Tuberous sclerosis in a Bantu female

No Abstrac

Adenoma sebaceum with psychosis in a Bantu woman

No Abstrac

Walking the last mile on the long road to evidence-informed development: building capacity to use research evidence

The systematic application of rigorous evidence to inform the design and implementation of development policies and programmes has the potential to positively influence development outcomes. To achieve such evidence-informed development, a process of generating, transmitting, and using high-quality, policy-relevant evidence of development effectiveness is required. This article focuses on the final step in this casual chain – the use of evidence by national development policymakers. It proposes a people- and demandfocused approach to capacity building for the use of research evidence by policymakers. This support in building personal as well as team capacity and demand is assumed to encourage a growing institutionalisation of evidence use. The article integrates these capacity-building efforts into the wider theory of change for evidence-informed development, highlighting the importance of effective mechanisms to encourage research use in order to achieve the objective of improving lives through research evidence

Structural and Attitudinal Barriers to Bicycle Ownership and Cycle-Based Transport in Gauteng, South Africa

Policies that aim to facilitate and promote non-motorised transport (NMT), and in particular cycling, have been developed by many high-income countries facing increasingly congested roads and saturated public transport systems. Such policies are also emerging in many low- and middle-income settings where high rates of urbanisation have led to similar problems with motorised transport. The aim of the present study was to better understand the potential structural and attitudinal barriers to cycle-based transport in one such context: South Africa’s Gauteng Province, the industrial powerhouse of sub-Saharan Africa that has recently made a firm commitment to NMT. The study focussed on demographic and socioeconomic variation in bicycle and car ownership, and related this to: (1) the reported use of motorised and non-motorised transport (both private and public); and (2) perceived ‘problems’ with cycling. The analyses drew on interviews with key respondents from n = 27,490 households conducted in 2013 as part of the third Quality of Life survey undertaken by the Gauteng City Regional Observatory. The survey contained items on three outcomes of interest: household vehicle ownership (bicycles and cars); modes of transport used for the “trips” most often made; and respondents’ “single biggest problem with… cycling”. Respondent- and household-level demographic and socioeconomic determinants of these outcomes were examined using descriptive and multivariable statistical analyses, the latter after adjustment for measured potential confounders identified using a theoretical causal path diagram (in the form of a directed acyclic graph). Of the n = 26,469 households providing complete data on all of the variables examined in the present study, only n = 8722 (32.9%) owned a car and fewer still (n = 2244; 8.4%) owned a bicycle. The ownership of these assets was commonest amongst wealthier, economically active households; and those that owned a car had over five times the odds of also owning a bicycle, even after adjustment for potential confounding (OR 5.17; 95% CI 4.58, 5.85). Moreover, of household respondents who reported making ‘trips’ during the preceding month (n = 18,209), over two-thirds of those whose households owned a car (70.1%) reported private car-based transport for such trips, while only 3.2% of those owning a bicycle reported cycling. Amongst the specific responses given to the item requesting the “single biggest problem with… cycling” by far the commonest was “Don’t know how to cycle” (32.2%), less than half as many citing “Vehicle accident risk” (15.9%), and fewer still: “Destination is too far” (13.9%); “Crime” (10.3%); “Too much effort” (9.2%); or “Lack of good paths” (4.6%). While the first of these reasons was commonest amongst poorer households, concerns about risk and effort were both most common amongst better educated, economically active and wealthier/better serviced households. In contrast, concerns over (cycle) paths were only common amongst those owning bicycles. The low prevalence of household bicycle ownership, and the disproportionate number of households owning bicycles that also owned cars, might explain the very small proportion of the ‘the trips most often made’ that involved cycle-based transport (0.3%), and the preferential use of cars amongst households owning both bicycles and cars. Low levels of bicycle ownership might also explain why so many respondents cited “Don’t know how” as the “single biggest problem with… cycling”; although risk and effort were also substantial concerns (presumably for many who did, and some who did not, know how to cycle); the lack of suitable cycle lanes being only primarily a concern for those who actually owned bicycles. Structural and attitudinal barriers to cycle-based transport limit the use of cycle-based transport in Gauteng, not only amongst the vast majority of household respondents who lack the means to cycle (and the means to learn how), but also amongst those dissuaded from learning to cycle, purchasing a bicycle and/or using a bicycle they own by: the risks and effort involved; the lack of suitable cycle paths; and/or because they also own a car and prefer to drive than cycle

Introducing Johannesburg’s new cycle lanes to potential student users: experiences, impact and recommendations

The present study evaluated an intervention designed to introduce University students as potential users of Johannesburg’s cycle lanes. Participants: A total of 393 undergraduate and postgraduate students from the University of Johannesburg took part. Methods: Following cycling and safety training, participants undertook a 1.2 km supervised cycle ride between University of Johannesburg campuses using loaned bicycles. The evaluation of the intervention drew on quantitative and qualitative data collected using participant questionnaires; and fieldworkers’ photographic and reflective accounts. Results: Perceived cycling competency improved following the intervention, though similar proportions of participants became more and less interested in bicycle ownership (7-8%). The physical effort entailed; and flaws in the design and maintenance of cycle lanes (that affected utility and safety) were the strongest themes emerging from the qualitative analyses. Conclusions: The supervised cycle rides improved perceived cycling competency, but also enabled participants to reappraise the potential benefits and desirability of bicycle ownership

Economic vulnerability and poor service delivery made it more difficult for shack-dwellers to comply with COVID-19 restrictions : the impracticability and inequitable burden of universal/unstratified public health policies

In South Africa, demand for housing close to viable/sustained sources of employment has far outstripped supply; and the size of the population living in temporary structures/shacks (and in poorly serviced informal settlements) has continued to increase. While such dwellings and settlements pose a number of established risks to the health of their residents, the present study aimed to explore whether they might also undermine the potential impact of regulations intended to safeguard public health, such as the stringent lockdown restrictions imposed to curb the spread of COVID-19 in 2020 and 2021. Using a representative sample of 1,381 South African households surveyed in May-June 2021, the present study found that respondents in temporary structures/shacks were more likely to report non-compliance (or difficulty in complying) with lockdown restrictions when compared to those living in traditional/formal houses/flats/rooms/hostels (OR:1.61; 95%CI:1.06-2.45). However, this finding was substantially attenuated and lost precision following adjustment for preceding sociodemographic and economic determinants of housing quality (adjusted OR:1.20; 95%CI:0.78-1.87). Instead, respondents were far more likely to report non-compliance (or difficulty in complying) with COVID-19 lockdown restrictions if their dwellings lacked private/indoor toilet facilities (adjusted OR:1.56; 95%CI:1.08,2.22) or they were ‘Black/African’, young, poorly educated and under-employed (regardless of: their socioeconomic position, or whether they resided in temporary structures/shacks, respectively). Restrictions imposed to safeguard public health need to be more sensitively designed to accommodate the critical role that poverty and inadequate service delivery play in limiting the ability of residents living in temporary structures/shacks and inadequately serviced dwellings/settlements to comply

Training South African clinician-scientists: Lessons from the University of Cape Town’s intercalated programme

In 2011, the Faculty of Health Sciences at the University of Cape Town, South Africa (SA), established the Clinician-Scientist Training Programme (UCTCSTP), consisting of intercalated BMedSci Hons/MB ChB and integrated MB ChB/MSc/PhD tracks. We report and reflect on the programme’s performance and challenges. The UCTCSTP has so far enrolled 71 students: 51 have received BMedSci Hons degrees and 4 have received Master’s degrees, while there are 14 BMedSci Hons, 4 MSc and 4 PhD candidates. Graduates have produced significant research outputs, and many remain actively engaged in research. The UCTCSTP has been successful in encouraging a cohort of future clinician-scientists, but should aim to broaden and improve its appeal to address the need to transform and grow the SA clinical academic workforce. As graduates progress with their postgraduate clinical training, they require institutional support and guidance, which may necessitate policy reform