Policy issues in the urban South

This paper will be dealing with elements of global regionalization and how it impacts economically on different groups of developing regions. It will highlight the spatial economic disadvantages Africa is facing in its quest to reconnect to the global economy. Moving its focus to urban South Africa, it will show how different sections of the country’s urban population are reacting to local economic conditions vis-à-vis current global economic trends. Based upon the structure of the informal urban economic sector in South Africa and how it has been impacting on the formal urban economic sector in the country over the past fifteen years, the paper will end with an assessment of the possible longer term effects the country’s ‘redesign city’-approach may have on urban economic structural changes in the future.

Analisis Sosial Terhadap Strategi Pemasaran Tape Sebagai Oleh - Oleh Khas Jember

Kabupaten Jember merupakan salah satu daerah di Jawa Timur yang memiliki lahan pertanian dan perkebunan yang sangat luas. Dari sektor pertanian dan perkebunan wilayah Jember mempunyai beberapa tanaman pangan yang umum kita jumpai yaitu singkong. Di Kabupaten Jember sebaran singkong cukup merata yakni di 28 kecamatan dari 31 kecamatan di Jember. Singkong merupakan salah satu tanaman yang mudah ditemui di Kabupaten Jember. Singkong dapat diolah menjadi makanan yaitu menjadi tape singkong. Tape singkong merupakan hasil fermentasi ragi makanan. Tape singkong merupakan salah satu produk olahan singkong. Salah satu perusahaan tape yang ada di Kabupaten Jember yang sedang berkembang saat ini adalah UD. CIPTA RASA tape berbahan dasar singkong kuning makanan khas Jember. Pemasaran tape oleh-oleh Jember dianalisis dengan menggunakan metode deskriptif sebagai metode penelitian. Metode ini digunakan untuk menggambarkan pemasaran tape yang dijadikan oleh-oleh khas Jember bagi masyarakat sekitar Jember. Data-data tersebut dianalisis dengan menggunakan pendekatan kualitatif, yaitu metode penelitian yang menggambarkan atau menjelaskan secara mendalam tanggapan narasumber terhadap suatu fenomena sosial di masyarakat. Dalam penelitian ini, kami juga melakukan wawancara tatap muka dengan pemilik usaha tape rempah khas Jember. Usaha pita merupakan salah satu industri pangan yang mempunyai permintaan pasar yang besar dan luas. Mengenai daya saing produk tape di daerah Jember bisa dikatakan cukup kompetitif karena banyak masyarakat Jember yang memilih perusahaan tape singkong karena tape singkong merupakan makanan khas Jember yang sangat diinginkan oleh warga dan masyarakat Jember

Assessment of lung function abnormalities in adult patients with tuberculosis in a high HIV-prevalent setting and the impact of a pulmonary rehabilitation intervention to improve lung function, functional capacity, and quality of life

Background: Globally, tuberculosis (TB) continues to be a major health problem. In the most recent World Health Organisation (WHO) Global Tuberculosis Report of 2019, TB was ranked as the leading cause of death from an infectious disease ahead of the human immunodeficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS). In the 2019 WHO Global Report on TB, there is little information relating to TB post-cure effects and management. Although there is evidence that successful completion of TB treatment does not equate to normal lung function, there is growing need for research, both during and after TB treatment, on the extent of lung function abnormalities and how these impact on the individual's quality of life (QoL). Pulmonary rehabilitation programmes may provide a continuum of care for individuals with TB to address both lung function abnormalities as well as positively impacting on QoL. Objectives: The present PhD thesis aimed to provide insight into the extent of pulmonary disease in individuals with pulmonary TB during and near completion of TB treatment as well as to establish whether provision of a pulmonary rehabilitation programme (PRP) could address the research gap. To achieve this, three linked studies were undertaken in the form of observational (prevalence) study (Study 1), a systematic review (Study 2), and a randomised control trial (Study 3). Study One: Observational Study Objectives: The overall aim of the present observational study was to ascertain the prevalence of lung function abnormalities in first time, drug sensitive individuals living with TB, with or without HIV coinfection, at near completion (at least four months) of TB treatment. The specific objectives were to determine: i) baseline clinical and socio-economic profile, ii) baseline information pertaining to the QoL outcome measures of EQ-5D-3L and the St George's Respiratory Questionnaire (SGRQ), iii) measure lung function parameters, iv) establish the proportion of participants with normal or abnormal (obstructive, restrictive, or mixed) lung function and the severity of these, v) whether a correlation of lung function abnormalities with chest x-ray (CXR) abnormalities exist, vi) establish whether a relationship exists between lung function and QoL measures, and vii) identify the predictors of lung function abnormality in individuals being treated for active TB. Methods: A cross-sectional observational study using a sample of convenience was conducted. Inclusion criteria included all adult male and females between the age of 18-80 years with confirmed (smear positive or by CXR) drug-susceptible TB who were receiving treatment, with or without HIV coinfection, for at least four months (16 weeks). ii Participants were excluded from Study 1 if they were adult patients who had had previous TB episodes, recent severe chest trauma (within the previous three months), a recent history of pneumonia, known atopic asthma, chronic bronchitis, emphysema, bronchiectasis prior to TB diagnosis, cardiac failure, or any other unrelated respiratory disease as reported in their medical folder. Participants completed two QoL questionnaires (EQ-5D-3L and SGRQ), a self-designed clinical research form to collect descriptive data, a six-minute walk test (6MWT), CXR, and spirometry once off. Results: The sample of 305 participants were predominantly male (n=168:55; 1%), had a median age of 36 years (IQR:28-43), and had median time of 19 weeks (IQR:18-22) on TB treatment. Overall, 32% of the sample presented with abnormal lung function (obstructive=11%, restrictive=15%, and mixed=6%). Only 2.2% of the total sample had two or more co-morbidities. There was no statistically significant difference (p=0.29) in distance covered by participants who had obstructive compared to restrictive lung function abnormality. After logistic regression analysis of clinical and sociodemographic variables (multi-variate), only being older (56–65 years old) and being obese were statistically significant (p=0.02 and p=0.04 respectively). When considering QoL, only the domain of mobility for the EQ-5D-3L questionnaire was statistically associated with abnormal lung function (p=0.02). Linear regression modelling for continuous variables of lung function (FEV1, FVC, FEV1/FVC and percentage predicted of FEV1, FVC, and FEV1/FVC) with SGRQ, 6MWD, and CXR scores yielded no predictor. Conclusion: Overall, 32% of participants presented with abnormal lung function, which is lower than comparator studies investigating lung function in TB populations. Quality of life measures for most participants was considered good at the time of assessment. Limitations to Study 1 related to the absence of normative data for a healthy population relating to lung function and 6MWD to compare the findings in this TB population. Recommendations for future research would be to establish normative data for these outcome measures. Regarding lung function testing, it is recommended that training of correct execution of the spirometry techniques is performed prior to assessment as the technique may be unfamiliar compared to the routine tests done at clinic visits for individuals receiving TB treatment. iii Study Two: Systematic Narrative Review A systematic review was conducted to establish the evidence of the impact of non-pharmacological intervention programmes (pulmonary rehabilitation) in the rehabilitation of individuals living with TB on lung function outcomes. Methods: MEDLINE via Pubmed, CENTRAL, CINAHL, PEDro, Web of Science, Scopus, Science Direct, and African Index Medicus, including Google Scholar were searched (from January 1995 to December 2016 with an updated search in November 2018) for randomised control trials, quasi-experimental and pre-post-test studies on PRPsfor adult individuals with TB specifically with lung function measures as primary outcome. Results: In total, 1 705 studies were obtained from the search. Once duplicate studies were removed, 1 220 studies remained. The titles and abstracts of these studies were screened resulting in 1 210 studies being excluded. Therefore, 10 studies were potentially eligible. Once the full-text articles were assessed, four studies met the inclusion criteria. Of the included studies, only one was a randomised control trial, two studies were single arm before and after studies, and one study was a prospective non-randomised open trial (two arms). In total, there were 178 participants in these studies, with sample sizes ranging from 10 to 67 participants. All four selected studies had both male and female participants; however, overall, male participants were the majority with 69% versus 21% females. The mean age across the studies was 70 years. No statistically significant difference (p>0.05) was found regarding lung function parameters and the PRPs. No meta-analysis could be performed as data could not be pooled due to the differences in study characteristics and outcome measures. Conclusion: This review was unable to support or negate the use of pulmonary rehabilitation for individuals with TB primarily due to the lack of well-designed and executed randomised control trials. The studies showed that no effect on FEV1 was demonstrated. The researchers recommended that future research investigates the extent of pulmonary sequelae in patients after completion of TB chemotherapy in large-scale studies. Long-term follow-up in those who have had TB without surgical intervention should be prioritised to see the extent of lung function disorders in this population, particularly in countries on the high-burden list for the disease. A further recommendation is that well executed randomised control trials that control for biases to investigate pulmonary rehabilitation in populations of individuals with TB should be prioritised as there is a need to develop an evidencebased continuum of care. iv Study Three: Randomised Controlled Trial Objectives: The overall objective of study three was to determine what the impact of a contextually relevant PRP would have on individuals living with TB, with or without HIV co-infection, on outcomes related to lung function, functional capacity, and QoL. Methods: A pilot randomised, single blinded, pre-test-post-test design was used. Inclusion criteria were all adult males and females between 18-65 years with TB confirmed by Gene Xpert, irrespective of number of TB episodes, HIV status, or having chronic obstructive pulmonary disease. Participants had to be within their first week of TB treatment. Participants with only extra-pulmonary TB, recent severe chest trauma (within the last three months), a recent history of pneumonia (within one month), known atopic asthma, cardiac failure, or any other unrelated respiratory disease as reported in their medical folders or who had defaulted on their treatment were excluded. In addition to this, if participants failed the pre-participation health screening and were non-ambulate due to paralysis or amputation, they were also excluded. Fifty-eight participants were randomised into a control group (CG) receiving only pharmacological therapy and the intervention group (IG) who received pulmonary rehabilitation in addition to pharmacological therapy. The PRP was held for 12 weeks and consisted of two weekly sessions with a duration of 45 minutes each, which was delivered at a community centre. Participants completed two QoL questionnaires (EQ-5D-3L and SGRQ), a self-designed clinical research form to collect descriptive data, a three-minute step test, and spirometry at three time points (enrolment, at six weeks, and at 12 weeks). T-tests were conducted to determine the difference between means of the CG and IG for lung function parameters, functional capacity, and QoL outcomes. Results: There were 29 participants in each group. Regarding sex, age, and number of co-morbidities the two groups were well matched. Regarding HIV status, the CG had more participants that were HIV positive (n=22) and on anti-retroviral therapy (n=11) than their IG counterparts (n=13 and n=5 respectively). Nearly half of the participants had a first time TB diagnosis, with the participants in the IG having reported more recurring TB incidences overall (n=16 vs. n=13). A t-test for difference between means showed no statistical significance for the CG and IG regarding FEV1, FVC, and FEV1/FVC ratio for absolute or percentage predicted values. Forty-three percent of participants in the total sample had normal lung function at baseline, with the remaining participants being classified as having either obstructive (26%), restrictive (21%), or mixed (10%) lung function. At baseline, 48% of participants in the CG had abnormal lung function compared to 67% in the IG. At six weeks there was no change in the CG regarding lung abnormalities. However, the IG only had 33% abnormal lung function at the same time point. v Although there was no statistical significance for any of the lung function categories, there was a 42% improvement in normal lung function at six weeks in the IG compared to the CG at baseline. The median baseline number of steps taken by the CG was 79 steps (IQR:42-134) compared to 117 steps by the IG (IQR:84-154). A t-test conducted to test the difference between means for the CG and IG was statistically significant for the step test (p=0.002) at six weeks for the IG, but not at 12 weeks (p=0.13). No correlation was found between the SGRQ (QoL parameter) and any lung function parameter (p>0.05) at 12 weeks. Conclusion: Although the changes in lung function, functional capacity, and QoL did not reach statistical significance at completion of the PRP for the IG, the continued improvement in all the outcomes for the IG from 0 weeks to 12 weeks holds potential clinical significance

Meeting the challenges in the diagnosis of inflammatory myopathies

Inflammatory myopathy (IM) is a rubric term to describe a heterogeneous group of muscle diseases typified by dermatomyositis andpolymyositis. The current classifications are unsatisfactory, but IM associated with other connective tissue diseases (CTDs), such assystemic lupus erythematosus, underlying malignancy and HIV, should also be included. Although uncommon, IM should always beconsidered in a patient who presents with proximal weakness of gradual onset and has raised serum muscle enzymes.The diagnosis may be obvious if the patient has diagnostic skin signs such as heliotropic rash (peri-orbital discoloration) and Gottron’slesions (typically on the extensor surfaces of the fingers). In the absence of obvious skin manifestations, other features of a CTD such asRaynaud’s phenomenon, abnormal capilloroscopy and the presence of serum antinuclear factor antibody should be searched for.Conditions that mimic IM include other causes of myopathy such as endocrine disorders, adverse effects of medication, metabolicmyopathies and muscle dystrophies. Atypical features suggesting an alternative diagnosis are acute onset, severe pain, assymmetricalinvolvement, distal weakness and wasting.Appropriate investigations include a chest radiograph indicating interstitial lung disease or malignancy. Electromyography and musclebiopsy are useful in cases where other diagnoses are suspected

The informal sector in urban Nigeria: Reflections from almost four decades of research

The rapid expansion of the informal sector or economy in both developed and developing countries has not only captured the attention of researchers, development analysts, government officials and international agencies but is also prompting a massive profusion of literature on the topic. In the face of the huge plethora of informal sector literature, some scholars advocate ‘country distinction’ as a scale-bound and context-specific template for gauging both the ‘national’ and ‘global’ accounts of the informality story. The Nigerian informal sector is metaphoric of old wine in a new wineskin since ‘informality’ research in the country predates the introduction of the concept there. It was the ILO city-study mission to Lagos in 1975 that pioneered the concept but the terminology tottered until the mid-1980s before it diffused the mainstream of academic and policy circles. Ever since the structural adjustment programme (SAP) of 1986, the ascribed informal workforce has grown in leaps and bounds both in real numbers and in activity diversification. The article explores the nearly two decades’ trajectory and substance of informal sector research in Nigeria. It is significant for two reasons: no previous elaborate attempt has been made to systematically document or review the motleys of informal sector literature in Nigeria, and this evaluation promises, among other things, to provide the feedbacks necessary to avert a slide of informality research into “ritual academic blind alleys” (Flyvbjerg, 2004a: 422). Based on the foregoing, the article synthesises the knowledge gains (as well as gaps) and concludes with recommendations for future research.&nbsp

‘Picking up the pieces’: Reconstructing the informal economic sector in Bulawayo, Zimbabwe

Since the launch of Operation Restore Order in May 2005 in all urban centres by the Zimbabwean government, the informal economic sector in Bulawayo has undergone significant transformations and growth. In contravention of the legal and regulatory controls and against the backdrop of a severe economic crisis, the government embarked on a clean-up campaign that devastated the urban poor and reduced them to destitute people. The blitz destroyed informal business structures, evicting and detaining operators and confiscating their wares purporting to restore the lost glimmer and liveliness of the city. Even registered vendors that operated at designated sites with operating licences properly issued by the city authorities were not spared. This study’s preliminary findings reveal how the planning system has metamorphosed to keep up with changing circumstances and how it has helped to revolutionise the vendors’ struggles by organising and mobilising them to revive the indispensable  informal economy. In conclusion the article argues that city authorities should work closely with the associations of the urban poor to achieve the objectives both of maintaining urban health and of ensuring the means of livelihood for the unemployed, in particular against the backdrop of a distressed formal sector that has reeled under economic structural adjustments that led to massive deindustrialisation and retrenchments since the 1990s.&nbsp