Institutionalizing Anti-Migrant Discourse in Public Healthcare: An Analysis of Medical Xenophobia against Zimbabwean Migrant Women in Johannesburg

The provision of healthcare services to African migrants within the South African public healthcare system has been characterized as marred by medical xenophobia. While the literature on xenophobia in the country draws connections between xenophobic violence and how the migrant is characterized through demeaning metaphors in the media and the political space, medical xenophobia literature somewhat remains with the burden of categorically connecting specific practices that constitute medical xenophobia with the broader anti-migrant discourse. Drawing on the narratives of Zimbabwean migrant women seeking antenatal care services within the public healthcare system in Johannesburg, this paper analyzes the utterances and practices of some healthcare providers to draw connections with the anti-migrant narratives obtaining in the media, the political space, and certain anti-migrant formations (bearers of discourse). Like studies before it, this paper observes medical xenophobia and relying on Foucault’s disciplinary power as a conceptual tool, it argues that the utterances by some public healthcare professionals are indeed unabridged rearticulations of the normalized anti-migrant discourse in various sites bearing anti-migrant discourse. While acknowledging that some bureaucrats’ practices are tangential to the anti-migrant discourse, which decouples their individual actions from the discursive norm, the paper maintains that the standardized anti-migrant discourse for the large part provides frames of reference for some healthcare providers on how to perceive and treat the migrant patient, as their utterances are a restage of this discourse, usually with little to no annotations

Menopause Transition and Labor Market Outcomes

Over the past 50 years, women have become important participants in the labor market. With the increase in the number of middle-aged women going through the menopause transition, the question arises as to the effect of this transition on the labor market. Previous studies have shown that reproductive cycles have a non-trivial negative effect on women’s labor market outcomes. Thus, the cessation of these reproductive cycles (menopause) should bring relief for these women. However, another body of literature asserts that the menopause transition itself has a negative effect on women’s mental and physical health and so may have a negative effect on labor market outcomes. This study seeks to explore the effect of the menopause transition on labor market outcomes. The empirical analyses are done using data from the National Longitudinal Survey of Young Women, with the key explanatory variables being the menopause transition stages: premenopause, perimenopause, surgical menopause and natural postmenopause. The regressions include a control for whether the woman experienced early menopause and whether she had a hysterectomy. The first part of the study examines the impact of the menopause transition on health using depression and the scores on the activities of daily living as the measures of health status. These analyses use cross sectional data drawn from the 1995 wave of the survey for activity limitations and the 2003 wave for the depression measure. The findings of these analyses indicate that the menopause transition increases the likelihood of depression and functional limitations. The main part of the study explores the effect of the menopause transition on the following labor market outcomes: labor force participation, hours worked, full time employment, wages, and self-employment. Ordinary Least Squares, the fixed effects model, the random effects model, and the family fixed effects (siblings) model are used to examine these questions. The analysis also uses 2SLS to correct for endogeneity of the menopause variables and the Heckman two-step procedure to correct for sample selection bias. The findings show that women in premenopause are less likely to be in the labor force than women in natural postmenopause, even after controlling for life-cycle variables. The results also indicate that there are certain benefits from using hormone replacement therapy (HRT), as women who had surgical menopause and are using hormones are more likely to be in the labor force than women with surgical menopause who are not using HRT. Women in premenopause and women in perimenopause are less likely to work full-time compared to women who experienced natural postmenopause. The findings also show that there are no significant differences in hours worked by women in the different menopause stages. Women in premenopause typically earn more than women in natural postmenopause. Furthermore, women in perimenopause and women with surgical menopause are more likely to be self employed. The findings indicate that, among a generally healthy population, the menopause transition results in an increase in labor supply. However, a wage penalty is observed among women in postmenopause, when compared to women who are premenopause. The implications of the findings are that menopause should not be medicalized but should be viewed in a social and cultural context as the changes that occur during the transition may open up possibilities for positive individual development. Thus the cessation of menstrual cycles brings relief for women and results in an increase in labor supply, albeit one associated with a wage penalty

The cost-effectiveness of multi-purpose HIV and pregnancy prevention technologies in South Africa.

INTRODUCTION: A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi-purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost-effectiveness of combinations of candidate multi-purpose prevention technologies (MPTs), in South Africa among general population women and female sex workers (FSWs). METHODS: We combined a cost model with a static model of product impact based on incidence data in South Africa to estimate the cost-effectiveness of five candidate co-formulated or co-provided MPTs: oral PrEP, intravaginal ring, injectable ARV, microbicide gel and SILCS diaphragm used in concert with gel. We accounted for the preferences of end-users by predicting uptake using a discrete choice experiment (DCE). Product availability and protection were systematically varied in five potential rollout scenarios. The impact model estimated the number of infections averted through decreased incidence due to product use over one year. The comparator for each scenario was current levels of male condom use, while a health system perspective was used to estimate discounted lifetime treatment costs averted per HIV infection. Product benefit was estimated in disability-adjusted life years (DALYs) averted. Benefits from contraception were incorporated through adjusting the uptake of these products based on the DCE and through estimating the costs averted from avoiding unwanted pregnancies. We explore the additional impact of STI protection through increased uptake in a sensitivity analysis. RESULTS: At central incidence rates, all single- and multi-purpose scenarios modelled were cost-effective among FSWs and women aged 16-24, at a governmental willingness-to-pay threshold of $1175/DALY averted (range:$214-$810/DALY averted among non-dominant scenarios), however, none were cost-effective among women aged 25-49 (minimum$1706/DALY averted). The cost-effectiveness of products improved with additional protection from pregnancy. Estimates were sensitive to variation in incidence assumptions, but robust to other parameters. CONCLUSIONS: To the best of our knowledge, this is the first study to estimate the cost-effectiveness of a range of potential MPTs; suggesting that MPTs will be cost-effective among higher incidence FSWs or young women, but not among lower incidence older women. More work is needed to make attractive MPTs available to potential users who could use them effectively

The significance of tasks in second language learning: The case of Africa University in Zimbabwe

Purpose: This study utilised the case study approach for an in-depth understanding of the practices of teaching English as a Second Language (ESL) at Africa University (AU), Zimbabwe. The study aimed to provide a description of unique and typical ESL experiences in a particular African context. Research Methodology: The study investigated 60 participants who were prospective undergraduate students enrolled in the ESL programme and were separated into two groups. Each group consisted of 30 participants who received task-based instruction hinged on reading, writing, listening, and speaking. Result: An analysis of the learners' performance revealed that tasks facilitate the learning of ESL by exposing learners to different problem-solving scenarios that required higher-order cognitive skills. Limitations: This study was based on the ESL classroom at AU, which enrols students from African countries. A similar study could be conducted with students from more diverse backgrounds to establish if the results of this study could be corroborated or refuted. Similar studies could also be conducted in other second language contexts where English is not the target language. Contribution: The results of this study are important for the discipline of ESL as they support existing knowledge that tasks allow learners to communicate using the correct grammatical structures in a given relevant context

Memory and violence: Displaced Zimbabwean rural communities reliving the memories of the March 2008 political violence.

This thesis is premised on the argument that a distinct kind of narrative (‘truth’) about political violence, a narrative of the first-person experience, a narrative that is valued for its power to counter totalising historical narratives, is thought to reside in the subjective experience of each individual. Be that as it may, this study aimed to answer the question: What meanings do rural Zimbabweans who were internally displaced by the March 2008 state-sponsored political violence attach to this violence? In particular, the study investigated these meanings in a context where the victims remain(ed) in close proximity to the perpetrators during and after the violence. It also examined these meanings in an alleged silence by the state and local communities, and how these meanings have shaped the victims’ present socio-political identities. In order to answer the question, in-depth narrative interviews were conducted with purposively selected respondents. The study assumed a qualitative exploratory design which was underpinned by the phenomenological and constructionist theoretical approaches. It was concluded that the victims’ interpretation of the state-sponsored political violence is negotiated and mediated in the course of interaction. The personal narrative of the memory attains some latent political and redemptive value when it is interpreted in a social context. The meanings of the violence particularly assume a complex moral and ethical plane in a scenario where the perpetrator remains a permanent feature in the victim’s physical and social space, without any recourse. The complexity is imminent as the victim has to contend with the socio-psychological effects of the daily direct interface with their unpunished aggressor especially due to the communal nature of rural life. It was also concluded that the 2008 state-sponsored violence was increasingly interpreted as unfinished business by the victims. More so, it was also understood to be synonymous and complicit with silence at the communal and national level. Thus, the silence was synonymous with adaptation to power relations, cultural censorship, and liminality. In terms of identity, the victims suffer an identity crisis. They have developed personalities that have arguably, failed to internalise a sense of self as trusting and trustworthy. Last, the identification of the violence as unfinished business has also led to the reaffirmation of the victims’ spiritual identities as they have invoked bewitchment to avenge the death of their loved ones and in the process try to reconnect with them spiritually by invoking their spirits to seek revenge

South African shipping and ship finance : constraints and prospects of container shipping joint venture

Study project (M. Phil.) -- University of Stellenbosch, 1999.ENGLISH SUMMARY: The changes taking place in the maritime trade provide broad and complex areas of interrelationships that can be identified as the main reason leading to the need for a joint venture South African container industry. The world economics and commercial developments, intense competition, low freight rates, high operational cost, liquidations, loss of market share and trade necessitated the investigation of market strategies that will provide the South African container industry with a sustainable comparative advantages on the traditional North/South route. This study addresses the benefits of a joint venture between Safmarine and a South African Black Operator. The benefit of the joint venture is dual. Firstly, the operational benefits are realising economies of scale, more access to capital finance, stronger bargaining power and acquisition of a bigger market share. Secondly, there are benefits to the South African Balance of Payments because of retained foreign exchange spending on freight rates, the gaining of foreign exchange on freight earnings, the benefits associated with the flying of the South African flag, the skills transfer and maintenance of management skills in South Africa, and the opportunity to create black economic empowerment. With the expected growth and recovery of an export-led economy the latent benefits of a South African operator could have been realised if such a joint venture could have come about. However, Safmarine Container Line was sold to a foreign shipowner, i.e. AP Moller. Although, most of the operational benefits can be realised with such a buy-out, South Africa has lost the opportunity to become a significant player in the· shipping trade with ancillary benefits.AFRIKAANSE OPSOMMING: Die veranderinge wat tans plaasvind in die maritieme handel veroorsaak wye en komplekse areas van onderlingsooreenkomste wat geidentifiseer kan word as die hoofrede vir die behoefte om 'n gesanientlike ooreenkoms in die Suid Afrikaanse houerskip industrie. Die wereld ekonomiese en kommersiele ontwikkelinge, hewige kompetisie, lae vragtariewe, hoe bed ryfskoste , likwidasies, verlies aan markaandeel en handel noodsaak die ondersoek na nuwe vergelykbare mark strategiee wat die Suid Afrikaanse houerskip industrie sal verseker van 'n langdurige kompeterende voordeel in die tradisionele Noord/Suid markte sal verseker. Hierdie studie spreek die voordele van 'n gesametlike ooreenkoms tusseo Safmarine, en 'n Suid Afrikaanse Swart Operateur aan, Die voordeel is tweeledig. Eerstens, die bedryfsvoordele deurdat skaalvoordele gerealiseer word, meer toegang tot kapitale finansiering verkry kan word, sterker mededingende mag en die verkryging van 'n groter markaandeel. Tweedens, is daar voordele vir die Suid Afrikaanse Betalingsbalans deurdie voorkoming van uitvloei van buitelandse val uta aan vraggeld en versekering, die inkomste uit vragverdienste, die verdien van buitelandse valuta aan vraggeld, die voordele wat gepaardgaan met die vaar van die Suid Afrikaanse vlag, die oordrag van vaardigheid en die behoud van bestuursvermoe in Suid Afrika, en die geleentheid am swart ekonomiese vol mag te skep. Met die verwagte ekonomiess groei en herstel van 'n uitvoer-gebasseerde ekonomie kon die latente voordeel van 'n Suid Afrikaanse operateur verwesentlik word indien so 'n gesamentlike ooreenkoms plaas gevind het Nieteenstaande, Safmarine Container Line was verkoop aan 'n buitelandse skeepseienaar, i.e. AP. Moller. Alhoewel, meeste van die bedryfsvoordele verwesentlik word as gevolg van die transaksie, het Suid Afrika die geleentbeid verloor om 'n merkwaardige mededinger in die seehandel te word met die aanverwante voordele wat dit bied

HIV prevention is not all about HIV - using a discrete choice experiment among women to model how the uptake and effectiveness of HIV prevention products may also rely on pregnancy and STI protection.

INTRODUCTION: In sub-Saharan Africa, considerable HIV-burden exists among women. Anti-retroviral (ARV) based prevention products could decrease this burden, and their uptake could be increased if they also protect against pregnancy and sexually transmitted infections (STI). METHODS: A discrete choice experiment (DCE) was undertaken in South Africa (2015) through a household survey of adult females (n = 158) and adolescent girls (n = 204) who self-reported HIV-negative status. The DCE was used to project the uptake (percentage using product) of oral pre-exposure prophylaxis (PrEP), vaginal rings, and injectable long-lasting ARV agents among these women, and how uptake could depend on whether these products protect against pregnancy or STI acquisition. Uptake estimates were used to model how each product could decrease a women's HIV acquisition risk. RESULTS: In adolescent women, there will be limited uptake ( 14% of women will remain unprotected and > 31% of the baseline acquisition risk will remain. CONCLUSIONS: Incorporating multiple prevention components into new ARV-based prevention products may increase their uptake and impact among women

Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: Inherited mutations in deoxyribonucleic acid (DNA) mismatch repair (MMR) genes lead to an increased risk of colorectal cancer (CRC), gynaecological cancers and other cancers, known as Lynch syndrome (LS). Risk-reducing interventions can be offered to individuals with known LS-causing mutations. The mutations can be identified by comprehensive testing of the MMR genes, but this would be prohibitively expensive in the general population. Tumour-based tests - microsatellite instability (MSI) and MMR immunohistochemistry (IHC) - are used in CRC patients to identify individuals at high risk of LS for genetic testing. MLH1 (MutL homologue 1) promoter methylation and BRAF V600E testing can be conducted on tumour material to rule out certain sporadic cancers. OBJECTIVES: To investigate whether testing for LS in CRC patients using MSI or IHC (with or without MLH1 promoter methylation testing and BRAF V600E testing) is clinically effective (in terms of identifying Lynch syndrome and improving outcomes for patients) and represents a cost-effective use of NHS resources. REVIEW METHODS: Systematic reviews were conducted of the published literature on diagnostic test accuracy studies of MSI and/or IHC testing for LS, end-to-end studies of screening for LS in CRC patients and economic evaluations of screening for LS in CRC patients. A model-based economic evaluation was conducted to extrapolate long-term outcomes from the results of the diagnostic test accuracy review. The model was extended from a model previously developed by the authors. RESULTS: Ten studies were identified that evaluated the diagnostic test accuracy of MSI and/or IHC testing for identifying LS in CRC patients. For MSI testing, sensitivity ranged from 66.7% to 100.0% and specificity ranged from 61.1% to 92.5%. For IHC, sensitivity ranged from 80.8% to 100.0% and specificity ranged from 80.5% to 91.9%. When tumours showing low levels of MSI were treated as a positive result, the sensitivity of MSI testing increased but specificity fell. No end-to-end studies of screening for LS in CRC patients were identified. Nine economic evaluations of screening for LS in CRC were identified. None of the included studies fully matched the decision problem and hence a new economic evaluation was required. The base-case results in the economic evaluation suggest that screening for LS in CRC patients using IHC, BRAF V600E and MLH1 promoter methylation testing would be cost-effective at a threshold of £20,000 per quality-adjusted life-year (QALY). The incremental cost-effectiveness ratio for this strategy was £11,008 per QALY compared with no screening. Screening without tumour tests is not predicted to be cost-effective. LIMITATIONS: Most of the diagnostic test accuracy studies identified were rated as having a risk of bias or were conducted in unrepresentative samples. There was no direct evidence that screening improves long-term outcomes. No probabilistic sensitivity analysis was conducted. CONCLUSIONS: Systematic review evidence suggests that MSI- and IHC-based testing can be used to identify LS in CRC patients, although there was heterogeneity in the methods used in the studies identified and the results of the studies. There was no high-quality empirical evidence that screening improves long-term outcomes and so an evidence linkage approach using modelling was necessary. Key determinants of whether or not screening is cost-effective are the accuracy of tumour-based tests, CRC risk without surveillance, the number of relatives identified for cascade testing, colonoscopic surveillance effectiveness and the acceptance of genetic testing. Future work should investigate screening for more causes of hereditary CRC and screening for LS in endometrial cancer patients. STUDY REGISTRATION: This study is registered as PROSPERO CRD42016033879. FUNDING: The National Institute for Health Research Health Technology Assessment programme.Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Researc