Finding the benefits: Estimating the impact of the South African child support grant

The paper estimates the impact of the South African Child Support Grant (CSG) on child health, nutrition and education. Data from the 2008 South African National Income Dynamics Study (NIDS) are used. Two non-experimental treatment evaluation techniques, both relying on propensity scores, are applied to six different outcome variables. Using propensity score matching with a binary outcome variable, no convincing evidence of improvements on any of the outcome variables is found. A second technique is therefore also applied, using a generalised form of the propensity scores. This follows the approach of Hirano and Imbens (2004) and Agüero et al. (2009). The generalised approach estimates a positive treatment effect for children’s height-for-age and progress through the school system. Although these estimates do provide some evidence of the positive effect of the Child Support Grant on the lives of children, the estimates are small and do not provide clear evidence that the transfers received by caregivers are spent mainly on improving the well-being of beneficiary children. Some potential and plausible explanations for this result are discussed in the paper. Nevertheless, the findings seem to suggest that some of the cash transferred through the Child Support Grant appears to be spent on improving the well-being of children.Conditional cash transfer child health and nutrition continuous treatment estimator South Africa

Finding the Benefits: Estimating the Impact of the South African Child Support Grant

The paper estimates the impact of the South African Child Support Grant (CSG) on child health, nutrition and education. Data from the 2008 South African National Income Dynamics Study (NIDS) are used. Two non-experimental treatment evaluation techniques, both relying on propensity scores, are applied to six different outcome variables. Using propensity score matching with a binary outcome variable, no convincing evidence of improvements on any of the outcome variables is found. A second technique is therefore also applied, using a generalised form of the propensity scores. This follows the approach of Hirano and Imbens (2004) and Agüero et al. (2009). The generalised approach estimates a positive treatment effect for children’s height-for-age and progress through the school system. Although these estimates do provide some evidence of the positive effect of the Child Support Grant on the lives of children, the estimates are small and do not provide clear evidence that the transfers received by caregivers are spent mainly on improving the well-being of beneficiary children. Some potential and plausible explanations for this result are discussed in the paper. Nevertheless, the findings seem to suggest that some of the cash transferred through the Child Support Grant appears to be spent on improving the well-being of children.Conditional cash transfers, child health and nutrition, continuous treatment estimator, South Africa

Rehabilitation needs in individuals with knee OA in rural Western Cape, South Africa: an exploratory qualitative study

Background: Current clinical practice guidelines have suggested that each individual with knee osteoarthritis (OA) should receive three core treatments from their health care provider. These core treatments comprise of exercise, education and weight loss. Identification of the health care and rehabilitation needs of individuals with knee OA in rural areas are imperative for focusing service delivery in a specific context in order to empower the individual. The aim of this study was to explore the rehabilitation needs of individuals with knee OA living in rural Western Cape in order to identify the gaps in services offered and inform rehabilitation programmes in these settings. Methods: Semi-structured in-depth individual interviews were performed on 16 individuals with knee OA living in rural settings of the Western Cape, South Africa. A deductive data analysis approach was used and the needs of the individuals were identified and categorised for interpretation and comparison with the reported services received. Findings: The three major themes identified were ‘I would like to know more’, ‘There’s not much support from the clinic’ and ‘I don’t feel myself anymore’. These themes relate to the lack of disease-specific education, barriers in the health systems and service delivery resulting in individuals lack of self-worth and poor mental wellbeing. The results revealed the integral relationship between health care systems, service delivery and the effect on patient wellbeing. Conclusion: The rehabilitation needs of individuals with knee OA in rural areas advocates for addressing barriers in rural primary health care system such as adequate human resources, referral systems and continuity of care. This will allow for a comprehensive, person-centred and context-specific multidisciplinary approach focused on empowering individuals with knee OA through disease-specific education, improving functional participation and symptom management strategies. This could improve the social inclusion and mental wellbeing of individuals living with knee OA.National Research Fund of South Afric

Health equity profile of knee replacement patients in the South African public sector: A descriptive study

Background: Knee replacement surgery can significantly improve the quality of life of patients with severe knee osteoarthritis. Equitable access to knee replacement surgery is important to ensure that everyone, regardless of their socioeconomic status or geographical location, have fair and timely access. Objectives: The aim of our study was to (1) describe the health equity profile and quality of life of patients awaiting knee replacement at a single academic hospital in South Africa and to (2) describe the association between these health equity factors and the waiting time. Method: A cross-sectional survey and retrospective record review of patients awaiting knee replacement was conducted using the PROGRESS-Plus health equity framework. Chi-square statistics were used to calculate association between health equity factors and the waiting time. Results: Three-hundred and two (N = 302) patients (77% female; mean age 67 years) participated, of whom one in three patients waited 5 years or longer for surgery. Elderly patients ( 70 years) and patients from lower socio-economic background were less likely to have equitable access to surgery. Conclusion: The current screening protocol for knee replacement surgery in the public health care sector does not provide equitable access to surgery. A more holistic screening approach alongside selective surgical prioritisation and rehabilitation could reduce the waiting list and facilitate equitable access to care. Clinical implications: Health equity factors such as socioeconomic status, age, and other patient characteristics such as life roles and employability should be taken into consideration when screening patients for elective knee replacement waiting lists

Best land-use strategies towards sustainable biodiversity and land degradation management in semi-arid western rangelands in southern Africa, with special reference to ants as bio-indicators

Thesis (Ph.D. (Botany))--North-West University, Potchefstroom Campus, 2007.In South Africa, the unsustainable use of natural resources by domestic livestock has led to resource depletion and serious land degradation. Rangeland degradation, especially bush encroachment and soil erosion, is particularly acute in the North-West Province, where all districts show signs of desertification and a loss of biodiversity resulting in a deterioration of human and animal health. This has a major impact on livestock productivity and the economic viability of livestock farming with serious consequences for the livelihoods of pastoral communities. It is important to recognise ecological change before irreversible changes occur. The aim of this study, which falls within the Global Environmental Facility Desert Margins Programme (GEF-DMP), was to investigate to what extent vegetation in combination with ant communities can be used as indicators of ecosystem change due to anthropogenic human induced land-use patterns and how can this information be used in land degradation management and biodiversity conservation in the semi-arid western rangelands of Southern Africa. Sites, representing a degradation gradient (relative poor and relative good rangeland condition extremes) within each of three Tribal-, three Commercial- and three Reserve areas, were surveyed. The impacts of these land uses on the herbaceous species composition, woody-, soil- and ant components were evaluated. Both the woody and herbaceous species components reflected the existence of a rangeland condition/degradation gradient across the larger study area. The herbaceous species composition reflected similar degradation tendencies within the Commercial and Reserve land uses, with sites being associated with low rangeland as well as high rangeland condition scores. The tendencies differed between these two land uses based on the woody degradation gradient. The entire Tribal herbaceous- and woody species components showed a transitional shift towards another state, which differed significantly from the Commercial and Reserve land uses. Both the Tribal herbaceous and woody components were associated with low to intermediate rangeland condition ranges, with no significant rangeland condition gradient existing within the Tribal land use. Understanding and quantification of the soil-vegetation dynamics hold important implications for rangeland degradation management. This study provided criteria for selecting the most appropriate measures when incorporating the soil parameters as additive data in the multivariate analyses with the vegetation, ant and nominal environmental data. Different land use practices resulted in different soil patterns, with significant gradients pertaining to the soil stratum and openness/woodiness groups. There was a significant though neglectable difference pertaining to the rangeland condition/degradation gradient based on the soil component. Ants have been extensively used as bio-indicators, also with regard to the monitoring of the environmental effects of rangeland pastoralism. Ant species compositional patterns and functional groups displayed congruent clustering and diversity patterns as those of the vegetation and soil components. In contrast to the vegetation components, ant assemblages did not reflect a degradation gradient, but rather reflected environmental changes (modifications) to the habitat structure and - heterogeneity as a result of different land use disturbances. Both vegetation and ant diversity measures were mainly associated with the Tribal land use. These diversity indices were indicators of habitat complexity, heterogeneity and moderate disturbance, rather than indicators of a rangeland condition/degradation gradient. The diversity patterns are best described by a dichotomy between the humped-shaped productivity/diversity and the habitat complexity/heterogeneity models. Vegetation and ant diversity measures for this study should be considered as environmental indicators of habitat disturbance rather than as biodiversity indicators. It is suggested that vegetation, soil and ant patterns are best described by the state-and-transition model, which encompasses both equilibrium and non-equilibrium systems. The resilient nature of these rangelands, typical of non-equilibrium systems, was reflected by the low to intermediate differences between land uses with regard to the herbaceous, woody, soil and ant components. However, density dependent coupling of herbivores to key resources resulted in transitional shifts and modification of the vegetation composition and structure within and between land uses, displaying the equilibrium dynamics pertaining to these rangelands. Small disturbances in these rangelands may result in detrimental “snowball” interactive biotic-biotic /abiotic cascades. Spatial heterogeneous patterns within and between land uses as displayed by the vegetation, soil and ant parameters, necessitate that monitoring and management at patch, paddock and landscape scale should be conducted, cautioning against the extrapolation and over simplification of management strategies across all land uses. Because these arid rangelands are linked socio-ecological systems, it is not possible to address biophysical issues associated with land degradation without including the human dimensions. A “Key assessment matrix” is provided for monitoring and management purposes pertaining to land degradation and diversity aspects within and between the different land uses, and can be used by the land user, extension officer and scientist.Doctora

The influence of contextual factors on knee osteoarthritis self-management and education interventions in rural settings of the Western Cape

Thesis (MScPhysio)--Stellenbosch University, 2019.ENGLISH SUMMARY : Background: Musculoskeletal (MSK) disorders are a global health concern, and the effect of MSK related disability is amplified in rural areas where the community members are affected by their environmental and social situation. The implementation of a self-management and education programme could improve the health outcomes of individuals in these settings, however, the recommendations in the current evidence-based clinical practice guidelines lack description and contextual information. Understanding the specific context could improve the uptake of these clinical guidelines, and therefore improve patient care and health outcomes. Aim: The aim of this particular study was to describe the contextual factors that could influence the implementation of a self-management and education programme for people with knee OA living in the rural settings of the Western Cape. Method: A descriptive and exploratory qualitative research method with a phenomenological approach was used to conduct this study. In-depth semi-structured individual interviews and focus group discussions were the chosen mode of data collection. Eighteen participants with knee OA were interviewed individually, and 19 community health care workers participated in three area specific focus group, providing collateral information about the community and their health related behaviour. The first two individual interviews were used as pilot interviews, therefore the data of the remaining 16 individual interviews were used along with the focus group data for analysis. The transcribed and translated interviews were coded using the coding software Atlast.ti, after which a deductive data analysis approach was followed. Results: The results showed that the current services offered to individuals with knee OA living in the rural areas of the Western Cape are insufficient in addressing their concerns and managing their symptoms. Various rehabilitation needs have been identified in these areas of which information and exercise needs were the most prominent. The needs identified could be addressed by a self-management and education programme within these communities. However, contextual barriers and facilitators have been identified as possible aspects which could influence the implementation of a self-management and education programme. Personal factors such as ownership, compliance and social isolation as well as environmental factors such as the community attitudes, continuity of care and available transport could have an impact on the uptake and success of a self-management and education programme. Conclusion: This study found that when compared to current clinical practice guidelines, the services offered to people living with knee OA are not sufficient and that there is a need for education and exercise. A self-management programme are the ideal intervention to address the needs of the people living with knee OA in rural areas of the Western Cape. However, this study identified certain contextual factors that has to be considered when planning and implementing such a programme, and a feasibility study should be considered to ascertain the strategy for implementation in these areas.AFRIKAANSE OPSOMMING : Agtergrond: Muskuloskeletale (MS) kondisies is ‘n globale gesondheids bekommernis en die effek van MS verwante gestremdheid is verhoog in landelike gebiede waar lede van die gemeenskap deur hul omgewing en sosiale omstandighede geaffekteer word. Die implementering van ‘n self-hantering en opvoedingsprogram kan die gesondheidsuitkomstes van individue in hierdie omgewings verbeter. Die aanbevelings in die huidige bewysgesteunde kliniese praktyk riglyne het egter ‘n tekort aan konteks spesifieke inligting. Om die konteks te verstaan kan dit die opname van hierdie riglyne verbeter en dus die pasiëntsorg en gesondheiduitkomstes van hierdie individue verbeter. Doel: Die doel van hierdie studie was om die kontekstuele faktore te beskryf wat ‘n invloed kan hê op die implementering van ‘n self-hantering en opvoedingsprogram vir mense met knie osteoarthritis (OA) wat in landelike gebiede van die Weskaap, Suid Afrika woon. Metode: ‘n Beskrywende en verkennende kwalitatiewe navorsingsmetode is gevolg met ‘n fenomonologiese aanslag om hierdie studie uit te voer. In diepte gedeeltelik gestruktureerde individuele onderhoude asook fokus groep onderhoude is gekies as die metode van data insameling. Onderhoude is gevoer met 18 deelnemers wat knie OA het en 19 gemeenskap gesondheidswerkers, wat kolaterale inligting oor die gemeenskap en hul gesondheidsverwante gedrag kon verskaf. Die eerste twee individuele onderhoude is gebruik as toets onderhoude, dus is die oorblywende 16 individuele onderhoude saam met die fokus groep gesprekke gebruik vir analise. Die transkripsies is vertaal en gekodieer met die Atlas.ti koderings sagteware, waarna ‘n deduktiewe data analise gevolg is. Resultate: Die resultate toon dat die huidige dienslewering aan individue met knie OA wat in landelike gebiede van die Weskaap woon, nie voldoende is om hul kommer aan te spreek of hul simptome te hanteer nie. Verskeie rehabilitasie behoeftes is geidentifiseer in hierdie areas, en die grootste tekortkoming was korrekte inligting en oefen programme. Hierdie behoeftes kan aangespreek word deur ‘n self-hantering en opvoedingsprogram in hierdie gemeenskappe. Kontekstuele hindernisse en fasiliterende aspekte wat ‘n invloed kan hê op die implementering van ‘n self-hantering en opvoedingsprogram is egter geidentifiseer. Persoonlike faktore soos eienaarskap, die volvoering en sosiale isolasie sowel as omgewingsfaktore soos die gemeenskap se instelling, kontinuïteit van sorg asook vervoer kan ‘n impak hê op die opname en sukses van ‘n self-hantering en opvoedingsprogram. Gevolgtrekking: Hierdie studie het gevind dat invergelyking met die huidige kliniese praktyk riglyne, die dienste wat aan mense met knie OA gebied word nie voldoende is nie, en daar steeds ‘n behoefte is aan opvoeding en oefening. ‘n Self-hanterings program is die ideale ingryping om die behoeftes van mense met knie OA wat in landelike gebiede van die Weskaap woon, aan te spreek. Die studie het egter ook kontekstuele faktore geidentifiseer wat in ag geneem sal moet word tydens die beplanning en impementering van so ‘n program. Dus word ‘n haalbaarheidsstudie voorgestel om ‘n strategie te ontwikkel vir die implementering van so ‘n program in hierdie areas

Large Scale Testbed for Intercontinental Smart City Experiments and Pilots – Results and Experiences

The challenges that cities face today are diverse and dependent on the region they are located. Inherently cities are complex structures. To improve service delivery in these complex environments the cities are being augmented by “Internet of Things” (IoT) and “Machine to Machine” (M2M) type of technologies that lead to the emergence of extremely complex Cyber-Physical Systems (CPS), often referred to as “Smart Cities”. To support choices for technology deployments in Smart Cities, one has to gain knowledge about the effects and impact of those technologies through testing and experimentation. Hence experimentation environments are required that support the piloting and evaluation of service concepts, technologies and system solutions to the point where the risks associated with introducing these as part of the cities’ infrastructures will be minimised. With this rational, the TRESCIMO (Testbeds for Reliable Smart City Machine to Machine Communication) project deployed a large scale federated experimental testbed across European and South African regions, allowing for experimentation over standardised platforms and with different configurations. Among others, the main requirement for the testbed federation was to cater for the different contextual dimensions for Smart Cities in Europe and South Africa. The testbed is composed of a standards-based M2M platform (openMTC), using standard FIRE SFA-based management tools (FITeagle) and including a variety of sensors and actuators (both virtual and physical). Furthermore, a Smart City Platform attached to openMTC hosts applications for a variety of stakeholders (i.e. experimenters or typical end-users). Aseries of experiments were conducted with the TRESCIMO testbed to validate the plug-and-play approach and Smart City Platform-as-a-Service architecture. This architecture is positioned to provide smart services using heterogeneous devices in different geographical regions incorporating multiple application domains. This chapter elaborates on, and validates the TRESCIMO testbed by presenting the experimental results and experiences from two trials executed in South Africa and Spain

Programmatically selected multidrug-resistant strains drive the emergence of extensively drug-resistant tuberculosis in South Africa

South Africa shows one of the highest global burdens of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). Since 2002, MDR-TB in South Africa has been treated by a standardized combination therapy, which until 2010 included ofloxacin, kanamycin, ethionamide, ethambutol and pyrazinamide. Since 2010, ethambutol has been replaced by cycloserine or terizidone. The effect of standardized treatment on the acquisition of XDR-TB is not currently known.; We genetically characterized a random sample of 4,667 patient isolates of drug-sensitive, MDR and XDR-TB cases collected from three South African provinces, namely, the Western Cape, Eastern Cape and KwaZulu-Natal. Drug resistance patterns of a subset of isolates were analyzed for the presence of commonly observed resistance mutations.; Our analyses revealed a strong association between distinct strain genotypes and the emergence of XDR-TB in three neighbouring provinces of South Africa. Strains predominant in XDR-TB increased in proportion by more than 20-fold from drug-sensitive to XDR-TB and accounted for up to 95% of the XDR-TB cases. A high degree of clustering for drug resistance mutation patterns was detected. For example, the largest cluster of XDR-TB associated strains in the Eastern Cape, affecting more than 40% of all MDR patients in this province, harboured identical mutations concurrently conferring resistance to isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin, ethionamide, kanamycin, amikacin and capreomycin.; XDR-TB associated genotypes in South Africa probably were programmatically selected as a result of the standard treatment regimen being ineffective in preventing their transmission. Our findings call for an immediate adaptation of standard treatment regimens for M/XDR-TB in South Africa