A social history of the experiences of Africans with physical disabilities who were associated with the Cripple Care Association (renamed the Association for the Physically Challenged) in KwaZulu-Natal, 1970s to 2000s.

Master of Social Sciences in Historical Studies. University of KwaZulu-Natal, Durban 2017.This thesis provides an analysis of the social experiences of people with disabilities who belonged to the Cripple Care Association (CCA), which was later, renamed the Association for the Physically Challenged (APC). The experiences of people living with disabilities during apartheid and post-apartheid are different from one person to another. During apartheid race, class and gender influenced the lives of people with disabilities in what would become the province of KwaZulu-Natal especially in accessing resources. During the apartheid period, the state played a limited role in assisting and caring for the needs of people with impairments in South Africa. This compelled families to take an active role in caring for the needs of such persons. After 1994, the democratic government in South Africa produced a variety of policies for the betterment of people living with disabilities. This research also considers the experiences of people with disabilities who have lived in the post-apartheid period and looks at whether the lives of people with physical impairments has changed for the better

The limits and possibilities of monitoring and evaluation: a case study of the KwaZulu Natal Department of Co-operative Governance and Traditional Affairs (KZN CoGTA).

Master of Science in Political Science. University of KwaZulu-Natal, Pietermaritzburg 2016.As South Africa seeks to consolidate and deepen the country‟s democracy post-1994, subsequently it has had to focus on good governance to achieve efficiency and effectiveness in the conduct and operations of government. The country‟s development efforts towards improving accountability, transparency, efficiency as well as effectiveness of government in service delivery seeks to create and maintain high levels of performance in government departments. As a result monitoring and evaluation (M&E) has developed into a significant practice in guiding the transformation of the South African Public Service. M&E is the systematic assessment of the policy processes as well as the measurement of a policy‟s impact. It can be used to assess whether a policy or program achieves its objectives. M&E practice in South Africa is anchored towards developing an efficient Public Service that delivers on the objectives and mandate of the South African Government as enshrined in the country‟s post-1994 Constitution. In 2005, Cabinet approved a plan for the development of a Government-wide Monitoring and Evaluation System (M&E), which was envisaged as a system in which each department would have a functional M&E system. In 2009 a Ministry of Performance M&E was created in the Presidency, and a Department of Performance Monitoring and Evaluation (DPME) in January 2010 was established. Subsequently, monitoring and evaluation has become a subject of interest in public policy implementation. This study seeks to understand the limits and possibilities of monitoring and evaluation using the KwaZulu Natal Department of Co-operative Governance and Traditional Affairs (KZN CoGTA) as a case study. It aims to ascertain how M&E as defined in the National Monitoring and Evaluation Framework and the literature is implemented, conceptualised and used. KZN CoGTA is a South African provincial government Department whose legislative mandate according to the South African Constitution is to provide effective, transparent, accountable and coherent intergovernmental system for the Provincial government departments. Evidently, as a relatively new strategic and operational practice in the South African government, M&E exposes some of its own limits and possibilities. Ultimately, not all resources invested into M&E actually get implemented to strengthen transparency, accountability and improvement. The study adopted an interpretative approach whilst using a qualitative methodology to identify and capture meaning that informs the understanding and implementation of monitoring and evaluation, (M&E). Non-probability; purposive sampling was used to select elements for a specific purpose of their unique position and capabilities to provide information on practical and expert knowledge in M&E. Therefore, the data collection method includes interviews with relevant personnel in the M&E practice, as well as the documents about the implementation of monitoring and evaluation in KZN CoGTA, South Africa. The implementation of M&E which is the focus of the study was analysed within the theoretical framework of public policy implementation which involves monitoring and evaluation. The challenges encountered when implementing M&E within the various approaches such as the Results-Based Management are also analysed in order to understand the limits and possibilities of monitoring and evaluation. The results pointed to the importance of an improved and standardised M&E practice with enhanced and standardised coordination between different spheres of government in national, provincial and local government institutions, as responsible for monitoring the process of design, implementation and continuous monitoring and evaluation of the public service, aiming to improve the quality of its services

COVID-19 vaccine uptake, confidence and hesitancy in rural KwaZulu-Natal, South Africa between April 2021 and April 2022: A continuous cross-sectional surveillance study

High COVID-19 vaccine hesitancy in South Africa limits protection against future epidemic waves. We evaluated how vaccine hesitancy and its correlates evolved April 2021-April 2022 in a well-characterized rural KwaZulu-Natal setting. All residents aged >15 in the Africa Health Research Institute's surveillance area were invited to complete a home-based, in-person interview. We described vaccine uptake and hesitancy trends, then evaluated associations with pre-existing personal factors, dynamic environmental context, and cues to action using ordinal logistic regression. Among 10,011 respondents, vaccine uptake rose as age-cohorts became vaccine-eligible before levelling off three months post-eligibility; younger age-groups had slower uptake and plateaued faster. Lifetime receipt of any COVID-19 vaccine rose from 3.0% in April-July 2021 to 32.9% in January-April 2022. Among 7,445 unvaccinated respondents, 47.7% said they would definitely take a free vaccine today in the first quarter of the study time period, falling to 32.0% in the last. By March/April 2022 only 48.0% of respondents were vaccinated or said they would definitely would take a vaccine. Predictors of lower vaccine hesitancy included being male (adjusted odds ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.65-0.76), living with vaccinated household members (aOR:0.65, 95%CI: 0.59-0.71) and knowing someone who had had COVID-19 (aOR: 0.69, 95%CI: 0.59-0.80). Mistrust in government predicted greater hesitancy (aOR: 1.47, 95%CI: 1.42-1.53). Despite several COVID-19 waves, vaccine hesitancy was common in rural South Africa, rising over time and closely tied to mistrust in government. However, interpersonal experiences countered hesitancy and may be entry-points for interventions

Protocol: Leveraging a demographic and health surveillance system for Covid-19 Surveillance in rural KwaZulu-Natal

A coordinated system of disease surveillance will be critical to effectively control the coronavirus disease 2019 (Covid-19) pandemic. Such systems enable rapid detection and mapping of epidemics and inform allocation of scarce prevention and intervention resources. Although many lower- and middle-income settings lack infrastructure for optimal disease surveillance, health and demographic surveillance systems (HDSS) provide a unique opportunity for epidemic monitoring. This protocol describes a surveillance program at the Africa Health Research Institute�s Population Intervention Platform site in northern KwaZulu-Natal. The program leverages a longstanding HDSS in a rural, resource-limited setting with very high prevalence of HIV and tuberculosis to perform Covid-19 surveillance. Our primary aims include: describing the epidemiology of the Covid-19 epidemic in rural KwaZulu-Natal; determining the impact of the Covid-19 outbreak and non-pharmaceutical control interventions (NPI) on behaviour and wellbeing; determining the impact of HIV and tuberculosis on Covid-19 susceptibility; and using collected data to support the local public-sector health response. The program involves telephone-based interviews with over 20,000 households every four months, plus a sub-study calling 750 households every two weeks. Each call asks a household representative how the epidemic and NPI are affecting the household and conducts a Covid-19 risk screen for all resident members. Any individuals screening positive are invited to a clinical screen, potential test and referral to necessary care � conducted in-person near their home following careful risk minimization procedures. In this protocol we report the details of our cohort design, questionnaires, data and reporting structures, and standard operating procedures in hopes that our project can inform similar efforts elsewhere.</ns4:p

Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study.

BACKGROUND: There has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and non-communicable diseases in such a population in rural South Africa. METHODS: We did a cross-sectional study of eligible adolescents and adults from the Africa Health Research Institute demographic surveillance area in the uMkhanyakude district of KwaZulu-Natal, South Africa. The participants, who were 15 years or older, were invited to participate at a mobile health camp. Medical history for HIV, tuberculosis, hypertension, and diabetes was established through a questionnaire. Blood pressure measurements, chest x-rays, and tests of blood and sputum were taken to estimate the population prevalence and geospatial distribution of HIV, active and lifetime tuberculosis, elevated blood glucose, elevated blood pressure, and combinations of these. FINDINGS: 17 118 adolescents and adults were recruited from May 25, 2018, to Nov 28, 2019, and assessed. Overall, 52·1% (95% CI 51·3-52·9) had at least one active disease. 34·2% (33·5-34·9) had HIV, 1·4% (1·2-1·6) had active tuberculosis, 21·8% (21·2-22·4) had lifetime tuberculosis, 8·5% (8·1-8·9) had elevated blood glucose, and 23·0% (22·4-23·6) had elevated blood pressure. Appropriate treatment and optimal disease control was highest for HIV (78·1%), and lower for elevated blood pressure (42·5%), active tuberculosis (29·6%), and elevated blood glucose (7·1%). Disease prevalence differed notably by sex, across age groups, and geospatially: men had a higher prevalence of active and lifetime tuberculosis, whereas women had a substantially high prevalence of HIV at 30-49 years and an increasing prevalence of multiple and poorly controlled non-communicable diseases when older than 50 years. INTERPRETATION: We found a convergence of infectious and non-communicable disease epidemics in a rural South African population, with HIV well treated relative to all other diseases, but tuberculosis, elevated blood glucose, and elevated blood pressure poorly diagnosed and treated. A public health response that expands the successes of the HIV testing and treatment programme to provide multidisease care targeted to specific populations is required to optimise health in such settings in sub-Saharan Africa. FUNDING: Wellcome Trust, Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network. TRANSLATION: For the isiZulu translation of the abstract see Supplementary Materials section