A critical assessment of developmental local government and its relevance to the democratic South Africa: A case study of Amathole District Municipality

The notion of developmental local government has become part of the South African local government dispensation as from the year 2000. According to Smith and Vawda (2003:28) the idea of developmental local government (DLG) emerged from the fusion of the social interventionist goals of the Reconstruction and Development Programme (RDP) and the market driven economic strategies of the Growth Employment and Redistribution policy (GEAR); the two main national policies of the post-apartheid era for addressing economic growth and poverty eradication. The RDP and GEAR represented different visions for how to bring about equity and redistribution in a deeply divided state and economy. In itself South Africa as a state has 283 municipalities which are wall to wall in terms of demarcation. However, despite the fact that local democracy is deeply entrenched in South African society and furthermore, a very futuristic local government policy framework has been introduced, there is no guarantee that the new local government system will be financially viable and capable of discharging its democratic and developmental mandate. There are major challenges that have to be addressed, namely promoting job-creation, local economic development, capacity development and civic education which, in the final analysis, will ensure that the concept of developmental local government becomes a reality for the majority of South Africans

Frequent malaria illness episodes in two Malawian patients on antiretroviral therapy soon after stopping cotrimoxazole preventive therapy

We describe two Malawian adults on successful antiretroviral therapy who experienced frequent malaria episodes after stopping cotrimoxazole prophylaxis. We argue that, in addition to stopping cotrimoxazole, diminished malaria immunity and drug interactions between efavirenz and artemether–lumefantrine may have played a causative role in the recurrent malaria our patients experienced

Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances

BACKGROUND: Previous research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a topic of interest for public health policy makers, and health and social care practitioners. As part of a wider mixed-methods systematic review, realist principles were applied to synthesise evidence about interventions aiming to reduce repeat pregnancies in adolescence.METHODS: A multi-streamed, mixed-methods systematic review was conducted searching 11 major electronic databases and 9 additional databases from 1995 onwards, using key terms such as pregnancy, teen or adolescent. The principles of realist synthesis were applied to all included literature to uncover theories about what works, for whom, how and in what context. Initial theory areas were developed through evidence scoping, group discussion by the authors and stakeholder engagement to uncover context + mechanism = outcome (CMO) configurations and related narratives.RESULTS: The searches identified 8,664 documents initially, and 403 in repeat searches, filtering to 81 included studies, including qualitative studies, randomised controlled trials, quantitative studies and grey literature. Three CMO configurations were developed. The individual experiences of young mothers' triggered self-efficacy, notions of perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters. The choice between motherhood and other goals triggered notions of motivations, resulting in the adolescent managing their expectations of motherhood and controlling their fertility and sexual encounters. Barriers and facilitators to accessing services triggered notions of connectedness and self-determination; resulting in interventions that are tailored so they are relevant to young persons, and improve access to services and engagement with the issue of pregnancy in adolescence.CONCLUSIONS: Pregnancy in adolescence is a complex issue with many factors to consider. The conceptual platform described here could help guide policy makers and professionals towards a number of areas that need to be attended to in order to increase the likelihood of an intervention working to prevent rapid repeat pregnancy in adolescence.TRIAL REGISTRATION: PROSPERO CRD42012003168

Factors associated with physical activity amongst patients with hypertension in two community health centres in uMgungundlovu health district, KwaZulu-Natal, 2018

Background: Hypertension (HPT) is a global public health challenge. It predisposes to cardiovascular diseases, kidney diseases and disability as well as contributing to high death rates. HPT is increasing tremendously in sub-Saharan Africa with HPT-related mortality risk having increased by 25% in less than 10 years in South Africa. Physical activity is a cost-effective way of reducing, controlling and preventing hypertension. The aim of the study was to establish the level of physical activity, and factors associated with physical activity, amongst patients with hypertension, in two community health centres in uMgungundlovu Health District, KwaZulu-Natal, 2018.Methods: An observational, cross-sectional descriptive study with an analytic component was implemented. Data were collected utilising an interviewer-administered questionnaire. Frequency distribution tables and the chi-square test were used in the analysis of data. A p-value less than 0.05 was deemed statistically significant.Results: A total of 374 questionnaires were administered of which 373 were adequately completed, yielding a response rate of 99.7%. The results showed that 39.1% were highly physical active, 32.4% were moderately physical active and 28.4% had low physical activity. Age, marital status, employment status and level of education were significantly associated with physical activity. Major barriers to physical activity included health problems and having no time to exercise. Health-related reasons were reported to be the major motivator towards physical activity.Conclusion: Over a third of the participants presented with high levels of physical activity. Health education should focus on promoting physical activity for HPT clients