Reproduction and establishment of two endangered African cedars, Widdringtonia cedarbergensis and Widdringtonia whytei

In this thesis I determine the effect of population decline on reproduction for two critically endangered African cedars. Widdringtonia whytei (Mulanje cedar) endemic to Mt Mulanje, in Malawi and Widdringtonia cedarbergensis (Clanwilliam cedar) endemic to the Cedarberg Mountains in the Western Cape Province of South Africa. Populations of both species have declined dramatically in the recent past and both show evidence of insufficient recruitment. Recent research has shown that a reduction in population density may limit pollen dispersal, reduce seed viability and increase self-pollination rates, causing an inbreeding depression, resulting in less fit offspring. Based on this research, I hypothesise that pollen transfer in Widdringtonia is distance-dependant and therefore populations with greater distances to the nearest adult neighbour will have lower seed viability, due to pollination failure. I also hypothesise, that trees which receive less outcross pollen due to distance-dependant pollination will have higher rates of self-pollination. I further hypothesise that seed viability may also increase with increased soil nutrients and more amenable climate differences linked to changes in altitude. To test these hypotheses, I determine the extent to which reduced population density has resulted in a decline in viable seed using germination experiments, followed by cut tests and tetrazolium chloride tests. For W. cedarbergensis seedling survival was determined in a greenhouse and self-pollination was assessed with ISSR markers, using DNA extracted from parent and offspring. My results show that seed viability for both W. cedarbergensis and W. whytei is not significantly correlated with distance to nearest-neighbour, altitude or soil nitrogen, carbon or phosphorus. These results suggest that current population densities are not effecting the reproduction either of W. whytei or W. cedarbergensis. My results for population genetics show relatively low levels of genetic variation in W. cedarbergensis typical of endangered and endemic species. The genetic differentiation between populations is low, suggesting that pollen flow between populations is adequate and populations are not genetically isolated. I conclude that there is no evidence that population decline is causing any noticeable limitations on pollen transfer and reproduction in Widdringtonia

Shade or light? : size class distribution and δ¹³C values as clues to the recruiting environment of Widdringtonia whytei

In order to determine the recruitment environment of the endangered Mulanje Cedar, Widdringtonia whytei, size class distributions were measured for six populations on Mount Mulanje, Malawi. Carbon isotope ratios were also collected from leaf tissue in trees of varying height in order to determine the effects of positioning within or below the canopy. Carbon isotope ratios were also taken from wood cores and the δ¹³Cvalues for the innermost and outermost wood were compared for two sites. Size class :frequency distributions had a tendency to be normally distributed but one site showed skewed values towards seedling and another showed a flat distribution, possibly due to continual logging of the trees. Height correlated well with leaf δ¹³Cvalues. Sombani and Bvunje showed the same current (outer wood) δ¹³Cvalues but different recruitment (inner wood) δ¹³Cvalues. Results indicate that Bvunje trees recruited in the shade and Sombani recruited in the sunlight. There is ambiguity in both size class data and carbon isotope data and therefore either Widdringtonia whytei is able to recruit in a variety of manners and environments or other factors are influencing the results

Certain syndrome or complex conundrum? : the pollination of Erica lanuginosa

The flower of Erica lanuginosa has a tightly closed corolla, held in place by hinged sepals. with a dull reddish-pink colour which makes make it hard to determine a likely pollinator. Rodent trapping and pollen analysis of faecal matter showed it unlikely to be pollinated by a rodent. Flowers excluded from external pollination showed no seed set, hence it is not considered to be self-pollinated. Nectar analysis are inconclusive as an indicator of pollination syndrome. Entomophily by a robust insect with a medium length proboscis is considered unlikely due to phenology and morphology of the flower. Omothiphily is a possibility as stem thickness correlates with previous studies investigating the correlation between stem thickness and pollination syndromes. The pollination syndrome of Erica lanuginosa remains indeterminate by I hypothesize that, due to phenology, thick supportive, stem and large quantities of nectar and close-formed flower, which needs to be manoeuvred open, its pollinator is likely a short-billed generalist-feeding bird restricted by food choice during the winter months

The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa.

OBJECTIVE: Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions. DESIGN: Interviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency. RESULTS: All champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. 'Disease-centred' champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while 'patient-centred' champions promoted pathways of care that would optimise patients' recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context. CONCLUSION: Policymakers can learn from champions' experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives

The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa

From BMJ via Jisc Publications RouterHistory: received 2022-02-24, accepted 2022-11-07, ppub 2022-12, epub 2022-12-09Peer reviewed: TrueAcknowledgements: This paper draws on data from a 4-year project that aimed to gain an understanding of the policy context, patient care pathways and models of decentralisation of DR-TB care in three South African provinces. The authors would like to thank and acknowledge Dr Norbert Ndjeka (SA NDOH), key informants, staff and participants interviewed and the provinces of the Western Cape, Eastern Cape, KwaZulu-Natal for all their time, critical insights and assistance.Publication status: PublishedFunder: Medical Research Council; FundRef: http://dx.doi.org/10.13039/501100000265; Grant(s): MR/N015924/1Karina Kielmann - ORCID: 0000-0001-5519-1658 https://orcid.org/0000-0001-5519-1658Objective: Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions. Design: Interviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency. Results: All champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. ‘Disease-centred’ champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while ‘patient-centred’ champions promoted pathways of care that would optimise patients’ recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context. Conclusion: Policymakers can learn from champions’ experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives.pubpu

Organisation of care for people receiving drug-resistant tuberculosis treatment in South Africa: a mixed methods study

From BMJ via Jisc Publications RouterHistory: received 2023-03-03, accepted 2023-10-09, ppub 2023-11, epub 2023-11-18Peer reviewed: TrueAcknowledgements: The authors wish to thank the Departments of Health of the Western Cape, Eastern Cape, KwaZulu-Natal, and acknowledge the staff at the NHLS for their tremendous input and assistance. We give special mention to the late Dr Iqbal Masters and Mrs Anna Maria Evans for their contributions to the study. We also appreciate the support of Staff Nurse Cheryl Liedeman and Dr Widaad Zemanay.Publication status: PublishedFunder: Medical Research Council; FundRef: http://dx.doi.org/10.13039/501100000265; Grant(s): MR/N015924/1Funder: Wellcome Trust; FundRef: http://dx.doi.org/10.13039/100010269; Grant(s): MR/N015924/1Funder: Australian National Health and Medical Research Council; Grant(s): APP1174455Karina Kielmann - ORCID: 0000-0001-5519-1658 https://orcid.org/0000-0001-5519-1658Objectives: Treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is increasingly transitioning from hospital-centred to community-based care. A national policy for decentralised programmatic MDR/RR-TB care was adopted in South Africa in 2011. We explored variations in the implementation of care models in response to this change in policy, and the implications of these variations for people affected by MDR/RR-TB. Design: A mixed methods study was done of patient movements between healthcare facilities, reconstructed from laboratory records. Facility visits and staff interviews were used to determine reasons for movements. Participants and setting: People identified with MDR/RR-TB from 13 high-burden districts within South Africa. Outcome measures: Geospatial movement patterns were used to identify organisational models. Reasons for patient movement and implications of different organisational models for people affected by MDR/RR-TB and the health system were determined. Results: Among 191 participants, six dominant geospatial movement patterns were identified, which varied in average hospital stay (0–281 days), average patient distance travelled (12–198 km) and number of health facilities involved in care (1–5 facilities). More centralised models were associated with longer delays to treatment initiation and lengthy hospitalisation. Decentralised models facilitated family-centred care and were associated with reduced time to treatment and hospitalisation duration. Responsiveness to the needs of people affected by MDR/RR-TB and health system constraints was achieved through implementation of flexible models, or the implementation of multiple models in a district. Conclusions: Understanding how models for organising care have evolved may assist policy implementers to tailor implementation to promote particular patterns of care organisation or encourage flexibility, based on patient needs and local health system resources. Our approach can contribute towards the development of a health systems typology for understanding how policy-driven models of service delivery are implemented in the context of variable resources.pubpu

Organisation of care for people receiving drug-resistant tuberculosis treatment in South Africa: a mixed methods study.

OBJECTIVES: Treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is increasingly transitioning from hospital-centred to community-based care. A national policy for decentralised programmatic MDR/RR-TB care was adopted in South Africa in 2011. We explored variations in the implementation of care models in response to this change in policy, and the implications of these variations for people affected by MDR/RR-TB. DESIGN: A mixed methods study was done of patient movements between healthcare facilities, reconstructed from laboratory records. Facility visits and staff interviews were used to determine reasons for movements. PARTICIPANTS AND SETTING: People identified with MDR/RR-TB from 13 high-burden districts within South Africa. OUTCOME MEASURES: Geospatial movement patterns were used to identify organisational models. Reasons for patient movement and implications of different organisational models for people affected by MDR/RR-TB and the health system were determined. RESULTS: Among 191 participants, six dominant geospatial movement patterns were identified, which varied in average hospital stay (0-281 days), average patient distance travelled (12-198 km) and number of health facilities involved in care (1-5 facilities). More centralised models were associated with longer delays to treatment initiation and lengthy hospitalisation. Decentralised models facilitated family-centred care and were associated with reduced time to treatment and hospitalisation duration. Responsiveness to the needs of people affected by MDR/RR-TB and health system constraints was achieved through implementation of flexible models, or the implementation of multiple models in a district. CONCLUSIONS: Understanding how models for organising care have evolved may assist policy implementers to tailor implementation to promote particular patterns of care organisation or encourage flexibility, based on patient needs and local health system resources. Our approach can contribute towards the development of a health systems typology for understanding how policy-driven models of service delivery are implemented in the context of variable resources