Developing appropriate Fetal Alchohol Spectrum Disorder (FASD) prevention initiatives within a rural community in South Africa

Includes bibliographical references.This study focused on women who consumed alcohol during pregnancy. The study population was situated in the West Coast/Winelands, a rural area in the Western Cape Province of South Africa. The study was done in a community which is classified as one of the many previously disadvantaged groups in South Africa. This study was done as part of a larger three-year project on Fetal Alcohol Syndrome Prevention in the Western Cape and Gauteng Provinces of South Africa. The phenomenon of drinking during pregnancy was used as a case example of health compromising occupations in the South African context. Prenatal alcohol exposure may result in brain damage that affects behaviors of those affected. The beliefs, norms, values and perceptions of mothers regarding alcohol consumption are also an important aspect in maintaining healthy pregnancies

Occupations of women who live and/or work in a rural farming community and who are at risk of having children with Foetal Alcohol Syndrome (FAS)

Includes bibliographical references (leaves 87-96).This collective case study explores the occupations of women who live and/or work in a rural farming community and who are at risk of having children with Foetal Alcohol Syndrome (FAS). Although FAS is incurable, it is completely preventable. This study approached the issue of FAS from an occupational perspective, highlighting historical and current political, economic, social and individual influences on the occupational engagement of study participants. In-depth unstructured interviews were conducted with three famale farm workers from a rural farming community in the Western Cape, South Africa. Other methods of data collection included direct observation, field notes and an interview with a key informant and gatekeeper. Four themes emerged from a process of inductive analysis. The findings show that despite progressive human rights and labour law policies in South Africa participants still experience extreme forms of occupational injustice. A central theme of suffering is associated with the harsh lives of these three female farm workers. Although feelings of worthlessness, helplessness and powerlessness persist, a strong sense of hope helps these women to make it through yet another day. Ond day they will rise amidst their circumstances, like fully baked bread. Ineffective coping strategies to deal with the stress of having to survive within this context lead to occupational risk behaviour (e.g. abusing alcohol), and hence occupational imbalance. Strategies for addressing individual coping mechanisms are suggested. Deconstructing disabling environments and building support for women in the home and work environment as a combined strategy for all role players (government, local authorities, farmers and farm workers) should be geared towards facilitating healthful participation in occupation of choice. A broader occupational repertoire should be provided from which farm workers can choose

Lived experiences of caregivers of children with autism spectrum disorder in Kenya

Background: Autism spectrum disorder (ASD) is a global public health concern. In African countries such as Kenya, there is a greater need for establishing support services for developmental disorders such as ASD. The emotional, social and economic burden of ASD on caregivers is unknown because of a number of challenges. Citizens of Kenya have a unique view of disability and inclusion. Objectives: To explore the perspectives of caregivers who are responsible for caring for both family and children living with ASD and to highlight the needs of children with ASD as well as the needs of their caregivers. Method: A qualitative, descriptive phenomenological study utilising focus group discussions (FGDs) was conducted. Verbatim transcription was used. QSR N ’Vivo 10 was used to organise and analyse the data. Content analysis was used to identify important ideas and concepts. Results: One theme, namely ‘the burden of caring for children with ASD’, was identified. Children with ASD and their caregivers experience isolation and stigmatisation. Conclusion: Occupational therapists in Kenya should collaborate with the relevant national and global stakeholders for the promotion of the inclusion of children with ASD and their families. Responsive and context-appropriate occupational therapy interventions may begin to address service barriers

Screens or MP4s: Acquiring Clinical Competencies Through the Use of e-OSPEs in Occupational Therapy

The assessment of clinical competence of undergraduate students is a crucial part of higher education training in occupational therapy. The use of online objective standardized practical examinations (e-OSPEs) was piloted as a technological innovation to determine student learning needs. An action research framework with four phases was used. Descriptive statistics in the form of frequency tables and percentages were used to report survey results. The students had multiple practice opportunities before uploading their best attempt. Thirty participants completed a 12-item survey. The results were analyzed using descriptive analysis and presented by means of statistical graphs. Peer assessment facilitated experiential learning. Twenty-seven out of 30 students (90%) felt adequately prepared for submitting their video clips. The students found the opportunity to practice the skills multiple times before uploading the e-OSPEs helpful. The students experienced an increase in workload when the e-OSPEs were due during clinical placement and examination periods. Additional resources are needed for creating initial infrastructure for implementing e-OSPEs. The findings of this study could inform the planning of future online assessment practices of clinical competencies in occupational therapy. Identifying, formulating, and assessing competence standards electronically may guide occupational therapy practitioners’ work with diverse patients and populations

Policymakers’ perspectives towards developing a guideline to inform policy on fetal alcohol spectrum disorder: A qualitative study

Fetal alcohol spectrum disorder (FASD) has a high prevalence in South Africa, especially among the poor socioeconomic communities. However, there is no specific policy to address FASD. Using a qualitative study design, we explored the perspectives of policymakers on guidelines/policies for FASD, current practices and interventions, and what practices and interventions could be included in a policy for FASD. The data analysis was done using the Framework Method. Applying a working analytical framework to the data, we found that there is no specific policy for FASD in South Africa, however, clauses of FASD policy exist in other policy documents. Preventive services for women and screening, identification, assessment, and support for children are some of the current practices

Collaborative capacity development to complement stroke rehabilitation in Africa

This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke

Exploring service providers’ perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa: a qualitative study

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is among the leading causes of developmental and intellectual disabilities in individuals. Although efforts are being made toward the prevention and management of FASD in South Africa, the prevalence remains high. The sustained high prevalence could be attributed to several factors, including the lack of policy for a coordinated effort to prevent, diagnose and manage FASD nationally. In this study, our aim was to explore the perspectives of service providers (health and allied professionals, teachers, social workers) on the prevention and management of FASD towards developing a guideline to inform policy. METHOD: Guided by the exploratory qualitative research design, we purposively sampled relevant service providers in the field of FASD prevention and management for focus group discussions. Nine of these discussions were conducted with to eight participants per discussion session. The discussants were asked various questions on the current and required interventions and practices for the prevention and management of FASD. Following the Framework Method, data were transcribed verbatim and analysed using the thematic content analysis approach. RESULTS: Our findings show that aspects of the prevention and management of alcohol-related conditions are present in various policies. However, there is no clear focus on coordinated, multi-sectoral efforts for a more comprehensive approach to the prevention and management of FASD. The participants recognized the need for specific requirements on broad-based preventive awareness programs, training and support for parents and caregivers, inclusive education in mainstream schools and training of relevant professionals. CONCLUSION: Comprehensive and coordinated prevention and management programs guided by a specific policy could improve the prevention and management of FASD. Policy formulation demonstrates commitment from the government, highlights the importance of the condition, and elaborates on context-specific prevention and management protocols.IS

The experiences and challenges faced by rehabilitation community service therapists within the South African Primary Healthcare health system

CITATION: Ned, L., Cloete, L. & Mji, G. 2017. The experiences and challenges faced by rehabilitation community service therapists within the South African Primary Healthcare health system. African Journal of Disability, 6:1-11, doi:10.4102/ajod.v6i0.311.The original publication is available at http://www.ajod.orgPublication of this article was funded by the Stellenbosch University Open Access Fund.Background: Twenty-two years after the promulgation of a plethora of progressive health policies since 1994, the South African public health system reflects a number of stumbling blocks regarding implementation. Rehabilitation professionals are not sufficiently equipped nor allowed the opportunity to comprehensively implement Primary Healthcare (PHC) from a bottom-up approach, thus engaging communities. Training on addressing social health determinants and their impact on ill-health and health outcomes is inadequate. The inadequate understanding of the advocacy role that rehabilitation professionals could play in addressing social health determinants remains a challenge in healthcare. Rehabilitation, a pillar of PHC, remains poorly understood in terms of its role within the health system. Aim: We argue for rehabilitation as a vehicle for addressing social determinants of health with community service practitioners playing a critical role in addressing the inequities within the healthcare package. Setting: The article reflects the opportunities and challenges faced by rehabilitation community service therapists in the delivery of rehabilitation services in a rural area of the Eastern Cape province of South Africa. Methods: A single case study from the perspective of a researcher was used to explore the experience and reflection of the first author during her community service as an occupational therapist. Results: The case study highlights some existing gaps within the delivery of rehabilitation services in the rural Eastern Cape. A community service package with a specific approach towards addressing social determinants of health for persons with disability at a community level is suggested. Conclusion: Advocating for a rehabilitation service package to shift to community-based levels is critical. It is envisaged that a community-based approach will facilitate an understanding of the barriers faced by persons with disabilities as constituting disability, thus facilitating learning about the disabling consequences of the rural environment coupled with the system as experienced by persons with disabilities.http://www.ajod.org/index.php/ajod/article/view/311Publisher's versionAuthors retain copyrigh

Playfulness and prenatal alcohol exposure: A comparative study

Background/aim: South Africa carries a high burden of alcohol abuse. The effects of maternal alcohol consumption during pregnancy are most pronounced in poor, rural communities. Earlier research suggests that children with prenatal alcohol exposure have poor social behaviour; however, to date, no research has investigated their playfulness. This study investigated the differences in playfulness of children with and without prenatal alcohol exposure. Methods: Grade one learners with a positive history of prenatal alcohol exposure (n = 15) and a reference group without a positive history of prenatal alcohol exposure (n = 15) were filmed engaging in free play at their schools. The Test of Playfulness was used to measure playfulness from recordings. Data were subjected to Rasch analysis to calculate interval level measure scores for each participant. The overall measure scores and individual Test of Playfulness social items were subjected to paired samples t-tests to calculate if significant differences existed between the groups. Results: Children with prenatal alcohol exposure had a significantly lower mean overall playfulness score than the reference group (t = -2.51; d.f. = 28; P = 0.02). Children with prenatal alcohol exposure also scored significantly lower than the reference group on 5 of the 12 Test of Playfulness items related to social play. Conclusions: This research suggests that children with prenatal alcohol exposure are more likely to experience poorer overall quality of play, with particular deficits in social play. Considering play is a child's primary occupation, this finding becomes pertinent for occupational therapy practice, particularly in post-apartheid South Africa, where high prenatal alcohol exposure prevalence rates are couched within persistent socio-economic inequalities

Playfulness and prenatal alcohol exposure: a comparative study

Background/aim\ud \ud South Africa carries a high burden of alcohol abuse. The effects of maternal alcohol consumption during pregnancy are most pronounced in poor, rural communities. Earlier research suggests that children with prenatal alcohol exposure have poor social behaviour; however, to date, no research has investigated their playfulness. This study investigated the differences in playfulness of children with and without prenatal alcohol exposure.\ud \ud Methods\ud \ud Grade one learners with a positive history of prenatal alcohol exposure (n = 15) and a reference group without a positive history of prenatal alcohol exposure (n = 15) were filmed engaging in free play at their schools. The Test of Playfulness was used to measure playfulness from recordings. Data were subjected to Rasch analysis to calculate interval level measure scores for each participant. The overall measure scores and individual Test of Playfulness social items were subjected to paired samples t-tests to calculate if significant differences existed between the groups.\ud \ud Results\ud \ud Children with prenatal alcohol exposure had a significantly lower mean overall playfulness score than the reference group (t = −2.51; d.f. = 28; P = 0.02). Children with prenatal alcohol exposure also scored significantly lower than the reference group on 5 of the 12 Test of Playfulness items related to social play.\ud \ud Conclusions\ud \ud This research suggests that children with prenatal alcohol exposure are more likely to experience poorer overall quality of play, with particular deficits in social play. Considering play is a child's primary occupation, this finding becomes pertinent for occupational therapy practice, particularly in post-apartheid South Africa, where high prenatal alcohol exposure prevalence rates are couched within persistent socio-economic inequalities