover nearly 500 kilometres of freeways and which are controlled from three state-of-theart control centres in Midrand, Cape Town and Pietermaritzburg. In general, FMS offers various benefits, amongst others real-time information to the public for real-time route choices but it also offers faster detection times of incidents that should result in faster responses to the scene and better management of the scene. This paper explores the benefits of the FMSs specifically in terms of what has happened to incident response and clearance times over the past 3,5 years. The focus is specifically on the performance of the Western Cape FMS. The system has been in place since May 2010, i.e. for nearly four years. Data was collected throughout this period and these are used to investigate operational trends. From the available data, it is evident that response times have reduced with at least 67% over the past three years. This applies to all responding services in the Western Cape. Clearance times of incidents involving fatalities have also reduced significantly from more than four hours to around 2, 5 hours. However, lately there has been an increasing trend which needs to be management carefully.
SDG11—Research
Agenda 2063: A2
Keywords: road safety, traffic accidents
BACKGROUND : Occupational tuberculosis (TB) continues to plague the healthcare workforce in South Africa. A 2-year cluster randomized controlled trial was therefore launched in 27 public hospitals in Free State province, to better understand how a combined workforce and workplace program can improve health of the healthcare workforce. OBJECTIVE : This mid-term evaluation aimed to analyze how well the intervention was being implemented, seek evidence of impact or harm, and draw lessons. METHODS : Both intervention and comparison sites had been instructed to conduct bi-annual and issue-based infection control assessments (when healthcare workers [HCW] are diagnosed with TB) and offer HCWs confidential TB and HIV counseling and testing, TB treatment and prophylaxis for HIV-positive HCWs. Intervention sites were additionally instructed to conduct quarterly workplace assessments, and also offer HCWs HIV treatment at their occupational health units (OHUs). Trends in HCW mortality, sick-time, and turnover rates (2005 2014) were analyzed from the personnel salary database (PERSAL). Data submitted by the OHUs were also analyzed. Open-ended questionnaires were then distributed to OHU HCWs and indepth interviews conducted at 17 of the sites to investigate challenges encountered. RESULTS : OHUs reported identifying and treating 23 new HCW cases of TB amongst the 1,372 workers who used the OHU for HIV and/or TB services; 39 new cases of HIV were also identified and 108 known- HIV-positive HCWs serviced. Although intervention-site workforces used these services significantly more than comparison-site healthcare staff (pB0.001), the data recorded were incomplete for both the intervention and comparison OHUs. An overall significant decline in mortality and turnover rates was documented over this period, but no significant differences between intervention and comparison sites; sick-time data proved unreliable. Severe OHU workload as well as residual confidentiality concerns prevented the proper implementation of protocols, especially workplace assessments and data recording. Particularly, the failure to implement computerized data collection required OHU staff to duplicate their operational data collection duties by also entering research paper forms. The study was therefore halted pending the implementation of a computerized system. CONCLUSIONS : The significant differences in OHU use documented cannot be attributable to the intervention due to incomplete data reporting; unreliable sick-time data further precluded ascertaining the benefit potentially attributable to the intervention. Computerized data collection is essential to facilitate operational monitoring while conducting real-world intervention research. The digital divide still requires the attention of researchers along with overall infrastructural constraints.
SDG3—Research
Agenda 2063:
Keywords: Free State, HIV, South Africa, TB, tuberculosis
The intrauterine contraception device (IUD) is highly effective, safe, cost-effective, long-acting, and rapidly reversible with few side effects. It is a private and convenient method of contraception, does not interfere with the spontaneity of sex, is acceptable to many patients, has superior continuation rates, and offers several non-contraceptive health benefits
SDG3—Research
Agenda 2063:
Keywords: family planning, reproductive health, sexual health, South Africa

Factors influencing utilisation of female condom among healthcare providers in Tshwane, South Africa

Authors: R N Ngunyulu, R S Mogale, F M Mulaudzi, M D Peu and M L S Mataboge
This article describes the factors influencing the utilisation of the female condom (FC2) among healthcare providers, which is part of a study that aimed at developing strategies to improve the utilisation by the patients of FC2 in prevention of STIs, HIV and AIDs and unplanned pregnancies. Like other women in the world, female healthcare providers are also biologically two to four times more vulnerable to STIs, HIV and AIDs infections than men. Women are also vulnerable to unplanned pregnancies. However, the utilisation of FC2 by healthcare providers is still inadequate. A qualitative, exploratory and descriptive research approach was used in this study. Purposive sampling was used to select the participants, because only healthcare providers responsible for the provision of FC2 were selected. In-depth individual interviews were used during data collection. Data were analysed following the qualitative data analysis methods. Factors influencing the utilisation of FC2 were identified as the main category during data analysis. The study confirmed that the healthcare providers are unable to utilise the FC2 because of: the shape and size of the FC2; complexities of the female genital organs hindering procedure; partners reaction to FC2; and cultural background around accepting FC2 use. The development of strategies to enable healthcare providers to use FC2 was recommended, in order to ensure protection and prevention of STIs, HIV and AIDs and unplanned pregnancies among healthcare providers.
SDG3—Research
Agenda 2063: A6
Keywords: family planning, Pretoria, reproductive health, sexual health, Tshwane

The relationship between scientific knowledge and behaviour: An HIV/AIDS case

Authors: Lindelani Mngunia, Mia Abrieb & Liesel Ebersohn
SDG3—Research
Agenda 2063:
Keywords: AIDS, HIV
SDG3—Research
Agenda 2063: A6
Keywords: reproductive health, sexual health, South Africa
This article describes challenges of conducting an HIV prevention program involving 40 male and female participants ages 1218 in Hammanskraal, South Africa, aimed at increasing awareness and knowledge of laws protecting childrens sexual health rights and access to services through a culturally based study circle format. Challenges highlighted by the project included Institutional Review Board approval of youth consent procedures, cooperation and coordination with local policymakers, the need to modify presentation materials to youths comprehension levels, availability of youth-based sexual health service providers, and cultural ambiguity over parental involvement in youth health care decisions and laws pertaining to sexual relationships among minors.
SDG3—Research
Agenda 2063:
Keywords: reproductive health, sexual health, South Africa
The reproductive desires of people living with HIV/AIDS (PLHIV) of low socioeconomic standing attending public health facilities in South Africa were studied. HIV-positive men, pregnant and non-pregnant women were recruited from two clinics at a large public hospital in Tshwane, South Africa. Individual interviews were used to explore the reproductive desires of HIV-positive participants. HIV counsellors perceptions of their clients reproductive desires were explored during focus group discussions. Parenthood proved to be an important factor to all participants in continuation of the family and establishing their gender identities, despite the possible risk of HIV transmission and community stigmatization. Different cultural procreation rules for men and women and stigmatizing attitudes towards PLHIV affected their reproductive decision making. Women had the dilemma of choosing which community expectations they wanted to fulfil. Community stigmatization towards PLHIV was visible in the negative attitudes of some HIV counsellors regarding HIV and procreation. Because the reproductive desires of PLHIV are currently not given high priority in HIV prevention and family planning in the public health sector in South Africa, the prevention of HIV transmission may be jeopardized. These results necessitate the integration of HIV and sexual and reproductive health counselling on a primary health care level.
SDG3—Research
Agenda 2063: A6
Keywords: family planning, HIV, reproductive health, sexual health
SDG3—Research
Agenda 2063: A6
Keywords: reproductive health, sexual health, South Africa
BACKGROUND : The increase in the number of teenage pregnancies and its negative consequences has encouraged various researchers to explore the possible causes of teenage pregnancy. Findings from previously-conducted research have indicated different preventable factors that predispose female teenagers to pregnancy, such as staff attitudes and the lack of information resulting from poor access to health facilities. OBJECTIVE : To explore and describe access to information and decision making on teenage pregnancy prevention by females using a primary healthcare clinic in Tshwane, South Africa. METHOD : In this study, the researchers used a descriptive qualitative and exploratory research design to explore and describe the verbal reports regarding prevention of teenage pregnancy by females using a primary healthcare clinic in Tshwane, South Africa. Face-to-face semistructured interviews were conducted with 15 female participants aged between 15 and 26, who had been pregnant once or more during their teens. RESULTS : Two themes emerged, namely, access to information and decision making by female teenagers. Five categories that emerged were: access to information on pregnancy prevention; ignoring of provided information; the use of alternative medicine with hormonal contraception; personal reasons for use and non-use of contraception; and decisions made by teenagers to not fall pregnant. Females in this study fell pregnant in their teens, even though they had access to information. CONCLUSION : Given the complexity of this problem, female teenagers should use their families as primary sources of information for reproductive health promotion and educational institutions should build on this to aid the prevention of teenage pregnancy.
SDG3—Research
Agenda 2063: A6
Keywords: family planning, Pretoria, reproductive health, sexual health, Tshwane
BACKGROUND : Unplanned pregnancies amongst students at higher education institutions are a major concern worldwide, including South Africa. Apart from various social and psychological challenges, unplanned pregnancies affect students objectives of achieving academic success. Research undertaken in the United States of America (USA) indicates that around 80% of female students in institutions of higher education between ages 18 and 24 are sexually active. OBJECTIVES : To assess and describe the use of contraceptives by undergraduate female students in a selected higher educational institution in Gauteng. METHOD : A cross-sectional, descriptive, quantitative design was used. A total of 400 female undergraduate students were requested to respond to a self-administered questionnaire. Stratified random sampling was used to select the participants. They were selected systematically from two campuses. Data were entered using an excel sheet at the Department of Statistics, and analysed using the Statistical Analysis Software programme, (SAS version 9.3), of the Department of Statistics higher educational institutions. RESULTS : A total of 74% females indicated they were sexually active, 79% of whom reported using contraceptives. The most common used methods were oral contraceptives at 38%, and 25% for male condoms. The most commonly known methods were condoms at 84%, and the oral contraceptive at 68%. The knowledge of condom use to prevent sexually transmitted diseases was high at 91%. CONCLUSION : Inadequate knowledge and awareness on some contraceptive methods was found. Thus, educational programmes to increase students knowledge on the use of all contraceptive methods are urgently needed.
SDG3—Research
Agenda 2063: A6
Keywords: family planning, Gauteng, reproductive health, sexual health, South Africa

Community care workers, poor referral networks and consumption of personal resources in rural South Africa

Authors: Ilona Sips, Ahmad Haeri Mazanderani, Helen Schneider, Minrie Greeff, Francoise Barten & Mosa Moshabela
Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers.
SDG3—Research
Agenda 2063:
Keywords: access to health care, health coverage, South Africa
BACKGROUND : Perceptions of female teenagers in the Tshwane District contribute to the nonuse and or discontinued use of contraceptives as evidenced by increased levels of unplanned pregnancies. OBJECTIVES : The objective of this study was to explore and describe the perceptions of female teenagers in the Tshwane District on the use of contraceptives. METHODS : A qualitative, explorative, descriptive approach was followed in this study. The population comprised of pregnant female teenagers who were purposively selected. Data were collected using unstructured individual interviews on a face-to-face encounter in a natural setting. Data were analysed using the discourse method of data analysis. RESULTS : The following perceptions on the use of contraceptives emerged: Perceptions on the use of contraceptives, emotions, contraceptive effects, social pressure and education on contraceptives. Teenagers perceptions were predominantly negative with unfounded fears. Though the teenagers were aware of the importance of the use of contraceptives, motivation to pursue contraception was lacking. Teenagers verbalised to be uncommitted as well. CONCLUSION : Various perceptions of female teenagers in the Tshwane District on the use of contraceptives were explored and described. It was noted that all the teenagers interviewed had great remorse and feelings of guilt regarding their behaviour of not using contraceptives. Their need for re-education was cited and seen as motivational enough to encourage the use of contraceptives at primary health care settings. Therefore, the study recommended that health education programmes should be restructured to effectively influence the female teenagers perceptions positively and to promote the use of contraceptives.
SDG3—Research
Agenda 2063:
Keywords: family planning, Pretoria, reproductive health, sexual health, Tshwane
Adolescents early sexual debut contributes to their huge burden of sexual and reproductive ill-health, especially in sub-Saharan Africa. Reports continually reveal that female adolescents, in particular, constitute a large portion of the 34 million people living with HIV worldwide. Other consequences associated with early adolescent sexuality include unplanned pregnancies, unsafe abortions and sexually-transmitted infections. In light of this, the article analyses approaches adopted by Nigeria and South Africa in fulfilling their international law obligations to respect, protect and fulfil adolescent girls right to access contraceptive information and services, specifically, in their domestic legislation, policy documents and court decisions. Sexuality education is compared, as well as actual access. There is extensive evidence of the measures put in place to ensure adolescent girls access to contraceptive information and services in Nigeria and South Africa. Although the level and extent of the barriers faced by adolescent girls when accessing contraceptive services and information vary, the consequences are similar: We find that Nigerian and South African adolescent girls, generally, lack access to contraceptive information and services. Despite measures to ensure adolescent girls access to contraceptive information and services in Nigeria and South Africa, several gaps remain.
SDG3—Research
Agenda 2063: A6
Keywords: family planning, reproductive health, sexual health, South Africa
BACKGROUND. Pollution arising from mine dumps in South Africa (SA) has been a source of concern to nearby communities. OBJECTIVE. To investigate whether comorbidity of respiratory and cardiovascular diseases among elderly persons (?55 years) was associated with proximity to mine dumps. METHODS. Elderly persons in communities 1 - 2 km (exposed) and ?5 km (unexposed) from five preselected mine dumps in Gauteng and North West provinces in SA were included in a cross-sectional study. RESULTS. Exposed elderly persons had a significantly higher prevalence of cardiovascular and respiratory diseases than those who were unexposed. Multiple logistic regression analysis indicated that living close to mine dumps was significantly associated with asthma + hypertension (odds ratio (OR) 1.67; 95% confidence interval (CI) 1.22 - 2.28), asthma + pneumonia (OR 1.86; 95% CI 1.14 - 3.04), emphysema + arrhythmia (OR 1.38; 95% CI 1.07 - 1.77), emphysema + myocardial infarction (OR 2.01; 95% CI 1.73 - 2.54), emphysema + pneumonia (OR 3.36; 95% CI 1.41 - 7.98), hypertension + myocardial infarction (OR 1.60; 95% CI 1.04 - 2.44) and hypertension + pneumonia (OR 1.34; 95% CI 1.05 - 1.93). CONCLUSION. Detrimental associations between comorbidity of the health outcomes and proximity to mine dumps were observed among the elderly in SA.
SDG11, SDG3—Research
Agenda 2063:
Keywords: air pollution, air pollution and health, air quality, South Africa
South Africa waived user fees for primary healthcare in 1994 and, again, in 1996. The first waiver focused on young children, elderly adults, pregnant women and nursing mothers, while the 1996 reform waived fees for the remainder of the population, subject to means tests. We take advantage of household survey information to examine the impact of the policy on a subset of the reform-eligible population. Although it was expected that public healthcare facility usage would have increased post-reform, no statistically significant evidence supported such a claim. Therefore, our results are consistent with some very recent research examining the 1994 reform, but are generally at odds with the general impression in the literature that user fee abolition matters, when it comes to alleviating inequities in access to healthcare.
SDG3—Research
Agenda 2063: A1
Keywords: access to health care, South Africa, universal health coverage
The study investigated the association between community proximity to mine dumps, and current wheeze, rhinoconjunctivitis, and asthma among adolescents. This study was conducted during May-November 2012 around five mine dumps in South Africa. Communities in close proximity to mine dumps had an increased likelihood of current wheeze OR 1.38 (95?% CI: 1.10-1.71), rhinoconjunctivitis OR 1.54 (95?% CI: 1.29-1.82), and a protective association with asthma OR 0.29 (95?% CI: 0.23-0.35). Factors associated with health outcomes included other indoor and outdoor pollution sources. Wheeze and rhinoconjunctivitis appear to be a public health problem in these communities. The findings of this study serve as a base for further detailed epidemiological studies for communities in close proximity to the mine dumps e.g. a planned birth cohort study.
SDG11, SDG3—Research
Agenda 2063:
Keywords: air pollution, air pollution and health, air quality, South Africa
BACKGROUND: An association between wheeze (a symptom of asthma) and environmental tobacco smoke (ETS), types of fuel used for residential heating or cooking and the frequency of trucks passing near homes, has been reported mainly in developed countries. Little is known about the strength of such associations in developing countries. This study was conducted in residential areas situated in Ekurhuleni Metropolitan Municipality, namely Tembisa and Kempton Park, which form part of the Highveld region, a priority area in terms of air pollution in South Africa. METHODS: From 3764 eligible school children, aged between 13 and 14 years, from 16 selected high schools in the study area, 3468 completed a modified questionnaire based on the International Study of Asthma and Allergies in Childhood (ISAAC). Data were analysed using multiple logistic regression models. RESULTS: The results are based on data from 3424 children. In the adjusted models, exposure to ETS at school was associated with wheeze ever (OR 1.22 95% CI: 1.03 ? 1.45) and current wheeze (OR 1.33 95% CI: 1.08 ? 1.64). When gas was most frequently used for residential heating the likelihood of wheeze ever increased by 47% (OR 1.47 95% CI: 1.15 ? 1.88). Trucks passing near homes for almost the whole day during weekdays, increased the likelihood of wheeze ever (OR 1.32 95% CI: 1.01 ? 1.73), current wheeze (OR 1.61 95% CI: 1.15 ? 2.24) and current severe wheeze (OR 2.22 95% CI: 1.28 ? 3.77). When data were stratified according to residential area, for children living in Tembisa, ETS exposure at home was associated with current wheeze (OR 1.36 95% CI: 1.06 ? 1.77); gas most frequently used for residential heating was associated with wheeze ever (OR 1.68 95% CI: 1.23 ? 2.28) and current wheeze (OR 1.61 95% CI: 1.08 ? 2.39); paraffin most frequently used for residential heating was associated with current severe wheeze (OR 1.85 95% CI: 1.04 ? 3.28). CONCLUSION: It was concluded that children living in one of the air pollution priority areas of South Africa, have an increased risk of wheezing due to exposure to both indoor and outdoor air pollution sources.
SDG11, SDG3—Research
Agenda 2063:
Keywords: air pollution, air pollution and health, air quality, South Africa
BACKGROUND : Allergic rhinitis (AR) is an increasing and common condition affecting many people globally, especially children. The aim of the study was to investigate the association between the frequency of truck traffic and allergic rhinitis symptoms, rhinoconjunctivitis and hayfever among 13 to 14 year old school children in Ekurhuleni Metropolitan Municipality, Gauteng Province, South Africa. METHODS : In a cross-sectional study design, 3764 children from 16 randomly selected high schools were eligible to participate, 3468 completed the International Study of Asthma and Allergies in Childhood (ISAAC) Phase I questionnaire of which 3424 were suitable for analysis; the overall response rate was 92 %. Data were analysed using multilevel logistic regression analysis. RESULTS : The prevalence of self-reported rhinitis ever, current rhinitis rhinoconjunctivitis and hayfever was 52, 40, 21 and 37 % respectively. Rhinitis ever, current rhinitis and current rhinoconjunctivitis were significantly associated with the frequency of trucks passing near residences almost all day on weekdays, (OR 1.46 95 % CI: 1.16 ? 1.84), (OR 1.60 95 % CI: 1.242.02) and (OR 1.42 95 % CI: 1.091.84) respectively. No association was observed between truck traffic and hay fever in the multiple analyses. CONCLUSION : The study shows a high prevalence of allergic rhinitis symptoms amongst children. The results support the hypothesis that traffic related pollution plays a role in the prevalence of allergic rhinitis symptoms in children residing in the area.
SDG11, SDG3—Research
Agenda 2063:
Keywords: air pollution, air pollution and health, air quality, South Africa
OBJECTIVE : The aim of this study was to investigate the association between eczema ever (EE) and current eczema symptoms (ES) in relation to exposure to environmental tobacco smoke (ETS). DESIGN : A cross-sectional study using the International Study of Asthma and Allergies in Childhood questionnaire. SETTING : 16 schools were randomly selected from two neighbourhoods situated in Ekurhuleni Metropolitan Municipality, Gauteng Province, South Africa. PARTICIPANTS : From a total population of 3764 school children aged 1214 years, 3468 completed the questionnaire (92% response rate). A total of 3424 questionnaires were included in the final data analysis. PRIMARY OUTCOME : The prevalence of EE and current ES was the primary outcome in this study. RESULTS : Data were analysed using Multilevel Logistic Regression Analysis (MLRA). The likelihood of EE was increased by exposure to ETS at home (OR 1.30 95% CI 1.01 to 1.67) and at school (OR 1.26 95% CI 1.00 to 1.60). The likelihood of EE was lower for males (OR 0.66 95% CI 0.51 to 0.84). The likelihood of ES was increased by ETS at home (OR 1.93 95% CI 1.43 to 2.59) and school (1.44 95% CI 1.09 to 1.90). The likelihood of ES was again lower for males (OR 0.56 95% CI 0.42 to 0.76). Smoking by mother/female guardian increased the likelihood of EE and ES, however, this was not significant in the multivariate analysis. CONCLUSIONS : Symptoms of eczema were positively associated with exposure to ETS at home and school. The results support the hypothesis that ETS is an important factor in understanding the occurrence of eczema.
SDG11, SDG3—Research
Agenda 2063:
Keywords: air pollution, air pollution and health, air quality, South Africa
BACKGROUND : The ethical concerns associated with HIV prevention and treatment research have been widely explored in South Africa over the past 3 decades. However, HIV cure research is relatively new to the region and significant ethical and social challenges are anticipated. There has been no published empirical enquiry in Africa into key informant perspectives on HIV cure research. Consequently, this study was conducted to gain preliminary data from South African HIV clinicians, researchers and activists. METHODS : In-depth interviews were conducted on a purposive sample of fourteen key informants in South Africa. Audiotaped interviews were transcribed verbatim with concurrent thematic analysis. The perspectives of HIV clinicians, researchers and activists were captured. Analyst triangulation occurred as the data were analysed by three authors independently. RESULTS : The rapid evolution of HIV cure research agendas was prominent with participants expressing some concern that the global North was driving the cure agenda. Participants described a symbiotic relationship between cure, treatment and prevention research necessitating collaboration. Assessing and managing knowledge and expectations around HIV cure research emerged as a central theme related to challenges to constructing cure - how patients understand the idea of cure is important in explaining the complexity of cure research especially in the South African context where understanding of science is often challenging. Managing expectations and avoiding curative misconception will have implications for consent processes. Unique strategies in cure research could include treatment interruption, which has the potential to create therapeutic and ethical conflict and will be perceived as a significant risk. Ethical challenges in cure research will impact on informed consent and community engagement. CONCLUSIONS : It was encouraging to note the desire for synergy amongst researchers and clinicians working in the fields of prevention, treatment and cure. Translation of complex HIV cure science into lay language is critical. Moving forward, RECs must be adequately constituted with scientific expertise and community representation when reviewing cure protocols. It is hoped that knowledge and resource sharing in the context of collaboration between research scientists working in cure and those working in treatment and prevention will accelerate progress towards cure.
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, South Africa
BACKGROUND : Evidence suggests that healthcare providers (HCPs) in South Africa do not consistently offer tobacco dependence treatment (TDT) during clinical consultations. In order to understand and explain this behaviour in a South African context, we conducted a qualitative exploration of HCPs experiences, perceptions and behaviours regarding TDT. METHODS : Individual qualitative interviews were conducted with physicians and nurses who were purposively selected. Themes were identified from interview transcripts using content analysis. Findings were triangulated and peer-reviewed, and were also verified by the participants. RESULTS : Fifteen physicians and four nurses were interviewed, none of whom used tobacco. These participants perceived TDT as an important task, but could not consistently implement it during clinical consultations due to health systems constraints (time-constraints because of patient-overload, the unavailability of cessation medications and a lack of support for referrals), misperceptions and misconceptions (negative outcome expectations about the effectiveness and feasibility of TDT), socio-cultural barriers (counselling older persons was perceived as challenging) and personal limitations (perceived low self-efficacy, poor knowledge and skills on implementing any evidence-based TDT framework). Patients are therefore selectively screened based on clinical relevance and offered only prescriptive brief advice. Participants recommended several systems changes, including academic detailing of tobacco status, training HCPs and incorporating tobacco cessation medications in the Essential Drug List. CONCLUSION : The reported selective screening and limited TDT interventions offered by HCPs are related to interactions between health systems constraints, personal limitations, and misperceptions and misconceptions about the effectiveness and feasibility of TDT during clinical consultation. Implementing the recommended systems changes has the potential to improve the implementation of TDT in South African primary health care (PHC).
SDG3—Research
Agenda 2063:
Keywords: South Africa, substance abuse

Technology as a tool to develop a community health model

Authors: E D Meyer, S Stoltz & S Smith
The paper describes a case study of a community health model that was developed and piloted at a University based clinic run in partnership with the South African Department of Health (DOH). The aim was to strategize, innovate and implement a collaborative care model strengthened by available technological resources that could improve the health and social outcomes of a struggling community. The 5 Cs e-Health framework for developing countries was applied to the case and compared to the Human Resources for Health 2030 strategy of Government to inform the development of a community care team (human capital based and enabled by an electronic management system) that could share patient health and social information, synergise resources and inform future community developments.
SDG3—Research
Agenda 2063: A1
Keywords: health systems
BACKGROUND. Integrated Management of Childhood Illness (IMCI) is an essential strategy known to deliver childhood interventions that reduce the under-five mortality rate. Objective. To evaluate the adherence to the IMCI case management guidelines by primary healthcare workers in the Tshwane area, South Africa. METHODS. The study was conducted between July and December 2012 on children referred from clinics to Kalafong Hospital. Data on IMCI clinical symptoms and signs, classification and treatment given at the clinics before referral to the hospital were collected from patients referral letters. An interview with the caregiver on counselling received at the clinic was done using an adapted World Health Organization health facility survey tool. RESULTS. Eighty children between 2 and 60 months referred from 12 local clinics were included in the study. IMCI classification was done in just over half (52.9%) of 34 children with cough and 73% of 15 children with diarrhoea. Only 18% of children with chest indrawing and fast breathing were classified correctly. Prereferral treatment for all children with severe dehydration had been given correctly but not so for children with severe pneumonia and severe malnutrition. None of the children with severe disease had been checked for glucose levels before referral. CONCLUSIONS. The IMCI guidelines had not been adhered to in all children referred to the hospital. Children, particularly those with severe disease, had been incorrectly classified, leading to inadequate prereferral treatment. Healthcare workers had not given the expected treatment at the clinic before referral.
SDG3—Research
Agenda 2063: A1
Keywords: health training, medical training, Pretoria, South Africa, Tshwane

Establishing a reading culture in a rural secondary school: A literacy intervention with teachers

Authors: Ina Joubert, Liesel Eberso?hn, Ronel Ferreira, Loraine du Plessis & Melanie Moen
The purpose of this study was to explore and describe the nature of a reading culture in a rural secondary school in South Africa before and after a literacy intervention. The systems theory with interpretivism as the epistemological paradigm was employed. A rural secondary school was selected as part of an on-going Flourishing Learning Youth and Supportive Teachers Assets and Resilience studies on resilience and rural schools. Language teachers (n = 6, male = 1, female = 5) were purposively selected to participate. The literacy intervention was developed with phonetic acquisition as the basis to develop reading skills. It became evident that implementing English (additional language) as teaching and learning language in the school may have contributed to barriers to learning. Limited resources and reading instruction training exacerbated the problems. However, once the teachers acquired new skills and the children received the needed support, the improvement in overall academic achievement was significant.
SDG4—Research
Agenda 2063: A1, A6
Keywords: literacy, secondary education, secondary schools, South Africa, teachers training

Functional urban schools amidst dysfunctional settings: Lessons from South Africa

Authors: Ralph D Mawdsley, Keshni Bipath & James L Mawdsley
Similar to Dickenss Tale of Two Cities, this research study is about a tale of two schools. The first type of school is a dysfunctional school. Dysfunctional schools are schools in a state of chaos (Shipengrower & Conway, 1998). The second school is that of order. The researchers refer to this school as a functional school. In 2003, the functional school in this research project scored a 100% pass rate in the Senior Certificate Examination (SCE), whereas the dysfunctional school scored 57.35%. Dysfunctional schools, known as failing schools are usually found in the poorest neighborhood, where children are mostly Black or immigrants who are not proficient in English. One of the casualties of the apartheid era has been the diminishing authority of the school principal. The aim of this research is to investigate the role of the leader in managing a functional school situated in a dysfunctional environment in the Gauteng province of South Africa. The research study is also directed at predicting the characteristics of dysfunctional /functional schools in the Gauteng province of South Africa.
SDG4—Research
Agenda 2063: A1, A6
Keywords: quality education, secondary schools, South Africa
On attainment of democracy, South Africa ratified several international conventions such as UN Convention on the Elimination of all forms of Discrimination against Women (CEDAW), the Convention on the Rights of the Child (CRC) Education for All (EFA) and the Millennium Development Goals (MDG), which all among other objectives, seek to attain gender equality in education. This study investigated how, despite their formal access to schooling, pregnant learners at two high schools in Vhembe district of South Africa faced challenges in actively participation in schooling. The study used key participant and focus group interviews to gather the views of 6 pregnant learners enrolled at two formal schools, 12 mainstream learners, and 12 teachers on the participation of pregnant learners in school curriculum activities. The study revealed that although the countrys bill of rights and the education policy on the management of pregnancy in schools created prospects for equal educational provision for pregnant teenagers in South Africa, on the ground, there were conservative socio-cultural beliefs, values and norms that militated against pregnant teenagers full educational participation and opportunity. The study therefore concluded that there is a split between official policy and practice, or espoused theories of action and the actual theories-in-use which negatively impacted on equal educational opportunity for enrolled pregnant learners in South African formal schools.
SDG4—Research
Agenda 2063: A1, A6
Keywords: access to education, equal access + education, South Africa
This article highlights important dimensions of public theology and shows how the identified dimensions are relevant to the specific situation of informal early childhood development (ECD) facilities in a South African urban setting. The article considers the contributions and challenges of informal community-based ECD on the basis of research conducted in the Rustenburg/Phokeng area of the North West province of South Africa. It critically discusses the sociocultural discourses and legislation regulating ECD centres, by focusing on the constraints put on informal ECD service providers. It concludes by considering ways in which urban public theology should act to serve, strengthen and advocate this vitally important, yet informal, sector.
SDG4—Research
Agenda 2063: A1
Keywords: early childhood development, South Africa
Managing an instructional program is recognized as constituting a major area of focus for successful school leadership. Linked to this recognition is the acknowledgement of the importance of the school principal in improving performance in this area and accounting for decisions made in the process. To improve learner performance and strengthen accountability, principals are encouraged to turn to data. This enables them to examine performance, generate informed decisions and plan for sustainable improvement. In this study, current school performance and leadership practices in South Africa are examined against a literature background. Based on a qualitative study, this paper examines specifically how principals in South African primary schools use data to manage the instructional program. The paper shows challenges which principals face in improving learner performance without the capacity for effective data use. One key finding is that school leaders lack capacity to create a culture of collaborative enquiry in schools.
SDG4—Research
Agenda 2063: A1
Keywords: primary education, primary schools, quality education, South Africa, teachers training
This article examines the potential for a videogame-based pedagogy in a South African open and distance learning (ODL) environment, wherein videogame interactivity might address the absence of individualised tuition. The discipline of Classics is utilised as a working example, with its primary educational elements, namely the study of history and culture, illustrating the broader appeal of a videogame-based pedagogy that can be deployed to courses ranging from anthropology to cultural and media studies, to history and even art. In largely literature review format, this article first assesses the representation of these elements in commercial videogames, before concentrating on user-modified videogame scenarios (mods), and the employment of easy to understand toolsets for creating such course specific content. The creation of such content using these toolsets and other means (eg, free-to-play games) enables lecturers to construct unique videogame learning environments (VGLEs) for teaching purposes. Modern pedagogical principles are also brought to bear upon this notion of a videogame-centred multimedia approach to student-centred learning to properly situate it within the parameters of current educational practice. Finally, the pros, cons, and particular challenges of the use of a VGLE within the South African educational environment are considered.
SDG4—Research
Agenda 2063: A6
Keywords: quality education, South Africa
Low throughput rates at schools and universities across South Africa are cause for great concern because of the resultant financial burden on the state; the increase in unemployment; and the inadequate delivery of much-needed highly skilled professionals. The advent of the fourth economic wave accompanied as it is by fundamental changes in the workplace globally has called for a judicious response from theorists, practitioners, researchers and learners. This article surveys the extent and possible causes of the low throughput rates in higher education and draws on the results of recent research projects to design intervention guidelines aimed at facilitating access to and success in higher education. An integrated, quantitative and qualitative approach is recommended.
SDG4—Research
Agenda 2063: A1, A6
Keywords: educational outcomes, higher education, tertiary education, university education
Non-formal adult education and training (NFET) in South Africa is instrumental in breaking the high level of poverty and decreasing the social inequality the country continues to face as a post-apartheid democracy. Public and private NFET centres in South Africa aim to meet the training needs of adults who have been deprived of formal education with courses which foster access to opportunities for skills acquisition and employment and bring about social and economic inclusion. However, many adults who were facing long-term unemployment due to a lack of marketable skills remain unemployed after completing NFET programmes. This paper reports on a study which investigated what constitutes favourable conditions (internal enabling environments) for skills acquisition inside NFET centres leading to employment and how they can be improved to contribute to coordinated efforts of increasing NFET graduates paid and/or self-employment capacities. The authors found that centres focusing on activities suitable for self-employment during training were more likely to create internal enabling environments for skills acquisition and income generation than centres offering courses designed for entering paid employment. The authors conclude that there appears to be a significant correlation between NFET centres training programme objectives, financial resources, trainee selection criteria, the process of training needs assessment, and skills acquisition for successful employment outcomes of NFET graduates. Without these internal enabling factors, adult trainees are likely to continue finding it difficult to integrate into the labour market or participate in economic activities and hence break the cycle of poverty and social exclusion.
SDG4—Research
Agenda 2063: A1, A6
Keywords: relevant skills, skills development, South Africa, technical training, vocational training

Are we there yet? En route to professionalism

Authors: Andrea L Meyer & Ann Leonard
The debate on the professional status of Communication Management/Public relations1has been high on the worldwide agenda for decades. While previous research has focusedon the criteria for professionalism in this field, practitioners and academics often questionthe efforts of professional associations to adequately address the issue of implementingsystems to facilitate professional status. The emergence of the Global Alliance for PublicRelations and Communication Management (GA) as an umbrella body for various regionalprofessional associations, as well as the increased emphasis on regulation, standards andgovernance in all spheres of the global business environment, have led to renewed ques-tions about global efforts to achieve professional status for this field. This study focused onthe goals and actions of member associations of the GA in relation to the question of profes-sional status. In order to understand the current state of affairs an exploratory qualitativeapproach was followed in which member associations were surveyed and their websitesreviewed. The fact that fewer than half of the 27 member associations responded to thesurvey suggests that a study about this matter is not deemed particularly important and/orthat the issue of professional status is not widely pursued. However, the associations thatparticipated in this study agree that professional status is important. The study has alsofound that many similarities exist across continents in terms of the mechanisms utilizedto achieve professional status. Codes of ethics, contributions to a body of the knowledgeand the provision of professional training opportunities are regarded as quite importantwhile divergent viewpoints exist in relation to issues like accreditation and a standardizedtertiary curriculum.
SDG4—Research
Agenda 2063:
Keywords: relevant skills, skills development
BACKGROUND : Entrepreneurship education interventions are deemed effective when they enhance interns entrepreneurial intent (EI) and entrepreneurial self-efficacy (ESE). Notwithstanding the emergence of internship as an experiential learning approach in entrepreneurship education, evidence about their potential to foster EI and ESE lacks systemisation. AIM : The aim of this study was to determine whether internships enhance EI and ESE. Furthermore, to what extent South African tertiary institutions include internships in their entrepreneurship and management curricula and the obstacles to such inclusion. SETTING : South Africa has made a concerted effort to insert an entrepreneurship component across tertiary curricula. The evolution of this entrepreneurship component to experiential learning approaches is, however, unclear. METHODS : A qualitative research approach was followed. Firstly, it reviewed empirical evidence for the positive relationship between internships and EI and ESE. Secondly, it conducted a survey of entrepreneurship and business management programmes at all 23 South African tertiary institutions and content analysed the retrieved information to determine whether such programmes include internships. Finally, 10 experts were interviewed to unveil the constraints inhibiting the inclusion of internships in tertiary curricula. RESULTS : The results revealed empirical support for the positive influence of internships on both EI and ESE. Significant lack of inclusion of internships in tertiary curricula in South Africa emerged, owing mainly to administrative issues, curriculum re-design challenges, and lack of mentoring capacity. CONCLUSION : Tertiary-level entrepreneurship education programmes should include an internship component. The paper suggested that tertiary institutions pilot-test the inclusion of internships with a small number of students and a selected cohort of small business owners.
SDG4, SDG8—Research
Agenda 2063: A1, A6
Keywords: entrepreneurship, skills development, South Africa
The removal of trade barriers has encouraged the entry of new competitors into formerly protected markets. This situation creates pressure on many small and medium enterprises (SMEs) in emerging economies such as Tanzania. Using a survey method and cross-sectional research design, the research examines three dimensions of entrepreneurial orientation (EO), namely: pro-activeness, risk-taking and competitive aggressiveness. Understanding their relationships and variance may help to improve our ability to explain SME performance. The findings contribute to how SME performance in emerging economies can be enhanced to enable SMEs to face challenges posed by competitor influx in the context of an open market economy. The findings indicate a strong relationship between EO dimensions and performance, with risktaking and competitive aggressiveness moderating the effect of pro-activeness. The proposed model could predict 72% of the variance explained in SME performance.
SDG4, SDG8—Research
Agenda 2063: A1
Keywords: entrepreneurship, micro, small and medium-sized enterprises, SMEs
Functional and enterprising competencies were identified in the integrated entrepreneurial performance model and the paper highlights which key skills and which supportive skills should be included in entrepreneurial training models and programmes. Functional competencies depend on business management/general business and technical skills. Enterprising competencies depend on entrepreneurial and personal skills. A clear distinction is made between general management and entrepreneurial skills. A multi-sample of 570 start-up and established small and medium enterprises (SMEs) was used to determine whether there are statistically significant differences between the groups in terms of the importance and proficiency in these competencies. Exploratory factor analysis was conducted to confirm the validity and reliability of the measuring instrument and several statistical tests, including t-tests and ANOVAs, were performed to test the hypotheses. Established SMEs considered functional competencies as being much more important than start-ups. This finding implies that start-up SMEs need to focus on the importance of functional competencies if they want to increase their chances of becoming established businesses. It was found that start-up, as well as established SMEs, consider enterprising competencies as important. The established group considered themselves very proficient in both the functional and enterprising competencies while the divergent was true for the start-up group.
SDG4, SDG8—Research
Agenda 2063: A1, A6
Keywords: entrepreneurship, micro, skills development, small and medium-sized enterprises, SMEs
The purpose of this paper is to report stakeholder views on the role of the educational psychologist in supporting inclusive education at schools in South Africa. An interpretivist paradigm with a qualitative case study design provided insight into the challenges associated with inclusive education and the potential supportive role of educational psychologists. We followed a purposive sampling procedure to select the following participants: a) two education officials b) seven teachers c) one educational psychologist d) one counsellor e) three district officials and f) one parent. Data was gathered from semi-structured interviews and focus group discussions with participants at a public school in Pretoria. Non-participant classroom observations were conducted. Through a process of thematic content analysis, the following themes emerged: a) Perceptions of the role of the educational psychologist in supporting inclusion and b) Improving educational psychology services to support inclusion. Findings suggest that the successful implementation of inclusive education remains a challenge in South Africa and that educational psychologists play a supportive role in implementing inclusive practices. Conclusion: The findings confirm that by means of forging alliances and collaboration between educational psychologists and stakeholders, the implementation process of inclusive education practices could be better supported.
SDG4—Research
Agenda 2063: A1
Keywords: access to education, inclusive education
In South Africa, up to 70% of children of school-going age with disabilities are out of school. Of those who do attend, most are still in separate, "special" schools for learners with disabilities. This situation prevails despite the push for the educational inclusion of learners with disabilities over twelve years ago by the South African policy document, the Education White Paper 6. In this article, we take a primarily top-down theoretical approach to policy implementation and focus on two main factors that hinder the implementation of inclusive education. Firstly, we focus on what we regard as the most significant constraint, namely, the apparent lack of clarity in the policy, i.e. ambiguity about the goals for inclusion and the means through which they can be achieved and, secondly, various issues around the poor implementation of the policy. We argue further that the primary means by which the divide between inclusive policy and practice will ultimately be closed is through the implementation and enforcement of education policy by the South African Department of Education.
SDG4—Research
Agenda 2063: A1
Keywords: access to education, inclusive education, South Africa
In a job-scarce environment, where unemployment is rife the need for fostering entrepreneurship especially among youth is a prime concern. This is arguably the case in South Africa, where despite a number of government-pioneered interventions, the level of youth entrepreneurship, particularly in township areas remains unsatisfactory. This study takes a two-pronged approach to establish specific factors that are inhibiting youth entrepreneurship development, and determine the prospects of youth entrepreneurship development in Khayelitsha in the Western Cape, South Africa. The data was collected via self-administered questionnaires that were distributed to 132 respondents, which were randomly drawn from a population of 200 youth entrepreneurs registered on the database of a local organisation which promotes and develops entrepreneurship in the Western Cape. The findings revealed, among others, that a major inhibiting factor to entrepreneurship development is the lack of awareness and inaccessibility of youth entrepreneurship support structures and initiatives in this community. Interestingly though, this hindrance does not appear to have a negative bearing on the identified growing enthusiasm of the youth to engage in entrepreneurial activities. Overall, on the basis of the challenges and prospects revealed, recommendations to improve the current situation are made. This study is an applied research effort and its relevance is linked to the fact that it provides rare insight into the state of youth entrepreneurship in a large but under-researched township community in the Western Cape. The findings and recommendations therefore bear far-reaching ramifications for all stakeholders who are concerned about developing youth entrepreneurship in this society.
SDG4, SDG8—Research
Agenda 2063: A1, A6
Keywords: entrepreneurship, skills development, South Africa, Western Cape

Inclusive education: A case of beliefs competing for implementation

Authors: Adrienne Meltz, Chaya Herman & Venitha Pillay
The study explored the understanding and implementation of inclusive education in an independent Jewish community school; a school with a community ethos of care and belonging, whose context is, by definition, exclusionary on the grounds of a particular social category religion. However, this exclusionary agenda positioned the school as inclusive on the grounds of strong communal values. Nevertheless, the school struggled with difference and diversity despite its purportedly strong communal spirit and religious culture. Further, it is arguable that the challenges encountered by the school may be indicative of the emergent economic context of South Africa where aspiration is often thwarted by economic realities. This study relied on qualitative methods of data generation such as insider interviews, personal accounts and document analysis. The participants were drawn from four stakeholder groups, namely, teachers, parents, middle managers and top managers. Guided by Lewins theory of planned change, the study identified four belief systems which influenced the way inclusive education was both understood and practised in this school. The study argued for the recognition of the importance of different belief systems in the implementation of inclusion in South Africa.
SDG4—Research
Agenda 2063: A1
Keywords: inclusive education
A significant number of young learners entering into Grade 1 in South Africa have not reached the required level of readiness for formal learning due to inadequate early learning experiences. As found in many studies worldwide, these learners are often traumatised because they cannot keep up with the pace and requirements of the formal learning situation, putting them at risk for school failure. Focus group interviews were conducted with Grade 1 teachers at two city schools in Pretoria to explore their experiences regarding the insufficient school readiness of their learners and the impact thereof on the learning process. The predominant concerns emerging from this investigation are the inaccessibility of the current curriculum (Curriculum and Assessment Policy Statement CAPS) for learners with insufficient school readiness, and education policies which seem to work against inclusivity. Although Education White Paper 6 (RSA DoE 2001) states that providing quality education to all learners requires adapting curricula, teaching strategies and organisational arrangements to meet the needs of the learners, the teachers in this study feel that they are not allowed the freedom to do so. Recommendations are made to remedy the situation.
SDG4—Research
Agenda 2063: A1
Keywords: access to education, inclusive education, primary education, primary schools

Mainstreaming disability in education beyond 2015

Authors: Maximus Monaheng Sefotho
This article presents an exemplary case study of an Independent Business Owner (IBO) from multiple case studies on narratives of differently abled persons. The aim of this article is to illustrate mainstreaming disability through an exemplary case of the IBO. The article is informed by the imperatives of critical theory to understand mainstreaming disability. I examine mainstreaming disability in reference to inclusive education and sustainable development via hephapreneurship (later described in the text). The purposively selected sample of the study was (n=18) participants. The argument forwarded suggests hephapreneurship as one way of mainstreaming disability. Data were collected through interviews, observations and informal conversations. Results indicate the need to unlock entrepreneurial capacities of persons with disabilities such that they may contribute to sustainable development. The study concludes by showing that the participation of independent business owners in sustainable development activities could serve as an anchor for mainstreaming disability beyond 2015.
SDG4—Research
Agenda 2063: A1
Keywords: inclusive education
Current developments in government law and policies have created the hope that people living with a disability will enjoy the same rights and privileges as the non-disabled. Unfortunately, only 2.8% of disabled persons have access to higher education. The aim of this study was to determine if a group of students, living with a physical disability, experienced constraints with regard to access to a South African higher education institution. This study, following a two-phase sequential mixed method approach, consisted of a questionnaire survey, a focus group discussion, and individual interviews. It was found that students living with a physical disability experienced constraints relating to the accessibility of the relevant higher education institution. Since access constraints affect the lives of students living with a disability, it is necessary to provide guidelines to universities on how to address these challenges.
SDG4—Research
Agenda 2063: A1
Keywords: access to education, inclusive education, South Africa
It is widely acknowledged that different communities, such as language groups and socio-economic status (SES) families, practice literacy in different ways. Certain language communities of low SES observe literacy interactions differently from the traditional schooled literacy, which may influence learners reading literacy. However, the link between language communities, SES and reading literacy has not been extensively researched, especially in the South African context where there are 11 official languages and wide socio-economic disparities. This article examines students social literacy in relation to their reading literacy levels, and reveals that the literacy gap between indigenous South African language (ISAL) speakers, a number of whom are from low SES families, and speakers of English and Afrikaans is further widened at the tertiary level due to the mismatch between the social literacy practices of the different language groups and the education system that operates in the country. Recommendations are made on how educators could employ strategies such as social relevance and culturally sensitive teaching to bridge the academic literacy gap among the language groups.
SDG4—Research
Agenda 2063: A1
Keywords: literacy, South Africa
In a previous study Moodley, Kritzinger and Vinck (2014) found that formal English Additional Language (EAL) instruction contributed significantly better to listening and speaking skills in Grade R learners, than did a play-based approach. The finding in multilingual rural Mpumalanga schools was in agreement with numerous studies elsewhere. Additional extraneous variables such as teachers first language, qualifications, age and experience, and learners first language and gender may also relate to EAL performance. The aim of the present study has been to determine whether these variables were significantly associated with learners EAL performance scores. A matched two group comparison study was conducted, utilising 175 learners and 10 teachers from isiNdebele, isiZulu, Sepedi, siSwati and Xitsonga first language backgrounds. The English Language Proficiency standards assessment tool was used. Learners of IsiNdebele teachers and young qualified teachers performed better than other learners. Learners with isiNdebele as first language performed better than learners from other languages. No association between gender and learner performance was found. The advantage of isiNdebele speaking teachers and learners in EAL teaching and learning may relate to the many borrowed phonemes and words from English. Further research is required to strengthen the evidence.
SDG4—Research
Agenda 2063: A1
Keywords: literacy, Mpumalanga, South Africa
This study draws on the preProgress in International Reading Literacy Study (prePIRLS) 2011 data. It aims to illustrate the effect of early home literacy activities and the early introduction of reading skills and strategies in the school setting on reading literacy achievement amongst South African Grade 4 learners across the 11 official languages. South African learner performance is consistently poor across a variety of international assessment programmes. The prePIRLS 2011 study results place South African Grade 4 learners results substantially below the international centre point of 500 at 461 (SE = 3.7). As part of the reading achievement assessment, prePIRLS 2011 gathered background information in the form of learner, parent, teacher and school questionnaires. This study investigates two aspects as reported by parents and school principals of Grade 4 learners: firstly, parents of Grade 4 learners reported in the Learning to Read survey (or Parent Questionnaire) on the frequency with which early home literacy activities were conducted in the home before the learner commenced schooling. Secondly, principals of learners reported on the grade level (from Grade 1 to Grade 4 and beyond) at which a number of critical reading skills and strategies were introduced to learners. Fourteen such skills are identified, ranging from basic skills to skills with increased complexity. This study links the frequency of early home literacy activities, as reported by Grade 4 learners parents, and the introduction of the 14 reading skills, as reported by school principals, to learner achievement scores in the prePIRLS 2011 assessment.
SDG4—Research
Agenda 2063: A1, A6
Keywords: literacy, South Africa
This study aims to identify factors that predict reading literacy achievement among Grade 4 learners in South Africa by utilising aspects of Carrolls model of school learning. The study draws on the preProgress in International Reading Literacy Study (prePIRLS) 2011 data, which places South African Grade 4 learners results substantially below the international centre point of 500 at 461 (SE = 3.7). Selected items from the prePIRLS 2011 learner, parent and teacher questionnaires were used in a two-level model to determine the effect of learner aptitude, opportunity to learn and quality of instructional events on reading literacy achievement. The results point to the statistical significance of engaged reading and cultivating motivation for reading among learners from an early age, specifically through parental involvement in introducing early literacy activities as foundation of reading literacy by school-going age. Other results provide evidence for the importance of the value of reading across the curriculum not confined to formal reading lessons only. The teaching of reading comprehension skills and strategies is identified as a significant predictor of reading literacy achievement, instruction of which should form an integral part of teaching reading in the classroom.
SDG4—Research
Agenda 2063: A1, A6
Keywords: literacy, South Africa
The study contextualises the position of child citizens in the South African democracy and highlights how education for democratic citizenship is employed through a literacy-based approach. The qualitative study was exploratory and based on a lesson presented to nine-year-old township children by giving them language-related tasks. Through the childrens voices we present the life experiences that expressed their need for basic services, education, extra facilities and security. We argue that children need to experience the benefits of democracy and education for democratic citizenship to build and sustain a resilient democratic society.
SDG4—Research
Agenda 2063: A1, A3
Keywords: citizenship education, South Africa
Mathematical Literacy (ML) is a relatively new school subject that learners study in the final 3 years of high school and is examined as a matric subject. An investigation of a 2009 provincial examination written by matric pupils was conducted on both the curriculum elements of the test and learner performance. In this study we supplement the prior qualitative investigation with an application of Rasch measurement theory to review and revise the scoring procedures so as to better reflect scoring intentions. In an application of the Rasch model, checks are made on the test as a whole, the items and the learner responses, to ensure coherence of the instrument for the particular reference group, in this case Mathematical Literacy learners in one high school. In this article, we focus on the scoring of polytomous items, that is, items that are scored 0, 1, 2 m. We found in some instances indiscriminate mark allocations, which contravened assessment and measurement principles. Through the investigation of each item, the associated scoring logic and the output of the Rasch analysis, rescoring was explored. We report here on the analysis of the test prior to rescoring, the analysis and rescoring of individual items and the post rescore analysis. The purpose of the article is to address the question: How may detailed attention to the scoring of the items in a Mathematical Literacy test, through theoretical investigation and the application of the Rasch model, contribute to a more informative and coherent outcome?
SDG4—Research
Agenda 2063: A1, A6
Keywords: mathematics, numeracy
The teaching of mathematics in South African schools is placed among the worst in the world, despite recognizing the development of the country as a knowledge economy that largely depends on mathematics teaching and competency. The simple logic flowing from this line of thinking is that for learners to perform in mathematics, they need competent teachers who are responsive to the context of the right to basic education. Inclusive education defines such context. For effective teaching of mathematics within an inclusive education setting to be possible in lower grades, this study argues for differentiated teaching practices to support all learners. For this to be possible, teachers need capacity to carry out curriculum differentiation. This study followed a qualitative approach in which data was collected through observations, document analysis and interviews. The results show that Foundation Phase Mathematics teachers face such challenges as the lack of training in curriculum differentiation and the inability to respond to learner diversity
SDG4—Research
Agenda 2063:
Keywords: mathematics, numeracy, teachers training

Perceptions and needs of South African mathematics teachers concerning their use of technology for instruction

Authors: G Stols, R Ferreira, A Pelser, W A Olivier, A van der Merwe, C de Villiers & S Venter
Although many South African teachers have access to the internet, they often refrain from using available online resources to improve the quality of their own teaching. In an attempt to promote Mathematics teachers effective use of online resources, we developed a web-based platform. This article reports on the first phase of a broader project that focuses on Mathematics teachers perceptions about and needs for utilising technology in the classroom. Twenty-two teachers participated in this mixed-method pilot study. To obtain qualitative data, we facilitated a Participatory Reflection and Action (PRA) workshop and for the quantitative part of our study, we implemented a questionnaire. The Unified Theory of Acceptance and Use of Technology (UTAUT) were selected for the theoretical framework. With regard to effort expectancy, participating teachers found the use of technology overwhelming, resulting in a need for further training. No evidence was found of social influence affecting the participants acceptance of technology. The participants proved to have access to sufficient equipment. However, their perceptions of their own limited skills weighed heavier than external facilitating conditions. As a result, participating teachers were hesitant to utilise technology in their teaching.
SDG4—Research
Agenda 2063:
Keywords: mathematics, numeracy, teachers training
Development has been a right in Africa since African leaders made the commitment thereto at the adoption of the African Charter on Human and People's Rights in 1981. Yet, in Africa, the majority of women cannot exercise citizenship rights because of the manner in which their society view them and, sometimes, even because of the way women view themselves. Development in critical aspects of the lives of the people is regarded as one of the envisaged products of constitutional democratic institutions. Women are at most times relegated to the status of "second class citizens" who only operate within the private spheres. While regional human rights instruments have made remarkable gains in ensuring that women within the region are protected, there is, however, a disconnect between the rights enshrined in the instruments and the daily reality of the majority of women. The majority of African countries are still far from creating an egalitarian society where men and women have equal opportunity and access to benefits. In this article, the authors argue that the conduct of governments in protecting the substantive rights of the majority of women in Africa is in total violation of domestic, regional and international law. Nigeria, for example, is committed to the protection of the human rights of all its citizens. However, citizenship rights in Nigeria do not seek to promote and protect the substantive rights of the majority of women. The implication is the complete erosion of dignity and fundamental rights. In other words, the majority of women lose the essence of the inherent membership of their society.
SDG5—Research
Agenda 2063: A6
Keywords: gender equality
In 2013 there are still thousands of children in South Africa attending dilapidated mud schools, schools lacking sanitation, and schools without electricity. The situation took a positive turn in 2009 when the government was taken to court about the severe infrastructure backlogs in the Eastern Cape province. The case settled out of court, and resulted in a memorandum of agreement which pledged R 8.2 billion over three years. However, the allocation of these and other funds has not immediately translated into tangible results on a broad scale. This is because large infrastructure projects require management capacity that is lacking in Department of Education in South Africa. This paper demonstrates the justiciability of the right to education, and shows that litigation, implementation monitoring and budgetary analysis may be new tools to lever funds for education at the country level, and to hold government accountable for efficient spending. The significance of this to the post-2015 development context is that developing countries must find new methods for ensuring the provision and expenditure of funds from existing budgets within their own countries. In order to achieve this education activists must forge new alliances with partners who have knowledge in budgeting, budgetary analysis and where necessary, litigation.
SDG4—Research
Agenda 2063: A1
Keywords: education facilities, school buildings, school infrastructure, South Africa

Stepping Stones and Creating Futures intervention: Shortened interrupted time series evaluation of a behavioural and structural health promotion and violence prevention intervention for young people in informal settlements in Durban, South Africa

Authors: Rachel Jewkes, Andrew Gibbs, Nwabisa Jama-Shai, Samantha Willan, Alison Misselhorn, Mildred Mushinga, Laura Washington, Nompumelelo Mbatha & Yandisa Skiweyiya
BACKGROUND : Gender-based violence and HIV are highly prevalent in the harsh environment of informal settlements and reducing violence here is very challenging. The group intervention Stepping Stones has been shown to reduce mens perpetration of violence in more rural areas, but violence experienced by women in the study was not affected. Economic empowerment interventions with gender training can protect older women from violence, but microloan interventions have proved challenging with young women. We investigated whether combining a broad economic empowerment intervention and Stepping Stones could impact on violence among young men and women. The intervention, Creating Futures, was developed as a new generation of economic empowerment intervention, which enabled livelihood strengthening though helping participants find work or set up a business, and did not give cash or make loans. METHODS : We piloted Stepping Stones with Creating Futures in two informal settlements of Durban with 232 out of school youth, mostly aged 1830 and evaluated with a shortened interrupted time series of two baseline surveys and at 28 and 58 weeks post-baseline. 94/110 men and 111/122 women completed the last assessment, 85.5% and 90.2% respectively of those enrolled. To determine trend, we built random effects regression models with each individual as the cluster for each variable, and measured the slope of the line across the time points. RESULTS : Mens mean earnings in the past month increased by 247% from R411 (~$40) to R1015 (~$102, and womens by 278% R 174 (~$17) to R 484 (about $48) (trend test, p < 0.0001). There was a significant reduction in womens experience of the combined measure of physical and/or sexual IPV in the prior three months from 30.3% to 18.9% (p = 0.037). This was not seen for men. However both men and women scored significantly better on gender attitudes and men significantly reduced their controlling practices in their relationship. The prevalence of moderate or severe depression symptomatology among men and suicidal thoughts decreased significantly (p < 0.0001 and p = 0.01). CONCLUSIONS : These findings are very positive for an exploratory study and indicate that the Creating Futures/ Stepping Stones intervention has potential for impact in these difficult areas with young men and women. Further evaluation is needed.
SDG4—Research
Agenda 2063: A1, A4
Keywords: non-violence education, South Africa, violence prevention

Violence against women in South Africa

Authors: Lerato Langa-Mlambo & Priya Soma-Pillay
South Africa is currently experiencing a huge burden of morbidity and mortality arising from violence and injury. In 2000, violence and unintentional injuries combined were the second leading cause of all death and disability adjusted life years (DALY).1 The first cause being Human Immunodeficiency Viral (HIV) diseases.1 Interpersonal violence is the leading risk factor after unsafe sex and for loss of DALYs.1 According to the crime statistics report of South Africa during the 2011/12 financial year there were 777 104 serious crimes arrests and 806 298 in 2012/13.2 There were 197 877 crimes reported against women in 2009/10 in comparison to 175 880 in 2012/13, a reduction of 11.1%.2 However, the reviews of evidence for gender based violence has reported that no reduction occurred in the past decade.3 There are no reliable national data for the prevalence of intimate partner violence (IPV), but the best population based estimates from 1998 identifies a lifetime prevalence of physical violence of 25%.
SDG5—Research
Agenda 2063: A6
Keywords: gender violence, sexual violence, South Africa
The adverse impact of human trafficking on individuals, societies, countries and regions have necessitated legal and non-legal efforts being made at global, regional and national levels to combat the phenomenon. This article specifically compares South African and Mozambican approaches to countering human trafficking and provides a conceptual framework of trafficking. This does not entail a comprehensive evaluation of the effectiveness of South African and Mozambican measures in combating trafficking, but a content analysis of major provisions of their anti-trafficking legislation enacted in fulfilment of the obligations of the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children of 2000 (Palermo Protocol). It is contended that the adoption of anti-trafficking legislation by these countries signifies a willingness to comprehensively address the problem. While similarities can be observed in provisions relating to prosecution, protection, prevention, national co-ordination and co-operation as well as international co-ordination and co-operation, certain differences still exist. These differences are observed in, for example, provisions relating to reporting and investigation of cases of trafficking. While fewer powers appear to be given to the Mozambican police to investigate trafficking cases, more powers are given to the South African police. Again, while the South African legislation makes provision for extra-territorial jurisdiction regarding cases of trafficking, the Mozambican legislation has not provided for this. Despite comprehensive provisions to address human trafficking, the anti-trafficking legislation of both countries contains certain weaknesses in areas such as the provision of guidelines for victim identification. These weaknesses, it is contended, will hinder effective implementation of the anti-trafficking laws. Against this background, suggestions are made for prioritisation of the campaign against trafficking through national co-operation and co-ordination, as well as bi-lateral and multi-lateral international co-operation.
SDG8—Research
Agenda 2063:
Keywords: human trafficking
Transformation of higher education in South Africa included among others, forcing institutions of higher learning to implement policies aimed at elevating women to managerial positions. Although the challenges to get to the desired government objectives are still there, universities have not been making a fast progress. Focusing on women already occupying managerial positions, this paper explored their lived experiences, views and attitudes about their roles in higher education leadership. A random sample of eight female managers at an urban traditional university in South Africa was interviewed about their personal experiences as managers in higher education and difficulties associated with being a woman in management. The sample included Deputy Vice Chancellors, Deans of faculties, Heads of Departments and Executive Directors. The results were transcribed and analysed with the aid of computer assisted qualitative data analysis software, Atlas.ti. The results suggested that, women are not afraid to make unpopular decisions. Women are also more considerate of others (peers) when taking decisions, especially in delicate situations where politics play a greater role. Additionally, it emerged from the study that empowerment of other people by not silencing or oppressing them is notable and important among women managers.
SDG5—Research
Agenda 2063: A6
Keywords: South Africa, women in leadership, women leaders

Continuing the discourse of women in information technology: A South African perspective

Authors: Hendrik W Pretorius, Tendani Mawela, Ian Strydom, Carina de Villiers & Roy D Johnson
Currently, there is a worldwide decline in the participation of women in the information technology (IT) profession and education. This article continues the existing discourse on women in IT by discussing the South African domestic and IT work environments. The aim is to understand whether South African women experience similar levels of career problems in the IT industry as their international counterparts. Using critical interpretive analysis, we used the experiences of 48 women working in the private sector IT firms to investigate not only what attracts women in South Africa to the IT industry but also what discourages them from following a career in this field. The data were collected by means of an anonymous online questionnaire consisting of open- and close-ended Currently, there is a worldwide decline in the participation of women in the information technology (IT) profession and education. This article continues the existing discourse on women in IT by discussing the South African domestic and IT work environments. The aim is to understand whether South African women experience similar levels of career problems in the IT industry as their international counterparts. Using critical interpretive analysis, we used the experiences of 48 women working in the private sector IT firms to investigate not only what attracts women in South Africa to the IT industry but also what discourages them from following a career in this field. The data were collected by means of an anonymous online questionnaire consisting of open- and close-ended questions. This study provides an insight into the impact of domestic influences on women in the IT industry in South Africa. It also contributes to communities, such as, feminists, academia, practitioners, or governments, in the creation of an emancipation theory or a series of interventions to improve the situation for women in the South African IT industry.
SDG5—Research
Agenda 2063: A6
Keywords: gender discrimintatoin, South Africa
In July 2003 the Minister of Water Affairs, now known as Water and Sanitation appointed the Mopani District Municipality in the Limpopo Province as the Water Service Authority for their area of jurisdiction as determined by the Municipal Demarcation Board. According to section 11 of the Water Services Act 108 of 1997, every Water Service Authority has a duty to all consumers or potential consumers in the area of jurisdiction to progressively ensure efficient, affordable, economical and sustainable access to water services. In response to this obligation the Mopani District Municipality appointed all five local municipalities as water service providers. In addition, the Mopani District Municipality has signed a bulk water supply agreement with the Lepelle Northern Water Board in the area of the Ba-Phalaborwa and Greater Letaba municipalities based on the fact that the board has the abstraction license and the bulk infrastructure for purifying water. This article examines the manner in which the Mopani District Municipality provided water services and the factors affecting the provision of sustainable water services. The findings suggest that the provision of water in the Mopani District Municipality is not sustainable owing to the ageing infrastructure, inadequate water resources, poor planning, limited capacity in municipalities and the nonpayment of water services by the households. The results show that it will take considerable time for the service to be sustainable, especially in the rural areas unless the upgrading of the infrastructure as well as effective and efficient conservation management is prioritised.
SDG6—Research
Agenda 2063: A1, A2
Keywords: drinking water, Limpopo, South Africa, water access, water quality

Womens managerial aspirations: An organizational development perspective

Authors: Jenny M Hoobler, Grace Lemmon & Sandy J Wayne
Some authors have explained the dearth of women leaders as an opt-out revolutionthat women today are making a choice not to aspire to leadership positions. The authors of this article present a model that tests managers biased evaluations of women as less career motivated as an explanation for why women have lower managerial aspirations than men. Specifically, they hypothesize that day-to-day managerial decisions involving allocating challenging work, training and development, and career encouragement mean women accrue less organizational development, and this is one explanation for their lower managerial aspirations. The authors model is based on social role theory and is examined in a sample of 112 supervisor subordinate dyads at a U.S. Fortune 500 firm.
SDG5—Research
Agenda 2063: A6
Keywords: gender discrimintatoin, women in leadership, women leaders

Design of smart sensors for real-time water quality monitoring

Authors: Niel Andre Cloete, Reza Malekian & Lakshmi Nair
This paper describes work that has been done on the design and development of a water quality monitoring system, with the objective of notifying the user of the real-time water quality parameters. The system is able to measure physiochemical parameters of water quality, such as flow, temperature, pH, conductivity and the oxidation reduction potential. These physiochemical parameters are used to detect water contaminants. The sensors which are designed from first principles and implemented with signal conditioning circuits are connected to a microcontroller-based measuring node, which processes and analyses the data. In this design, ZigBee receiver and transmitter modules are used for communication between the measuring and notification node. The notification node presents the reading of the sensors and outputs an audio alert when water quality parameters reach unsafe levels. Various qualification tests are run to validate each aspect of the monitoring system. The sensors are shown to work within their intended accuracy ranges. The measurement node is able to transmit data via ZigBee to the notification node for audio and visual display. The results demonstrate that the system is capable of reading physiochemical parameters, and can successfully process, transmit and display the readings.
SDG6—Research
Agenda 2063: A1, A2
Keywords: water management, water quality
The Local Government: Municipal Demarcation Act, 27 of 1998 established new municipal areas according to, amongst other, geographical parameters such as interdependence of communities, grouped and connected logistical capacity, existing magisterial boundaries, land use patterns (e.g. topocadastral farm boundaries), political reasons (e.g. location of voters), and the topographical, environmental and physical characteristics of an area. Unfortunately, the geographical jurisdiction of the municipalities for the purpose of improving integrated municipal management (e.g. planning, organising and control) neither acknowledges nor utilises the Department of Water and Sanitation (DWS)s identifi ed and demarcated surface water (rivers) catchment boundaries. This could lead to ineffective, inefficient and uneconomical municipal environmental services, and water and sanitation management. By determining the status of the geographical, geo-hydrological and macroorganisational arrangements of the municipal service providers and public managers in various municipal areas through an extensive literature review and archival research since 2010, the author found the aforementioned prevalent in all the researched municipal areas. It was concluded that the use of surface water catchments in regional public planning and organising is essential to facilitate, amongst other, effective integrated water resources management and co-operative governance in the local sphere of government in a developing South Africa.
SDG6—Research
Agenda 2063: A2
Keywords: South Africa, water co-operation, water management
Rainwater harvesting (RWH) is a relatively inexpensive technology that has the potential to provide safe water in communities where conventional technologies are difficult to implement. In this study, the microbiological quality of rainwater harvested from rooftops and ground-surface runoff was evaluated based on the concentrations of Escherichia coli, total coliforms and enterococci. Samples were collected from 15 roof-harvested rainwater (RHRW) tanks, 4 ground-surface runoff rainwater harvesting (GRWH) tanks, 3 rivers and 1 spring water source in the Eastern Cape Province of South Africa, and 14 RHRW tanks in Gauteng Province. In the Eastern Cape Province E. coli and enterococci were detected in 7 and 4 of the 15 RHRW tanks, respectively. Enterococci were detected only from one river whereas E. coli was detected in all three rivers; in spring water neither enterococci nor E. coli were detected. Samples from GRWH tanks were positive for E. coli and enterococci in 2 and 3 of the 4 tanks, respectively. In Gauteng Province, E. coli, coliforms and enterococci were detected from 6, 6 and 9 of the 14 rainwater tanks, respectively. On average, E. coli and enterococci were detected in 44.8% of the RHRW tanks, although enterococci concentrations were several times higher than those for E. coli. We further evaluated the significance of urban pigeons as the likely sources of contamination by isolating 156 enterococci from 30 pigeon faecal samples and 208 enterococci from RHRW samples collected from Gauteng Province. Matrix-assisted laser desorption ionisation identification of the various enterococci revealed 4 species E. faecalis (20.5%), E. mundtii (20.51%), E. faecium (23.1%) and E. casseliflavus (17.3%) to be dominant in faecal samples, whereas E. casseliflavus (34.6%) and E. mundtii (33.2%) were dominant in RHRW.
SDG6—Research
Agenda 2063:
Keywords: South Africa, water harvesting
Concentrations of pollutants were measured in water, sediment and algal samples collected along a longitudinal gradient from a stretch of the Olifants River, South Africa, that receives AMD from the Klipspruit River. The effects of AMD were determined through macroinvertebrate biotic indices (SASS5) and multivariate analysis of macroinvertebrate communities. The acidic Klipspruit River caused increased concentrations of total Al, Fe and Mn in the Olifants River. Upon mixing of the Klipspruit with that from the alkaline Olifants River, Al and Fe precipitate rapidly, leading to lower concentrations in the dissolved phase and higher concentrations in the suspended phase and in sediment at sites in close proximity to the confluence. Similarly filamentous algae accumulated high concentrations of Al, Fe and Zn immediately after the confluence. Mn remains in the dissolved phase and sediment and algal concentrations increase with increasing distance downstream. Metal speciation analysis indicate that Al is rapidly converted from more toxic forms (e.g., Al3+ and Al(OH)2+) to less toxic forms (e.g., Al(OH)3(aq) and Al(OH)4-). In contrast, Mn remains in the soluble Mn2+ form. Macroinvertebrate metrics and community structure showed clear signs of deterioration in water quality in the Olifants River downstream of the point of AMD input . While total TDS concentrations at all sites fall within ranges likely to affect macroinvertebrates, the relative composition of major ions changes as a result of AMD input, which may also account for the observed changes in macroinvertebrate communities. Further downstream, the Wilge River discharges into the Olifants River, and significantly improves water quality downstream of the confluence. Future mining and development activities in the Wilge catchment should be carefully managed and monitored so as to ensure sufficient flows of acceptable quality to prevent further deterioration of water quality in the Olifants River and downstream reservoirs.
SDG6—Research
Agenda 2063:
Keywords: Olifants River, South Africa, water pollution
Instream water quality management encompasses field monitoring and utilisation of mathematical models. These models can be coupled with optimisation techniques to determine more efficient water quality management alternatives. Among these activities, wastewater treatment plays a crucial role. In this work, a Streeter-Phelps dissolved oxygen model (DO) is implemented in a semi-hypothetical Upper Olifants River system to forecast instream dissolved oxygen profiles in response to different wastewater discharge scenarios. A mixed integer programming (MIP) numerical approach was used in the simulation and determination of the best treatment regimen to meet the instream DO standard at the minimum cost for the chosen river catchment. The Olifants River catchment modelled in this study features 9 wastewater treatment plants. Three treatment levels were evaluated for biochemical oxygen demand (BOD) and the impact was evaluated at specific measuring points (checkpoints) within the river system. Using this model, it was demonstrated that water quality standards can be met at all monitoring points at a minimum cost by simultaneously optimising treatment levels at each treatment plant.
SDG6—Research
Agenda 2063:
Keywords: wastewater treatment, water management, water quality
This paper employs an economy-wide framework to evaluate impacts of water and trade policy reforms in South Africa (SA) on virtual water flows. To pursue this analysis, the study derives net virtual water trade flows between SA and its partners to assess implications of recent trade agreements within the South African Development Community compared to economic cooperation with other major trading blocks (e.g. European Union, Asia, and Brazil, Russia, India and China (BRIC)). Recent trends in actual trade confirm model predictions that liberalization of water allocation would switch water from field crops to horticulture and promote growth in non-agricultural exports. The results suggest that it is necessary to introduce policies that enhance likely outcomes of liberalization promoting higher water use efficiency within irrigation agriculture such as increased adoption of more efficient irrigation methods (sprinkler, drip, etc.) as water becomes more expensive under wider open competition. Moreover, investment in higher water use efficiency and improved competitiveness of dryland agriculture therefore represent the sound economic options for strengthening the capacity to achieve food security objectives as the country strives to lower net water exports. Finally, careful coordination of trade and water policy reforms is another necessary challenge for SAs strive to manage a water stressed economy.
SDG6—Research
Agenda 2063: A2
Keywords: South Africa, water management
South Africa is over-exploiting its freshwater resources and water could be a large constraint on the implementation of the National Development Plan. Using the International Futures forecasting system, this paper models and forecasts water demand and supply until 2035, the period covered by the National Water Resource Strategy 2013. The authors research finds that the gap between demand and supply increases and that the solutions proposed by the Department of Water Affairs and Sanitation will not close the gap without additional, aggressive measures. The authors propose such measures for each sector of demand and each source of water supply.
SDG6—Research
Agenda 2063: A1
Keywords: access to drinking water, South Africa, water management, water quality
This paper provides an assessment of the implementation of principles of integrated water resource management (IWRM) in the Inkomati River Basin (IRB), shared by South Africa, Swaziland and Mozambique. A methodology with a set of principles, change areas and measures was developed as a performance assessment tool. The tool was piloted in the IRB and results from the application were used to refine and finalise the tool. Piloting of the tool did provide very useful insights into IWRM implementation in the IRB and highlighted gaps where future attention needs to focus. Good progress has been realised with respect to creating the enabling environment and institutional frameworks as the key principles of IWRM have been successfully articulated in policy and legislation and a relatively satisfactory degree of stakeholder participation achieved. Measures related to the IWRM implementation instruments seem to be the least developed, particularly the financial enabling environment and institutional capacity building change areas. More attention also needs to be paid to conflict resolution mechanisms. The results from the pilot also showed that countries should consider a phased approach to assessment of IWRM, as implementation does seem to follow a process of creating the enabling environment, followed by formulating and implementing the institutional framework and creation and application of IWRM management instruments.
SDG6—Research
Agenda 2063: A1, A2
Keywords: Inkomati River Basin, integrated water management, South Africa
Lack of infrastructural facilities, empowerment, hunger and malnutrition are some of the major challenges facing the rural communities in Southern region of Africa, while the latter two often so because of the choices of whether to buy food or to buy the expensive cooking fuel or other family needs with the insufficient available income; inadequate infrastructures on the other hand has led to rural-urban migration boom amounting to an increase of over 62 percentage of the urban population over the last 15 years thereby adding to the urban unemployment problems in Southern Africa. For this purpose developing and promoting affordable solar cooking/heating system that can use the free available energy of the sun for Southern African condition is of utmost importance. Since Parabolic solar cookers are known to be most effective in terms of heat production, this paper thus looks into how the parabolic solar cooking system capable of working during the day and night or when there is no radiation can be used to fight the major challenges facing the rural areas in the southern Africa which are deforestation, hunger and poverty among others and how it can be used to develop local industries (Bread, Brownies, Pancake and Post-harvest) in Southern Africa.
SDG9—Research
Agenda 2063: A1
Keywords: access to electricity, access to energy, industrialisation, South Africa
Large numbers of households and communities will not be connected to the national electricity grid for the foreseeable future due to high cost of transmission and distribution systems to remote communities and the relatively low electricity demand within rural communities. Small-scale hydropower used to play a very important role in the provision of energy to urban and rural areas of South Africa. The national electricity grid, however, expanded and offered cheap, coalgenerated electricity and a large number of hydropower systems were decommissioned. In this study, a feasibility and implementation model was developed to assist in designing and financially evaluating small-scale hydropower (SSHP) plants. The implementation model describes steps to be followed in identifying a technically possible and economically feasible opportunity to develop a SSHP site for rural electrification. The development model was used in designing the Kwa Madiba SSHP plant. The Kwa Madiba SSHP plant was economically evaluated on net present value, internal rate of return, levelised cost of energy, financial payback period and cost/benefit ratio. The outcome of this study proved that it is technically possible to provide SSHP installations for rural electrification in South Africa that are more feasible than local or national electricity grid extensions or even alternative energy sources such as diesel generators. It was concluded that the levelised cost of SSHP projects indicates that the cost of SSHP for low energy generation is high compared to levelised cost of coal-fired power generation. However, the remoteness of SSHP for rural electrification increases the cost of infrastructure to connect remote rural communities to the national electricity grid. This provides a low cost/benefit ratio and renders technically implementable SSHP projects for rural electrification feasible on this basis.
SDG7, SDG9—Research
Agenda 2063: A2
Keywords: access to energy, renewable energy, South Africa, sustainable electricity, sustainable energy
The Wetland Classification and Risk Assessment Index (WCRAI) is based on manifestations of ecological processes in natural wetland ecosystems. The index is hierarchical in structure and is designed to allow identification and rapid assessment at the broadest levels by non wetland experts in different disciplines to manage natural wetlands. From previous studies, landscape ecology has demonstrated the importance of considering landscape context in addition to local site attributes when explaining wetland ecological processes and ecological integrity. The pressures that land uses and activities exert on wetlands generate impacts that affect both the biotic and abiotic characteristics of the surface water column and the surrounding riparian zone. Therefore, human-altered land in a catchment and spatial patterns of surrounding wetlands provide a direct way to measure human impacts and can be correlated with indicators such as water chemistry and biotic variables. The objective of this study was to develop and test the WCRAI so that the index can be used to classify different types of wetlands and to assess their ecological condition (also known as Eco-status) under different ecological conditions. The results obtained from the WCRAI were indicative of the integrity of these wetlands when compared to the status of the abiotic and biotic variables measured at each sampling site. From an economical perspective, the WCRAI can play a crucial role in preventing unnecessary degradation of wetlands, hence reducing financial loss through management, restoration, or rehabilitation efforts. The methodology can be applied very easily (due to its simplistic nature) by industry stakeholders to continually monitor these wetlands.
SDG6—Research
Agenda 2063: A1
Keywords: ecosystem services

South African renewable energy investment barriers: An investor perspective

Authors: Derick de Jongh, Dhirendra Ghoorah & Anesu Makina
As recently as the year 2010, renewable energy contributed less than 1% of all the energy sources in South Africa. Possible reasons include the lack of private sector investment in Renewable Energy technologies. By way of a structured interview methodology, this paper explores the reasons why private investors are reluctant to invest in renewables. The responses point to political, economic, social and technological barriers limiting private investment in renewable energy. Other barriers that were identified include poverty, low levels of education, limited technological readiness and access to the electricity grid. Some of these barriers are specific to the South African context. The paper concludes that a closer relationship between government and the private sector is required to stimulate innovation in the renewable energy sector.
SDG7—Research
Agenda 2063: A2
Keywords: clean energy, renewable energy, South Africa, sustainable energy

A preliminary investigation of the water use efficiency of sweet sorghum for biofuel in South Africa

Authors: M G Mengistu, J M Steyn, R P Kunz, I Doidge, H B Hlophe, C S Everson, G P W Jewitt & A D Clulow
Sweet sorghum (Sorghum bicolor (L.) Moench) has been recognized globally as a potential biofuel crop for ethanol production. Sweet sorghum is a drought-tolerant crop that is widely adapted to different environmental growing conditions. The aim of this study was to determine the water use efficiency (utilisable yield per unit amount of water used) of drip-irrigated sweet sorghum (variety Sugargraze) under two different climatic conditions in South Africa. The sweet sorghum trials were conducted at Ukulinga research farm (University of KwaZulu-Natal, Pietermaritzburg) and Hatfield experimental farm (University of Pretoria, Pretoria), South Africa. Field trials were conducted in two successive seasons, viz., 2010/11 and 2011/12. Seasonal water use was estimated using eddy covariance and surface renewal methods. Fresh and dry aboveground biomass yield, stalk yield and stalk Brix % were measured at final harvest. Theoretical ethanol yield was calculated from fresh stalk yield and Brix %. Water use for the two growing seasons was 415 mm at Ukulinga and 398 mm at Hatfield. The ethanol water use efficiency (WUE) values for the sweet sorghum at Ukulinga were 0.27 and 0.60 L?m-3 for 2010/11 and 2011/12 growing seasons, respectively. The ethanol WUE estimate of the sweet sorghum at Hatfield was 0.53 L?m-3 for the 2010/11 season and 0.70 L?m-3 for the 2011/12 growing season. WUE estimates of the sweet sorghum crop were higher for Hatfield compared to Ukulinga research farm. The results from this study showed that the WUE of sweet sorghum was sensitive to plant density. The WUE values confirm that sweet sorghum has high WUE under different climatic conditions.
SDG7—Research
Agenda 2063: A2
Keywords: renewable energy, South Africa, sustainable electricity, sustainable energy

Determining the feasibility of harvesting invasive alien plant species for energy

Authors: Worship Mugido, James Blignaut, Matthew Joubert, John de Wet, Andrew Knipe, Selm Joubert, Ben Cobbing, James Jansen, David Le Maitre & Marius van der Vyfer
Woody invasive alien plants (IAPs) are a threat to South Africas water resources, biodiversity and land productivity. The impacts of IAPs were the main reason for the South African government to embark on a natural resource management public works programme called Working for Water (WfW), which was aimed at controlling IAPs in a cost-effective yet labour-intensive way. At the same time, the high biomass of these species presents opportunities for synergies between the clearing of IAPs and the generation of biomassbased energy. The purpose of this study was to determine the cost of harvesting and extracting, chipping, and transporting the biomass, and also to determine the financial and economic feasibility of such an exercise from a commercial perspective. Sampling of the biomass was done at 31 representative sites within the Nelson Mandela Metropolitan Municipality, South Africa. The cost of the operation was carefully monitored, documented and reported at each stage, and compared to the cost of replacing the thermal coal currently used by industry within this municipality. The project proved to be financially viable, but only when the energy entrepreneur forms a partnership with the WfW programme, and then only under specific conditions. The project has, however, very high socio-economic returns with respect to a reduction in environmental externalities and job creation.
SDG7—Research
Agenda 2063: A2
Keywords: renewable energy, sustainable electricity, sustainable energy

Biogas production from water hyacinth blends

Authors: A A Fadairo & R O Fagbenle
This work studied the biogas generation potential of water hyacinth. This was with a view to determining the effects of blending cow dung and poultry droppings with water hyacinth on the yield of biogas. Samples of water hyacinth, cow-dung and poultry droppings were obtained from the Lagoon front of the University of Lagos Nigeria, an abattoir in Ile Ife Nigeria and the Teaching and Research Farm of the Obafemi Awolowo University Ile Ife Nigeria respectively. The sample of water hyacinth was subjected to some pretreatments before it was blended with cow-dung and poultry droppings in varying proportions and then digested in anaerobic digesters for a retention time of thirty days. The results showed that the water hyacinth blend with proportions of water hyacinth, cow dung and poultry droppings in the ratio of 2 : 2 : 1 respectively, produced the largest volume of biogas of 3.073 Litres per 2.5kg of the feedstock while water hyacinth alone which served as the control for the experiment produced the smallest volume of biogas of 0.931 Litres per kg of the feedstock. The result of the Gas Chromatography analysis revealed that the biogas had Methane (62.14%), Ammonia (0.44%), Carbon (IV) oxide (34.44%), Hydrogen sulphide (1.38%) and Carbon monoxide (0.44%). The study concluded that the biogas production from water hyacinth could be optimized by subjecting it to some pretreatments like blending with animal wastes.
SDG7—Research
Agenda 2063: A2
Keywords: renewable energy, sustainable electricity, sustainable energy

A review of low head hydropower technologies and applications in a South African context

Authors: I Loots, M van Dijk, B Bartac, S J van Vuuren & J N Bhagwan
This paper provides a review of available low head hydropower technologies, followed by the identification of sites where the technologies can be implemented, applied specifically to a South African context. The potential sites where low head hydropower can be installed in South Africa are grouped as follows: dams and barrages (retrofitting); rivers; irrigation systems (canals and conduits); and urban areas (industrial and urban discharge, storm water systems and water distribution systems). Keywords: low head hydropower, review, hydropower potential
SDG7—Research
Agenda 2063: A2
Keywords: renewable energy, South Africa, sustainable electricity, sustainable energy
In water distribution networks, water is often fed under gravity from a higher reservoir to another reservoir at a lower level. The residual pressure head at the receiving reservoir is then dissipated through control valves (mechanically or hydraulically actuated), sometimes augmented by orifice plates where there is a propensity for cavitation. There are possibilities to add turbines in parallel and generate hydroelectricity at these locations using the flow and head available. The benefit of this hydropower generating application is that minimal civil works need to be done, as the control valves are normally inside a control room/valve chamber. No negative environmental or social effects require mitigation, and the anticipated lead times should be short. From a topographical perspective the City of Tshwane has a lower elevation than the bulk service reservoirs of Rand Water, which is the main water supply. Water is distributed through a large water system that includes 160 reservoirs, 42 water towers, 10 677 km of pipes and more than 260 pressure reducing stations (PRS) that operate at pressures of up to 250 m. The top ten hydropower potential sites in the City of Tshwane water distribution network have a total energy generating capacity of approximately 10 000 MWh/a. A number of potential conduithydropower sites have shown promise of short payback periods. The identifying and development of these sites in Tshwane to convert water pressure to electricity is ongoing and exploited further. Various challenges currently exist with reservoir communication in isolated areas due to vandalism and theft of necessary infrastructure, including electricity cables and solar panels. Because conduit-hydropower systems can be housed completely inside chambers, vandalism and theft can be mitigated. Therefore, one of the major benefits of hydropower turbines at these sites is that the hydroelectric potential could be exploited to power telemetry, pressure management, flow control and monitoring/security systems. Alternatively or additionally, other local demand and/or (depending upon the quantum of energy available) off-site energy demand clusters, or even a municipal or national grid, could also be serviced by these power stations. The capacity of hydroelectric installations can vary to suit the application for the amount of power needed or to be generated. Short payback periods, especially when using pumps as turbines, also make conduit-hydropower systems attractive.
SDG7—Research
Agenda 2063: A2
Keywords: Pretoria, renewable energy, sustainable electricity, sustainable energy, Tshwane

Accuracy-enhanced solar resource maps of South Africa

Authors: M Suri, T Cebecauer, A J Meyer & J L van Niekerk
SolarGIS is a global database of solar resource and meteorological parameters, developed and operated by GeoModel Solar. This database is updated daily by real-time satellite, atmospheric and meteorological data inputs. The aim of presented work was accuracy enhancement of solar resource data for South Africa, Lesotho and Swaziland. This was achieved by regional adaptation of SolarGIS solar model with data measured at fourteen high-standard solar measuring stations sourced by Eskom, GeoSUN Africa, SAURAN, STERG and Ripasso Energy. The accuracy-enhancement procedure is based on correlation of the ground measurements with the satellite-based SolarGIS model and determination of correction coefficients for model inputs. Use of these coefficients reduced systematic deviation of the input aerosol data, which is key factor determining the model accuracy in Southern Africa. The user uncertainty of the longterm estimate based on adapted data is in the range of 5% to 7.5% for DNI, and 3% to 4% for GHI. The model now delivers more accurate high-resolution solar resource time series, which helps reducing financial risk and improving engineering quality of the solar power plants. The presented maps show longterm yearly averages of Direct Normal Irradiation (DNI) and Global Horizontal Irradiation (GHI) with 1-km spatial resolution. They are calculated by aggregation of sub-hourly modeled time series, representing a period 1994 to 2013. The maps are accessible from http://www.sauran.net/. High resolution data can be accessed from http://solargis.info.
SDG7—Research
Agenda 2063: A2
Keywords: renewable energy, South Africa, sustainable electricity, sustainable energy

Demand side management of photovoltaic-battery hybrid system

Authors: Zhou Wu, Henerica Tazvinga & Xiaohua Xia
In the electricity market, customers have many choices to reduce electricity cost if they can economically schedule their power consumption. Renewable hybrid system, which can explore solar or wind sources at low cost, is a popular choice for this purpose nowadays. In this paper optimal energy management for a grid-connected photovoltaic-battery hybrid system is proposed to sufficiently explore solar energy and to benefit customers at demand side. The management of power flow aims to minimize electricity cost subject to a number of constraints, such as power balance, solar output and battery capacity. With respect to demand side management, an optimal control method (open loop) is developed to schedule the power flow of hybrid system over 24 h, and model predictive control is used as a closed-loop method to dispatch the power flow in real-time when uncertain disturbances occur. In these two kinds of applications, optimal energy management solutions can be obtained with great cost savings and robust control performance.
SDG7—Research
Agenda 2063: A2
Keywords: energy efficiency
The improvement of energy efficiency is considered internationally as one of the ways to ensure energy security of supply, reduce greenhouse gas (GHG) emissions and mitigate the negative consequences of the climate change. In this paper, we propose a benchmark-and-trade system to improve the electricity intensity in South Africa in an effort towards the reduction of the country's emissions.This theoretical system is then used into a calculative application, as a simplistic example, with 2006 being the base year.The results show that the majority of the economic sectors will benefit by participating in the system. Also, the system has the ability to decrease the electricity intensity of the country without affecting its economic output.The findings indicate that, compared to the implementation of a carbon tax, this system gives the participants' stronger incentives to change their behaviour.
SDG7—Research
Agenda 2063: A2
Keywords:
The energy savings achieved by implementing energy efficiency (EE) lighting retrofit projects are sometimes not sustainable and vanish rapidly given that lamp population decays as time goes by if without proper maintenance activities. Scope of maintenance activities refers to replacements of failed lamps due to nonrepairable lamp burnouts. Full replacements of all the failed lamps during each maintenance interval contribute to a tight project budget due to the expense for the lamp failure inspections, as well as the procurement and installation of new lamps. Since neither no maintenance nor full maintenance is preferable to the EE lighting project developers (PDs), we propose to design an optimal maintenance plan that optimises the number of replacements of the failed lamps, such that the EE lighting project achieves sustainable performance in terms of energy savings whereas the PDs obtain their maximum benefits in the sense of costbenefit ratio. This optimal maintenance planning (OMP) problem is aptly formulated as an optimal control problem under control system framework, and solved by a model predictive control (MPC) approach. An optimal maintenance plan for an EE lighting retrofit project is designed as a case study to illustrate the effectiveness of the proposed control system approach.
SDG7—Research
Agenda 2063: A2
Keywords: energy efficiency
Following the application in March 2013 by the South African Poultry Association for increased tariffs to insure the sustainability of South African broiler production, this paper critically evaluates the effect of increased tariffs on broiler producers and chicken meat consumers in South Africa. Arguing beyond the level of tariffs, it highlights some of the deeper underlying drivers of competitiveness in the industry. From a self-sufficiency perspective, the need to support broiler producers is clear, yet the cost to consumers as well as the segment of the population that would have to bear the cost of higher tariffs is questioned. The proposed tariffs, as well as two other possible scenarios are simulated within a partial equilibrium framework in order to determine the effect on the fundamentals of the South African broiler industry. Simulations highlight the difference in outcomes when imports originating from the EU are also included in the general tariff increase. Under the basic scenario that simulates the impact of the current tariff application by SAPA, consumer prices for whole frozen chicken will increase by 2.6% while producers will enjoy an increase in producer prices of approximately 5%. On average, local production will increase by 16 000 tons per annum in the long run. Although 5% is a significant margin on the bottom line for broiler producers and a 2% increase in the average consumer price seems to be digestible, one has to take a step back and ask the question why our chicken producers cannot compete against imported chicken.
SDG8—Research
Agenda 2063: A1
Keywords: economic growth, economic productivity, South Africa
This study explores South Africas exports to Australia from 2000 to 2012, using both a static and a dynamic augmented gravity model. Sectors with export potential are identified, whether these are reliable and stable is considered. The largest export potential includes the apparel sectors as well as the basic metals, communication, furniture, glass, iron, leather, motor, paper and printing sectors. The most stable and reliable export sectors are the motor, machinery, iron, basic chemicals and food sectors. Although these sectors could target the promotion of South African exports, South Africa could also serve as an important source country for Australia in strengthening ties with the African continent.
SDG8—Research
Agenda 2063: A1
Keywords: economic growth, South Africa
Preliminary investigations into the energy efficiency of manufacturing firms operating in South Africa have shown that no previous study of the barriers to energy efficiency has been conducted. This paper sets out to investigate whether there is an energy efficiency gap in medium to large manufacturing firms operating in the eThekwini municipal area. It goes on further to analyse the barriers to energy efficiency in such firms. These barriers are analysed by firm characteristics and across manufacturing sectors. The findings of this research indicate that more can be done to improve the energy efficiency profile within South African manufacturing subsectors. Policy-makers should take these findings into consideration when drafting new policy on energy efficiency.
SDG7—Research
Agenda 2063: A2
Keywords: energy efficiency, eThekwini, South Africa
Many scholars have dedicated their studies to understanding the kind of assistance given to small business. Likewise, numerous studies have concentrated on how government in particular, through a small business policy, can be instrumental in providing business support. This article evaluates South Africas small business policy by concentrating on its objectives, outputs and outcomes. Studies evaluating small business policy according to its objectives, outputs and outcomes, have been limited. Such policy evaluation goes beyond merely reporting to understanding why certain phenomena take place. As an emerging economy, South Africa is in dire need of well-developed policies. This article proposes that understanding the link between small business policy and the age and location of a business may help government to refine policy formulation and design. Using a survey method and cross-sectional research design, the sample size of 340 respondents consisted of start-up and established business owners. This study found that not the age of the business, but only its location (the metropolitan municipality where the business is located) has a statistically significant effect on the objectives, outputs and outcomes of the small business policy. These findings should assist both national and international policymakers to identify specific context-bound interventions relevant to the location of businesses with a view to improving them.
SDG8—Research
Agenda 2063:
Keywords: micro, small and medium-sized enterprises, SMEs
This paper is primarily concerned with the revenue and tax efficiency effects of adjustments to marginal tax rates on individual income as an instrument of possible tax reform. The hypothesis is that changes to marginal rates affect not only the revenue base, but also tax efficiency and the optimum level of taxes that supports economic growth. Using an optimal revenue-maximising rate (based on Laffer analysis), the elasticity of taxable income is derived with respect to marginal tax rates for each taxable-income category. These elasticities are then used to quantify the impact of changes in marginal rates on the revenue base and tax efficiency using a microsimulation (MS) tax model. In this first paper on the research results, much attention is paid to the structure of the model and the way in which the database has been compiled. The model allows for the dissemination of individual taxpayers by income groups, gender, educational level, age group, etc. Simulations include a scenario with higher marginal rates which is also more progressive (as in the 1998/1999 fiscal year), in which case tax revenue increases but the increase is overshadowed by a more than proportional decrease in tax efficiency as measured by its deadweight loss. On the other hand, a lowering of marginal rates (to bring South Africas marginal rates more in line with those of its peers) improves tax efficiency but also results in a substantial revenue loss. The estimated optimal individual tax to gross domestic product (GDP) ratio in order to maximise economic growth (6.7 per cent) shows a strong response to changes in marginal rates, and the results from this research indicate that a lowering of marginal rates would also move the actual ratio closer to its optimum level. Thus, the trade-off between revenue collected and tax efficiency should be carefully monitored when personal income tax reform is being considered.
—Research
Agenda 2063: A7
Keywords: domestic resource mobilisation, South Africa, tax collection
This paper examines the causal relationship between imports and growth in nine provinces of South Africa for a period 1996-2011, using panel causality analysis, with accounts for cross-section dependency and heterogeneity across regions. Our empirical results support unidirectional causality running from economic growth to imports from Gauteng, Mpumalanga, North West, and Western Cape ; br - rectional causality between imports and economic growth for KwaZulu-Natal ; an no causality in any direction between economic growth and imports for the rest of provinces. This suggests that import liberalisation might not be an efficient strategy to improve provincial economic performance in South Africa. Indeed, provincial imports tend to increase in some provinces as economic improves.
SDG8—Research
Agenda 2063: A1
Keywords: economic growth, South Africa
ORIENTATION : Organisations constantly strive to understand the impact of leader behaviour on continued superior organisational performance. RESEARCH PURPOSE : The purpose of the study was to establish a framework of requisite leader behavioural competencies for sustainable (repeated) organisational performance and to determine the interrelationship between leader behaviour and sustainable organisational performance. RATIONALE/ MOTIVATION : Many studies have been conducted investigating the impact of leadership on organisational performance, but a gap exists in studying the interplay between leader behavioural competencies, organisational performance and organisational context. RESEARCH DESIGN, APPROACH AND METHOD : A case study research design was used employing a qualitative approach with a constructivist grounded theory research philosophy. Data collection comprised archival document review and semi-structured, in-depth interviews with senior executives in a high performing multinational listed South African organisation as case. Data analysis was conducted with the aid of qualitative data analysis computer software, as well as through iterative open and axial coding to discover patterns and themes. MAIN FINDINGS : The study resulted in a leader behavioural competency framework purporting a model founded strongly in context and simplicity. PRACTICAL/ MANAGERIAL IMPLICATIONS : Requisite leader behavioural competencies were identified as: 1) simple focus and providing direction; 2) a sincere regard for people, or employee wellbeing; 3) creating an environment of absolute trust and empowerment; 4) enforcing innovation and entrepreneurship; 5) full leader support and backup; and 6) affording profound reward and recognition for achievements. CONTRIBUTION : Organisations can benefit from an insight into understanding how the identified requisite leader behavioural competencies possibly can impact organisational performance in their respective environments.
SDG8—Research
Agenda 2063: A3
Keywords: economic productivity
This study examines the importance of technological progress to aggregate economic growth in South Africa. Quantifying the contribution of technological progress to economic growth has become imperative, considering the outcome of a simple growth accounting exercise. The findings of this exercise indicate that the contribution of technological growth to aggregate economic growth increased substantially, over the past three decades. Economic growth is modelled through a Cobb-Douglas production function, employing Kalman filter to determine the evolution of the Solow residual over time. The Solow residual represents both technological progress and structural change. According to the Kalman filter results, technological progress is characterised by an upward trend since the 1980s with a steeper slope during the 2000s. Our results show that technological progress has become a factor as important to production as capital stock and labour; fact that policy makers should take into consideration to boost economic growth.
SDG8—Research
Agenda 2063: A1
Keywords: economic growth, economic productivity, South Africa
Although the success of small, medium and micro enterprises (SMEs) is extremely important for the South African economy, their failure rate is amongst the highest in the world; some researchers estimate as high as 90 percent. Research has shown that the lack of financial management skills and application of financial management practices are some of the biggest factors contributing to SME failure. However, it is not clear from the literature which of these skills and practices are more important than others. This study aims to fill this gap by determining which financial management skills are relevant for successful SMEs. A survey was done on a sample of owner-managers of successful SMEs who had been asked, firstly, whether they performed different financial management practices and, secondly, how frequently they performed these in their companies. The study concludes that practices regarding working capital as well as profitability are much more relevant than those regarding a balance sheet or strategic finance. Similarly, financial practices related to cash flow and decision making are more relevant than those related to planning or analysing. It may be true, due to the high risk and volatile environment of SMEs, as well as the challenges that are often underestimated, that financial practices which academics regard as important are not always implemented by these companies. This study contributes to the existing body of knowledge as it determines the relative relevance and frequency of use of financial management practices by successful SMEs.
SDG8—Research
Agenda 2063:
Keywords: entrepreneurship, micro, small and medium-sized enterprises, SMEs, South Africa
This paper investigates the effects of productive government spending on the relationship between growth and inequality in an economy subject to idiosyncratic production shocks and heterogeneous endowments. Assuming lognormal distributions, we derive tractable closed form solutions describing the equilibrium dynamics. We show how the effect of government investment on the equilibrium dynamics of both inequality and growth depends crucially upon the elasticity of substitution between public and private capital in production. This has important consequences for the growth- and welfaremaximizing rates of government investment. Finally, we supplement our theoretical analysis with numerical simulations, calibrated to approximate the productive characteristics of a real world economy. With the empirical evidence strongly supporting the complementarity between public and private capital, our simulations suggest that conclusions based on the commonly employed Cobb-Douglas production function may be seriously misleading.
SDG8—Research
Agenda 2063: A1
Keywords: economic growth, inequality

Optimal public investment, growth, and consumption: Evidence from African countries

Authors: Augustin Kwasi Fosu, Yoseph Yilma Getachew & Thomas H. W. Ziesemer
This paper develops a model positing a nonlinear relationship between public investment and growth. The model is then applied to a panel of African countries, using nonlinear estimating procedures. The growth-maximizing level of public investment is estimated at about 10% of GDP, based on System GMM estimation. The paper further runs simulations, obtaining the constant optimal public investment share that maximizes the sum of discounted consumption as between 8.1% and 9.6% of GDP. Compared with the observed end-of-panel mean value of no more than 7.26%, these estimates suggest that there has been significant public underinvestment in Africa.
SDG8—Research
Agenda 2063: A1
Keywords: economic growth
A survey of 52 smallholder fresh produce farmers was conducted in the Gauteng province of South Africa to grasp how risk and its management affect the mainstreaming of smallholder farmers into formal, high-value markets. The study employed a supply chain analysis approach, which focused on the functions and risks that occur along the fresh produce chain. The results highlight the risks that impede the participation of smallholder farmers in formal, high-value chains. At the production level, risk is prominent from input procurement through to the post-harvest stage of the chains. At the retail and consumption level, risks are linked to the adherence to quality and quantity standards, including prescribed packaging, grading, labelling and traceability and transport requirements. As a result of these risks across the formal chain, smallholder farmers often resort to distributing their products in low-value informal markets. The consequence is that smallholder farmers tend to remain trapped in poverty, in part, because of their risk appetites and their ability to bear risk. 8Further research is required in the areas pertaining to smallholder farmers risk appetite and risk-bearing ability and mechanisms to deal with the particular risks in the value chain that impede their all-round ability to escape the smallholder dilemma.
SDG2, SDG8—Research
Agenda 2063:
Keywords: micro, small and medium-sized enterprises, small-scale farmers, small-scale food producers, SMEs, South Africa
Namibia has recently introduced policies regarding the regulation of agency work, and South Africa is in the process of doing the same. The promotion of the decent work agenda by the International Labour Organization (ILO) and the implementation of flexicurity policies by the European Union (EU) have been followed by the adoption of instruments giving recognition to agency work. This contribution revisits the approach to the regulation of agency work in Namibia and South Africa. It considers the question of whether these two cases can cast light on the changing role of labour law regulation as developments unfold on the international front.
SDG8—Research
Agenda 2063: A1
Keywords: decent work, South Africa
While tourism has often been proposed as a mechanism for equitable and sustainable development in developing countries, most destination communities remain relegated to the role of passive tourees who are unable to participate in economic opportunities often controlled by tourism retail monopolies. Guided by information systems (IS) research on mobile and temporarily interconnected systems (MTIS), this work examines the ubiquitous nature of information services for users on the move. That is, users that are largely dependent on mobile telephones and temporary tourism services. Stakeholder interviews included local South African micro-entrepreneurs from under-resourced rural and peri-urban communities and other national and regional stakeholders. The findings informed the development and early implementation of a web marketplace for tourism micro-entrepreneurs (i.e., www.peoplefirsttourism.com) that bridges hyper-connected consumers with under-resourced microentrepreneurs who use simple mobile phones. Further, this study builds on interdisciplinary research to enrich discussions about ICT for Development (ICT4D).
SDG12, SDG8—Research
Agenda 2063: A1
Keywords: sustainable tourism
This paper surveys frameworks of labour migration in southern Africa and determines South Africas policy responses to inflows of migrants from seven neighbouring countries. Legislations, policy reports and scientific publications on migration were thoroughly reviewed and interviews and correspondence with key policymakers were conducted. Statistical analyses of data on foreign worker recruitments and permits issued by South Africas Department of Home Affairs were also performed. The absence of a migration protocol in southern Africa suggests SADC Members have not implemented the African Unions migration policy basic guidelines. Two systems coexist in southern Africa that complicate migration governance: a South Africa?managed bilateral migration policy, and aspirations for a formal SADC?managed migration policy. Bilateral agreements between South Africa and neighbours have established a labour migration system that dims prospects for a regional migration policy. SACU Members could establish a two?tier policy to achieve free movement while maintaining managed migration policy outside SACU. An official multilateral migration governance mechanism would serve SADC better than the current ad?hoc measures.
SDG8—Research
Agenda 2063: A2
Keywords: migrant workers, migrants, South Africa
Within the context of this paper, a migrant is defined as an asylum seeker, a refugee, a legal and or an illegal immigrant. Labour migration in South Africa has received little attention due to concerns with immigration, which are regarded as far more immediate and pressing. This consideration and others provide the impetus for this paper, which in the opinion of the authors adds to the growing concern over the issues of xenophobia and incidences of maltreatment of African immigrants in South Africa, especially against the background of the bold posture of South Africas constitution as the most promising constitution in the world. One must note that South Africas independence in 1994 and the prospects of a booming economy in a democratic setting unleashed a floodgate for immigration into the Republic from a variety of countries in Africa including Eastern Europe. This paper finds that despite narratives that tend to argue that migrant workers are deficiently protected in South Africa, evidence suggests that their rights within and outside of the workplace are indeed under the veil of protection by the legislation and the courts. Nonetheless, we are of the opinion that more interventions need to be in place, especially with regard to mitigating the levels of exploitation of migrant workers. This and many other recommendations have been put forward considering that migrant workers are susceptible to exploitation.
SDG8—Research
Agenda 2063: A2
Keywords: migrant workers, migrants, refugees, South Africa
The Port of Durban is the busiest in South Africa. As the port has expanded over time, freight and logistics developments have located in close proximity to the port, leading to the infiltration of trucking into all areas around the city, and this has affected businesses, residents, public transport and general traffic. The permeation of trucking throughout the municipal area impacts negatively on air quality, road safety, road maintenance and general business efficiency in the city. This paper commences with a status quo assessment which included a comprehensive literature review on port cities and innovative transport and logistics solutions. Interviews were held with key stakeholders. The analysis covered freight commodity flows, hazardous and abnormal goods movement, freight movements (including empty containers), container depots, impacts of truck overloading on the municipal road network, and assessment of freight accident records. The status quo analysis was followed by a 20-year phased strategic framework which developed a vision for freight and logistics in the municipal area that identifies, describes and explains each intervention and the anticipated time frame over which interventions need to be implemented. Interventions were categorised into short-, medium- and long-term freight and logistics solutions for the eThekwini Municipal Area (EMA). Short-term interventions were taken through a more detailed planning process, the implementation of which will commence in the next five years. Budgets were prepared and an indication was given of the responsibilities of different spheres of government and parastatals such as Transnet, the KwaZulu-Natal Department of Transport, DubeTradePort and SANRAL.
SDG9—Research
Agenda 2063: A2
Keywords: eThekwini, quality infrastructure, reliable infrastructure, resilient infrastructure, South Africa
Facilitating regional trade and commerce is vital for the Southern African Development Community (SADC). It also constitutes a pivotal policy plank for South Africa in terms of bolstering regional economic integration. However, a host of constraints and impediments located and operating at different scales make prospects for increased and unencumbered economic activity amongst the countries of this regional economic community (REC) untenable. One such formidable impediment is a non-tariff barrier associated with land ports of entry (POEs). This paper presents an exploratory analysis of constraints and impediments at selected POEs into South Africa. This is achieved through taking stock of the status quo at 15 of the 53 official POEs with a view to exploring challenges related to the efficient movement of people, goods and information into and out of South Africa. Literature reviews were supplemented by insights gleaned from interaction with a cross-section of stakeholders including truck drivers, travellers, and customs officials. In addition, on-site observations at POEs ensured that a richer understanding and interpretation of the research findings was achieved. While the research findings attest to the existence of pockets of good practice at some POEs, the overwhelming evidence was of POEs largely operationally manacled and hamstrung by structural constraints. The study provides recommendations revolving around the need to adequately plan for and upgrade the physical infrastructure, for example, in terms of redesigning clearing facilities to facilitate easy flow of pedestrian and commercial traffic, deploying adequate infrastructure for law monitoring and enforcement, as well as implementing a raft of strategic and operational measures at individual POEs aimed at optimising the use of the port and minimising border delay. In the long-term, institutional reform relating to, for example, the establishment of a single agency dedicated to border management, a commitment to continuous capacity building as well as the development of one-stop-border-posts (OSBP) at selected POEs are considered integral to efforts to finding long-term solutions.
SDG9—Research
Agenda 2063: A2
Keywords: reliable infrastructure, South Africa
Poverty remains a critical challenge in developing economies, as presented in the Sustainable Development Goals. The South African government, in particular, has undertaken a number of initiatives to alleviate poverty. However, a symbiotic relationship can be created when infrastructure development and poverty alleviation are considered in unison. A clear distinction needs to be drawn between urban and rural road transport infrastructure development and the associated benefits for these differing contexts. This study investigates the potential benefit that road transport infrastructure development has for poverty alleviation. The study was qualitative in nature and made extensive use of secondary sources, particularly focused on research from developing economies. Furthermore, an inductive research approach was followed. The contribution of the research is a theoretical overview of the potential benefits road infrastructure development has on prevailing and future poverty levels, from an emerging economies lens. Results indicate a strong positive relationship between road infrastructure development and poverty alleviation. Both direct and indirect poverty-related benefits can be associated with this type of investment. In particular, the investment does not only result in the creation of job opportunities, but also has associated effects on standards of living, market accessibility, community development and local growth rates.
SDG9—Research
Agenda 2063: A1, A2
Keywords: road infrastructure
In addition to selecting the preferred border post design layout, the appraisal approach demonstrated how the selection of the preferred location for future border post expansion could minimise travel cost, to maximise productivity gains, and to take advantage of economic opportunities. It was, for example, also established that separating freight and pedestrian processing can have substantial developmental and economic advantages. In addition we noted that remote processing of freight can be economically viable under certain conditions, provided that the additional regional travel time does not erode too much of the processing benefits.
SDG9—Research
Agenda 2063: A2
Keywords: regional infrastructure, trans-border infrastructure

Feasibility study on traffic decongestion strategies at Maseru bridge border post

Authors: G Serero, G Van Jaarsveld, V de Abreu & A Brislin
The decongestion strategy of Maseru Bridge was informed by a research exercise investigating different border post decongestion measures and border precinct typologies. Generic design parameters for border post decongestion strategies were compiled. Each measure and typology was evaluated against the generic design parameters. A short list of three decongestion strategies was determined. The capacity requirements of each was determined based on data surveys at the existing border crossing which determined the travel needs for light vehicles, public transport vehicles, freight vehicles and pedestrians. Design years and directional and seasonal peaks were taken into consideration when the patronage forecast was estimated. A spreadsheet based queueing model was developed to determine the number of entry lanes, number of parking bays and queueing capacity required for each decongestion strategy. The model took consideration of a large variety of design related constraints or parameters. The generic design parameters in conjunction with the capacity requirements as provided by the queueing model were taken into account in the conceptual design of the different border precincts.
SDG9—Research
Agenda 2063: A2
Keywords: road infrastructure, South Africa, trans-border infrastructure
This paper unpacks the cross border road transport challenges experienced at most of South African border posts with particular focus on Beitbridge border. The paper is based on research conducted by the Cross-Border Road Transport Agency (C-BRTA) in 2011 focusing on the State of South African border posts and Analysis of Trade Supply Chains. The historic structural and institutional configuration of South African border posts like other SADC border posts manifest deficiencies in terms of facilitating smooth cross border road transport movements. The number of government departments and agencies operating at South African border posts range from five (5) to twelve (12) and the departments/ agencies operates in silos. Customs processes constitute the greatest transit time in undertaking cross border movement in either direction, that is, for both northbound and southbound traffic at Beitbridge border post. Other transport challenges include inadequate and poorly maintained infrastructure, misalignment of working hours and lack of coordination between domestic border agencies and other stakeholders. Understanding of the origins and magnitude of cross border transport challenges is a fundamental departure point towards finding ideal interventions to the challenges experienced at Beitbridge. This paper outlines some of the solutions that may be deployed to address the cross border transport challenges experienced at South African border posts.
SDG9—Research
Agenda 2063: A2
Keywords: regional infrastructure, South Africa, trans-border infrastructure, transport infrastructure
During the past four decades, Sandton experienced significant land use growth, particularly in office and retail development. This is evident from the number of new buildings that have been built recently including the Ernest & Young and Alexander Forbes buildings on Rivonia Road, expansion of Sandton shopping centre and the construction of the Norton Rose Precinct on Fredman Street. The development of the transport system serving Sandton developed largely in response to the land use growth and is mainly rooted on private car based transport. Currently the roads in Sandton are wide and a disproportionate number serves a high-order mobility function. Pedestrian infrastructure and facilities are limited and not thoroughly planned and public transport has little impact on the travel choice of commuters. Due to the limited availability of residential development within or close to Sandton, the greater majority of trips are medium and long distance and therefore erodes the potential for non-motorised transport. Sandton is in many aspects not a unique node and other established areas experience similar transport issues present in Sandton. This paper explores some of these transport issues within established nodes and also outlines solutions presented in the Sandton Integrated Transport Master plan recently developed for the area which may be applicable elsewhere. This plan realises that the current car-based transport network development approach, mainly fuelled by new developments adding to the road network cannot be maintained and that significant intervention is required. Future year scenarios include business as usual, a focus on public transport and a truly integrated land-use and transport view and the implications of each scenario were considered. To reach the desired transport outcome for Sandton over a period of 20 years, the master plan identified a number of structuring interventions addressing all modes of transport but also land use development issues. These interventions aim to create a balanced multi-modal transportation network that accommodates a high level of accessibility and rebalancing streets to provide space for people walking and cycling and in this way creating a liveable city environment. This paper advocates an alternative, more sustainable approach to maintaining the accessibility of established nodes.
SDG9—Research
Agenda 2063:
Keywords: Gauteng, reliable infrastructure, resilient infrastructure, road infrastructure, Sandton
The present study employs recent World Bank data to shed light, in a global context, on the transformation of changes in income and inequality into poverty reduction for a large number of countries in sub-Saharan Africa (SSA). The study begins by discussing SSAs progress on poverty. Next, it presents data on how various African countries have fared in terms of the incidence of poverty relative to other countries, with special emphasis on the period since the mid-1990s, when SSA generally experienced a growth resurgence. The paper then decomposes performance on poverty into changes in income and inequality for a sample of SSA countries that have the requisite data. The paper finds that recent progress on poverty has been considerable, in contrast to the earlier, 1980early 1990s, period. Compared with the progress in a global sample of countries, however, progress has been mixed: nonetheless, although African countries lag behind the Brazil, India, China and Russia group of countries as a whole, many of them have outperformed India. Furthermore, while income growth is found to be the main engine for poverty reduction in SSA in general, the role of inequality is crucial in certain countries. Viewed in a global context, moreover, the low levels of income have inhibited the effectiveness of income and inequality improvements in reducing poverty in many African countries.
SDG10, SDG9—Research
Agenda 2063: A1
Keywords: economic growth, inequality
Based on data from South Africas research and development (R&D) surveys, the countrys R&D expenditure has grown in real terms by 52% over the period 2001 to 2012. This growth has been driven by government funding, which rose from 34% of the total funding in 2003 to 45% by 2012. Much of the additional funding has been granted to universities, with government support of R&D in this sector rising 450% in nominal terms, or 250% in real terms, over the same period. This funding focus, indicative of a growing role for universities as R&D performers within the national system of innovation, follows a pattern set earlier in many developed countries and reflects a revision in the states steering of knowledge creation. The R&D Survey also revealed a decline in the average cost of research, as expressed by expenditure per full-time equivalent researcher. This finding suggests that the researcher labour market is being better supplied and the constraints identified by earlier reviews are slowly being overcome. Both trends are highly positive for the research system. However, the 34% decline in business R&D expenditure since its peak in 2008 is a matter of concern and needs to be addressed. In particular, the level of state-industry embeddedness must be increased to encourage private investment and to overcome South Africas present growth constraints in respect of developing competitive medium- to high-technology sectors.
SDG9—Research
Agenda 2063: A1
Keywords: research and development, research and innovation
This paper sets out the experience of the City of Johannesburg in trying to develop a more sustainable approach to the implementation of their Rea Vaya Bus Raid Transit (BRT) system. It reports on a sustainability study that was conducted to determine the key features of the third phase of their roll out. It sets out the proposed sustainability criteria and shows how these criteria were used to evaluate the previous modes and how the criteria influenced proposed changes. The paper concludes by highlighting some additional issues relating to operational sustainability that the City has experienced and how sustainability is not a once off consideration but something to constantly to be considered and strived for.
SDG11—Research
Agenda 2063:
Keywords: access to transport, affordable transport, Johannesburg, public transport, safe transport
This paper examines the dynamic relationship between fiscal decentralization and poverty in South Africa within a panel data framework. The data used covers the period from 2005 to 2011 for the eight metropolitan municipalities making a total of 56 observations. We use real household consumption expenditure per capita as a proxy for poverty and the ratio of metropolitan expenditure to national government expenditure as fiscal decentralization. The results from a panel VAR estimated with GMM, show a negative short run effect of fiscal decentralization on real household consumption per capita in South Africa. These results have important policy implications.
SDG1, SDG10—Research
Agenda 2063: A1
Keywords: inequality, poverty, South Africa

Utilizing transport to revitalize rural towns: The case of Mthatha

Authors: M Mashiri, M Mokonyama, B Mpondo, J Chakwizira & D Mdunge
Mthatha, located in King Sabata Dalindyebo Municipality (KSD) is a rapidly growing rural town. Its sphere of influence is geographically much wider than the administrative boundaries of KSD. Mthatha is thus a regional rural town servicing a hinterland characterised by significant structural problems that tend to impede rural communities from fully accessing services, resources, markets and information. In order for the regional rural development agenda to take root, the paper argues that KSD needs to carve out a pragmatic and proactive leading role for Mthatha in support of shared growth for KSD and the region. It further contends that KSD needs to nurture and accentuate the role of Mthatha as a regional centre offering not only higher order services, but also significant employment opportunities to a potential growth region underpinned by appropriate investment packages. Transportation necessarily plays a decisive role in this vanguard role for town. However, from a transportation perspective, the paper observes that poor planning for this growth has led to failure symptoms such as severe road traffic congestion, conflicting vehicle-pedestrian movements, increased number of uncoordinated small-scale freight vehicles and severe parking shortages. Productivity in Mthatha is thus negatively impacted by this ever-present congestion, exacerbated by road infrastructure conditions (it has been determined that 90% of Mthathas surfaced road network has deteriorated beyond pothole repair requirements especially in the central business district [CBD]). Thus circulation (and by extension doing business) within the CBD is decidedly cumbersome, while movement through town is interminable generating a relatively significant carbon footprint for a town of its size. Using primary data collected in KSD between 2011 and 2012, this paper enumerates and assesses the transportation challenges impeding productivity in Mthatha with a view to determining the gaps in the current approach in terms of type and intensity of intervention options as a departure point for crafting a much more robust implementation framework. This framework will be underpinned by a transport model for the Mthatha (CBD). With a few modifications, the proposed model could be customized for other small towns in South Africa.
SDG11, SDG8—Research
Agenda 2063:
Keywords: Eastern Cape, economic growth, Mthatha, public transport, South Africa
In South Africa, the integration of Non-Motorised Transport (NMT) facilities into spatial development and the streetscape has not yet received sufficient attention by the different spheres of government and their implementation agencies. Therefore, urban development and structure has significant deficiency with regard to the provision and quality of NMT infrastructure, facilities and services. As a further consequence, NMT users are at risk using the road network and pedestrian and cyclist fatalities, leading to a major proportion of the road casualties in South African cities, towns and villages. The authors point of view is that the rhetorical paradigm shift in the planning, implementation and operation of NMTrelevant infrastructure needs to be revolutionised. This is necessary to effect rapid change of the status quo in South Africa by practicably mobilise the proverbial walk the talk. Various international examples of good practice exist where conceptual thinking and renewed focus on the needs of NMT users have led to a paradigm shift in major cities with regard to NMT policy formation and infrastructure provision; and in the process creating more friendly NMT environments. This includes design concepts that can assist in NMT and public transport implementation opportunities such as Universal Design, Complete Streets, Road Diets, Modal Hierarchy, Last Mile, Liveable Communities, Walkability Indices and Greenways, amongst others. The paper covers the various concepts; and show how they may assist in reshaping planning and implementation strategies, policies and operational frameworks in South Africa over the short-, medium- and long term. NMT is formally recognised as an independent and primary transport mode in transport planning circles, but it also serves as feeder system to public transport services. The paper highlights the different opportunities that currently exist in South Africa to include and integrate NMT conceptual thinking into transport planning practice. Firstly, this includes the current process of implementing BRT systems and optimally linking the surrounding communities to these routes. Secondly, the need exist to provide much needed and welldesigned NMT feeder systems from communities to other existing public transport operations including municipal bus, rail, Gautrain, BRT, future light rail and minibus taxi operations. Thirdly, the Strategic Land Transport Frameworks, e.g. Integrated Rapid Public Transport Network and Integrated Development Plans are to be updated on a five yearly cycle. Fourthly, NMT infrastructure still needs to be provided in many instances where NMT serves as a primary transport mode between destinations. The paper concludes that the above-mentioned transport planning processes and planning documents must reflect and support the NMT-relevant conceptual thinking that will embrace Universal Design and Complete Streets principles.
SDG11—Research
Agenda 2063:
Keywords: access to transport, affordable transport, public transport, safe transport, South Africa
South Africa as a developing country has to make the most out of the infrastructure that are available. Given the high level of crash involving pedestrians, it is critical that all means available are utilised to characterise pedestrian movements on the highway and pedestrian bridges. This paper will focus on using the existing camera infrastructure, but will extend its use to automatically detect and count pedestrians that use the pedestrian bridges. The pedestrian movement data can be used to aid with the evaluation of pedestrian safety campaigns, or to recognise trends in pedestrian movement. The paper presents the impact of various parameter changes to the state of the art technique used, as well as orientation suggestions for future installations. This is done to make optimal use of existing infrastructure, and provides an alternative to existing high-end systems. The methodology includes training a computer vision-based algorithm to recognise and count pedestrians for specific scenes, for example pedestrian bridges. The paper evaluates different suppression techniques to reduce false positives. The results show that 72% of pedestrians can be detected (a hit rate of 72%), with the camera facing a pedestrian bridge squarely from the side, so that silhouettes are clearly visible. High end products not using existing infrastructure typically have a hit rate of 70%-90%. The solution in this paper competes with high-end products, and can be expanded for infrastructure security applications, e.g. monitoring copper cables or monitoring of high risk areas.
SDG11, SDG3—Research
Agenda 2063:
Keywords: road deaths, road fatalities, road safety, South Africa
This paper revolves around the data-driven development of an integrated rural transport plan (IRTP) for King Sabata Dalindyebo Municipality (KSD) in the Province of the Eastern Cape in South Africa. The IRTP's departure point is that there is a high socio-economic price to pay if the travel and transport needs of the poor rural majority are not adequately provided for. This realization compelled KSD to seek to craft an inclusive intervention regime with a view to not only to improving access to socio-economic opportunities, but also stimulating sustainable economic development. The KSD IRTP was thus structured around four strategic pillars, as follows: ? Establishing and strengthening KSD?s spatial logic through spatial reorganization by way of coordinated development of an interlinked network of rural service nodes and transportation linkages ? nodal and linkage development ? Improving access to socio-economic opportunities through not only integrated planning but also development of a responsive, balanced and sustainable transportation system ? Widening economic choices by ensuring that the plan stimulates and oils not just the mainstream economy, but also facilitates and entrenches KSD?s ?second economy?, and ? Establishing and nurturing a community-based service delivery agenda, especially given KSD?s privileged position not only at the epicentre of a relatively impoverished rural region, but also at the coal face of development endeavours. The KSD IRTP provides both strategic direction and operational guidance to the development of transport for sustainable rural development in KSD. As indicated above, it does this through the medium of strategic intervention pillars undergirding it. These pillars find expression in and are supported by the KSD IRTP Action Agenda. The KSD IRTP Action Agenda is an amalgam of proposed policy positions, supported by intervention options, which are in turn, buttressed and made operational through detailed specific action items. Finally, a selection of projects (which seek to find a balance between focusing on investment for economic growth and investment in social redistributive measures to ensure development endeavours also reach poor households in KSD) are drawn complete with indicative costs ? providing a blueprint for plan implementation.
SDG11—Research
Agenda 2063: A1, A2
Keywords: access to transport, affordable transport, public transport, safe transport, South Africa
The National Development Plan (NDP) of South Africa describes a 2030 vision for the country. The NDP proposes an observatory as one of the measures to develop capabilities for effective spatial decision-making and implementation. This article presents results of a review of observatories with the aim to unpack the details for setting up the proposed observatory. A review of mainly South African observatories was conducted in order to clarify the focus of the observatory (i.e. its purpose and main operations) and how it should be set up (i.e. stakeholders to be involved and hosting options). The review draws on interviews, questionnaires and a workshop with stakeholders, experts and key players. A review of relevant scientific literature and observatory websites was also done. Results underline the importance of drawing on existing data collection, integration and analysis initiatives, as well as the coordinating role such an observatory will have to play.
SDG11—Research
Agenda 2063:
Keywords: human settlement planning, South Africa, spatial planning, urban design

Benefits of restoring ecosystem services in urban areas

Authors: T Elmqvist, H Setl, S N Handel, S van der Ploeg, J Aronson, J N Blignaut, E Gmez-Baggethun, D J Nowak, J Kronenberg & R de Groot
Cities are a key nexus of the relationship between people and nature and are huge centers of demand for ecosystem services and also generate extremely large environmental impacts. Current projections of rapid expansion of urban areas present fundamental challenges and also opportunities to design more livable, healthy and resilient cities (e.g. adaptation to climate change effects). We present the results of an analysis of benefits of ecosystem services in urban areas. Empirical analyses included estimates of monetary benefits from urban ecosystem services based on data from 25 urban areas in the USA, Canada, and China. Our results show that investing in ecological infrastructure in cities, and the ecological restoration and rehabilitation of ecosystems such as rivers, lakes, and woodlands occurring in urban areas, may not only be ecologically and socially desirable, but also quite often, economically advantageous, even based on the most traditional economic approaches.
SDG11, SDG15—Research
Agenda 2063: A1
Keywords: ecosystem protection, ecosystem restoration, resilient cities, sustainable cities, sustainable human settlements
The article investigates the cultural and industrial history of the Tswaing salt works which were established and operated for a period of 50 years at the Tswaing (seTswana for place of salt) meteorite crater 40km north of the Pretoria CBD. After the 1960s the industrial activities ceased and the site was abandoned, leading to decay and vandalism of the remaining buildings. Whereas the meteorite crater as a natural phenomenon remains a tourist attraction, the socio-cultural heritage of the industrial ruins has been neglected and the question is put whether these industrial ruins warrant commemoration in some way or another. The argument is made that to commemorate the Tswaing crater, commemorating the Tswaing salt works industrial ruined remains becomes a necessary complementary approach. Various memorialisation options are explored and illustrated with case studies; ranging from demolishing any remains of the industrial ruins and perhaps allowing only a palimpsest, to leaving the ruin to further decay, to a range of conservation interventions and to a restoration, alteration and re-use option. The potential value of partly restored, conserved or reused industrial ruins is discussed, i.e. ruins as nature reserves, heterotopias, tourist destinations, museums or places of recreation. The commemoration of these ruins however remains a disputed issue, with opinions ranging from removing all traces of industrial activities from the site of this natural phenomenon to recognising the importance of the socio-cultural influences on the natural environment and to allocating new values and uses to the now abandoned human activities, thus allowing the complete narrative.
SDG11—Research
Agenda 2063:
Keywords: cultural heritage, South Africa

Evaluating procedural modelling for 3D models of informal settlements in urban design activities

Authors: Victoria Rautenbach, Yvette Bevis, Serena Coetzee & Carin Combrinck
Three-dimensional (3D) modelling and visualisation is one of the fastest growing application fields in geographic information science. 3D city models are being researched extensively for a variety of purposes and in various domains, including urban design, disaster management, education and computer gaming. These models typically depict urban business districts (downtown) or suburban residential areas. Despite informal settlements being a prevailing feature of many cities in developing countries, 3D models of informal settlements are virtually non-existent. 3D models of informal settlements could be useful in various ways, e.g. to gather information about the current environment in the informal settlements, to design upgrades, to communicate these and to educate inhabitants about environmental challenges. In this article, we described the development of a 3D model of the Slovo Park informal settlement in the City of Johannesburg Metropolitan Municipality, South Africa. Instead of using time-consuming traditional manual methods, we followed the procedural modelling technique. Visualisation characteristics of 3D models of informal settlements were described and the importance of each characteristic in urban design activities for informal settlement upgrades was assessed. Next, the visualisation characteristics of the Slovo Park model were evaluated. The results of the evaluation showed that the 3D model produced by the procedural modelling technique is suitable for urban design activities in informal settlements. The visualisation characteristics and their assessment are also useful as guidelines for developing 3D models of informal settlements. In future, we plan to empirically test the use of such 3D models in urban design projects in informal settlements.
SDG11—Research
Agenda 2063:
Keywords: human settlement planning, spatial planning, urban design
Medium-density mixed-housing is promoted in various countries as a means toward creating more sustainable settlements. It does, however, require residents to live closer to their neighbours, share outdoor spaces, and be more neighbourly than what may typically be required in lower density suburban neighbourhoods. Yet, how important are outdoor design and neighbourliness for the success of medium-density mixed-housing in a South African context? This article examines the perceived importance of a number of outdoor design and neighbourliness factors from the point of view of residents living in such developments in South Africa. A survey of 300 residents across 10 developments reveals the importance of both outdoor design and neighbourliness, particularly if children, women, and older residents are involved. Planners and designers should, therefore, include sufficient private and common outdoor spaces to address the needs of residents and to promote neighbourliness and consequently the social acceptability of this type of housing in South Africa.
SDG11—Research
Agenda 2063:
Keywords: accessible public spaces, green public spaces, public spaces
Public parks and open recreational facilities are essential elements of healthy modern cities. The importance of the public parks in urban residential areas is uncontested from the health and environment point of view. Although, public parks are integral parts of the urban residential areas in most of the cities in South Africa, they are observed to be highly underutilised. Literature suggests that accessibility, environmental and social factors are some of the challenges for proper utilization of the public parks. However, the challenges of accessibility to the public parks, particularly in residential areas of cities are least explored. Therefore, using the case study of Bloemfontein this investigation identified the most important accessibility factors that deter the utilisation of public parks, and examined their level of influence on the utilisation of public parks in the residential areas of a South African city. This study was conducted by using a survey research methodology and consequent development and application of empirical models. Primary data collected through both household surveys, and physical park utilisation surveys by continuous digital photography and videography were used to explore the influential accessibility variables, and subsequent development of empirical models to examine their influence on the utilisation of public parks. It was revealed that the ratio of road network to pedestrian facilities (paved pathways) network, number of access streets to the parks, size (in area) of parks, and the level of illumination in the parks during evening periods are the major variables, which influence the utilisation of the parks to varied extent. An optimal level of number of access streets to the parks, proportionate pedestrian facilities (paved pathways) facilities on the roads providing access to parks and appreciable illumination will enable significant improvement in the utilisation of parks in the residential areas of South African cities.
SDG11—Research
Agenda 2063:
Keywords: accessible public spaces, green public spaces, Mpumalanga, public spaces, South Africa
Indeed, the implicit hypothesis that there is little possibility, if any, for the Pedi traditional healers to experience the supernatural form of healing without performing music and dancing to it raises the issue of What makes the dance potent as a healing therapy? or What is the role of music in such healing processes?. This article is a result of a guided investigation carried out in order to answer these questions. The primary sources for data collection were literature reviews, informal interviews, observations and recordings. During the study, informal discussions with traditional healers and their trainees revealed that participation in malopo rituals enables community members to inherit their music tradition. The impression created during interviews and observations was that Pedi traditional healers perform malopo songs to communicate with the ancestors. The results suggest that malopo rituals are aimed at enriching the personal and social life of the Pedi community.
SDG11—Research
Agenda 2063:
Keywords: cultural heritage, South Africa
SDG12—Research
Agenda 2063:
Keywords: recycling, South Africa, waste management
SDG11—Research
Agenda 2063:
Keywords: accessible public spaces, green public spaces, Pretoria, public spaces, Tshwane
SDG12, SDG13—Research
Agenda 2063: A1
Keywords: sustainability education, sustainability reporting
SDG12—Research
Agenda 2063:
Keywords: sustainability reporting
SDG12—Research
Agenda 2063:
Keywords: sustainability reporting

Integrated Reporting: Insights, gaps and an agenda for future research

Authors: Charl de Villiers, Leonardo Rinaldi & Jeffrey Unerman
SDG12—Research
Agenda 2063:
Keywords: sustainability reporting
SDG12, SDG13—Research
Agenda 2063: A1
Keywords: sustainability education, sustainable consumption, sustainable lifestyles
SDG12, SDG13—Research
Agenda 2063: A1
Keywords: sustainability education, sustainable consumption, sustainable lifestyles
SDG13—Research
Agenda 2063: A1
Keywords: climate change mitigation, South Africa

Regional projections of extreme apparent temperature days in Africa and the related potential risk to human health

Authors: Rebecca M Garland, Mamopeli Matooane, Francois A Engelbrecht,Mary-Jane M Bopape, Willem A Landman, Mogesh Naidoo, Jacobus van der Merwe & Caradee Y Wright
SDG13—Research
Agenda 2063:
Keywords: climate change adaptation

Consumers preferences for eco-friendly appliances in an emerging market context

Authors: Nadine C Sonnenberg, Alet C Erasmus & Adr Schreuder
SDG12, SDG13—Research
Agenda 2063: A1
Keywords: sustainability education, sustainable consumption, sustainable lifestyles
SDG13—Research
Agenda 2063: A1
Keywords: climate change adaptation, climate change mitigation, South Africa

Restoration of natural capital: Mobilising private sector investment

Authors: James N Blignaut & Leandri van der Elst
SDG13, SDG15—Research
Agenda 2063: A1
Keywords: climate change resilience, ecosystem restoration

Role of landscape designers in promoting a balanced approach to green infrastructure

Authors: Christina A Breed, Sarel S Cilliers & Roger C Fisher
SDG9—Research
Agenda 2063:
Keywords: sustainable infrastructure
SDG13—Research
Agenda 2063:
Keywords: climate change education, South Africa, sustainability education
SDG14, SDG15—Research
Agenda 2063: A1
Keywords: illegal fishing, poaching, South Africa
SDG14—Research
Agenda 2063:
Keywords: coastal ecosystem, marine ecosystem, marine resources
SDG14—Research
Agenda 2063: A1
Keywords: coastal ecosystem, fish stocks, fishing regulation, KwaZulu-Natal, overfishing

Biomass increases go under cover: Woody vegetation dynamics in South African rangelands

Authors: Penelope J Mograbi, Barend F N Erasmus, E T F Witkowski, Gregory P Asner, Konrad J Wessels, Renaud Mathieu, David E Knapp, Roberta E Martin & Russell Main
SDG15—Research
Agenda 2063:
Keywords: ecosystem services, South Africa
SDG15—Research
Agenda 2063:
Keywords: conservation

Prescribing innovation within a large-scale restoration programme in degraded subtropical thicket in South Africa

Authors: Anthony J Mills, Marius van der Vyver, Iain J Gordon, Anand Patwardhan, Christo Marais, James Blignaut, Ayanda Sigwela & Barney Kgope
SDG15—Research
Agenda 2063:
Keywords: Eastern Cape, ecosystem restoration, South Africa
SDG15—Research
Agenda 2063: A1
Keywords: conservation, Eastern Cape, South Africa, threatened species
SDG15—Research
Agenda 2063:
Keywords: conservation, South Africa, threatened species

Landscape connectivity of the Grassland Biome in Mpumalanga, South Africa

Authors: Louise Fourie, Mathieu Rouget & Mervyn Ltter
SDG15—Research
Agenda 2063: A1
Keywords: ecosystem services, ecosystems, land degradation, Mpumalanga, South Africa

Effect of rehabilitation on survival rates of endangered Cape vultures

Authors: Ara Monadjem, Kerri Wolter, Walter Neser & Adam Kane
SDG15—Research
Agenda 2063: A1
Keywords: conservation, South Africa, threatened species

The demography and dynamics of an expanding, managed African wild dog metapopulation

Authors: Harriet T Davies-Mostert, Michael G L Mills & David W Macdonald
SDG15—Research
Agenda 2063:
Keywords: conservation, threatened species

The evolving landscape of plant breeders rights regarding wheat varieties in South Africa

Authors: Charity R Nhemachena, Frikkie G Liebenberg & Johann Kirsten
SDG15—Research
Agenda 2063: A1
Keywords: access to genetic resources, sharing of genetic resources, South Africa
SDG15—Research
Agenda 2063: A1
Keywords: endangered species, extinction
SDG16—Research
Agenda 2063: A3
Keywords: corruption

Remotely piloted aircraft systems as a rhinoceros anti-poaching tool in Africa

Authors: Margarita Mulero-Pzmny, Roel Stolper, L D van Essen, Juan J Negro & Tyrell Sassen
SDG15—Research
Agenda 2063: A1
Keywords: conservation, poaching, threatened species, wildlife trafficking
SDG15—Research
Agenda 2063: A1
Keywords: poaching, threatened species, trafficking of protected species, wildlife trafficking
SDG16—Research
Agenda 2063: A3
Keywords: corruption, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: corruption, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: corruption, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, South Africa, transparent institutions
SDG16—Research
Agenda 2063: A3
Keywords: bribery, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, South Africa, transparent institutions
SDG16—Research
Agenda 2063: A3
Keywords: effective institutions, inclusive institutions, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, eThekwini, South Africa, transparent institutions
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, South Africa, transparent institutions
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, South Africa, transparent institutions
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, South Africa, transparent institutions
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, South Africa, transparent institutions
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, Johannesburg, South Africa, transparent institutions
SDG16—Research
Agenda 2063: A3
Keywords: inclusive institutions, representative institutions, responsive institutions, South Africa

Causes of cost overruns of Municipal Infrastructure Grant funded projects at the OR Tambo District Municipality

Authors: https://leadershipanddevelopmentorg.files.wordpress.com/2016/12/mulenga-bekker_2015.pdf
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, South Africa, transparent institutions
SDG16—Research
Agenda 2063: A3
Keywords: inclusive institutions, representative institutions, responsive institutions, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: inclusive institutions, representative institutions, responsive institutions
—Research
Agenda 2063: A7
Keywords: domestic resource mobilisation, revenue collection, tax collection
SDG16—Research
Agenda 2063: A3
Keywords: inclusive institutions, representative institutions, responsive institutions, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: inclusive institutions, representative institutions, responsive institutions

Debt sustainability and financial crises in South Africa

Authors: Ruthira Naraidoo & Leroi Raputsoane
—Research
Agenda 2063: A7
Keywords: debt financing, debt sustainability, South Africa
—Research
Agenda 2063: A7
Keywords: domestic resource mobilisation, revenue collection, South Africa, tax collection
—Research
Agenda 2063: A7
Keywords: domestic resource mobilisation, revenue collection, South Africa, tax collection

Identifying strategic markets for South Africas citrus exports

Authors: Tinashe Kapuya, Evans K Chinembiri & Mmatlou W Kalaba
The article identifies South Africas strategic citrus markets among its major export partners using three complementary methodologies. Firstly, South Africas major markets for citrus are characterised according to a growth-share matrix to identify strategic country markets. Secondly, the paper uses an Indicative Trade Potential analysis to identify strategic markets that are high potential export countries. Thirdly, a gravity model is used to identify which strategic high potential markets are encouraging South African citrus exports. Out of South Africas 51 major citrus export destinations, 44 countries are considered strategic markets. From these 44 strategic markets, 26 are high potential markets. Among the 26 high potential markets, an identified 17 countries represent the most attractive markets that possess opportunities for greater export expansion. These 17 countries can be prioritised for an export promotion strategy: six are in the EU, four are in Asia, and two are in Eastern Europe; while three are from Middle East and two from North America. The paper concludes that more aggressive trade policy efforts should also be directed towards nine countries which are high potential markets, but exhibit trade-inhibiting features discouraging South Africas citrus exports. Trade facilitation efforts and bilateral agreements with such countries could be considered as an option to lock in the benefits of unexploited export potential in key strategic citrus export markets.
—Research
Agenda 2063: A1
Keywords: export markets, South Africa
SDG7—Research
Agenda 2063: A1, A2
Keywords: renewable electricity, renewable energy, South Africa, sustainable electricity, sustainable energy
SDG4—Research
Agenda 2063: A1
Keywords: access to education, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: inclusive institutions, participatory institutions, responsive institutions
SDG16—Research
Agenda 2063: A6
Keywords: child abuse, South Africa
SDG5—Research
Agenda 2063: A6
Keywords: gender equality, South Africa
SDG11—Research
Agenda 2063: A1
Keywords: sustainable transport

How ready are our health systems to implement prevention of mother to child transmission Option B+?

Authors: Palesa Nkomo, Natasha Davies, Gayle Sherman, Sanjana Bhardwaj, Vundli Ramokolo, Nobubelo K Ngandu, Nobuntu Noveve, Trisha Ramraj, Vuyolwethu Magasana, Yages Singh, Duduzile Nsibande & Ameena E. Goga
SDG3—Research
Agenda 2063: A1, A3
Keywords: AIDS, HIV
SDG11—Research
Agenda 2063:
Keywords: cultural heritage, South Africa
Beliefs help shape how teachers perceive effective mathematics teaching. Providers of professional development, be they local or from other countries, need to be cognisant of such perceptions. This paper seeks to answer the question, What do South African teachers perceive as effective and ineffective teaching for developing conceptual understanding of mathematics? A sample of 46 mathematics teachers was shown vignettes from eight different classrooms where the lesson dealt with some aspect of teaching fractions, and were then asked to comment on the strengths and weakness of what they observed. The comments were classified into seven themes with 18 sub-themes or categories. The majority of the comments focused on two themes, use of materials and modes of instruction. The various mathematical approaches for developing the concept of fractions received little attention. Perceptions of which vignette was considered to be the most effective approach to teaching mathematics resulted in a wide variety of responses. Finally implications for professional development are explored. It is suggested that in-service courses should be geared to what teachers themselves consider best practice, and that reflection on practice should play a more significant role in professional development.
SDG4—Research
Agenda 2063: A1, A6
Keywords: mathematics, numeracy, South Africa
SDG4—Research
Agenda 2063: A1, A6
Keywords: mathematics, numeracy, South Africa

Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa

Authors: Jonathan Betz Brown, Kaushik Ramaiya, Stphane Besanon, Paul Rheeder, Clarisse Mapa Tassou, Jean-Claude Mbanya, Katarzyna Kissimova-Skarbek, Eva Wangechi Njenga, Eva Wangui Muchemi, Harrison Kiambuthi Wanjiru & Erin Schneider
SDG3—Research
Agenda 2063: A1
Keywords: diabetes
SDG13, SDG3—Research
Agenda 2063: A1
Keywords: climate change, HIV, South Africa, TB, tuberculosis

Factors associated with patients understanding of their management plan in Tshwane clinics

Authors: Letitia Fernandez, Theresa Rossouw, Tessa Marcus, Angelika Reinbrech-Schutte, Nicoleen Smit, Hans F Kinkel, Shehla Memon & Jannie Hugo
SDG3—Research
Agenda 2063: A1
Keywords: Pretoria, South Africa, Tshwane
SDG16, SDG3—Research
Agenda 2063:
Keywords: child mortality, homicide, infant mortality, neonatal mortality, under-five mortality

The need for multipurpose prevention technologies in sub-Saharan Africa

Authors: S Abdool Karim,C Baxter, J Frohlich & Q Abdool Karim
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, reproductive health, sexual health
SDG11, SDG3—Research
Agenda 2063:
Keywords: road safety, safe transport

A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries

Authors: Esther F Adebayo, Olalekan A Uthman1, Charles S Wiysonge, Erin A Stern6, Kim T Lamont & John E Ataguba
SDG3, SDG8—Research
Agenda 2063: A1
Keywords: access to financial services, access to health care

Acquired immune responses to three malaria vaccine candidates and their relationship to invasion inhibition in two populations naturally exposed to malaria

Authors: Otchere Addai-Mensah, Melanie Seidel, Nafiu Amidu, Dominika J Maskus, Stephanie Kapelski, Gudrun Breuer, Carmen Franken, Ellis Owusu-Dabo, Margaret Frempong, Raphae?l Rakotozandrindrainy, Helga Schinkel, Andreas Reimann, Torsten Klockenbring, Stefan Barth, Rainer Fischer & Rolf Fendel
SDG3—Research
Agenda 2063: A1
Keywords: malaria
SDG11, SDG3—Research
Agenda 2063: A2
Keywords: public transport, road safety, safe transport
SDG13, SDG4—Research
Agenda 2063:
Keywords: climate change education, sustainability education, sustainable development education
SDG4—Research
Agenda 2063: A1, A6
Keywords: relevant skills, skills development

Contemporary wind generators

Authors: Udochukwu Bola Akuru & Maarten J Kamper
SDG7—Research
Agenda 2063: A2
Keywords: clean energy, renewable electricity, renewable energy, sustainable electricity, sustainable energy
SDG4—Research
Agenda 2063: A1, A3
Keywords: education facilities, human rights education, school buildings, school infrastructure, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: cancer, South Africa
SDG13, SDG4—Research
Agenda 2063:
Keywords: climate change education, South Africa, sustainability education, sustainable development education, Western Cape
SDG3—Research
Agenda 2063: A1
Keywords: National Health Insurance, South Africa, universal health coverage

Early ART results in greater immune reconstitution benefits in HIV-infected infants: Working with data missingness in a longitudinal dataset

Authors: Livio Azzoni, Russell Barbour, Emmanouil Papasavvas, Deborah K Glencross, Wendy S Stevens, Mark F Cotton, Avy Violari & Luis J Montaner
SDG3—Research
Agenda 2063: A1
Keywords: child mortality, HIV, infant mortality, neonatal mortality, under-five mortality
SDG3—Research
Agenda 2063: A1
Keywords: mental health, South Africa, suicide
SDG3—Research
Agenda 2063: A1
Keywords: KwaZulu-Natal, South Africa, TB, tuberculosis

South Africas renewable energy procurement: A new frontier?

Authors: Lucy Baker and Holle Linnea Wlokas
SDG7—Research
Agenda 2063: A1, A2
Keywords: renewable electricity, renewable energy, South Africa, sustainable electricity, sustainable energy

Mobile HIV screening in Cape Town, South Africa: Clinical impact, cost and cost-effectiveness

Authors: Ingrid V Bassett, Darshini Govindasamy, Alison S Erlwanger, Emily P Hyle, Katharina Kranzer, Nienke van Schaik, Farzad Noubary, A David Paltiel, Robin Wood, Rochelle P Walensky, Elena Losina, Linda-Gail Bekker & Kenneth A. Freedberg
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, Cape Town, HIV, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV
SDG4—Research
Agenda 2063: A1, A6
Keywords: mathematics, numeracy
SDG12—Research
Agenda 2063: A1
Keywords: sustainable consumption, sustainable production
SDG15—Research
Agenda 2063: A1
Keywords: conservation, South Africa

A unified classification of alien species based on the magnitude of their environmental impacts

Authors: Tim M Blackburn, Franz Essl, Thomas Evans, Philip E Hulme, Jonathan M Jeschke, Ingolf Khn, Sabrina Kumschick, Zuzana Markov, Agata Mruga?a, Wolfgang Nentwig, Jan Pergl, Petr Pyek, Wolfgang Rabitsch, Anthony Ricciardi, David M Richardson, Agnieszka Sendek, Montserrat Vil, John R U Wilson, Marten Winter, Piero Genovesi & Sven Bacher
SDG15—Research
Agenda 2063:
Keywords: conservation, ecosystem protection, ecosystem sustainability, invasive alien species, protect ecosystems
SDG15—Research
Agenda 2063: A1
Keywords: conservation, ecosystem protection, ecosystem sustainability

Minibus driving behaviour on the Cape Town to Mthatha route

Authors: M J Booysen & N A Ebot Eno Akpa
SDG11, SDG3—Research
Agenda 2063:
Keywords: public transport, road safety, safe transport, South Africa

PIQUE-ing an interest in curriculum renewal

Authors: J Blitz, N Kok, B van Heerden & S van Schalkwyk
SDG3—Research
Agenda 2063:
Keywords: health education, health training, medical training, South Africa

Who bites the bullet first? The susceptibility of Leopards Panthera pardus to trophy hunting

Authors: Alex Richard Braczkowski, Guy Andrew Balme, Amy Dickman, David Whyte Macdonald, Julien Fattebert, Tristan Dickerson, Paul Johnson1 & Luke Hunter
SDG15—Research
Agenda 2063:
Keywords: conservation, South Africa, threatened species

A socio-ecological approach for identifying and contextualising spatial ecosystem-based adaptation priorities at the sub-national level

Authors: Amanda Bourne1, Stephen Holness, Petra Holden, Sarshen Scorgie, Camila I Donatti & Guy Midgley
SDG13, SDG15—Research
Agenda 2063: A1
Keywords: climate change adaptation, ecosystem protection, ecosystem restoration, protect ecosystems, restore ecosystems
SDG3—Research
Agenda 2063: A1
Keywords: cancer, reproductive health, sexual health, South Africa

Results for a replacement yield model fit to catch and survey data for the south and west coasts Kingklip esource of South Africa

Authors: https://leadershipanddevelopmentorg.files.wordpress.com/2017/01/brandc3a3o-butterworth_2016.pdf
SDG15—Research
Agenda 2063: A1
Keywords: conservation, South Africa, threatened species
SDG15—Research
Agenda 2063:
Keywords: conservation, poaching, South Africa, trafficking of protected species, wildlife trafficking
SDG6—Research
Agenda 2063: A2
Keywords: water efficiency, water management

Combination HIV prevention among MSM in South Africa: Results from agent-based modeling

Authors: Ron Brookmeyer, David Boren, Stefan D Baral, Linda-Gail Bekker, Nancy Phaswana-Mafuya, Chris Beyrer & Patrick S. Sullivan
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, alcohol abuse, HIV, substance abuse, Western Cape
SDG3—Research
Agenda 2063: A1, A6
Keywords: South Africa, suicide
SDG3—Research
Agenda 2063: A1
Keywords: child mortality, infant mortality, South Africa, TB, tuberculosis

The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy: A systematic review and meta-analysis

Authors: David Champredon, Steven E Bellan, Wim Delva, Spencer Hunt, Chyun-Fung Shi, Marek Smieja & Jonathan Dushoff
SDG3—Research
Agenda 2063: A1
Keywords: HIV, sexual health, South Africa

Rethinking HIV prevention to prepare for oral PrEP implementation for young African women

Authors: Connie L Celum, Sinead Delany-Moretlwe, Margaret McConnell, Heidi van Rooyen, Linda-Gail Bekker, Ann Kurth, Elizabeth Bukusi, Chris Desmond, Jennifer Morton & Jared M Baeten
SDG3—Research
Agenda 2063: A1, A6
Keywords: HIV
SDG3—Research
Agenda 2063: A1
Keywords: mental health, substance abuse

Tuberculosis control in South Africa: Successes, challenges and recommendations

Authors: G J Churchyard, L Mvusi, A C Hesseling, A Reid, S Babatunde & Y Pillay
SDG3—Research
Agenda 2063: A1
Keywords: South Africa, TB, tuberculosis

Hepatitis B virus infection in HIV-exposed infants in the Western Cape, South Africa

Authors: Nafiisah Chotun, Etienne Nel, Mark F. Cotton, Wolfgang Preiser & Monique I Andersson
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, hepatitis, HIV, South Africa, Western Cape

Evaluating the potential impact of enhancing HIV treatment and tuberculosis control programmes on the burden of tuberculosis

Authors: Leonid Chindelevitch, Nicolas A Menzies, Carel Pretorius, John Stover, Joshua A Salomon & Ted Cohen
SDG3—Research
Agenda 2063: A1
Keywords: HIV, TB, tuberculosis
SDG3—Research
Agenda 2063: A1
Keywords: diabetes

Can social protection improve Sustainable Development Goals for adolescent health?

Authors: Lucie D Cluver, F Mark Orkin, Franziska Meinck, Mark E Boyes, Alexa R Yakubovich & Lorraine Sherr
SDG1, SDG10—Research
Agenda 2063: A1
Keywords: social protection

Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age

Authors: Andrea L Ciaranelloa, Kathleen Doherty, Martina Penazzato, Jane C Lindsey, Linda Harrison, Kathleen Kelly, Rochelle P Walenskya, Shaffiq Essajee, Elena Losinab, Lulu Muhe, Kara Wools-Kaloustian, Samuel Ayaya, Milton C Weinstein, Paul Palumbo & Kenneth A Freedberg
SDG3—Research
Agenda 2063: A1
Keywords: child mortality, HIV, infant mortality, South Africa, under-five mortality
SDG7—Research
Agenda 2063: A1, A2
Keywords: South Africa, sustainable electricity, sustainable energy

A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women

Authors: Christopher J Colvin, Sarah Konopka, John C Chalker, Edna Jonas, Jennifer Albertini, Anouk Amzel & Karen Fogg
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, maternal mortality
SDG3—Research
Agenda 2063: A1
Keywords: cardiovascular disease, South Africa

Evolution of extensively drug-resistant tuberculosis over four decades: Whole genome sequencing and dating analysis of Mycobacterium tuberculosis isolates from KwaZulu-Natal

Authors: Keira A Cohen, Thomas Abeel, Abigail Manson McGuire, Christopher, A Desjardins, Vanisha Munsamy, Terrance P Shea, Bruce J Walker, Nonkqubela Bantubani, Deepak V Almeida, Lucia Alvarado, Sinad B Chapman, Nomonde R Mvelase, Eamon Y Duffy, Michael G Fitzgerald, Pamla Govender, Sharvari Gujja, Susanna Hamilton, Clinton Howarth, Jeffrey D Larimer, Kashmeel Maharaj, Matthew D Pearson, Margaret E Priest, Qiandong Zeng, Nesri Padayatchi, Jacques Grosset, Sarah K Young, Jennifer Wortman, Koleka P Mlisana, Max R ODonnell, Bruce W Birren, William R Bishai, Alexander S Pym & Ashlee M Earl
SDG3—Research
Agenda 2063: A1
Keywords: KwaZulu-Natal, South Africa, TB, tuberculosis
SDG15—Research
Agenda 2063: A1
Keywords: conservation, ecosystems
SDG3—Research
Agenda 2063: A1
Keywords: infant mortality, neonatal mortality, under-five mortality
SDG3—Research
Agenda 2063: A3
Keywords: AIDS, HIV
SDG3—Research
Agenda 2063:
Keywords: AIDS, HIV

Time to ART initiation among patients treated for Rifampicin-resistant tuberculosis in Khayelitsha, South Africa: Impact on mortality and treatment success

Authors: Johnny Flippie Daniels, Mohammed Khogali, Erika Mohr, Vivian Cox, Sizulu Moyo, Mary Edginton, Sven Gudmund Hinderaker, Graeme Meintjes, Jennifer Hughes, Virginia De Azevedo, Gilles van Cutsem & Helen Suzanne Cox
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, Cape Town, HIV, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, South Africa, TB, tuberculosis
SDG3—Research
Agenda 2063:
Keywords: substance abuse
SDG5—Research
Agenda 2063: A6
Keywords: gender equality, non-discrimination

Urine lipoarabinomannan to monitor antituberculosis therapy response and predict mortality in an HIV-endemic region: A prospective cohort study

Authors: Paul K Drain, Lilishia Gounder, Anneke Grobler, Faieza Sahid, Ingrid V Bassett & Mahomed-Yunus S Moosa
SDG3—Research
Agenda 2063: A1
Keywords: TB, tuberculosis
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, South Africa

Adolescent girls and young women: Key populations for HIV epidemic control

Authors: Rachael C Dellar, Sarah Dlamini & Quarraisha Abdool Karim
SDG3—Research
Agenda 2063: A1, A6
Keywords: AIDS, HIV, reproductive health, sexual health

Indicated prevention of fetal alcohol spectrum disorders in South Africa: Effectiveness of case management

Authors: Marlene M de Vries, Belinda Joubert, Marise Cloete, Sumien Roux, Beth A Baca, Julie M Hasken, Ronel Barnard, David Buckley, Wendy O Kalberg, Cudore L Snell, Anna Susan Marais, Soraya Seedat, Charles D H Parry & Philip A May
SDG3—Research
Agenda 2063:
Keywords: alcohol abuse, substance abuse
SDG3—Research
Agenda 2063:
Keywords: infant mortality, neonatal mortality, under-five mortality

Evaluation of adherence measures of antiretroviral prophylaxis in HIV exposed infants in the first 6 weeks of life

Authors: Alicia Catherine Desmond, Dhayendre Moodley, Catherine A Conolly, Sandra A Castel & Hoosen M Coovadia
SDG3—Research
Agenda 2063: A1
Keywords: child mortality, infant mortality, neonatal mortality, under-five mortality
SDG3—Research
Agenda 2063: A1, A6
Keywords: AIDS, HIV, reproductive health, sexual health, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: cardiovascular disease, South Africa
SDG13, SDG7—Research
Agenda 2063: A1, A7
Keywords: cilmate change mitigation, sustainable electricity, sustainable energy
SDG13, SDG7—Research
Agenda 2063: A1, A7
Keywords: climate change mitigation, sustainable electricity, sustainable energy

Urban land restitution in Cape Town: demanding the return of land rights in Constantia and Kensington/Ndabeni

Authors: Ronnie Donaldson, Glen Hyman, David Chang, Andr Confiado, Ana Mari?a Ruiz, Ssicar Salud & Sanem yildiz
SDG1—Research
Agenda 2063:
Keywords: Cape Town, property rights, South Africa

Optimizing HIV prevention for women: A review of evidence from microbicide studies and considerations for gender-sensitive microbicide introduction

Authors: Elizabeth G Doggett, Michele Lanham, Rose Wilcher, Mitzy Gafos, Quarraisha A Karim & Lori Heise
SDG3—Research
Agenda 2063: A1, A6
Keywords: AIDS, contraceptives, HIV, reproductive health, sexual health
SDG6—Research
Agenda 2063: A1
Keywords: drinking water, water harvesting, water quality
SDG3—Research
Agenda 2063:
Keywords: health education, health training, medical training

Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis

Authors: Paul K Drain, Elena Losina, Sharon M Coleman, Janet Giddy, Douglas Ross, Jeffrey N Katz & Ingrid V Bassett
SDG3—Research
Agenda 2063: A1
Keywords: TB, tuberculosis
SDG7—Research
Agenda 2063: A2
Keywords: energy efficiency

School-based human papillomavirus vaccination: An opportunity to increase knowledge about cervical cancer and improve uptake of screening

Authors: G Dreyer, F H van der Merwe, M H Botha, L C Snyman, D Constant, C Visser & J Harvey
SDG3—Research
Agenda 2063: A1
Keywords: cancer, sexual health

Application of Intervention Mapping to develop a community-based health promotion pre-pregnancy intervention for adolescent girls in rural South Africa: Project Ntshembo (Hope)

Authors: Catherine E Draper, Lisa K Micklesfield, Kathleen Kahn, Stephen M Tollman, John M Pettifor, David B Dunger, Shane A Norris & Ntshembo Consortium
SDG3—Research
Agenda 2063: A6
Keywords: reproductive health, sexual health, South Africa

Missed opportunities for retention in pre-ART care in Cape Town, South Africa

Authors: Elizabeth du Toit, Cari van Schalkwyk, Rory Dunbar, Karen Jennings, Blia Yang, David Coetzee & Nulda Beyers
SDG3—Research
Agenda 2063: A1
Keywords: Cape Town, HIV, South Africa
SDG3—Research
Agenda 2063:
Keywords: alcohol abuse, South Africa
SDG2—Research
Agenda 2063: A1
Keywords: malnutrition, nutrition, South Africa

Fit for purpose? A review of a medical curriculum and its contribution to strengthening health systems in South Africa

Authors: L D Dudley, T N Young, A C Rohwer, B Willems, A Dramowski, C Goliath, F K Mukinda, F Marais, S Mehtar & N A Cameron
SDG3—Research
Agenda 2063: A3
Keywords: health education, health training, medical training, South Africa

High burden of human papillomavirus (HPV) infection among young women in KwaZulu-Natal, South Africa

Authors: Sumayyah Ebrahim, Xolani K Mndende, Ayesha B M Kharsany, Zizipho Z A Mbulawa, Vivek Naranbhai, Janet Frohlich, Lise Werner, Natasha Samsunder, Quarraisha Abdool Karim & Anna-Lise Williamson
SDG3—Research
Agenda 2063: A1
Keywords: cancer, KwaZulu-Natal, sexual health, South Africa

Total factor productivity of urban agriculture on the urban periphery of Cape Town

Authors: Martin Dyer, Richard Mills, Beatrice Conradie & Jenifer Piesse
SDG2—Research
Agenda 2063: A1
Keywords: Cape Town, small-scale farmers, small-scale food producers, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: cardiovascular disease, diabetes

Perceived barriers for accessing health services among individuals with disability in four African countries

Authors: Arne H Eide, Hasheem Mannan, Mustafa Khogali, Gert van Rooy, Leslie Swartz, Alister Munthali, Karl-Gerhard Hem, Malcolm MacLachlan & Karin Dyrstad
SDG3—Research
Agenda 2063: A1
Keywords: access to health care, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: Cape Town, diabetes, South Africa

Recognition of driving manoeuvres using smartphone-based inertial and GPS measurement

Authors: Jarrett Engelbrecht, Marthinus J Booysen & Gert-Jan van Rooyen
SDG11, SDG3—Research
Agenda 2063:
Keywords: road safety
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV

Is air pollution a risk factor for rheumatoid arthritis?

Authors: Mickael Essouma & Jean Jacques N Noubiap
SDG3—Research
Agenda 2063:
Keywords: air pollution, health and wellbeing

Plastic pollution in the worlds oceans: More than 5 trillion plastic pieces weighing over 250,000 tons afloat at sea

Authors: Marcus Eriksen, Laurent C M Lebreton, Henry S Carson, Martin Thiel, Charles J Moore, Jose C Borerro, Francois Galgani, Peter G Ryan & Julia Reisser
SDG14—Research
Agenda 2063:
Keywords: floating plastic, marine pollution

An assessment of the information content of South African alien species databases

Authors: Katelyn T Faulkner, Dian Spear, Mark P Robertson, Mathieu Rouget & John R U Wilson
SDG15—Research
Agenda 2063:
Keywords: invasive alien species, South Africa

Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa

Authors: Geoffrey Fatti, Eula Mothibi, Graeme Meintjes & Ashraf Grimwood
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, South Africa

Assessing the impact of multidrug-resistant tuberculosis in children: An exploratory qualitative study

Authors: Caroline Franck, James A Seddon, Anneke C Hesseling, H Simon Schaaf, Donald Skinner & Lucy Reynolds
SDG3—Research
Agenda 2063: A1
Keywords: TB, tuberculosis

The effect of HIV and the modifying effect of anti-retroviral therapy (ART) on body mass index (BMI) and blood pressure levels in rural South Africa

Authors: Andrea B Feigl, David E Bloom, Goodarz Danaei, Deenan Pillay, Joshua A Salomon, Frank Tanser & Till W. Ba?rnighausen
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa
SDG3—Research
Agenda 2063: A1, A6
Keywords: KwaZulu-Natal, reproductive health, sexual health, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: HIV
SDG7—Research
Agenda 2063: A1, A2
Keywords: access to electricity
SDG3—Research
Agenda 2063: A1
Keywords: cardiovascular disease, South Africa

Hypertension education and adherence in South Africa: A cost-effectiveness analysis of community health workers

Authors: Thomas A Gaziano, Melanie Bertram, Stephen M Tollman & Karen J Hofman
SDG3—Research
Agenda 2063: A1
Keywords: cardiovascular disease, South Africa
SDG13, SDG2—Research
Agenda 2063: A1
Keywords: climate change adaptation, South Africa, sustainable agriculture, sustainable food production
SDG3—Research
Agenda 2063: A3
Keywords: health education, health systems, health training
SDG3—Research
Agenda 2063: A3
Keywords: health systems, South Africa

Alcohol use, working conditions, job benefits, and the legacy of the dop system among farm workers in the Western Cape Province, South Africa: Hope despite high levels of risky drinking

Authors: J Phillip Gossage, Cudore L Snell, Charles D H Parry, Anna-Susan Marais, Ronel Barnard, Marlene de Vries, Jason Blankenship, Soraya Seedat, Julie M Hasken & Philip A May
SDG3—Research
Agenda 2063:
Keywords: alcohol abuse, substance abuse
SDG2—Research
Agenda 2063:
Keywords: nutrition, Western Cape

The burden of hypertension in sub-Saharan Africa: A four-country cross sectional study

Authors: David Guwatudde, Joan Nankya-Mutyoba, Robert Kalyesubula, Carien Laurence, Clement Adebamowo, IkeOluwapo Ajayi, Francis Bajunirwe, Marina Njelekela, Faraja S Chiwanga, Todd Reid, Jimmy Volmink3, Hans-Olov Adami, Michelle D Holmes & Shona Dalal
SDG3—Research
Agenda 2063: A1
Keywords: cardiovascular disease

Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa

Authors: Veloshnee Govender, Jana Fried, Stephen Birch, Natsayi Chimbindi & Susan Cleary
SDG1, SDG10, SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, social protection, South Africa

Implementation of cognitive-behavioral substance abuse treatment in Sub-Saharan Africa: Treatment engagement and abstinence at treatment exit

Authors: Hetta Gouse, Jessica F Magidson, Warren Burnhams, Jocelyn E Remmert, Bronwyn Myers, John A Joska & Adam W Carrico
SDG3—Research
Agenda 2063:
Keywords: substance abuse

Evaluation of selected aspects of the Nutrition Therapeutic Programme offered to HIV-positive women of child-bearing age in Western Cape Province, South Africa

Authors: Tine T Hansen, Marietjie Herselman, Lisanne du Plessis, Luzette Daniels, Tirsa Bezuidenhout, Cora van Niekerk, Laura Truter & Per O Iversen
SDG2, SDG3—Research
Agenda 2063: A1, A6
Keywords: HIV, nutrition, South Africa, Western Cape
SDG16—Research
Agenda 2063: A6
Keywords: child abuse, South Africa, violence against children

Revealing the social face of innovation

Authors: Tim G B Hart, Kgabo H Ramoroka, Peter T Jacobs & Brigid A Letty
SDG9—Research
Agenda 2063: A1
Keywords: innovation

An exploratory study of what happens to women who are denied abortions in Cape Town, South Africa

Authors: Jane Harries, Caitlin Gerdts, Mariette Momberg & Diana Greene Foster
SDG3—Research
Agenda 2063: A6
Keywords: Cape Town, reproductive health, sexual health, South Africa

A systematic review of hepatic tuberculosis with considerations in human immunodeficiency virus co-infection

Authors: Andrew J Hickey, Lilishia Gounder, Mahomed-Yunus S Moosa & Paul K Drain
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, TB, tuberculosis
SDG3—Research
Agenda 2063: A1
Keywords: TB, tuberculosis
SDG16—Research
Agenda 2063: A4
Keywords: Cape Town, homicide, murder, South Africa, violence

A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women

Authors: Ian Hodgson, Mary L Plummer, Sarah N Konopka, Christopher J Colvin, Edna Jonas, Jennifer Albertini, Anouk Amzel & Karen P Fogg
SDG3—Research
Agenda 2063: A1
Keywords: HIV, maternal mortality, South Africa

Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: A combined analysis of 11 mathematical models

Authors: Rein M G J Houben, Nicolas A Menzies, Tom Sumner, Grace H Huynh, Nimalan Arinaminpathy, Jeremy D Goldhaber-Fiebert, Hsien-Ho Lin, Chieh-Yin Wu, Sandip Mandal, Surabhi Pandey, Sze-chuan Suen, Eran Bendavid, Andrew S Azman, David W Dowdy, Nicolas Bacae?r, Allison S Rhines, Marcus W Feldman, Andreas Handel, Christopher C Whalen, Stewart T Chang, Bradley G Wagner, Philip A Eckhoff, James M Trauer, Justin T Denholm, Emma S McBryde, Ted Cohen, Joshua A Salomon, Carel Pretorius, Marek Lalli, Jeffrey W Eaton, Delia Boccia, Mehran Hosseini, Gabriela B Gomez, Suvanand Sahu, Colleen Daniels, Lucica Ditiu, Daniel P Chin, Lixia Wang, Vineet K Chadha, Kiran Rade, Puneet Dewan, Piotr Hippner, Salome Charalambous, Alison D Grant, Gavin Churchyard, Yogan Pillay, L David Mametja, Michael E Kimerling, Anna Vassall & Richard G White
SDG3—Research
Agenda 2063: A1
Keywords: South Africa, TB, tuberculosis

Expanding contraceptive options for PMTCT clients: A mixed methods implementation study in Cape Town, South Africa

Authors: Theresa Hoke, Jane Harries, Sarah Crede, Mackenzie Green, Deborah Constant, Tricia Petruney & Jennifer Moodley
SDG3—Research
Agenda 2063: A1
Keywords: Cape Town, contraceptives, family planning

Pathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or death

Authors: Peter Hodkinson, Andrew Argent, Lee Wallis, Steve Reid, Rafael Perera, Sian Harrison, Matthew Thompson, Mike English, Ian Maconochie & Alison Ward
SDG3—Research
Agenda 2063:
Keywords: child mortality, infant mortality, under-five mortality
SDG16—Research
Agenda 2063: A3
Keywords: protection of human rights
SDG2, SDG6—Research
Agenda 2063: A1
Keywords: South Africa, sustainable agriculture, wastewater treatment, Western Cape

Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late?

Authors: Steve Innes, Erica Lazarus, Kennedy Otwombe, Afaaf Liberty, Ramona Germanus, Anita Janse Van Rensburg, Nelis Grobbelaar, Theunis Hurter, Brian Eley, Avy Violari & Mark F Cotton
SDG3—Research
Agenda 2063: A1
Keywords: HIV

HIV, tuberculosis, and noncommunicable diseases: What Is known about the costs, effects, and cost-effectiveness of integrated care?

Authors: Emily P Hyle, Kogieleum Naidoo, Amanda E Su, Wafaa M El-Sadr & Kenneth A Freedberg
SDG3—Research
Agenda 2063: A1
Keywords: health systems, HIV, TB, tuberculosis

Screening, characterisation and prevention of Hepatitis B virus (HBV) co-infection in HIV-positive children in South Africa

Authors: Pieter Jooste, Anriette van Zyl, Emily Adland, Samantha Daniels, Louise Hattingh, Alethea Brits, Susan Wareing, Dominique Goedhals, Katie Jeffery, Monique Andersson, Philip Goulder & Philippa C Matthews
SDG3—Research
Agenda 2063: A1
Keywords: hepatitis, HIV, South Africa
SDG16—Research
Agenda 2063: A6
Keywords: gender violence, sexual violence, South Africa, violence

What keeps health professionals working in rural district hospitals in South Africa?

Authors: Louis S Jenkins, Colette Gunst, Julia Blitz & Johan F Coetzee
SDG3—Research
Agenda 2063: A3
Keywords: health systems, South Africa
SDG1, SDG10, SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, social protection, South Africa

Understanding the impact of hazardous and harmful use of alcohol and/or other drugs on ARV adherence and disease progression

Authors: Rehana Kader, Rajen Govender, Soraya Seedat, John Randy Koch & Charles Parry
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, alcohol abuse, HIV, substance abuse

HIV-positive status disclosure in patients in care in rural South Africa: Implications for scaling up treatment and prevention interventions

Authors: Quarraisha Abdool Karim, Rachael C Dellar, Benjamin Bearnot, Lise Werner, Janet A Frohlich, Ayesha B M Kharsany & Salim S Abdool Karim
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: Cape Town, South Africa, TB, tuberculosis
SDG1, SDG10—Research
Agenda 2063: A1
Keywords: social protection, South Africa
SDG8—Research
Agenda 2063:
Keywords: migrant workers, migrants, refugees, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: contraceptives, reproductive health, sexual health

Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby

Authors: Kate J Kerber, Matthews Mathai, Gwyneth Lewis, Vicki Flenady, Jan Jaap H M Erwich, Tunde Segun, Patrick Aliganyira, Ali Abdelmegeid, Emma Allanson, Nathalie Roos, Natasha Rhoda, Joy E Lawn & Robert Pattinson
SDG3—Research
Agenda 2063: A1
Keywords: infant mortality, maternal mortality, neonatal mortality

Eliminating preventable HIV-related maternal mortality in Sub-Saharan Africa: What do we need to know?

Authors: Tamil Kendall, Isabella Danel, Diane Cooper, Sophie Dilmitis, Angela Kaida, Athena P Kourtis, Ana Langer, Ilana Lapidos-Salaiz, Eva Lathrop, Allisyn C Moran, Hannah Sebitloane, Janet M. Turan, D Heather Watts & Mary Nell Wegner
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, HIV, maternal mortality

Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: A systematic review

Authors: Roxanne Keynejad, Maya Semrau, Mark Toynbee, Sara Evans-Lacko, Crick Lund, Oye Gureje, Sheila Ndyanabangi, Emilie Courtin, Jibril O Abdulmalik, Atalay Alem, Abebaw Fekadu, Graham Thornicroft & Charlotte Hanlon
SDG3—Research
Agenda 2063: A1, A3
Keywords: health systems, South Africa

The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: A cohort study

Authors: Andrew D Kerkhoff, Robin Wood, Frank G Cobelens, Ankur Gupta-Wright, Linda-Gail Bekker & Stephen D Lawn
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa
SDG3—Research
Agenda 2063:
Keywords: substance abuse

Fruit waste streams in South Africa and their potential role in developing a bio-economy

Authors: Nuraan Khan, Marilize le Roes-Hill, Pamela J Welz, Kerry A Grandin, Tukayi Kudanga, J Susan van Dyk, Colin Ohlhoff, W H (Emile) van Zyl & Brett I Pletschke
SDG2, SDG6—Research
Agenda 2063: A1
Keywords: South Africa, sustainable agriculture, wastewater treatment

The impact and cost-effectiveness of a four-month regimen for first-line treatment of active tuberculosis in South Africa

Authors: Gwenan M Knight, Gabriela B Gomez, Peter J Dodd, David Dowdy, Alice Zwerling, William A Wells, Frank Cobelens, Anna Vassall & Richard G White
SDG3—Research
Agenda 2063: A1
Keywords: South Africa, TB, tuberculosis
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa

Trends in HIV prevalence in pregnant women in rural South Africa

Authors: Ayesha B M Kharsany, Janet A Frohlich, Nonhlanhla Yende-Zuma, Gethwana Mahlase, Natasha Samsunder, Rachael C Dellar, May Zuma-Mkhonza, Salim S Abdool Karim & Quarraisha Abdool Karim
SDG3—Research
Agenda 2063: A1
Keywords: HIV, reproductive health, South Africa
SDG8, SDG9—Research
Agenda 2063: A1
Keywords: innovation, micro, small and medium-sized enterprises
SDG8, SDG9—Research
Agenda 2063: A1
Keywords: innovation, micro, small and medium-sized enterprises, SMEs, South Africa

Antenatal health promotion via short message service at a Midwife Obstetrics Unit in South Africa: A mixed methods study

Authors: Yan Kwan Lau, Tali Cassidy, Damian Hacking, Kirsty Brittain, Hanne Jensen Haricharan & Marion Heap
SDG3—Research
Agenda 2063: A1
Keywords: health education, South Africa

The Mpumalanga Mens Study (MPMS): Results of a baseline biological and behavioral HIV surveillance survey in two MSM communities in South Africa

Authors: Tim Lane, Thomas Osmand, Alexander Marr, Starley B Shade, Kristin Dunkle, Theodorus Sandfort, Helen Struthers, Susan Kegeles & James A McIntyre
SDG3—Research
Agenda 2063: A1
Keywords: HIV, Mpumalanga, South Africa

Developing family interventions for adolescent HIV prevention in South Africa

Authors: Caroline Kuo, Millicent Atujuna, Catherine Mathews, Dan J Stein, Jacqueline Hoare, William Beardslee, Don Operario, Lucie Cluverc & Larry K Brown
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa

Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa

Authors: Naomi S Levitt, Thandi Puoane, Catalina A Denman, Shafika Abrahams-Gessel, Sam Surka, Carlos Mendoza, Masuma Khanam, Sartaj Alam & Thomas A Gaziano
SDG3—Research
Agenda 2063: A1
Keywords: cardiovascular disease, South Africa

Antarctic climate change: Extreme events disrupt plastic phenotypic response in Adlie penguins

Authors: Amlie Lescrol, Grant Ballard, David Grmillet, Matthieu Authier & David G Ainley
SDG13, SDG15—Research
Agenda 2063:
Keywords: climate change, threatened species
SDG3—Research
Agenda 2063: A1
Keywords: cardiovascular disease, South Africa

Translational research for tuberculosis elimination: Priorities, challenges, and actions

Authors: Christian Lienhardt, Knut Lnnroth, Dick Menzies, Manica Balasegaram, Jeremiah Chakaya, Frank Cobelens, Jennifer Cohn, Claudia M Denkinger, Thomas G Evans, Gunilla Ka?llenius, Gilla Kaplan, Ajay M V Kumar, Line Matthiessen, Charles S Mgone, Valerie Mizrahi, Ya-diul Mukadi, Viet Nhung Nguyen, Anders Nordstrm, Christine F Sizemore, Melvin Spigelman, S Bertel Squire, Soumya Swaminathan, Paul D van Helden, Alimuddin Zumla, Karin Weyer, Diana Weil & Mario Raviglione
SDG3—Research
Agenda 2063: A1
Keywords: TB, tuberculosis
SDG10—Research
Agenda 2063: A1
Keywords: affirmative action, Black Economic Empowerment, employment equity, equal opportunity, South Africa

The unknown underworld: Understanding soil health in South Africa

Authors: Schalk v d M Louw, John R U Wilson, Charlene Janion, Ruan Veldtman, Sarah J Davies & Matthew Addison
SDG15, SDG2—Research
Agenda 2063:
Keywords: degraded soil, soil quality, soil restoration, South Africa
SDG13, SDG15, SDG4—Research
Agenda 2063:
Keywords: climate change education, sustainability education, sustainable development education

Association between health systems performance and treatment outcomes in patients co-infected with MDR-TB and HIV in KwaZulu-Natal, South Africa: Implications for TB Programmes

Authors: Marian Loveday, Nesri Padayatchi, Kristina Wallengren, Jacquelin Roberts, James C M Brust, Jacqueline Ngozo, Iqbal Master & Anna Voce
SDG3—Research
Agenda 2063: A1, A3
Keywords: health systems, KwaZulu-Natal, South Africa, TB, tuberculosis
SDG10—Research
Agenda 2063: A1
Keywords: affirmative action, Black Economic Empowerment, employment equity, equal opportunity, South Africa
SDG4—Research
Agenda 2063: A1, A6
Keywords: quality education, secondary education

Community-based care vs. centralised hospitalisation for MDR-TB patients KwaZulu-Natal, South Africa

Authors: Marian Loveday, Kristina Wallengren, J Brust, J Roberts, A Voce, B Margot, J Ngozo, I Master, G Cassell & N Padayatchi
—Research
Agenda 2063: A1
Keywords: KwaZulu-Natal, South Africa, TB, tuberculosis

Innate antibacterial activity in female genital tract secretions is associated with increased risk of HIV acquisition

Authors: Rebecca Pellett Madan, Lindi Masson, Jessica Tugetman, Lise Werner, Anneke Grobler, Koleka Mlisana, Yungtai Lo, Denise Che, Kelly B Arnold, Salim S Abdool Karim, Jo-Ann S Passmore & Betsy C Herold
SDG3—Research
Agenda 2063: A1, A6
Keywords: HIV

Towards the implementation of e-manufacturing: Design of an automatic tea drying control system

Authors: N Mabvuu, L Nyanga, A F van der Merwe, S Matope & S. Mhlanga
SDG9—Research
Agenda 2063: A1
Keywords: manufacturing, research and development, research and innovation
SDG3—Research
Agenda 2063: A1
Keywords: South Africa, TB, tuberculosis
SDG14, SDG15—Research
Agenda 2063:
Keywords: conservation, invasive alien species, marine ecosystem, marine resources
SDG6—Research
Agenda 2063: A2
Keywords: water efficiency, water management
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa

Efficacy of enhanced HIV counseling for risk reduction during pregnancy and in the postpartum period: A randomized controlled trial

Authors: Suzanne Maman, Dhayendre Moodley, Heathe Luz McNaughton-Reyes, Allison K. Groves, Ashraf Kagee & Prashini Moodley
SDG3—Research
Agenda 2063: A1
Keywords: HIV

Genital inflammation and the risk of HIV acquisition in women

Authors: Lindi Masson, Jo-Ann S Passmore, Lenine J Liebenberg, Lise Werner, Cheryl Baxter, Kelly B Arnold, Carolyn Williamson, Francesca Little, Leila E Mansoor, Vivek Naranbhai, Douglas A Lauffenburger, Katharina Ronacher, Gerhard Walzl, Nigel J Garrett, Brent L Williams, Mara Couto-Rodriguez, Mady Hornig, W Ian Lipkin, Anneke Grobler, Quarraisha Abdool Karim & Salim S. Abdool Karim
SDG3—Research
Agenda 2063: A1
Keywords: HIV
SDG7—Research
Agenda 2063: A2
Keywords: access to electricity, South Africa

Drivers of bird species richness within moist high-altitude grasslands in eastern South Africa

Authors: David H Maphisa, Hanneline Smit-Robinson, Les G Underhill & Res Altwegg
SDG15—Research
Agenda 2063: A1
Keywords: conservation, South Africa

Reaching the hard to reach: longitudinal investigation of adolescents attendance at an after-school sexual and reproductive health programme in Western Cape, South Africa

Authors: Catherine Mathews, Sander Matthijs Eggers, Petrus J de Vries, Amanda J Mason-Jones, Loraine Townsend, Leif Edvard Aar & Hein de Vries
SDG3—Research
Agenda 2063: A1, A6
Keywords: reproductive health, sexual health, South Africa, Western Cape
SDG11—Research
Agenda 2063: A1
Keywords: cultural heritage
SDG3, SDG5—Research
Agenda 2063: A1, A6
Keywords: gender equality, HIV

Prevalence and characteristics of Hepatitis B virus (HBV) coinfection among HIV-positive women in South Africa and Botswana

Authors: Philippa C Matthews, Apostolos Beloukas, Amna Malik, Jonathan M Carlson, Pieter Jooste, Anthony Ogwu, Roger Shapiro, Lynn Riddell, Fabian Chen, Graz Luzzi, Manjeetha Jaggernath, Gerald Jesuthasan, Katie Jeffery, Thumbi Ndungu, Philip J R Goulder, Anna Maria Geretti & Paul Klenerman
SDG3—Research
Agenda 2063: A1
Keywords: hepatitis, HIV, South Africa

Distance decay and persistent health care disparities in South Africa

Authors: Zo M McLaren, Cally Ardington & Murray Leibbrandt
SDG3—Research
Agenda 2063:
Keywords: access to health care, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: human rights, South-South Cooperation
SDG16—Research
Agenda 2063: A6
Keywords: child abuse, South Africa
SDG16—Research
Agenda 2063: A6
Keywords: child abuse, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: Cape Town, HIV, South Africa
SDG16—Research
Agenda 2063: A6
Keywords: child abuse, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: South Africa, TB, tuberculosis
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, South Africa, transparent institutions

Socio-economic implications of mitigation in the power sector including carbon taxes in South Africa

Authors: Bruno Merven, Alfred Moyo, Adrian Stone, Anthony Dane & Harald Winkler
SDG13, SDG7—Research
Agenda 2063: A2
Keywords: climate change mitigation, South Africa, sustainable electricity, sustainable energy

Implementation of adolescent-friendly voluntary medical male circumcision using a school based recruitment program in rural KwaZulu-Natal, South Africa

Authors: Carl Montague, Nelisiwe Ngcobo, Gethwana Mahlase, Janet Frohlich, Cheryl Pillay, Nonhlanhla Yende-Zuma, Hilton Humphries, Rachael Dellar, Kogieleum Naidoo & Quarraisha Abdool Karim
SDG3—Research
Agenda 2063: A1
Keywords: HIV, KwaZulu-Natal, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: Cape Town, reproductive health, sexual health, South Africa

Assessing the effects of climate change on distributions of Cape Floristic Region amphibians

Authors: Mohlamatsane M Mokhatla, Dennis Rdder & G John Measey
Climatic changes have had profound impacts on species distributions throughout time. In response, species have shifted ranges, adapted genetically and behaviourally or become extinct. Using species distribution models, we examined how changes in suitable climatic space could affect the distributions of 37 endemic frog species in the Cape Floristic Region (CFR) an area proposed to have evolved its megadiversity under a stable climate, which is expected to change substantially in future. Species distributions were projected onto mean climate for a current period (1950 to 2000), hindcasted to palaeoclimate (Last Glacial Maximum; LGM ? 21 kya and Holocene Glacial Minimum; HGM ? 6 kya) and forecasted for two emissions scenarios (A2a and B2a) for the year 2080. We then determined the changes in area sizes, direction (longitude and latitude), fragmentation index and biotic velocity, and assessed if these were affected by life-history traits and altitude. We found that the biotic velocity at which the CFR amphibian community is expected to shift north (A2a ? 540.5 km/kya) and east (B2a ? 198 km/kya) far exceeds historical background rates (?1.05 km/kya, north and west ? 2.36 km/kya since the LGM). Our models further suggest that the CFR amphibian community has already lost about 56% of suitable climate space since the LGM and this loss is expected to accelerate under future emission scenarios (A2a ? 70%; B2a ? 60%). Lastly, we found that highland species were more fragmented than lowland species between the LGM and current period, but that the fragmentation of lowland species between current and future climates is expected to increase.
SDG13, SDG15—Research
Agenda 2063:
Keywords: climate change adaptation, conservation, South Africa, Western Cape

High prevalence and incidence of asymptomatic sexually transmitted infections during pregnancy and postdelivery in KwaZulu Natal, South Africa

Authors: Dhayendre Moodley, Prashini Moodley, Motshedisi Sebitloane, Deepak Soowamber, Heather Luz McNaughton-Reyes, Allison K Groves & Suzanne Maman
SDG3—Research
Agenda 2063: A1
Keywords: KwaZulu-Natal, reproductive health, sexual health, South Africa
SDG5—Research
Agenda 2063: A6
Keywords: gender violence, sexual violence
SDG5—Research
Agenda 2063: A6
Keywords: gender equality, South Africa
SDG1, SDG5—Research
Agenda 2063: A6
Keywords: gender equality, property rights, South Africa

Loss from treatment for drug resistant tuberculosis: Risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa

Authors: Sizulu Moyo, Helen S Cox, Jennifer Hughes, Johnny Daniels, Leigh Synman, Virginia de Azevedo, Amir Shroufi, Vivian Cox & Gilles van Cutsem
SDG3—Research
Agenda 2063: A1
Keywords: Cape Town, South Africa, TB, tuberculosis

Paediatric ART outcomes in a decentralised model of care in Cape Town, South Africa

Authors: M M Morsheimer, A Dramowski, H Rabie & M F Cotton
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, Cape Town, HIV, South Africa
SDG5—Research
Agenda 2063: A6
Keywords: gender violence, sexual violence, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: maternal mortality

Identifying recent HIV infections: From serological assays to genomics

Authors: Sikhulile Moyo, Eduan Wilkinson, Vladimir Novitsky, Alain Vandormael, Simani Gaseitsiwe, Max Essex, Susan Engelbrecht & Tulio de Oliveira
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa
The availability and depletion of natural resources is increasingly punted as the limiting factor for sustainability. A lot of focus is currently placed on the role and effect of fossil fuels as well as water conservation. One way to affect prudence with these scarce resources is to generally create timely awareness of consumption thereof, and also the related cost for the consumers. Existing metering solutions for electrical energy and water are often manually read by officials, and the information difficult to digest. Moreover, billing information, which serves as feedback, lags consumption by several weeks. Smart meters address many of these challenges by enabling electronic and real-time metering, but are still prohibitively expensive. In this paper, a low-cost power meter is discussed and also a novel low-cost water flow meter is developed to integrate into a household smart metering system. Electricity supply to appliances as well as the main water supply is controlled through relays and a valve. The whole system is connected to the Trintel SMART web platform by means of cellular communications from where end-users can manage their own energy and water usage. The results demonstrate that the smart metering system provides a functional, accurate and less expensive alternative to household metering. Further improvements on the system are also suggested.
SDG6, SDG7—Research
Agenda 2063: A2
Keywords: energy efficiency, water efficiency
SDG2, SDG6—Research
Agenda 2063: A1
Keywords: sustainable agriculture, wastewater treatment
SDG3—Research
Agenda 2063: A3
Keywords: health education, health training, medical training
SDG1, SDG13—Research
Agenda 2063:
Keywords: climate change resilience, natural resource governance, South Africa, Western Cape
SDG3, SDG5—Research
Agenda 2063: A1, A6
Keywords: access to health care, discrimination, gender equality
SDG4—Research
Agenda 2063: A1, A6
Keywords: higher education, tertiary education
SDG11—Research
Agenda 2063: A1
Keywords: access to housing, affordable housing, Cape Town, South Africa
SDG2—Research
Agenda 2063: A1
Keywords: hunger, Limpopo, malnutrition, nutrition, South Africa
SDG7—Research
Agenda 2063: A2
Keywords: clean energy, renewable energy, South Africa, sustainable electricity, sustainable energy

Implementation of an electronic monitoring and evaluation system for the antiretroviral treatment programme in the Cape Winelands District, South Africa: A qualitative evaluation

Authors: Hanlie Myburgh, Joshua P Murphy, Mea van Huyssteen, Nicola Foster, Cornelius J Grobbelaar, Helen E Struthers, James A McIntyre, Theunis Hurter & Remco P H Peters
SDG3—Research
Agenda 2063: A1
Keywords: AIDS, Cape Winelands District, HIV, South Africa

Perceived need for substance use treatment among young women from disadvantaged communities in Cape Town, South Africa

Authors: Bronwyn Myers, Tracy L Kline, Irene A Doherty, Tara Carney & Wendee M Wechsberg
SDG3—Research
Agenda 2063: A1
Keywords: Cape Town, South Africa, substance abuse

Risk factors for HIV acquisition in high risk women in a generalised epidemic setting

Authors: Nivashnee Naicker, Ayesha B M Kharsany, Lise Werner, Francois van Loggerenberg, Koleka Mlisana, Nigel Garrett & Salim S Abdool Karim
SDG3—Research
Agenda 2063: A1
Keywords: HIV

Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: An exploratory study

Authors: Jean B Nachega, Donald Skinner, Larissa Jennings, Jessica F Magidson, Frederick L Altice, Jessica G Burke, Richard T Lester, Olalekan A Uthman, Amy R Knowlton, Mark F Cotton, Jean R Anderson & Gerhard B Theron
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: KwaZulu-Natal, mental health, South Africa

Cost-effectiveness of initiating antiretroviral therapy at different points in TB treatment in HIV-TB coinfected ambulatory patients in South Africa

Authors: Kogieleum Naidoo, Anneke C. Grobler, Nicola Deghaye, Tarylee Reddy, Santhanalakshmi Gengiah, Andrew Gray & Salim Abdool Karim
SDG3—Research
Agenda 2063: A1
Keywords: HIV, South Africa
SDG11—Research
Agenda 2063: A1
Keywords: development planning, South Africa
SDG3—Research
Agenda 2063: A1
Keywords: diabetes, mental health, South Africa

Mental health inequalities in adolescents growing up in post-apartheid South Africa: Cross-sectional survey, SHaW study

Authors: Jayati Das-Munshi, Crick Lund, Catherine Mathews, Charlotte Clark, Catherine Rothon & Stephen Stansfeld
SDG3—Research
Agenda 2063: A1, A6
Keywords: mental health, South Africa
SDG16—Research
Agenda 2063: A3
Keywords: accountable institutions, effective institutions, South Africa, transparent institutions

Challenges and opportunities for implementing integrated mental health care: A district level situation analysis from five low- and middle-income countries

Authors: Charlotte Hanlon, Nagendra P Luitel, Tasneem Kathree, Vaibhav Murhar, Sanjay Shrivasta, Girmay Medhin, Joshua Ssebunnya, Abebaw Fekadu, Rahul Shidhaye, Inge Petersen, Mark Jordans, Fred Kigozi, Graham Thornicroft, Vikram Patel, Mark Tomlinson, Crick Lund, Erica Breuer, Mary De Silva & Martin Prince
SDG3—Research
Agenda 2063: A1, A3
Keywords: health systems, mental health