scholarly journals How local context influences access to neuropsychological rehabilitation after acquired brain injury in South Africa

2019 ◽  
Vol 4 (Suppl 10) ◽  
pp. e001353
Author(s):  
Noorjehan Joosub
Keyword(s):  
South Africa ◽  
Brain Injury ◽  
Low Income ◽  
Resource Constraints ◽  
Acquired Brain Injury ◽  
Local Context ◽  
Contextual Influences ◽  
Healthcare Resources ◽  
Middle Income ◽  
Neuropsychological Rehabilitation

The numbers of acquired brain injury (ABI) survivors in South Africa are increasing; however, facilities to provide neuropsychological rehabilitation are limited due to a lack of healthcare resources. The updated International Classification of Health, Functioning, and Disability (ICF) from the WHO emphasises how the context of an impairment influences the patient’s activity limitations and participation restrictions. This analysis examined South African contextual influences on the accessibility, quality and efficiency of neuropsychological rehabilitation interventions after ABI in South Africa. Three main contextual influences were identified, namely, socioeconomic disparities, sociocultural influences and discharge to underprepared communities. Systems thinking and inclusive models of healthcare are needed in low-income and middle-income countries, such as South Africa, where resource constraints necessitate creative and ecological forms of rehabilitation interventions after ABI. Contextual influences are vital to consider when designing neuropsychological rehabilitation interventions in order to improve the accessibility and relevance of these interventions and to ensure the effective utilisation of scarce healthcare resources.

scholarly journals The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: call for a contextualised pandemic response in LMICs

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tanvir Ahmed ◽  
Ahmed Ehsanur Rahman ◽  
Taiwo Gboluwaga Amole ◽  
Hadiza Galadanci ◽  
Mushi Matjila ◽  
...  
Keyword(s):  
South Africa ◽  
Resource Constraints ◽  
Childhood Mortality ◽  
Health Priorities ◽  
Local Context ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Middle Income Countries ◽  
Care Family ◽  
Development Goals

AbstractGlobal response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and laregely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). Here we have explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic. Our findings suggest that between March and May 2020, there was a reduction in utilisation of basic essential MNCH services such as antenatal care, family planning and immunization due to: a) the implementation of lockdown which triggered fear of contracting the COVID-19 and deterred people from accessing basic MNCH care, and b) a shift of focus towards pandemic, causing the detriment to other health services, and c) resource constraints. Taken together these issues have resulted in compromised provision of basic general healthcare. Given the likelihood of recurrent waves of the pandemic globally, COVID-19 mitigation plans therefore should be integrated with standard care provision to enhance system resilience to cope with all health needs. This commentary suggests a four-point contextualised mitigation plan to safeguard MNCH care during the pandemic using the observed countries as exemplars for LMIC health system adaptations to maintain the trajectory of progress regarding sustainable development goals (SDGs).

scholarly journals Spiritual care practices in hospices in the Western cape, South Africa: the challenge of diversity

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ronita Mahilall ◽  
Leslie Swartz
Keyword(s):  
South Africa ◽  
Spiritual Care ◽  
Resource Constraints ◽  
Care Service ◽  
Western Cape ◽  
Group Discussions ◽  
Middle Income ◽  
Care Services ◽  
African Context ◽  
Care Practices

Abstract Background South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust. Discussion Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.

scholarly journals Fatal drowning in the Western Cape, South Africa: a 7-year retrospective, epidemiological study

2018 ◽  
Vol 25 (6) ◽  
pp. 529-534 ◽  
Author(s):  
Colleen Jayne Saunders ◽  
Robyn Adriaanse ◽  
Abigail Simons ◽  
Ashley van Niekerk
Keyword(s):  
South Africa ◽  
Young Adult ◽  
Low Income ◽  
Western Cape ◽  
Middle Income ◽  
Registration System ◽  
Drowning Prevention ◽  
Adult Men ◽  
Context Specific ◽  
Public Holidays

IntroductionDrowning is a neglected public health threat in low-income and middle-income countries where the greatest drowning burden is observed. There is a paucity of drowning surveillance data from low-resource settings, particularly in Africa. Understanding local epidemiological factors will enable the development of context-specific drowning prevention initiatives and the appropriate allocation of resources.AimThe primary aim of this study was to describe the epidemiology of fatal drowning in the Western Cape, South Africa.MethodThis retrospective study describes fatal drowning incidents captured in the Western Cape vital registration system between 2010 and 2016. Data were obtained from the Forensic Pathology Services of the Western Cape Government. One-way analysis of variance was performed to detect a trend in mean drowning mortality rates between 2010 and 2016. χ2 tests for independence were performed to detect differences in the distribution of variables between groups.ResultsA total of 1391 fatal drownings occurred in the Western Cape between 2010 and 2016, with an age-adjusted drowning mortality rate of 3.2 per 100 000 population. Rates were fourfold higher in men compared with women. Children, particularly young children aged 0–4 years, and young adult men between 20 and 34 years of age were identified to be at high risk of fatal drowning. Drowning occurred predominantly in large, open bodies of water with concentrations in summer and public holidays.ConclusionsThe Western Cape drowning prevention strategy should prioritise interventions to reduce drowning in children and young adult men, with a targeted focus on festive periods such as public holidays.

scholarly journals Relationship between children’s cognitions and later educational progress in rural South Africa: a longitudinal study

2019 ◽  
Vol 73 (5) ◽  
pp. 422-426
Author(s):  
Melissa Cortina ◽  
Helen E Jack ◽  
Rebecca Pearson ◽  
Kathleen Kahn ◽  
Stephen Tollman ◽  
...  
Keyword(s):  
South Africa ◽  
Longitudinal Study ◽  
Low Income ◽  
Psychological Functioning ◽  
Behavioural Therapy ◽  
Educational Progress ◽  
Rural South ◽  
Middle Income ◽  
Cognitive Triad ◽  
Rural South Africa

BackgroundChildren in low-income and middle-income countries (LMICs) who remain in school have better health and employment outcomes. South Africa, like many LMICs, has a secondary school completion rate under 50%, leaving room for improvement if we can identify factors that affect educational attainment. This is the first longitudinal study to examine the effects of childhood mental health and cognitions on educational outcomes in LMIC.MethodsUsing the Strengths and Difficulties Questionnaire (SDQ) and Cognitive Triad Inventory for Children (CTI-C), we assessed the psychological functioning and cognition of children aged 10–12 in rural South Africa. We linked that data with measures of educational progress collected 5 years later and examined associations between educational progress and (1) behavioural and emotional problems and (2) cognitive interpretations, adjusting for possible confounders.ResultsEducational data were available for 443 individuals. 92% (n=408) of individuals had advanced three or fewer grades in 7 years. Having more positive cognitions (CTIC-C) was positively associated with progressing at least three grade levels (adjusted OR 1.43, 95% CI 1.14 to 1.79). There was no evidence for an association between emotional and behavioural problems (SDQ) and educational progress (OR 0.90, 95% CI 0.72 to 1.11).ConclusionIf children in LMICs can develop more positive perspectives, they may be able to stay in school longer. Cognitions can be modified, and future studies should test interventions that work to improve cognition in childhood, guided, for example, by principles of cognitive–behavioural therapy.

scholarly journals Maximizing the potential of trauma registries in low-income and middle-income countries

2020 ◽  
Vol 5 (1) ◽  
pp. e000469
Author(s):  
Leah Rosenkrantz ◽  
Nadine Schuurman ◽  
Claudia Arenas ◽  
Andrew Nicol ◽  
Morad S. Hameed
Keyword(s):  
Low Income ◽  
Resource Constraints ◽  
Injured Patient ◽  
Process Of Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Trauma Registries ◽  
Injury Event ◽  
Global Health Issue ◽  
Injury Burden

Injury is a major global health issue, resulting in millions of deaths every year. For decades, trauma registries have been used in wealthier countries for injury surveillance and clinical governance, but their adoption has lagged in low-income and middle-income countries (LMICs). Paradoxically, LMICs face a disproportionately high burden of injury with few resources available to address this pandemic. Despite these resource constraints, several hospitals and regions in LMICs have managed to develop trauma registries to collect information related to the injury event, process of care, and outcome of the injured patient. While the implementation of these trauma registries is a positive step forward in addressing the injury burden in LMICs, numerous challenges still stand in the way of maximizing the potential of trauma registries to inform injury prevention, mitigation, and improve quality of trauma care. This paper outlines several of these challenges and identifies potential solutions that can be adopted to improve the functionality of trauma registries in resource-poor contexts. Increased recognition and support for trauma registry development and improvement in LMICs is critical to reducing the burden of injury in these settings.

scholarly journals Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa

2021 ◽  
Author(s):  
Krishna P Reddy ◽  
Kieran P Fitzmaurice ◽  
Justine A Scott ◽  
Guy Harling ◽  
Richard J Lessells ◽  
...  
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Clinical Outcomes ◽  
Program Implementation ◽  
Resource Constraints ◽  
Vaccination Program ◽  
Middle Income ◽  
Symptomatic Disease ◽  
Epidemic Dynamics ◽  
Wide Range

Low- and middle-income countries are implementing COVID-19 vaccination strategies in light of varying and uncertain vaccine efficacies and costs, supply shortages, and resource constraints. We used a microsimulation model to evaluate clinical outcomes and cost-effectiveness of a COVID-19 vaccination program in South Africa. We varied vaccination coverage, pace, acceptance, effectiveness, and cost as well as epidemic dynamics. Providing vaccine to at least 40% of the population and prioritizing accelerated vaccine rollout prevented >9 million infections and >73,000 deaths and reduced costs due to fewer hospitalizations. Further, the vaccination program was cost-saving even at the lowest examined levels of acceptance (50%), effectiveness against infection (20%), effectiveness against symptomatic disease (30%), and effectiveness against severe/critical disease requiring hospitalization (40%), and with vaccination costs of up to USD25/person. In summary, a COVID-19 vaccination program would reduce both deaths and health care costs in South Africa across a wide range of assumptions. Vaccination program implementation factors, including prompt procurement, distribution, and rollout, are likely more influential than characteristics of the vaccine itself in maximizing public health benefits and economic efficiency.

scholarly journals Spiritual care practices in hospices in the Western Cape, South Africa: The challenge of diversity

2020 ◽  
Author(s):  
Ronita Mahilall ◽  
Leslie Swartz
Keyword(s):  
South Africa ◽  
Spiritual Care ◽  
Resource Constraints ◽  
Care Service ◽  
Western Cape ◽  
Group Discussions ◽  
Middle Income ◽  
Care Services ◽  
African Context ◽  
Care Practices

Abstract Background: South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints. Methods: Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis. Results:Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust.Discussion:Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints. Conclusions:While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.

scholarly journals Systematic review to identify proxy indicators to quantify the impact of eHealth tools on maternal and neonatal health outcomes in low-income and middle-income countries including Delphi consensus

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e022262 ◽  
Author(s):  
Caroline Perrin ◽  
Lothaire Hounga ◽  
Antoine Geissbuhler
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Delphi Study ◽  
Risk Of Bias ◽  
Neonatal Outcomes ◽  
Local Context ◽  
Neonatal Health ◽  
Middle Income ◽  
Proxy Indicators ◽  
The Impact

ObjectiveTo identify interventions that could serve as reliable proxy indicators to measure eHealth impact on maternal and neonatal outcomes.DesignSystematic review and Delphi study.MethodsWe searched PubMed, Embase and Cochrane from January 1990 to May 2016 for studies and reviews that evaluated interventions aimed at improving maternal/neonatal health and reducing mortality. Interventions that are not low-income and middle-income context appropriate and that cannot currently be diagnosed, managed or impacted by eHealth (eg, via telemedicine distance diagnostic or e-learning) were excluded. We used the Cochrane risk of bias, Risk Of Bias In Non- randomised Studies - of Interventions and ROBIS tool to assess the risk of bias. A three-step modified Delphi method was added to identify additional proxy indicators and prioritise the results, involving a panel of 13 experts from different regions, representing obstetricians and neonatologists.ResultsWe included 44 studies and reviews, identifying 40 potential proxy indicators with a positive impact on maternal/neonatal outcomes. The Delphi experts completed and prioritised these, resulting in a list of 77 potential proxy indicators.ConclusionsThe proxy indicators propose relevant outcome measures to evaluate if eHealth tools directly affect maternal/neonatal outcomes. Some proxy indicators require mapping to the local context, practices and available resources. The local mapping facilitates the utilisation of the proxy indicators in various contexts while allowing the systematic collection of data from different projects and programmes. Based on the mapping, the same proxy indicator can be used for different contexts, allowing it to measure what is locally and temporally relevant, making the proxy indicator sustainable.PROSPERO registration numberCRD42015027351.

scholarly journals Cost and cost-effectiveness of a parenting programme to prevent violence against adolescents in South Africa

2019 ◽  
Vol 4 (3) ◽  
pp. e001147 ◽  
Author(s):  
Alice Redfern ◽  
Lucie D Cluver ◽  
Marisa Casale ◽  
Janina I Steinert
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Low Income ◽  
Emotional Abuse ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cluster Randomised Controlled Trial ◽  
Economic Benefits ◽  
Parenting Programme ◽  
Middle Income

IntroductionThis paper presents the costs and cost-effectiveness of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a non-commercialised parenting programme aimed at preventing violence against adolescents in low-income and middle-income countries.MethodsThe effectiveness of Sinovuyo Teen was evaluated with a cluster randomised controlled trial in 40 villages and peri-urban townships in the Eastern Cape of South Africa from 2015 to 2016. The costs of implementation were calculated retrospectively and models of costs at scale estimated, from the perspective of the programme provider. Cost-effectiveness analysis considers both the cost per incident of abuse averted, and cost per disability-adjusted life year averted. Potential economic benefits from the societal perspective were estimated by developing a framework of possible savings.ResultsThe total implementation cost for Sinovuyo Teen over the duration of the trial was US$135 954, or US$504 per family enrolled. Among the 270 families in the treatment group, an estimated 73 incidents of physical and emotional abuse were averted (95% CI 29 to 118 incidents averted). During the trial, the total cost per incident of physical or emotional abuse averted was US$1837, which is likely to decrease to approximately US$972 if implemented at scale. By comparison, the economic benefits of averting abuse in South Africa are large with an estimated lifetime saving of US$2724 minimum per case.ConclusionParenting programmes are a cost-effective intervention to prevent the abuse of adolescents by their caregivers in South Africa, when compared with existing violence prevention programmes and cost-effectiveness thresholds based on GDP per capita.

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