Factors that influence utilization of primary health facilities by adolescents in Tafelsig, Mitchells Plain

Magister Public Health - MPHPromoting positive and healthy decision-making practices and encouraging the utilization of health care facilities amongst adolescents is an important public health priority given that the period of adolescence is characterized by experimentation and risk taking behaviour. In the Tafelsig area of Mitchell‟s Plain, a poor socio-economic community within the Cape Town metropole, adolescents are exposed to a range of social problems (such as alcohol and substance abuse) that can potentially be harmful to their health. Given this context there was some concern raised by the sub-district health management team that adolescents are not making sufficient use of the local health facilities. The purpose of this study was to gain a greater understanding of the factors that contribute to, or hinder, the utilization by adolescents of the public health facilities in the Tafelsig area and in turn provide the Department of Health with information on adolescents‟ preferences concerning access to and use of the local primary-level health services in Mitchells Plain.An exploratory descriptive study was conducted to explore the topic using qualitative research methods. Permission to conduct the research was obtained from the Higher Degrees Committee of the University of the Western Cape and the School Principal. In-depth interviews were conducted with eight Grade 9 and seven Grade 10 male and female learners from the local secondary school - all of whom were randomly selected from a list of learners who indicated their willingness to participate in the study and who had obtained the written consent from their parents or guardian to do so. Interviews with the learners explored the positive and negative experiences, perceptions and opinions they have of using – or contemplating the use of – the local health facilities. The data from these interviews were analyzed using thematic content analysis.The study demonstrated that even when public health services are available, adolescents are often not in a position themselves to choose for themselves: their parents or guardians invariably make the choice for them. At times they are also reluctant to use public health facilities for fear of being judged by health personnel for being sexually active. The idea of waiting for long periods of time to see a health professional, or being observed at the health facility by other members of their community, are also considered to be disincentives.Many of the learners interviewed expressed a need for more information about sexual and reproductive health issues and matters that affect their health. The findings of this study also suggest that there is an urgent need for youth-friendly health services to be made available in the Mitchells Plain community. It is thus recommended that the Department of Health strategically assess whether an existing public health facility can be re-orientated to cater for the specific health needs of adolescents in Mitchells Plain

The Impact of Densification by Means of Informal Shacks in the Backyards of Low-Cost Houses on the Environment and Service Delivery in Cape Town, South Africa

This paper investigates the state-sponsored low cost housing provided to previously disadvantaged communities in the City of Cape Town. The strain imposed on municipal services by informal densification of unofficial backyard shacks was found to create unintended public health risks. Four subsidized low-cost housing communities were selected within the City of Cape Town in this cross-sectional survey. Data was obtained from 1080 persons with a response rate of 100%. Illegal electrical connections to backyard shacks that are made of flimsy materials posed increased fire risks. A high proportion of main house owners did not pay for water but sold water to backyard dwellers. The design of state-subsidised houses and the unplanned housing in the backyard added enormous pressure on the existing municipal infrastructure and the environment. Municipal water and sewerage systems and solid waste disposal cannot cope with the increased population density and poor sanitation behaviour of the inhabitants of these settlements. The low-cost housing program in South Africa requires improved management and prudent policies to cope with the densification of state-funded low-cost housing settlements

Promoting Handwashing and Sanitation Behaviour Change in Low- and Middle-Income Countries: A Mixed-Method Systematic Review

This systematic review shows which promotional approaches are effective in changing handwashing and sanitation behaviour and which implementation factors affect the success or failure of such interventions. The authors find that promotional approaches can be effective in terms of handwashing with soap, latrine use, safe faeces disposal and open defecation. No one specific approach is most effective. However, several promotional elements do induce behaviour change. Different barriers and facilitators that influence implementing promotional approaches should be carefully considered when developing new policy, programming, practice, or research in this area

The health and sanitation status of specific low-cost housing communities as contrasted with those occupying backyard dwellings in the city of Cape Town, South Africa

Thesis (PhD)--Stellenbosch University, 2011.ENGLISH ABSTRACT: South Africa embarked on an ambitious program to rehouse the informally housed poor. These initiatives were formerly called the RDP and later the BNG programmes. This was aimed at improving the living conditions of the urban poor and consequently their health and poverty status. These low-cost houses were quickly augmented by backyard shacks in almost all settlements. The present study is an epidemiological assessment of the health and sanitation status of inhabitants of specific low cost housing communities in the City of Cape Town as contrasted with those occupying ‘backyard dwellings’ on the same premises. The study was undertaken in four low-cost housing communities identified within the City. A health and housing evaluation, together with dwelling inspections were carried out in 336 randomly selected dwellings accommodating 1080 inhabitants from Tafelsig, Masipumelela, Driftsands and Greenfields. In addition, the microbiological pollution of surface run-off water encountered in these settlements was assessed by means of Escherichia coli levels (as found by ColilertTM Defined Substrate Technology) as an indication of environmental health hazards. The study population was classified as ‘young’ - 43% of the study population was aged 20 years or younger. Almost a third of households were headed by a single-parent female. In all four communities combined, 47.3% of households received one or other form of social grant. At the time of inspection 58% of the toilets on the premises were non-operational, while all the houses showed major structural damage - 99% of homeowners reported not being able to afford repairs to their homes. In 32% of dwellings one or more cases of diarrhoea were reported during the two weeks preceding the survey. Five percent of the participants willingly disclosed that they were HIV positive, while 11% reported being TB positive (one of them Multiple Drug Resistant TB). None of the HIV positive or TB positive persons was on any treatment. The E. coli levels of the water on the premises or sidewalks varied from 750 to 1 580 000 000 organisms per 100 ml of water - thus confirming gross faecal pollution of the environment. Improvements in health intended by the re-housing process did not materialise for the recipients of low-cost housing in this study. The health vulnerability of individuals in these communities has considerable implications for the health services. Sanitation failures, infectious disease pressure and environmental pollution in these communities represent a serious public health risk. The densification caused by backyard shacks also has municipal service implications and needs to be better managed. Policies on low-cost housing for the poor need realignment to cope with the realities of backyard densification so that state-funded housing schemes can deliver the improved health that was envisaged at its inception. This is in fact a national problem affecting almost all of the state funded housing communities in South Africa. Public health and urban planning need to bridge the divide between these two disciplines in order to improve the health inequalities facing the urban poor.AFRIKAANSE OPSOMMING: Suid-Afrika is besig met 'n ambisieuse program om diegene wat in informele behuising woon te hervestig. Hierdie inisiatiewe is voorheen die HOP en tans die “BNG” programme genoem. Hierdie hervestigingsprogramme is gemik daarop om die lewensomstandighede van die stedelike armes en dus hulle gesondheid- en armoedestatus te verbeter. Hierdie laekoste huise is algou in byna alle nedersettings aangevul deur krotwonings in die agterplase. Die huidige studie is 'n epidemiologiese beoordeling van die gesondheid en sanitasiestatus van inwoners van spesifieke laekoste behuisingsgemeenskappe in die Stad Kaapstad in vergelyking met diegene wat krotwonings op dieselfde erwe bewoon. Die studie is onderneem in vier laekoste-behuising gemeenskappe geselekteer in die stadsgebied. 'n Gesondheid- en behuisingevaluasie tesame met 'n inspeksie van elke woning is uitgevoer in 336 ewekansig geselekteerde wonings wat 1080 inwoners gehuisves het. Die woonbuurte was Tafelsig, Masipumelela, Driftsands en Greenfields. Mikrobiologiese besoedelingsvlakke van oppervlak-afloopwater in hierdie gemeenskappe is bepaal deur middel van die bepaling van Escherichia coli vlakke (met behulp van ColilertTM Gedefinieerde Substraat Tegnologie) as aanduiding van gesondheidsgevare in die omgewing. Die studiepopulasie is as ‘jonk’ geklassifiseer - 43% was 20 jaar of jonger. Amper een-derde van die huishoudings het 'n enkelouer-vrou aan die hoof gehad. In al vier gemeenskappe gesamentlik het 47.3% van die huishoudings die een of ander vorm van maatskaplike toelae ontvang. Tydens inspeksie is 58% van die toilette op die erwe as "nie-funksioneel" bevind, terwyl al die huise substansiële strukturele skade getoon het - 99% van die huiseienaars het gerapporteer dat hulle nie herstelwerk aan hulle huise kan bekostig nie. In 32% van die wonings is daar een of meer gevalle van diarree gedurende die voorafgaande twee weke voor die opname gerapporteer. Vyf persent van die deelnemers het vrywillig gerapporteer dat hulle HIV positief was terwyl 11% gerapporteer het dat hulle TB positief was (een was Veelvuldige Middelweerstandige TB). Nie een van die HIV positiewe of TB positiewe persone was op enige behandeling nie. Die E. coli vlakke van die water op die erwe of sypaadjies het gewissel vanaf 750 to 1 580 000 000 organismes per 100 ml water - wat erge fekale besoedeling van die omgewing bevestig het. Die verbetering in gesondheid wat deur die hervestigingsproses voorsien is, het nie gematerialiseer vir die ontvangers van die laekoste-behuising in hierdie studie nie. Die kwesbaarheid van die gesondheid van die individue in hierdie gemeenskappe hou groot implikasies vir gesondheidsdienste in. Sanitasiefalings, infektiewe siektedruk en omgewingsbesoedeling hou groot openbare gesondheidsrisiko in. Die verdigting wat deur agterplaaskrotte meegebring word asook die gevolge vir munisipale dienste benodig beter bestuur. Beleide oor laekoste-behuising vir armes kort herbeplanning om die realiteite wat saamgaan met verdigting deur agterplaaskrotte te kan hanteer sodat die verwagte verbetering in gesondheid kan materialiseer. Hierdie is inderwaarheid 'n nasionale probleem wat omtrent alle staatsbefondste laekoste-behuising gemeenskappe in Suid-Afrika affekteer. Openbare gesondheid en stadsbeplanning behoort die skeiding tussen hierdie twee dissiplines te oorbrug om sodoende die ongelyke gesondheidstatus van die stedelike armes aan te spreek

Antifungal activity of epithelia from selected frogs species of the south Western Cape of South Africa

Thesis (MTech Biomedical Technology)) ---Cape Peninsula University of Technology, 2008Resistance to antibiotics has been acknowledged as a major global public health problem. The use of peptides to provide alternatives to combat multi drug resistant organisms is of current relevance to overcome antibiotic resistance. The high deversity of amphibian skin peptides render these animals a potential source for the discovery of novel drugs

The health status of the elderly receiving an old age pension in urban communities in the City of Cape Town

Thesis (MSc)--Stellenbosch University, 2012.ENGLISH ABSTRACT: In developing countries the increasing number of the aged are often viewed as a problem. In particular, the indigent elderly residing in poor urban areas are at risk of becoming marginalised and underserved. The Western Cape has the third largest elderly population in proportion to the total population in the country. Social assistance in the form of a monthly pension is paid out to all elderly who pass a national means test carried out by South African Social Security Agency (SASSA). An assessment of the characteristics and health status of the elderly collecting old age pensions living in low-income urban poor communities in the City of Cape Town was carried out at pension pay points across four communities, i.e. Gugulethu, Khayelitsha, Mitchells Plain and Bonteheuwel. In community health surveys, choices regarding the methodology have to be made that can have profound effects on the study design and study outcomes. The milieu of the present study is one of urban poverty and specifically those urban elderly who qualify for non-contributory pensions (also called social cash transfers or government grants). The paucity of existing community-based studies on old-age pensioners in the City of Cape Town meant that a cross-sectional survey with wide-ranging coverage of demographic, social and health factors was the most logical design to employ in order to determine the extent of present needs and generate hypotheses for further controlled studies. A systematic random sample of 703 elderly was drawn at nine pension pay-out points in Cape Town Metropole. No pensioners refused to participate in the study. Structured interviews were carried out covering demographics, number of dependents, living conditions, socioeconomic circumstances, health status and needs and utilisation of health services. A reported 43% of participants lived in shacks and 88% reported regularly eating less than 3 meals a day. Eighty-seven percent of respondents reported waiting 3 hours or longer for medication at a clinic while 90% reported being dissatisfied with the service at their clinic. Fifty-eight percent of pensioners reported not being able to see well while 83% did not know where to get their eyes tested. Almost 70% of pensioners said that they have been ill-treated by a family member and 64% scored as severely depressed on the geriatric depression scale. In this study, 266 pensioners solely supported 471 children of which 65 (14%) were disabled children. In 95% of cases the pensioner does not receive any support from the child's parents. The study found that the elderly on a state grant had considerable unmet health needs and required assistance with activities of daily living. The indigent pensioners in this study bore a huge duty of care for minor children as custodial grandparents while not receiving a high level of health support themselves.AFRIKAANSE OPSOMMING: Die toenemende aantal bejaardes word dikwels in ontwikkelende lande as 'n probleem gesien. In die besonder loop die bejaardes wat in lae-inkomste stedelike gebiede woon die risiko om gemarginaliseer te word en swak dienslewering te ondervind. Die Wes-Kaap het die derde grootste populasie van bejaardes in verhouding tot die totale bevolking in die provinsie. Sosiale bystand in die vorm van 'n maandelikse pensioen word betaal aan alle bejaardes wat die inkomstetoets slaag wat deur die Suid-Afrikaanse Agentskap vir Maatskaplike Sekerheid (SAAMS) uitgevoer word. 'n Ondersoek na die eienskappe en gesondheidstatus van bejaardes wat hulle ouderdomspensioene in lae-inkomste stedelike gemeenskappe in die Stad Kaapstad kom afhaal is uitgevoer. Die studie is gedoen by pensioen-uitbetaalpunte in vier gemeenskappe, naamlik Gugulethu, Khayelitsha, Mitchells Plein and Bonteheuwel. In gemeenskapsgesondheid-opnames moet keuses gemaak word ten opsigte van die metodologie wat diepgaande gevolge vir die studieontwerp en -uitkomste kan inhou. Die milieu van die huidige studie in dié van stedelike armoede en spesifiek die leefruimte van stedelike bejaardes wat kwalifiseer vir nie-bydraende pensioene (ook genoem sosiale kontantoordragte of staatstoelaes). Die gebrek aan bestaande studies van ouderdomspensioenarisse in Kaapstad het beteken dat 'n dwarsdeursnit-opname van die demografie, sosiale en gesondheidsfaktore die mees logiese ontwerp was om uit te voer. Dit is gedoen om die omvang van huidige behoeftes te bepaal en verdere hipoteses te genereer wat deur vergelykende studies ondersoek behoort te word. 'n Stelselmatige ewekansige steekproef van 703 bejaardes is getrek by nege betaalpunte in die Kaapse stadsgebied. Geen proefpersone het geweier om deel te neem nie. Gestruktureerde onderhoude is gevoer wat die volgende aspekte gedek het: demografiese eienskappe, aantal afhanklikes, gesondheidstatus en benutting van gesondheidsdienste. Van die deelnemers het 43% in informele behuising ("shacks") gewoon en 88% het gerapporteer dat hulle gereeld minder as 3 daaglikse maaltye eet. Daar het 87% gerapporteer dat hulle 3 uur of langer gewag het om medikasie by hulle plaaslike kliniek te ontvang terwyl 90% ontevrede was met die diens wat hulle by die kliniek ontvang het. Daar het 58% van die bejaardes gerapporteer dat hulle nie goed kan sien nie terwyl 83% van hulle nie geweet het waar hulle hulle oë kan laat toets nie. Omtrent 70% van bejaardes het gesê dat hulle deur 'n familielid mishandel word en 64% kon as ernstig depressief geklassifiseer word op die geriatriese depressieskaal. In hierdie studie was 266 pensioenarisse die enigste sorg en voog van 471 kinders van wie 65 (14%) gestremd was. In 95% van gevalle het die pensionaris geen geldelike of ander bydraes van die kind(ers) se ouers ontvang nie. Die studie het bevind dat bejaardes wat 'n staatstoelaag ontvang aansienlike onvervulde gesondheidsbehoeftes het en hulp benodig met aktiwiteite van daaglikse bestaan. Die behoeftige pensioenarisse in hierdie studie het 'n groot las gedra aan die versorging van minderjarige kinders as toesighoudende grootouers ("custodial grandparents") terwyl hulleself nie 'n hoë vlak van ondersteuning geniet nie

Antimicrobial properties of the skin secretions of frogs

Antimicrobial resistance results in increased morbidity and mortality, and increased health-care costs. Therefore the need to develop new classes of antibiotics is indispensable. Antimicrobial peptides are a relatively new class of potential antibiotics which are fast acting, possess broad-spectrum activity and are able to escape many of the currently known mechanisms of drug resistance. They have been shown to be active against Gram-negative and Gram-positive bacteria, fungi, enveloped viruses and even cancer cells. However, toxicity to healthy host cells remains a concern and has affected the clinical development of therapeutics based on antimicrobial peptides. The purpose of this review is to discuss recent advances in research focused on antimicrobial peptides from frogs and the challenges in conducting research in this area in southern Africa. An extensive literature review of relevant articles published between 1980 and the present was conducted using PubMed, ScienceDirect, Sabinet, Elsevier and GoogleScholar. There has been little research done on anurans from southern Africa which are endemic to the region, and there is therefore a need to focus on this group for the purposes of bioprospecting for potentially new antimicrobial peptide compounds

Engagement of stakeholders in the development of a Theory of Change for handwashing and sanitation behaviour change

A Theory of Change (ToC) is an approach to map programmes aimed at inducing change in a specific context, with the goal of increasing their impact. We applied this approach to the specific case of handwashing and sanitation practices in low- and middle-income countries and developed a ToC as part of a systematic review exercise. Different existing sources of information were used to inform the initial draft of the ToC. In addition, stakeholder involvement occurred and peer review took place. Our stakeholders included methodological (ToC/quantitative and qualitative research) and content experts (WASH (Water, Sanitation, Hygiene)/behaviour change), as well as end-users/practitioners, policy-makers and donors. In conclusion, the development of a ToC, and the involvement of stakeholders in its development, was critical in terms of understanding the context in which the promotional programmes are being implemented. We recommend ToC developers to work with stakeholders to create a ToC relevant for practice.status: publishe