Youth perceptions (18-24) on the role of youth clubs in delivering family planning information and services in Blantyre district, Malawi

Background: Unmet need for family planning is a significant health problem for youth in Malawi. In order to promote family planning uptake, youth clubs were established to provide a safe and friendly environment for the youth to access sexual and reproductive health information and services. Although these tailored youth clubs exist, evidence on family planning utilisation in this population has been collected in clinics and hospitals rather than youth clubs. This study explored the perspectives of the youth on the role of youth clubs in delivering family planning information and services including condom distribution. Methods: An exploratory qualitative study design was used for this study. Four focus group discussions and ten semi-structured interviews were used to collect information from young boys and girls aged between 18 – 24. Participants were purposively sampled and were asked to give a written consent before the commencement of the interviews. The discussions and semi-structured interviews were tape-recorded and transcribed verbatim. Transcripts were coded manually and analysed using thematic analysis. Results: Youth clubs played a role in creating awareness about family planning methods and promoting positive sexual and reproductive health wellbeing of young people. The youth identified effective facilitation skills, trained peer educators and dynamic collaborations with health service providers as the facilitators of smooth delivery of family planning information. The perceived barriers to the smooth delivery of family planning information in the clubs included limited availability of resources and religious/cultural biases. Conclusions: Youth clubs are crucial in empowering the youth with knowledge and understanding about family planning hence enabling them to make informed decisions about their sexual and reproductive health and wellbeing. Effective delivery of family planning information and services in youth clubs requires strong partnerships with relevant stakeholders such as local health service providers and non-governmental organisations through leveraging their expertise, resources and networks hence strengthening the impact of family planning initiatives

Exploring the relationship between multimodal magnetic resonance neuroimaging and cognitive outcomes in children: applying machine learning algorithms to brain MRI features to predict cognitive scores and performance categories of children living with and without HIV

Background: A constantly growing body of literature shows that children from low- socioeconomic status (SES) backgrounds are at risk of cognitive developmental delays, poor health outcomes, and cognitive difficulties which lead to high rates of school drop-outs and struggles in other areas of life. In sub-Saharan Africa, where the human immu- nodeficiency virus (HIV) is the most prevalent, low-SES households and communities are disproportionately affected by the disease and its effects on neurodevelopment. The ability to predict cognitive abilities or deficits from neuroimaging or other methods could make it easier to identify at-risk children who may benefit the most from targeted inter-ventions. This is of relevance in low-SES populations with relatively high rates of child-hood HIV that may affect neurodevelopment. Magnetic resonance (MR) imaging (MRI) is a versatile tool that can be used to measure a broad range of brain tissue properties giving rise to cognitive functions. For example, structural MRI (sMRI) can quantify brain volumes and other morphometrics, diffusion tensor imaging (DTI) can estimate the amount of nerve fibre damage, and proton MR spectroscopy (1H-MRS) can charac- terise the biochemical profile of grey and white matter (GM, WM).Research aims : The aims of this study were: First, collect evidence for what is known about the relationship between cognitive performance assessed by a comprehensive set of cognitive test batteries and brain changes measured with neuroimaging in children, adolescents, and youth living with HIV. Second, compare the predictive performance of penalised linear models (PLMs), support vector machines/regression (SVM/R), and de-cision tree ensembles (DTEs) in predicting continuous scores on cognitive tests, as well as categories of cognitive performance from multimodal neuroimaging in a cohort com-prising both children living with and without HIV. Third, determine whether multimodal MRI offers any predictive advantage compared to predicting future performance using cognitive scores at a younger age. Methods and materials : To address these aims, we first conducted a systematic liter-ature review and secondly a multimodal MRI neuroimaging and cognitive testing study of 132 children from low-SES backgrounds. For the review, we searched PubMed, Scopus, Web of Science, CINAHL, APA Psych Info & Psych Articles, and Academic Search Premier for studies published between 1 January 2006 and 31 October 2022. Inclusion criteria were studies that investigated a relationship between neuroimaging brain measures and cognitive test scores and included children (0–14 years), adolescents (15–18), and youth (19–26) living with HIV. For the neuroimaging and cognitive study, structural MRI, DTI, and 1H-MRS were ac-quired at ages 7 and 9 years. Cognitive performance was assessed using the Kaufman assessment battery for children, Beery-Buktenica developmental test of visual-motor in- tegrations, test of variables of attention, Purdue pegboard test, the Peabody picture vocabulary test, and semantic fluency test at both ages. PLMs, SVMs/R, and DTEs prediction models were implemented with Bayesian optimization and assessed with 10-fold cross validation (CV) and compared for their ability to predict continuous scores (regression) or categories of cognitive performance (classification). Poorer and better cognitive performance categories were identified with a hierarchical clustering algorithm. Regression performance was assessed via 10-fold CV errors, coefficient of determination (R2), and Pearson's r between predicted and actual values. For the classification models, 10-fold CV sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were obtained.Results : Evidence from the literature suggests that HIV may lead to alterations in the brain's structure, function, neurometabolism, and WM microstructure. Individual brain measures are linked to outcomes of short-term memory, processing speed, working memory, problem solving, and general intelligence quotients in children, adolescents, and youth living with and without. We could not find any studies linking multimodal MRI to cognitive performance in this population of young people. PLMs, SVMs/SVR, and DTEs performed poorly for the regression problem; the predic-tive models led to small training and fitting errors but high generalised CV errors. How-ever, using either multimodal MRI data or cognitive scores at age 7, we could predict auditory working memory (R2 = 0.45, r = 0.75), short-term memory (R2 = 0.43, r =0.62), visual-motor integration (R2 = 0.26, r = 0.39), and executive reasoning (R2 = 0.33, r = 0.27) scores at age 9 with moderate to strong Pearson's r. Classification of children into poorer or better performance categories was more successful than regression of the individual scores, with 0.75–0.81 AUC, 70–77% accuracies, 70–81% specificities, 71–79% sensitivities using historic multimodal MRI and cognitive scores. Historic multimodal MRI (AUC = 0.80, accuracy = 76%) was marginally better than cognitive scores (AUC= 0.75, accuracy = 70%) in classifying future overall cognitive performance.Conclusion: There were multimodal brain measures relevant in the prediction models, these included creatine and glutamate concentrations in midfrontal gray matter region, thalamus volume, diffusivity in the cingulum WM tract, cingulate gyrus area, and gyri-fication index of the parietal lobe. This suggests that multiple MRI modalities and fea-tures should be considered simultaneously to establish correlates of overall cognitive performance. The neural correlates we find could potentially be used to identify bi-omarkers of cognitive impairment, understand the developmental nature of cognitive plasticity, and enable the development of targeted interventions that can modulate brain networks associated with cognitive functions

Prevalence and correlates of cyber-victimization in a nationally representative sample of South African youth

Cyber-victimization is defined as “the experience of aggressive behaviours while using new electronic technologies, primarily mobile phones and the internet" (Álvarez-García et al., 2015a; Smith & Steffgen, 2013). Approximately 20 to 50% of adolescents have experienced online victimization globally (Zhu et al., 2021). This is a public health concern because cyber- victimization can harm the mental health of the victim thus leading to depressive symptoms such as anxiety, helplessness, distress, sadness, trauma symptoms, reduced self-esteem, feelings of isolation, fear of socialization, hopelessness, self-harm, or suicidal ideation (Hertz et al., 2015; Kim et al., 2022; Landoll et al., 2015; Mason et al., 2009). Research on the risk factors associated with cyber-victimization is relatively new and has some gaps and inconsistencies (Álvarez-García et al., 2015a; Zhu et al., 2021). This study will focus on analyzing the association of some demographic, psychological, educational, family factors and exposure to other forms of violence, with cyber-victimization, in a nationally representative sample of South African children. We aim to determine the lifetime prevalence and last-year prevalence (i.e., annual incidence) of cyber- victimization, as well as the association of cyber-victimization with its correlates, based on a nationally representative cross-sectional study of 15–17-year-old youth in South Africa. Method: This mini dissertation will use secondary data obtained, with permission, from the Optimus Study conducted in South Africa (Ward et al., 2018). The study drew on data from a population survey that was conducted with a sample of 15- to 17-year-old adolescents recruited nationally from schools (4 086 participants) as well as households (5 631 participants) (Ward et al., 2018). The aims of this study are as follows: To estimate the prevalence and incidence of cyber-victimization among South African youth as of 2013/2014, as well as in-person victimization. This will be achieved by reporting the relative frequencies with CI of both the lifetime and last-year prevalence, stratified by key demographic measures. We will also report the prevalence of each of the six types of cyberbullying. To measure the strength of association between cyber-victimization and potential risk/protective factors among South African youth. We will use logistic regression to estimate the association of each factor in table 1 with cyber-victimization, adjusting for the possible confounding factors listed. The associations will be expressed as odds ratios (ORs) with their 95% confidence intervals (Cis). The unadjusted odds ratios (OR) will be estimated using a univariable regression model for each correlate and adjusted OR (aOR) will be estimated using a multivariable regression model containing all correlates. To study the relationship between cyber-victimization and each of the potential consequences stratified by sex. For the factors, we will report differences in proportions, by cyber-victimization and CIs. The following correlates will be considered as consequences of cyber-victimization (table 2): Behavioral patterns (high-risky sexual behaviours, alcohol and substance misuse), educational (academic performance), and psychological (anxiety, depression, anger, and post-traumatic stress)

Current account deficits and sustainability: evidence from South Africa

This paper investigates current account sustainability in South Africa using stationarity and coin tegration approaches to assessing intertemporal solvency - where intertemporal solvency implies current account sustainability. The contribution in this paper are four-fold. First, we consider a key emerging market, South Africa, that runs persistent current account deficits that might leave the economy vulnerable to macroeconomic destabilisation. Second, the study utilises both stationarity and cointegration approaches for a consensus in results, where existing literature uses one or the other. Third, this study considers nonlinear methods in its evaluation, and to our knowledge, all studies evaluating South Africa, and most global literature, rely on linear methods. Lastly, we use three specifications of the current account in the cointegration approach for robust results, whereas existing studies tend to use a single specification. Stationarity of the current account to GDP ratio is assessed through linear unit toot tests; ADF, PP, KPSS, DFGLS, ZA unit root tests, and nonlinear KSS (ESTAR) and Sollis (AESTAR) unit root tests. The cointegration approach relies on the linear Engle-Granger, Johansen, Maki, ARDL tests, and nonlinear ARDL (NARDL) tests, on exports - imports, and investments – savings variables. The tests are applied to three data samples for robust results: annual data between 1946-2021, full quarterly data 1960Q1-2021Q4, and short quarterly data 1985Q3-2021Q4. The study consistently finds mean reversion properties through linear unit root tests on annual and full quarterly data. Contrastingly, sustainability cannot be established through linear unit root tests for the short quarterly data but is established through nonlinear KSS (ESTAR) and Sollis (AESTAR) unit root tests. This finding suggests that the current account to GDP ratio of South Africa is a nonlinear but stationary process in the short term. Furthermore, we consistently find cointegration in annual data through the Engle-Granger and Johansen tests, while cointegration is only found when incorporating breaks through the Maki test for quarterly data. Based on the DOLS and ARDL estimators, we are able to find evidence of strong current account sustainability. Still, this result is highly dependent on sample, current account components under consideration, and model specification, with short quarterly data resulting in a non-sustainability conclusion, whereas annual data over a longer time frame gives a sustainability conclusion. Lastly, we find evidence of asymmetric cointegration on utilising the NARDL on short quarterly data, with the conclusion that the current account is sustainable when asymmetries are considered

An exploratory study of the experiences of student support officers offering counselling services to students at TVET Colleges in the Western Cape

This study explored the experiences of student support officers (SSOs) who offer counselling services to students at Technical and Vocational Education and Training (TVET) colleges in the Western Cape province, South Africa. Methodologically, the study employs a phenomenological approach as its focus is on experience-generated knowledge. It is thus located within the qualitative paradigm to give voice and the perspectives of the SSOs. Previous literature demonstrates that students historically sought counselling primarily for academic and career purposes. However, over time, the nature and type of counselling students required became increasingly complex with greater expectations of counsellors at higher education institutions. Therefore, further research is necessary to better understand this consequential phenomenon from the perspective of the SSOs through their meaning-making. This study found that SSOs experienced their role to be ill-defined, fluid and riddled with challenges of language and culture thus affecting the quality of meaningful counselling. This study offers recommendations emanating from interviews with SSOs. This study is germane to governance in TVET colleges in the Western Cape but may offer insights to other institutions of higher learning

An exploration of the work experiences of taxi drivers in Cape Town: A study of Delft and Khayelitsha

Studies have outlined both the good and the bad sides of the taxi industry, pointing out that while it makes a positive economic contribution to the country through employment generation, the industry is beset by challenges. Among these are reckless driving, the use of unroadworthy vehicles, and persistent violence and turf wars that lead to widespread animosity and loss of life. Although there are many minibus taxi drivers in South Africa, little is known about the experiences of these employees, as most of the information provided by existing studies is based on government records rather than on personal interviews with taxi drivers. The aim of this study is to explore the work experiences of minibus taxi drivers in the Cape Town area, with a focus on Delft and Khayelitsha. The study sought to gain insight on the work experiences of minibus taxi drivers, looking at their health, social and family life, challenges, and the changes they wish to see in the industry. Methodologically, this aim was achieved through a qualitative study that adopted a phenomenological approach, in which 15 minibus taxi drivers in Cape Town, specifically Khayelitsha and Delft, were interviewed. The sample was purposively selected based on certain criteria and was conducted at Site C taxi rank in Khayelitsha, as well as the section of Delft taxi rank for the Palam and Mitchells Plain routes. Data collected from the participants was analysed using two theoretical frameworks: Social Exclusion Theory and Crenshaw's Intersectionality Theory. The results of this study have shown that the taxi driving job involves negative effects on the health and wellbeing of minibus taxi drivers, resulting in their use of poor coping strategies such as unhealthy eating and substance abuse. In addition, the taxi driving job was found to result in a deterioration of social and family life as a result of long working hours. The job has benefits such as providing relatively easy, low skilled employment and access to regular cash. Lastly, the findings show that minibus taxi drivers are faced with challenges such as exploitative working conditions, poor pay, and exposure to violence, prompting many to seek better working environments and growth. The findings of this study could inform the development of better employment policies for workers in the taxi industry and serve a guide to formalising processes in the taxi industry

The classic sound of Rudy Van Gelder. An investigation of the recording techniques used to create the iconic blue note sound

The Blue Note Sound, a “classic sound” created by Rudy Van Gelder in his Hackensack home during the 1950s, is characterized by the techniques he employed in his recordings, imparting warmth, clarity, and precision. This dissertation explores and evaluates Van Gelder's techniques, their effectiveness, and their potential application in the modern era. This work aims to raise awareness and offers insights and comparisons regarding the unique aesthetics of recordings in jazz. This dissertation takes a self-reflexive approach as it explicitly examines the Blue Note Sound and its effectiveness. To support this, data was collected through critical listening analysis and a comparison of literature, articles, and media captions. The techniques used were based on exploration and experimentation, leading to the creation of the Blue Note Sound, which became the signature sound of the Blue Note Records label in the 1950s and 1960s. This label featured some of the most iconic jazz records of all time. The dissertation aims to demonstrate a clear understanding of the creation of the Blue Note Sound, the evolution of jazz recording sound, and the aesthetics based on specific techniques

Patterns of care and outcomes for women with locally advanced cervical cancer, treated with curative intent, between 2013-2017 at a tertiary centre in South Africa

Objective Cervical cancer is the leading most common cause of cancer-related deaths in South Africa. The standard treatment guidelines of locally advanced cervical cancer (LACC) is external beam radiation followed by brachytherapy with concurrent platinum based chemotherapy. The aim of this study is to evaluate the patterns of care and outcomes for patients with LACC (Stage IB1 – IVA) treated with curative intent at a tertiary center in South Africa. Materials and Methods This is a retrospective study conducted at Groote Schuur Hospital (GSH) in Cape Town, South Africa between July 2013 – July 2017. Overall survival (OS) and disease free survival (DFS) were evaluated using the Kaplan–Meier method. Factors associated with outcomes were analyzed using Cox proportional hazards regression modeling. Logistic regression modeling was performed to assess factors associated with chemotherapy receipt and baseline hemoglobin ≥ 10 g/dL. Results A total of 278 women were eligible to participate in this study, of which 28.4% (n=79) were HIV infected and 71.6% (n=199) were HIV uninfected. Among the patients with HIV the median CD4 count was 441 cells/μL (IQR; 315-581 /μL) and all had been initiated ART before commencing treatment. The median age for all patients 51 years(IQR; 41-60). Most patients had stage II disease accounting for 48.6% (n=135) or stage III disease accounting for 45.3% (n=126). Majority of the patients had squamous cell carcinoma (SCC) 88.4% (n=246). Evaluation of baseline investigation showed median Hb for all patients was 11.3g/dL (IQR; 9.70-12.8). Patients who received concurrent chemotherapy were 64.8% (n=180) for a median of 5 cycles. Median EQD2 dose 74.5Gy (IQR;69-80.9). The 2-year OS and DFS in the entire population was 73.3% and 72.3% respectively. Factors associated with improved OS in our cohort were receipt of chemotherapy (HR 0.32, p=0.005) and higher baseline haemoglobin (HR 0.86; p=0.018). On multivariate logistic regression adjusting for age, stage, and HIV status, showed that patients with stage III/IV disease were less likely to receive chemotherapy (HR 48.17, p=10g/dL (HR 0.20, p<0.001). The 2- year OS was 87.4% for patients who received concurrent chemoradiotherapy (CCRT) vs. 52.8% for those who received radiotherapy (RT) alone (p<0.001). The 2-year DFS was 80.2% for those who received CCRT vs 58.3% for those who received radiotherapy alone(p=<0.001). Conclusion Concurrent chemotherapy is significantly associated with increased survival. In this study, patients with stage III and IV treated with curative intent did not receive chemotherapy, which was detrimental to their survival. Therefore, if performance status allows, it is essential for all to receive chemotherapy. However, patients with low Hb may require transfusion to necessitate they receive chemotherapy

Factors associated with health information systems that influence continuity of TB care between a District hospital and Primary Healthcare facilities

Background: South Africa is well known to have a high burden of Tuberculosis (TB) disease. The Western Cape has been identified as having one of the highest numbers of new infections of TB per year in South Africa. TB is the cause of significant mortality and morbidity and has substantial financial implications for patients and the health system. As a result of high levels of HIV, poverty and overcrowding TB has been difficult to eradicate. The significant burden of disease, the caseloads and staff shortages also contribute to challenges to successfully continuing care of TB patients. It has been noted that as much as 24% of TB patients may be lost to follow up (LTFU) in certain districts of the Western Cape. While previous studies have looked at factors that influence LTFU and continuity of care (COC), no studies have examined how the design and use of Health Information Systems (HIS) may influence these outcomes. This study aims to describe the current use of HIS in the discharge process of a TB patient at a district hospital in Western Cape and further aims to identify how HIS may facilitate or create barriers to successfully continuing a patient's TB treatment at primary healthcare level after discharge from a district hospital. Methods: The study was conducted through two phases. Phase 1, secondary data analysis of process maps previously created to understand the TB care pathways and the associated gaps in care within a district hospital and phase 2, a semi-structured interview process. Analysis of both phases involved qualitative thematic analysis attempting to identify and unpack Health Information Systems (HIS) challenges associated with TB care. Results: Barriers were identified which prevented seamless use of HIS and which did not promote COC. These included poor understanding of TB administrative and referral processes, and what is required to successfully link to TB care and continue care at primary healthcare (PHC) facilities. Further barriers were resources and usability of the HIS, as well as data integrity and fragmented HISs. The only facilitators identified was the availability of clinical information where access was possible and data was complete, as well as an electronic referral platform to TB hospitals. Conclusion: Obstacles exist to the effective utilization of HISs in ensuring continuity of TB care between district hospitals and community clinics. To mitigate some of these limitations, we propose that training on SOPs, HISs, and administrative procedures for TB management be intensified. Clarifying ambiguities regarding data, workflows, and HIS prerequisites that support COC could help HCWs better facilitate COC through HIS usage. Additionally, organizations should strive to minimize resource deficiencies hindering HIS utilization. Insights from the TB hospital referral system can be leveraged to enhance care linkage

“Foreign migrant women's perceptions of obstetric care in the Cape Town metro pole.”

This study explores the maternal healthcare experiences of nine foreign migrant women who received obstetric care in the Cape Town metropole. The Republic of South Africa's legislation enshrines the right to health for all who live within the country's borders, regardless of residency status. In practice however, foreign migrants can experience significant challenges and, in the Cape Town metropole how these women experience obstetric care has not been a focus of scholarly interrogation. With this study I hope to establish the factors that influence migrant women's experiences positively or negatively and to utilise the knowledge gained from their experiences to enhance pregnancy care of migrant women in the longer term. A literature review was performed covering the areas of migration to South Africa, migrant women's health, migrant's health challenges and official South African health care policies. Data was collected by doing one on one, open-ended and semi-structured interviews with nine foreign migrant women from seven different countries and with two key stakeholders employed at two of Cape Town's largest refugee centres. The interviews were recorded, professionally transcribed and then data inductively coded using thematic analysis. Thematic analysis was used since it is a way to extract descriptive information concerning the experiences of migrant women in Cape Town and to construct meaning, in order to understand their perceptions about the obstetric care. The findings indicate that the attitudes &amp; behaviours of staff, language, prior traumatic experiences, degree of assimilation and healthcare systemic issues are some of the chief factors that influence perception of care. Xenophobia and dismissive behaviour were the main issue with staff but that was juxtaposed against some excellent and compassionate care received. Some of the women struggled to communicate the nature of their problems and being understood but also found understanding local staff a significant barrier. Having had to endure staff attitudes and behaviours can reasonably be agreed to have delayed monitoring or intervention. Language barriers resulted in adherence issues with medications, potential missed appointments, issues around informed consent and missed opportunities at health promotion. The women had a poor understanding of the local healthcare system's design and had expecta tions in relation to their own experience of the system in origin countries. When these expectations were not met, it was perceived as poor. A key challenge was the failure of the facilities to recognise the asylum documentation and the rights afforded to those who had them. The reasons for fleeing their countries included warfare, geno cide, political turmoil and economic deprivation. The journeys to Cape Town were fraught with further trauma and this made the women vulnerable to mental health is sues which also impacted their perceptions of care. Further, a traumatic birth in Cape Town carried significant sway over how further births in Cape Town were viewed. It is clear from this study that multiple, complex factors influence the way foreign mi grant women perceive their care. These factors are personal and unique to each indi vidual but there were commonalities. Trained interpreters, cultural sensitivity training, education surrounding documentation, allowing birth partners to be present during visits and births, extra safety checks on perinatal mental health for first time births in Cape Town and a more robust, confidential and accountable complaints system were recommendations by this cohort