Social capital, community-based governance and resilience in an African artisanal river fishery

This is a study of a community-based fishery on the Rovuma River that forms the border between Mozambique and Tanzania. We postulate a relationship between social capital and community-based governance over access to and the use of the fish resource. In historical times social capital was high and community-based governance regulated access to and use of the fishery as a common property resource. Transforming forces particularly colonial administration, advocating Christianity, war and an emerging market economy undermined social capital, which in turn affected community-based governance. The deconstruction of social capital has resulted in attitudes and behaviours that challenge governance processes with dire consequences for sustainable resource utilisation. Harvesting of fish stocks occurs at levels that are no longer sustainable and inappropriate practices are being adopted. While the Mozambique government policy promotes community-based fisheries management in artisanal fisheries, we argue that under current conditions of ineffective community-based governance, a strong focus on reconstruction of social capital will be required before a community-based resource management process can be effectively implemented. The findings are discussed in the context of resilience in social ecological systems. We suggest that given the historical context in which community-based natural resource management is promoted within southern Africa such a focus may have wide relevance

The effect of a back pain campaign on back beliefs, coping strategies and participant activation for nurses in Lusaka, Zambia

Thesis (PhD)--Stellenbosch University, 2021.ENGLISH SUMMARY : Introduction: The prevalence of back pain in nurses globally is high and ranges from 55-84%. In Africa, the prevalence of back pain reported in different studies among nurses ranges from 33%-73.5%. While, in Zambia the reported prevalence for back pain among nurses is 58.3%. Nurses are exposed to labour intensive, repetitive tasks which are often performed in stressful postures. Furthermore, the high occurrence of back pain in nurses is of major concern because it decreases working efficiency and affects the safety of the patients and healthcare outcomes. Aim: The overall aim of this study was to design and assess the effects of a cross-culturally validated back pain campaign on back beliefs, coping strategies and participant activation for nurses in Lusaka, Zambia. Research setting: The research was done in Lusaka at Chawama, Chingwere, Chilenje, Chelstone and Kayama first level hospitals. The hospitals provide various health services and public health programmes at community level. The hospitals were purposefully selected as study sites because of the substantial number of nurses working at the centres and their similarity in operation level and system compared to the other centers. Methodology: Three studies, with different methodologies based on the principle of evidence-based practice (EBP), were carried out as follows: Study 1: A systematic review of self-management education campaigns on back pain, with the aim to retrieve and synthesise the content, mode, and duration of published evidence based on lower back pain (LBP) campaigns, and to describe the outcomes and the effectiveness of the campaigns. Study 2: Cross-cultural validation and formulation of key evidence-based back pain messages for nurses in Zambia. The aim was to ascertain which local contextual factors could influence the understanding, feasibility and uptake of evidence-based messages reported in published campaigns. In addition, it was aimed to design the campaign based on the information obtained in Study 1 and ascertain content validation with experts. Study 3: A pre-post quasi-experimental study to evaluate the effectiveness of a cross-cultural validated back pain campaign for nurses in Lusaka, Zambia, regarding on-participant activation and back beliefs as key outcomes. Results: Articles reviewed (Study 1) had back campaigns conducted in the general population. It was reported that participant activation, awareness, and satisfaction about back pain improved in the general population as an overall effect of the campaigns. Messages delivered during the campaigns were cited as having been helpful in decreasing effects of pain disability and in improving work outcomes by influencing population attitudes and beliefs. Fourteen back pain messages were retrieved, synthesised (Study 1) and cross-culturally validated for implementation among nurses in Zambia (Study 2). All the back pain messages except for one (“back pain is rarely caused by a dangerous illness”) were adapted for use among nurses in Lusaka, Zambia. Effects of the back pain campaign on back beliefs and participant activation for self-management of back pain among nurses in Lusaka, Zambia, showed no significant differences, even though positive trends were observed in many outcomes such as the participant activation measures, where positive trends were recorded in all the 11 items when more people agreed with the statements after the campaign (Study 3). Positive trends were also observed in participants’ coping strategies, use of pain medication, frequency of doctor visits and number of sick-leave days. Conclusion: The back campaign had an influence on the attitudes towards back care goals albeit, not significant, and promoting healthy behaviours. In addition, the campaign demonstrated an effective approach that could decongest the healthcare system and minimise healthcare costs because of the reductions in the number of sick-leave days, frequency of doctor visits and use of pain medication during back pain experiences. Recommendation: The back pain campaign was an effective strategy to advance self-management of back pain in the nursing profession. Their work-setting is also a good arena for implementing practical strategies aimed at promoting health and minimising the effects of back pain experiences.AFRIKAANSE OPSOMMING : Agtergrond: Die prevalensie van rugpyn onder verpleegkundiges is wêreldwyd hoog en wissel tussen 55% en 84%. In Afrika wissel die prevalensie van rugpyn in verskillende studies onder verpleegkundiges tussen 33% en 73.5%. In Zambië is die algemene voorkoms van rugpyn onder verpleegkundiges 58.3%. Verpleegkundiges word blootgestel aan arbeidsintensiewe, herhalende take wat dikwels in stresvolle liggaamsposture uitgevoer word. Die hoë voorkoms van rugpyn onder verpleegkundiges is 'n groot bron van kommer omdat dit werksdoeltreffendheid verminder en die veiligheid van pasiënte asook gesondheidsuitkomste beïnvloed. Doel: Die oorkoepelende doel van hierdie studie was om 'n kruiskultureel-gevalideerde rugpynveldtog vir verpleegkundiges in Lusaka, Zambië, te ontwerp, en die effektiwiteit daarvan te assesseer, in terme van rugpyn-oortuigings, hanteringstrategieë en deelname-aktivering. Navorsingsopset: Die navorsing is uitgevoer in Lusaka in die Chawama, Chingwere, Chilenje, Chelstone en Kayama eerstevlak-hospitale. Die hospitale bied verskillende gesondheidsdienste en openbare gesondheidsprogramme op gemeenskapsvlak. Die hospitale is doelgerig as studiegebiede gekies vanweë die groot aantal verpleegkundiges wat by die sentrums werk en die soortgelyke bedryfsvlakke en stelsels vergeleke met die ander sentrums. Metodologie: Drie studies, met verskillende metodologieë gebaseer op die beginsel van bewysgesteunde praktyk (BGP), is uitgevoer as volg: Studie 1: ʼn Sistematiese oorsig van selfbestuur-opvoedingsveldtogte oor rugpyn, met die doel om gepubliseerde navorsing oor die inhoud, modus en duur van lae rugpyn (LRP)-veldtogte op te spoor en te sintetiseer, en om die uitkomste en doeltreffendheid van die veldtogte te beskryf. Studie 2: Kruiskulturele validering en formulering van sleutel-bewysgesteunde rugpynboodskappe vir verpleegkundiges in Zambië. Die doel was om vas te stel watter plaaslike kontekstuele faktore die begrip, uitvoerbaarheid en opname van bewysgesteunde boodskappe wat in gepubliseerde veldtogte gerapporteer is, kan beïnvloed. Daarbenewens het hierdie studie ook ten doel gehad om die veldtog te ontwerp op grond van die inligting wat in Studie 1 verkry is, en om die inhoud daarvan onder kundiges te valideer. Studie 3: ʼn Voor-na kwasi-eksperimentele studie om die doeltreffendheid van 'n kruiskultureel-gevalideerde rugpynveldtog vir verpleegkundiges in Lusaka, Zambië, te evalueer, met die inagname van deelname-aktivering en rug-oortuigings as sleuteluitkomste. Resultate: Artikels wat nagegaan is (Studie 1) het rugpynveldtogte wat in die algemene bevolking uitgevoer is, bevat. Daar is gerapporteer dat deelname-aktivering, bewustheid en tevredenheid oor Stellenbosch University https://scholar.sun.ac.za vi | P a g e rugpyn in die algemene bevolking verbeter het as 'n algemene effek van die veldtogte. Boodskappe wat tydens die veldtogte gelewer is, is aangehaal as nuttig om die effekte van pyngestremdheid te verminder en werksuitkomste te verbeter, deur die bevolking se instellings en oortuigings te beïnvloed. Veertien rugpynboodskappe is geïdentifiseer, gesintetiseer (Studie 1) en kruiskultureel gevalideer vir implementering onder verpleegkundiges in Zambië (Studie 2). Al die rugpynboodskappe, behalwe een (“rugpyn word selde deur 'n gevaarlike siekte veroorsaak”), is aangepas vir gebruik onder verpleegkundiges in Lusaka, Zambië. Effekte van die rugpynveldtog op rug-oortuigings en deelnemeraktivering vir die selfbestuur van rugpyn onder verpleegkundiges in Lusaka, Zambië, het geen beduidende verskille getoon nie, alhoewel positiewe tendense waargeneem is in heelwat uitkomste; insluitend die deelnemeraktivering-maatstawwe, waar positiewe tendense waargeneem is in al 11 items wanneer meer mense saamgestem het met die stellings ná die veldtog (Studie 3). Positiewe tendense is ook waargeneem in deelnemers se hanteringstrategieë, gebruik van pynmedikasie, die frekwensie van doktersbesoeke en die aantal siekteverlofdae. Gevolgtrekking: Die rugpynveldtog het 'n invloed gehad op verpleegkundiges se houdings teenoor rugsorgdoelstellings, hoewel nie betekenisvol nie, en het gesonde gedrag bevorder. Daarbenewens het die veldtog 'n effektiewe benadering getoon wat kongestie van die gesondheidsorgstelsel kan verlig en gesondheidsorgkoste tot 'n minimum kan beperk weens die vermindering in die aantal siekteverlofdae, frekwensie van doktersbesoeke en pynmedikasie-gebruik tydens rugpyn-episodes. Aanbeveling: Die rugpynveldtog was ʼn effektiewe strategie om die selfbestuur van rugpyn in die verpleegsberoep te bevorder. Verpleegkundiges se werksopset is ook 'n goeie arena vir die implementering van praktiese strategieë wat daarop gemik is om gesondheid te bevorder en die gevolge van rugpyn-ervarings tot die minimum te beperk.Doctora

The prevalence and factots for work-related Musculoskeletal Disorders among physiotherapy personnel in Lusaka, Kitwe and Ndola

Injuries at a work place comprise a substantial part of injury burden. They are an important public health problem that affects not only the person sustaining the injury but other household members that are dependent on the injured adult. Although, health workers frequently treat patients with work-related injuries, they also suffer from the same injuries.Injury rate among hospital workers is estimated to be twice that of other service industries. The cause is attributed to high levels of patient contact, as well as other variables in the health care environment. Work-related musculoskeletal disorders (WRMDs) are common in the field of physiotherapy because the nature of job tasks is physically challenging and therapeutic procedures are often repetitive, labour intensive and involves direct contact with patients.The aim of this study was to determine the prevalence and factors for WRMDs among physiotherapy personnel in Lusaka, Kitwe and Ndola districts. The objectives were to determine the proportion of physiotherapy personnel in Lusaka, Kitwe and Ndola that had experienced WRMDs, the extent to which work-load is associated to the development of WRMDs among physiotherapy personnel also, to establish the extent to which job tasks are associated to the development of WRMDs among physiotherapy personnel and to identify possible measures which could be put in place to reduce occurrence of WRMDs among physiotherapy personnel.This was a cross-sectional quantitative study. Data was collected using a self- administered semi structured questionnaire and analysed using SPSS version 16.0. for windows. Association of factors was tested using the uncorrected Pearson’s chi-square test. The cut off point for statistical significance, was set at 5%.Most of the respondents (n=82) experienced WRMDs that lasted for more than 3 days in the last 12 months to the survey. The lower back was the most frequently affected body part.Onset of symptoms was gradual for the majority and their first episode was within five years of graduation.WRMDs were common among physiotherapy personnel in Lusaka, Kitwe and Ndola.Outcomes reflects similar WRMDs, work factors and coping strategies for physiotherapists elsewhere. Therefore, it underlines the importance of further research with large sample sizes to examine factors associated with WRMDs and identify work practices that contribute to injury with a view to formulating preventive strategies

Incentives for Managing Water Demands: Lessons from the Umgeni River Basin, KwaZulu-Natal, South Africa

This paper examines the incentives for managing water demands from a catchment or basin perspective by focusing on defined property rights dimensions. Using property rights theory, the paper has investigated the existence of relationships between attributes of property rights and intentions of water users to conserve water. A case study was used to test whether property rights can be used as incentives in the management of water demands. The results from the analyses that were conducted using IBM SPSS indicated that property rights would be very significant in curtailing water demands in a catchment by acting as incentives in water resource utilisation, specifically by motivating water user users to conserve water. This is an important finding because it would thus help water resource managers to use a properly defined property rights system (better duration and secure tenure) to enable water users curtail the ever-increasing water demands in the river basins

Antiretroviral Therapy in the Malawi Police Force: Access to Therapy and Treatment Outcomes

A national survey was carried out in all the 103 public sector and 38 private sector facilities in Malawi providing antiretroviral therapy (ART) to determine uptake of ART and subsequent treatment outcomes in police force personnel. All patients registered for ART and their subsequent treatment outcomes were censored on December 31st 2006. There were 85168 patients started on ART in both public and private sectors, of whom 463 (0.6%) were police force personnel. Of police force personnel starting ART, 17% were in WHO clinical stage 1 or 2 with a CD4-lymphocyte count of ≤250 cells/μL and 83% were in stage 3 or 4. Treatment outcomes of police force personnel by the end of December 2006 were 302 (65%) alive and on ART at their registration facility, 59 (13%) dead, 30 (7%) lost to follow-up, 1 stopped treatment and 71 (15%) transferred to another facility. Their probability of being alive on ART at 6-, 12- and 18-months was 83.2%, 78.6% and 76.7% respectively. There has been a good access of police force personnel to ART since national scale up commenced with good treatment outcomes, and this should serve as an example for other police forces in the region. Malawi Medical Journal Vol. 20 (1) 2008 pp. 23-2

Multi-sectoral action in non-communicable disease prevention policy development in five African countries

Background The rise of non-communicable diseases (NCDs) in Africa requires a multi-sectoral action (MSA) in their prevention and control. This study aimed to generate evidence on the extent of MSA application in NCD prevention policy development in five sub-Saharan African countries (Kenya, South Africa, Cameroon, Nigeria and Malawi) focusing on policies around the major NCD risk factors. Methods The broader study applied a multiple case study design to capture rich descriptions of policy contents, processes and actors as well as contextual factors related to the policies around the major NCD risk factors at single- and multi-country levels. Data were collected through document reviews and key informant interviews with decision-makers and implementers in various sectors. Further consultations were conducted with NCD experts on MSA application in NCD prevention policies in the region. For this paper, we report on how MSA was applied in the policy process. Results The findings revealed some degree of application of MSA in NCD prevention policy development in these countries. However, the level of sector engagement varies across different NCD policies, from passive participation to active engagement, and by country. There was higher engagement of sectors in developing tobacco policies across the countries, followed by alcohol policies. Multi-sectoral action for tobacco and to some extent, alcohol, was enabled through established structures at national levels including inter-ministerial and parliamentary committees. More often coordination was enabled through expert or technical working groups driven by the health sectors. The main barriers to multi-sectoral action included lack of awareness by various sectors about their potential contribution, weak political will, coordination complexity and inadequate resources. Conclusion MSA is possible in NCD prevention policy development in African countries. However, the findings illustrate various challenges in bringing sectors together to develop policies to address the increasing NCD burden in the region. Stronger coordination mechanisms with clear guidelines for sector engagement are required for effective MSA in NCD prevention. Such a mechanisms should include approaches for capacity building and resource generation to enable multi-sectoral action in NCD policy formulation, implementation and monitoring of outcomes

Exploring the Equity Impact of a Maternal and Newborn Health Intervention: A Qualitative Study of Participatory Women's Groups in Rural South Asia and Africa

A consensus is developing on interventions to improve newborn survival, but little is known about how to reduce socioeconomic inequalities in newborn mortality in low- and middle-income countries. Participatory learning and action (PLA) through women's groups can improve newborn survival and home care practices equitably across socioeconomic strata, as shown in cluster randomised controlled trials. We conducted a qualitative study to understand the mechanisms that led to the equitable impact of the PLA approach across socioeconomic strata in four trial sites in India, Nepal, Bangladesh, and Malawi

Scalable Transdiagnostic Early Assessment of Mental Health (STREAM): a study protocol

Introduction Early childhood development forms the foundations for functioning later in life. Thus, accurate monitoring of developmental trajectories is critical. However, such monitoring often relies on time-intensive assessments which necessitate administration by skilled professionals. This difficulty is exacerbated in low-resource settings where such professionals are predominantly concentrated in urban and often private clinics, making them inaccessible to many. This geographic and economic inaccessibility contributes to a significant ‘detection gap’ where many children who might benefit from support remain undetected. The Scalable Transdiagnostic Early Assessment of Mental Health (STREAM) project aims to bridge this gap by developing an open-source, scalable, tablet-based platform administered by non-specialist workers to assess motor, social and cognitive developmental status. The goal is to deploy STREAM through public health initiatives, maximising opportunities for effective early interventions. Methods and analysis The STREAM project will enrol and assess 4000 children aged 0–6 years from Malawi (n=2000) and India (n=2000). It integrates three established developmental assessment tools measuring motor, social and cognitive functioning using gamified tasks, observation checklists, parent-report and audio-video recordings. Domain scores for motor, social and cognitive functioning will be developed and assessed for their validity and reliability. These domain scores will then be used to construct age-adjusted developmental reference curves. Ethics and dissemination Ethical approval has been obtained from local review boards at each site (India: Sangath Institutional Review Board; All India Institute of Medical Science (AIIMS) Ethics Committee; Indian Council of Medical Research—Health Ministry Screening Committee; Malawi: College of Medicine Research and Ethics Committee; Malawi Ministry of Health—Blantyre District Health Office). The study adheres to Good Clinical Practice standards and the ethical guidelines of the 6th (2008) Declaration of Helsinki. Findings from STREAM will be disseminated to participating families, healthcare professionals, policymakers, educators and researchers, at local, national and international levels through meetings, academic journals and conferences

Assessing the Validity of Sexual Behaviour Reports in a Whole Population Survey in Rural Malawi

Background: Sexual behaviour surveys are widely used, but under-reporting of particular risk behaviours is common, especially by women. Surveys in whole populations provide an unusual opportunity to understand the extent and nature of such under-reporting.Methods: All consenting individuals aged between 15 and 59 within a demographic surveillance site in northern Malawi were interviewed about their sexual behaviour. Validity of responses was assessed by analysis of probing questions; by comparison of results with in-depth interviews and with Herpes simplex type-2 (HSV-2) seropositivity; by comparing reports to same sex and opposite sex interviewers; and by quantifying the partnerships within the local community reported by men and by women, adjusted for response rates.Results: 6,796 women and 5,253 men (83% and 72% of those eligible) consented and took part in sexual behaviour interviews. Probing questions and HSV-2 antibody tests in those who denied sexual activity identified under-reporting for both men and women. Reports varied little by sex or age of the interviewer. The number of marital partnerships reported was comparable for men and women, but men reported about 4 times as many non-marital partnerships. The discrepancy in reporting of non-marital partnerships was most marked for married women (men reported about 7 times as many non-marital partnerships with married women as were reported by married women themselves), but was only apparent in younger married women.Conclusions: We have shown that the under-reporting of non-marital partnerships by women was strongly age-dependent. The extent of under-reporting of sexual activity by young men was surprisingly high. The results emphasise the importance of triangulation, including biomarkers, and the advantages of considering a whole population