Strategies used to cater for students with diverse academic backgrounds in the provision of textile, clothing and design programmes: a case study of two universities of technology in Zimbabwe

Universities admit students from diverse backgrounds and have an obligation to accommodate all the students in various educational programmes to ensure that they acquire relevant skills and knowledge. The provision of Textile, Clothing and Design programmes to students with diverse academic backgrounds in universities of technology in Zimbabwe has led to various concerns raised by the textile and clothing stakeholders. The concerns include poor performance of students, high student failure rate, high student drop out, late completion of programmes by students, and other problems emanating from curriculum implementation approaches used by the lecturers. This study therefore, sought to find out how students with diverse academic backgrounds are catered for in the provision of TCD programmes in the two sampled universities of technology in Zimbabwe, with a view to assist the students and to enhance the quality of TCD provision. The study adopted a post-positivism paradigm and used a mixed method research approach that integrated concurrent qualitative and quantitative procedures in data collection, analysis and interpretation. A questionnaire, interviews and document analysis were used to collect data from respondents. Purposive sampling procedure was used to select 36 TCD lecturers, 2 universities’ quality assurance directors, 2 TCD faculty deans of studies, and 2 department chairpersons. Collected data were analyzed using statistical and non-statistical procedures. The study revealed that catering for students with diverse academic backgrounds was practiced in the two universities despite the absence of a curriculum implementation policy to guide the provision of TCD programmes to students with diverse academic backgrounds at university level. It emerged that catering for students with diverse academic backgrounds in implementing TCD curricular at the two sampled universities was faced with various challenges that include lack of lecturer training with regard to catering for students from diverse academic backgrounds and inadequate lecturer training in depth TCD subject content knowledge and ICT teaching technology packages. The study also revealed that there is not enough university and stakeholder participation with regards to supporting and monitoring curriculum implementation process to cater for students with diverse academic backgrounds. Although there were challenges encountered in catering for students with diverse academic backgrounds, the study reveals that there are pockets of good practice in some curriculum implementation strategies implemented by the two institutions such as use of student centered teaching and instructional approaches, university support and lecturer commitment to assist the students. The study findings conclude that although catering for TCD students with diverse academic backgrounds was being practiced in the two universities of technology, there are very critical issues observed over the programmes implementation process that include absence of curriculum implementation policy, lack of training of lecturers and inadequate participative TCD stakeholder involvement. Based on the study findings and reviewed literature, the researcher suggests an alternative curriculum implementation framework for catering for students with diverse academic backgrounds that may help improve effectiveness of university programmes implementation

HIV and TB care and treatment: patient utilization and provider perspectives in rural KwaZulu-Natal

Thesis submitted for the degree: Doctor of Philosophy, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg June 2017.The epidemics of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) in sub-Saharan Africa are closely related and particularly persistent, proving a considerable burden for healthcare provision, and complicating utilization of care. Concern has been expressed about patients’ experience at healthcare facilities as this may impact on drug adherence, treatment success and willingness to return for regular monitoring and drug pick-up. This is particularly relevant for HIV programmes, with HIV now a chronic disease, with daily treatment necessary for life; TB treatment is limited in duration, to six months although can be as long as two years in case of multiple drug resistant TB. Utilization of healthcare services is an important determinant of health outcomes generally, with public health relevance, particularly for HIV and TB services in areas of high prevalence. The main aim of universal health coverage is to make healthcare accessible without barriers based on affordability, availability or acceptability of services. Various factors have been shown to hinder or enable patient utilization of healthcare services, such as organization of services, costs of transport to and from clinics, time loss at clinics receiving care, staff attitudes, waiting times and cleanliness of facilities. Objectives This study aimed to determine and quantify factors associated with healthcare utilization in patients utilizing HIV care (including those not yet initiated on antiretroviral treatment (ART) - pre-ART) or TB treatments in a rural sub-district of Hlabisa in KwaZulu-Natal and to understand healthcare providers’ perspectives regarding patient care and provision of quality care. The study used data from patient exit interviews, and additionally findings from interviews with healthcare providers in the local HIV treatment and care programme, structured around the responses from the patient-exit interviews. The study had three specific objectives: 1) to establish and quantify factors associated with healthcare utilization, with utilization decomposed to availability, affordability and acceptability of healthcare services, for patients in HIV or TB treatment and care; 2) to quantify ability-to-pay for healthcare and identify associated factors for patients in pre-ART care, or on ART or TB treatment; 3) to understand the healthcare providers’ perspectives regarding patient care and provision of quality HIV care. Methods In 2009 patient-exit interviews were conducted in six primary healthcare (phc) clinics in rural South Africa with 300 patients receiving ART and 300 patients receiving TB treatment; patients were randomly selected using a two-stage cluster random sampling approach with primary sampling units (phc) selected with probability-proportional-to-size. In 2010 an additional 200 HIV-infected patients in pre-ART care from the same clinics were interviewed. Patient-exit interviews were conducted in a private room outside the facility and all data were analysed using STATA 11. In 2012, a qualitative study was carried out with healthcare providers in eight (of 17) randomly selected phc clinics; 25 ART healthcare providers were engaged in discussion structured around patient-exit interviews feedback to assess possible challenges/facilitators ART healthcare providers face when providing care. Discussions took place in the consultation rooms when no clinical sessions were ongoing and these were recorded and transcribed; and data were managed using Nvivo 10. Thematic content analysis was conducted using both inductive and deductive approaches and clinic or healthcare provider identifiers were removed and replaced with pseudonyms. Summary statistics describe patient characteristics by patient group and key availability, acceptability and affordability factors associated with utilization of healthcare services; separate univariate and multivariable regression models were run to assess associations between patient characteristics and these key availability, acceptability and affordability factors. Patient socio-demographic characteristics (sex, age, education, employment and marital status) were controlled for and adjusted for clustering at facility-level. Factor analysis was performed to investigate underlying patient satisfaction factors. Results Socio-demographic characteristics of the patients More women than men were seen in the primary care clinic, especially among pre-ART patients (79%), followed by 62% HIV and 53% utilized TB care, with an age-sex profile comparable to previous studies in the area. Pre-ART patients were significantly younger than ART and TB patients, with a median age of 32 years for pre-ART patients, 39 years for ART patients and 37 years for TB patients. Unemployment at household level was high, up to 86% of ART patients’ head of households were unemployed and only 9% of TB patients were employed.MT201

An integrated approach to improving the availability and utilisation of tuberculosis healthcare in rural South Africa

Background. Patients with tuberculosis (TB) face several challenges in accessing care, and an integrated service that includes HIV testingcould be preferable for them and ensure timely HIV treatment initiation and optimal TB care.Objectives. To investigate factors, including uptake of HIV testing, associated with availability and utilisation of healthcare by TB patientsin a rural programme devolved to primary care in Hlabisa sub-district, KwaZulu-Natal.Methods. Three hundred TB patients were randomly selected in a two-stage-sampling scheme with five primary healthcare clinic (PHC)sampling units selected with probability proportional to size. Data were collected using a structured questionnaire. We describe key availability and utilisation factors and analyse factors associated with being offered an HIV test in multiple regressions controlling for sex, age, education, employment and marital status.Results. Most patients (75.2%) received care for a first episode of TB, mainly pulmonary. Nearly all (94.3%) were offered an HIV test duringtheir current TB treatment episode, patients using their closest clinic being substantially more likely to have been offered HIV testing than those not using their closest clinic (adjusted odds ratio 12.79, p=0.05). About one-fifth (20.3%) of patients did not take medication under observation, and 3.4% reported missing taking their tablets at some stage. Average travelling time to the clinic and back was 2 hours, most patients (56.8%) using minibus taxis.Conclusion. We demonstrate high HIV testing rates among TB patients in a rural public programme, suggesting appropriate managementof HIV-TB co-infected patients. We describe healthcare availability and utilisation factors that can inform the proposed district managementteams for PHC re-engineering on areas needing improvement

Determinants of condom use among young adults aged 15-24 years in the Africa Centre Demographic Surveillance Area in Kwazulu Natal, South Africa, 2005

Abstract Objectives This study investigates the patterns and levels of condom use; the determinants of condom use and of consistency of use among young adults aged 15-24 years in the Africa Centre Demographic Surveillance Area (ACDSA) in 2005. Methodology Secondary data analysis of data from three sources of surveys conducted in ACDSA in 2005 was done. A sample of 4 157 respondents was analyzed. Univariate and multivariate analysis was employed to compare determinants of condom use and of consistency of use. Results Condom use with the most recent partner in the last year was (51.7%). The main determinants of condom use were partner age difference, residence of partner and assets. Having an older partner than a same age partner was associated with less likely to use condoms (AOR=0.71 p=0.03 females, AOR=0.51 p=0.01 males). Those who were not residing with their partners were more likely to use condoms than those residing with their partners (AOR=1.62 p=0.01 females, AOR=1.61 p=0.03 males). Having more than seven assets was associated with increased chances of using condoms than those with less than seven assets (AOR=1.51 p<0.01 females, AOR=1.67 p<0.01 males). The key determinants of consistent condom use were: age, sex and type of relationship. Females were less likely to use condoms consistently (AOR=0.63 p=0.02) and growing older was associated with lower consistent condom use (AOR=0.88 p<0.01 females, AOR=0.90 p<0.01 males). Being in a marital/cohabiting relationship was associated with lower consistent condom use (AOR=0.68 p<0.01 both sexes and AOR=0.64 p=0.01 males) than those in non-marital/non-cohabiting relationship. v Conclusion Condom use differs between sexes and decreases with age probably because condoms are a male determined method, high contraception use, poor negotiation skills for condom use, need for children and formation of more stable relationships. A better socio-economic status increases condom use. Consistent condom use is lower in marital relationships and when the partner is older. This could be because of gender power inequalities in sexual relationships

Parental status of African children in South Africa : the relationship to household composition and household socio-economic status.

Master of Arts in Population Studies. University of KwaZulu-Natal, Durban, 2016.The living arrangements and social economic status of households are reportedly a reflection of their coping strategy to shocks. Particularly for African South Africans: labour migration, low and decreasing rates of marriage and HIV/AIDS pandemic among others have clearly affected both the living arrangements and the parental status of African children. In this paper, descriptive statistics were employed to compare the living arrangements and socio-economic status of households with African children according to their parental status. The GHS (2012) data was used to formulate nine exhaustive parental categories and three separate orphan hood (paternal, maternal and double) categories. Basically, a comparison of the living arrangements of multi-generational households, female headed households and households with high dependency ratios was undertaken forchildren who have deceased parents (fathers/mothers/both) to non-orphaned children (both parents are alive) where children live with either or both of their biological parents or guardians. Furthermore, geographical location, household wealth status and the reception of social grants were used as socio-economic status indicators. The results across all the variables show that households with children who are co-residing with both their parents had the preferred outcomes when compared to the other parental statuses. Households with fathers only the mother being deceased or alive but absent also exhibit preferential socio-economic status when compared to households with mothers only the father being either dead or alive but not a resident and in households with children who co-reside with neither of their parents, for reasons of death or mere absenteeism. Basically, the living arrangements and socio-economic status was worse off for the former and latter parental status. Although child poverty was not my outright focus, the wide and deeply worrisome levels of poverty amongst African children motivated this study. In this study, I observed that a greater proportion of households with African children were headed by females. In these households, and in households were children reside with absent parents, children are highly likely to be socialized in some dimensions of poverty. Government can rectify this by correcting some institutional factors. Women face more disadvantages in almost all social, economic and political institutions. Furthermore, these disadvantages are exacerbated in households with single mothers and no adult males

Managing ancillary care in resource-constrained settings: Dilemmas faced by frontline HIV prevention researchers in a rural area in South Africa.

BACKGROUND: We describe the findings from a research ethics case study, linked with a team evaluating a package of intervention services to prevent HIV infection in adolescent girls and young women (AGYW) living in a rural and poor setting of KwaZulu-Natal, South Africa. METHODS: We conducted qualitative interviews (n=77) with members of the linked research team evaluating the intervention programme, programme implementing staff, AGYW enrolled in the intervention programme, caregivers, ethics committee members, Public Engagement officers, community advisory board members and community stakeholders. Data were analysed iteratively using thematic framework analysis. Themes were determined by the study aims combined with an inductive development of codes emerging from the data. RESULTS: The findings show that the burden of providing ancillary care fell primarily on the shoulders of frontline researchers and programme staff. Dilemmas around responding to gender-based violence illustrated the limits of 'referral to services' as a solution for meeting ancillary care obligations in contexts with barriers to basic health and social services. CONCLUSION: Our findings show important gaps in meeting ancillary care needs. Participants' needs required social and economic support which frontline researchers and implementing partners were not able to meet, causing moral distress

Young people's experiences of sexual and reproductive health interventions in rural KwaZulu-Natal, South Africa

Despite efforts to address HIV-infection, adolescents and young peoples’ (AYP) engagement in interventions remain suboptimal. Guided by a risk protection framework we describe factors that support positive and negative experiences of HIV and SRH interventions among AYP in rural KwaZulu-Natal, South Africa, using data from: community mapping; repeat semi-structured individual interviews (n = 58 in 2017, n = 50 in 2018, n = 37 in 2019–2020); and group discussions (n = 13). AYP who had appropriate and accurate HIV-and SRH-related information were reported to use health-care services. Responsive health-care workers, good family and peer relationships were seen to be protective through building close connections and improving self-efficacy to access care. In contrast to cross-generational relationships with men, alcohol and drug use and early pregnancy were seen to put AYP at risk. Policies and interventions are needed that promote stable and supportive relationships with caregivers and peers, positive social norms and non-judgemental behaviour within clinical services

Editorial: Understandings and conceptualizations of hope and how it influences engagement with sexual and reproductive health (SRH) services among adolescents in LMICs

This is the final version. Available on open access from Frontiers Media via the DOI in this rrecordAfrica Health Research InstituteWellcome TrustNational Institute for Health and Care Research (NIHR)UKR

An integrated approach to improving the availability and utilisation of tuberculosis healthcare in rural South Africa

Background. Patients with tuberculosis (TB) face several challenges in accessing care, and an integrated service that includes HIV testing could be preferable for them and ensure timely HIV treatment initiation and optimal TB care. Objectives. To investigate factors, including uptake of the offer of HIV testing, associated with availability and utilisation of healthcare by TB patients in a rural programme devolved to primary care in Hlabisa sub-district, KwaZulu-Natal. Methods. Three hundred TB patients were randomly selected in a two-stage-sampling scheme with five primary healthcare clinic (PHC) sampling units selected with probability proportional to size. Data were collected using a structured questionnaire. We describe key availability and utilisation factors and analyse factors associated with being offered an HIV test in multiple regressions controlling for sex, age, education, employment and marital status. Results. Most patients (75.2%) received care for a first episode of TB, mainly pulmonary. Nearly all (94.3%) were offered an HIV test during their current TB treatment episode, patients using their closest clinic being substantially more likely to have been offered HIV testing than those not using their closest clinic (adjusted odds ratio 12.79, p=0.05). About one-fifth (20.3%) of patients did not take medication under observation, and 3.4% reported missing taking their tablets at some stage. Average travelling time to the clinic and back was 2 hours, most patients (56.8%) using minibus taxis. Conclusion. We demonstrate high HIV testing rates among TB patients in a rural public programme, suggesting appropriate management of HIV-TB co-infected patients. We describe healthcare availability and utilisation factors that can inform the proposed district management teams for PHC re-engineering on areas needing improvement

The impact of ART initiation on household food security over time

While evidence suggests that adequate nutrition contributes to the efficacy of ART, the potential causal impact of ART initiation on household food security has not been thoroughly examined. In this study, we present some of the first causal evidence of the impact of ART initiation on household food security. We employ a quasi-experimental design, regression discontinuity, over 5540 individuals from an ongoing population cohort study in KwaZulu-Natal, South Africa, by utilizing the CD4 count-based ART eligibility threshold to examine the impact of ART initiation on household food security. We find that ART initiation causes a significant increase in the probability of food insecurity in the first year, which diminishes to zero within three years of initiation. Within the first year, ART initiation was found to significantly increase the probabilities that (1) the surveyed adult had missed any food in the past month by 10.2 percentage points (coefficient = 0.102, 95%CI = [0.039, 0.166]); (2) any adult in the household had missed a meal in the past month by 15.2 percentage points (coefficient = 0.152, 95%CI = [0.073, 0.231]); and (3) any child in the household had missed a meal in the past month by 8.9 percentage points (coefficient = 0.0898, 95%CI = [0.0317, 0.148]). While we cannot definitively isolate the mechanistic pathways from ART to household food security, our results are consistent with ART affecting food security through household resource strain and patient appetite recovery. Several policies could mitigate the negative impact of ART on food security, in particular food parcels or food vouchers for ART patients in the first two years after treatment initiation