School Vegetable Gardens As a Site for Reciprocity in Food Systems Research: An Example from Cape Town, South Africa

In this snapshot, I discuss the potential value of gardening as a reciprocal research method. I draw on my experience of partnering with a school in establishing and supporting an ongoing primary school vegetable garden, as part of a long-term research project. I suggest that the garden creates a space in which to “talk around” the problem of diet-related non-communicable disease,1 rather than trying to define or address it directly, and therefore allows for the co-construction of our understanding of “food choice,” both in exploring the limitations of choice, and in discovering participatory opportunities to leverage for change in the food system. In this light, I discuss the value of slow research around a shared physical space, where reciprocity is derived from a negotiated give-and-take of learning to grow vegetables. Over time, locally relevant, relational and cumulative framing emerges. I argue that slow, reciprocal research involves embracing the full complexity of context, and adopting a posture of flexibility means that, rather than trying to control outcomes, we remain curious about the process itself

No looking back : [food]ways forward for healthy african cities in light of climate change

The recent Intergovernmental Panel on Climate Change (IPCC) “Climate Change and Land Report,” states that transformational change will require integration of resilience and mitigation across all parts of the food system including production, supply chains, social aspects, and dietary choices. This paper argues for an explicitly urban lens to be brought to the IPCC’s call for food system transformation. For the African context there must be a re-imagining of the urban development trajectory. More specifically, it is essential for urban governments to proactively shape their food systems. The paper suggests some food specific interventions

Health care providers’ perspectives of diet-related non-communicable disease in South Africa

Abstract Background In South Africa, diet-related non-communicable diseases (dr-NCDs) place a significant burden on individuals, households and the health system. In this article, we investigate the experiences of eight key informants within the public sector health care system (nurse, doctor and dietician), in order to reflect on their experiences treating dr-NCDs. Methods We interviewed eight key informants who were central to the primary care service for at least 40,000 people living in a low-income neighbourhood of Cape Town, South Africa. In previous work, we had interviewed and conducted ethnographic research focused on dr-NCDs in the same neighbourhood. We then conducted a thematic analysis of these interviews. Results The perspectives of key informants within the public sector therefore offered insights into tensions and commonalities between individual, neighbourhood and health systems perspectives. In particular, the rising prevalence of dr-NCDs alarmed providers. They identified changing diet as an important factor driving diabetes and high blood pressure in particular. Health care practitioners focused primarily on patients’ individual responsibility to eat a healthy diet and adhere to treatment. A marked lack of connection between health and social services at the local level, and a shortage of dieticians, meant that doctors provided rapid, often anecdotal dietary advice. The single dietician for the district was ill-equipped to connect dr-NCDs with the upstream determinants of health. While providers often had empathy and understanding of patients’ circumstances, their training and context had not equipped them to translate that understanding into a clinical context. Providers seemingly could not reconcile their empathy with their perception of dr-NCDs as a failure of prudence or responsibility by patients. Significant shortcomings within health systems and social services make reflexive practice very difficult. Conclusions Supporting health care providers in understanding context, through approaches such as translational competency, while strengthening both health and social services, are vital given the high burden of NCDs in South Africa

A Qualitative study of language barriers between South African health care providers and cross-border migrants

Abstract Background Communication with health care providers represents an essential part of access to health care for the over 230 million cross-border migrants around the world. In this article, we explore the complexity of health communication from the perspective of cross-border migrants seeking antenatal care in Cape Town, South Africa in order to highlight the importance of high quality medical interpretation. Methods As part of a broader study of migrant maternal and infant nutrition, we conducted a secondary data analysis of semi-structured in-depth interviews (N = 23) with Congolese (n = 7), Somali (n = 8) and Zimbabwean (n = 8) women living in Cape Town, as well as nine focus group discussions (including men: n = 3 and women: n = 6) were conducted with migrant Somalis, Congolese, and Zimbabweans (N = 48). We first used content analysis to gather all data related to language and communication. We then analysed this data thematically. Results Zimbabwean participants described how the inability to speak the local South African language (IsiXhosa) gave rise to labelling and stereotyping by healthcare staff. Congolese and Somali participants described medical procedures, including tubal ligation, which were performed without consent. Partners often tried to play the role of interpreter, which resulted in loss of income and non-professional medical interpretation. Participants’ highlighted fears over unwanted procedures or being unable to access care. Challenges of communication without a common language (and without professional medical interpretation), rather than outright denial of care by healthcare professionals, mediated these encounters. Conclusion Although there are several factors impeding cross-border migrants’ access to health care, effective communication is a prerequisite for quality care. Free-to-patient professional medical interpretation would not only benefit migrant populations but would benefit the broader community where language and health literacy are barriers to accessing health care. Novel approaches to language access may include technology-enabled professional interpretation

Perceptions related to breastfeeding and the early introduction of complementary foods amongst migrants in Cape Town, South Africa

Abstract Background Infant feeding recommendations are of health importance, yet the extent to which migrant communities in low- and middle-income countries know or implement these recommendations is poorly understood. This study explores the perspectives of infant feeding amongst cross-border migrants in Cape Town, South Africa. Methods Between February and October 2013, semi-structured in-depth interviews (n = 23) were conducted face-to-face with Congolese, Somali and Zimbabwean mothers living in Cape Town. To assess commonly identified narratives of infant feeding, nine focus group discussions (three with men and six with women) were conducted with migrant Somalis, Congolese, and Zimbabweans. Results Three dominant themes framed infant feeding. 1) Pragmatism in feeding choices drove responses to baby’s cues, including cries, sleeping patterns, and weight gain (2). Formula feeding was normative in the South African context, whereas lack of commercial infant milk back home was described in terms of expense (3). Low rates of breastfeeding were explained in terms of work responsibilities including household work and lack of breastmilk supply resulting from stress and poor diet. However, women participants typically did not consider their feeding choices to negatively affect their baby’s health. Conclusions The reasons for early introduction of both commercial infant milk and solid foods were complex. Breastfeeding was not prioritized despite an awareness of medical recommendations. Rather than emphasizing specific breastfeeding intentions, participants favoured an approach that reacted to their baby’s perceived changing needs. The practical challenges of breastfeeding described by cross-border migrant women reflect one way in which socio-economic and health inequalities may currently be perpetuated for marginalised populations

Adolescent girls’ perceptions of breastfeeding in two low-income periurban communities in South Africa

In South Africa, exclusive breastfeeding rates are low, and rates of teenage pregnancy are high. Educational policy enables mothers’ return to school, which conflicts with policy emphasizing exclusive breastfeeding. We elicited adolescent women’s perceptions and experiences of infant feeding choices, and conducted six focus groups (N ¼ 57) in two periurban settlements. Participants knew arguments in favor of and against breast and formula-feeding, but in practice, mixed feeding occurred early after birth. While completion of high school was emphasized, exclusive breastfeeding was viewed as impractical. Congruent education policies and infant feeding policies/guidelines must address the constraints and contexts of adolescent mothers

Investigating the disjoint between education and health policy for infant feeding among teenage mothers in South Africa: a case for intersectoral work

Background: Many low-and-middle-income countries, including South Africa, have high rates of teenage preg‑ nancy. Following the World Health Organisation recommendations, South African health policy on infant feeding promotes exclusive breastfeeding until six months of age, with gradual weaning. At the same time, South Africa’s education department, in the interest of learners, promotes adolescents’ early return to school post-partum. Yet infant feeding at school is currently not perceived as a realistic option. Methods: Recognising his this policy tension, we aimed to explore how policies are interpreted and implemented by the health and education sectors through interviews with key informants who produce, interpret and implement these policies. Using an interview guide developed for this study, we conducted in-depth interviews with 24 health policy makers, managers in both sectors, school principals and nursing staf who manage adolescent mothers (aged 16-19) and their babies. Data was analysed using thematic analysis. Results: Informants from both sectors expressed discomfort at pregnant learners remaining in school late in preg‑ nancy and were uncertain about policy regarding when to return to school and how long to breast-feed. Educators reported that new mothers typically returned to school within a fortnight after delivery and that breastfeeding was not common. While health professionals highlighted the benefts of extended breastfeeding for infants and mothers, they recognised the potential confict between the need for the mother to return to school and the recommenda‑ tion for longer breastfeeding. Additionally, the need for ongoing support of young mothers and their families was highlighted. Conclusions: Our fndings suggest educators should actively encourage school attendance in a healthy pregnant adolescent until delivery with later return to school, and health providers should focus attention on breastfeeding for the initial 4-6weeks postpartum, followed by guided support of formula-feeding. We encourage the active engage‑ ment of adolescents’ mothers and extended families who are often involved in infant feeding and care decisions. Edu‑ cation and health departments must engage to facilitate the interests of both the mother and infant: some exclusive infant feeding together with a supported return to school for the adolescent mothe

Urban health research in Africa : themes and priority research questions

See erratum to article at http://dx.doi.org/10.1007/s11524-016-0064-7The urban growth of cities across Africa has drastically increased the number of people living in informal or under served conditions. Using a public health approach, this study examines the urban health inequity faced by many of these cities. This is an area that has yet to be fully addressed by public policy. Researchers examine the variety of ways that public health is impacted by urbanization, and develop an approach that will guide sustainable and cost-effective interventions