Recall of early non-fatal suicidality in a nationally representative sample of South Africans

This is an Accepted Manuscript of an article published by Taylor & Francis in Ethnicity & Health on 1 March 2012, available online: http://www.tandfonline.com/10.1080/13557858.2012.664271.Objectives. Little is known about socio-demographic patterns of non-fatal suicidality in early life in South Africa. We investigated the prevalence of self-reported early suicidality (suicidal ideation, planning and attempts) in a nationally representative sample of South Africans. Design. As part of a larger mental health survey, 3158 individuals aged over 25 years were asked to recall whether they engaged in non-fatal suicidal behaviour in early life (measured from childhood to 25 years). Race-based discrimination institutionalised under Apartheid profoundly influenced delivery and outcomes in health and other social services. Racial categories entrenched during Apartheid were therefore used to analyse data collected from individuals born before 1946, 1947-1956, 1957-1966 and 1967-1976. Results. 3.4% (95% CI=2.6-4.1) of participants recalled early suicidal behaviour. The youngest group (born 1967-1976) recalled higher rates of early suicidality than older groups in all races. In unadjusted analysis, White people were 2.84 (95% CI=1.62-4.97) and Coloured people 1.84 (95% CI=1.15-2.93) times more likely than Black people to recall early suicidality. Individuals growing up in urban and higher socio-economic settings were approximately twice (OR=2.2; 95% CI=1.14-4.28 and OR=1.92; 95% CI=1.27-2.90) as likely to recall early suicidality as those growing up in rural and lower socio-economic settings. Those with post-primary education were 2.79 (CI=1.71-4.53) times as likely to recall early suicidality as those with no or only primary education. Racial differences ceased to be significant after adjustment for rural/urban location and other socioeconomic measures estimated for early life. Conclusion. The study provides novel evidence of increasing levels of early non-fatal suicidality recalled by younger South Africans. Levels appeared significantly higher in Whites than in Blacks. Socio-economic contexts in early life were interpreted as mediators rather than confounders of the association between race and recalled early suicidality. The findings for decreased levels of suicidality among participants growing up in lower socio-economic strata and rural settings in South Africa require further investigation. The need for widespread suicide prevention programmes targeting young people at a population level is emphasised

Developing lay health worker policy in South Africa: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Over the past half decade South Africa has been developing, implementing and redeveloping its Lay Health Worker (LHW) policies. Research during this period has highlighted challenges with LHW programme implementation. These challenges have included an increased burden of care for female LHWs. The aim of this study was to explore contemporary LHW policy development processes and the extent to which issues of gender are taken up within this process.</p> <p>Methods</p> <p>The study adopted a qualitative approach to exploring policy development from the perspective of policy actors. Eleven policy actors (policy makers and policy commentators) were interviewed individually. Data from the interviews were analysed thematically.</p> <p>Results</p> <p>Considerations of LHW working conditions drove policy redevelopment. From the interviews it seems that gender as an issue never reached the policy making agenda. Although there was strong recognition that the working conditions of LHWs needed to be improved, poor working conditions were not necessarily seen as a gender concern. Our data suggests that in the process of defining the problem which the redeveloped policy had to address, gender was not included. There was no group or body who brought the issue of gender to the attention of policy developers. As such the issue of gender never entered the policy debates. These debates focused on whether it was appropriate to have LHWs, what LHW programme model should be adopted and whether or not LHWs should be incorporated into the formal health system.</p> <p>Conclusion</p> <p>LHW policy redevelopment focused on resolving issues of LHW working conditions through an active process involving many actors and strong debates. Within this process the issue of gender had no champion and never reached the LHW policy agenda. Future research may consider how to incorporate the voices of ordinary women into the policy making process.</p

Inclusive education for deaf students: literacy practices and South African sign language

This is an Accepted Manuscript of an article published by Taylor & Francis in Southern African Linguistics and Applied Language Studies on 16 July 2012, available online: http://www.tandfonline.com/10.2989/16073614.2012.693707.This article considers the feasibility of inclusive education for Deaf students in a mainstream Further Education and Training (FET) classroom through the use of a South African Sign Language interpreter. It revisits the centrality of language in Deaf students' education and reports on progressive policy changes in the areas of language, education and disability in South Africa. The article surveys classroom discourse and literacy practices in a mainstream FET classroom, focusing particularly on students' acquisition of text literacy skills in Business English. Drawing on theoretical frameworks from the New Literacy Studies, Critical Discourse Analysis and the Social Model of Disability, the article argues that there is definitely potential for establishing inclusive education for Deaf students in a mainstream classroom. It however highlights that there are many difficulties and challenges around providing fully inclusive education for Deaf students. It was found that the signed interpretations in this classroom frequently represent an impoverished form of language while some types of pedagogic practice impede the interpreter's signing. The article concludes that interpreters and teachers need to be trained in forms of language and pedagogy that would benefit all students in class, including Deaf students