An analysis of obstetric practices and outcomes in a deep rural district hospital in South Africa

Background Internationally, there has been a focus on ensuring that Caesarean deliveries are performed only when indicated, to ensure the best outcome for mother and baby. In South Africa, despite a variety of health system interventions, maternal and perinatal mortality remain unacceptably high. Objectives To describe and compare the clinical outcomes related to the mode of delivery, for patients managed at rural primary healthcare level. Methods This retrospective cross-sectional observational analytical study was conducted at a deep rural district hospital in northern KwaZulu-Natal, South Africa. Maternity Case Records and Caesarean delivery audit tools from 2018 were reviewed. Results In total, 634 files were retrieved. The Caesarean delivery rate in the sample was 30.8% (193 of 634 deliveries), and according to the Robson classification, groups 5 and 1 were the biggest contributors to Caesarean delivery. All Caesarean deliveries were deemed to have been medically indicated. As compared to those whose delivery was normal vaginal, the odds of having post-partum haemorrhage were 25 times higher, and the odds of having any complication were three times higher, if a mother delivered by Caesarean (p<0.001). In neonates who were delivered by Caesarean, the odds of being admitted to nursery were four times higher than those delivered vaginally (p<0.001). Conclusion Showing a significantly higher risk of maternal and neonatal complications, this study validated Caesarean delivery at rural primary care as a potentially dangerous undertaking, for which adequate precautions should be taken. There is a need for interventions targeting rural healthcare in South Africa, to ensure that obstetric services are offered to patients in as safe a manner as possible in this environment.

Rwandan solutions to Rwandan problems: Heritage decolonization and community engagement in Nyanza District, Rwanda

Highlighting the rural district of Nyanza in Rwanda, this article examines community relations to heritage resources. It investigates the possibilities for more ethical, engaged models of heritage management which can better deliver on agendas of decolonization and development. Our research finds that Nyanza’s heritage stakeholders highly value heritage’s social and economic roles, but communities are also significantly alienated from heritage resources. In seeking to bridge this gap, heritage professionals utilize a discourse of technocratic improvement, but community leaders emphasize ideas of ownership, drawing on higher state-level discourses of self-reliance and “homegrown solutions.” They mobilize the state’s own attempts to filter developing, decolonizing initiatives through Rwandan frameworks to advocate for communities’ right to participate in heritage. This local agency offers a roadmap for utilizing favorable aspects of existing governance to push heritage management toward community engagement and decolonization.

Conflicts, Confrontations and Conduits in Rural Environments: Is Resilience at Work in Gokwe South Rural District?

This article explores conflicts, confrontations and conduits for sustainable development in rural environments. Fragility and degradation with a slight resilience manifest heavily in Gokwe South Rural District (GSRD), Zimbabwe. The article notes rural development as a double-edged sword, bringing tremendous opportunities for innovation but also causing increased ecological degradation. As such, it often results in conflicts and confrontations among stakeholders. Like many Zimbabwean rural settlements, GSRD is experiencing serious land disputes. conflicts arise from the proposed changes, like extension of infrastructure, perceived by some stakeholders as contrary to their interests and wishes. Using focus group discussions and thematic analysis, a trend of how conflicts and confrontations emerged was established in GSRD. The findings show that land transition from rural to urban status without consultations instigates conflict between different development agencies and communities.

An investigation of the effect of the raising of the school leaving age in a rural district

The amendment or 1920 to the Education Act of 1914 ruled inter alia that every child between the ages of seven and fifteen years must attend school. This amendment, was held in abeyance for twenty-three years being put into operation by an Order-in-Council on 15th December 1943. Judging by the averages of the previous few years one result of the amendment is that 751 of those children who would have left school at the end or their primary school period have been obliged to continue their education in post-primary schools. This leads to speculation on the effect the legislation will have on a specific community, and to obtain a clear picture involves an analytical survey of the group chosen, taking in their educational needs, post-school aspirations and the opportunities for carrying such aspirations into effect, with, in passing what, if any, effect the legislation might have on the general labour situation.

An investigation of the effect of the raising of the school leaving age in a rural district

The amendment or 1920 to the Education Act of 1914 ruled inter alia that every child between the ages of seven and fifteen years must attend school. This amendment, was held in abeyance for twenty-three years being put into operation by an Order-in-Council on 15th December 1943. Judging by the averages of the previous few years one result of the amendment is that 751 of those children who would have left school at the end or their primary school period have been obliged to continue their education in post-primary schools. This leads to speculation on the effect the legislation will have on a specific community, and to obtain a clear picture involves an analytical survey of the group chosen, taking in their educational needs, post-school aspirations and the opportunities for carrying such aspirations into effect, with, in passing what, if any, effect the legislation might have on the general labour situation.

An Assessment of the County Review Process in Hampshire 1929–1932

Under the provisions of the Local Government Act 1929, Hampshire County Council along with other administrative counties was required to review the boundaries of the second and third tier authorities within its borders. As well as being a time-consuming process, it could also be a particularly contentious one. In the event, Hampshire used the opportunity to reduce significantly the number of relatively small second tier authorities, particularly rural district councils, and to adjust boundaries which sometimes gave rise to spirited local opposition. The arguments used by the County Council to justify changes and those resisting them, many of which were aired at an Inquiry conducted by a Ministry of Health Inspector at Winchester in late 1931, are considered.

Perspectives of Service Providers on Aftercare Service Provision for Persons with Substance Use Disorders at a Rural District in South Africa.

Background: Provision of aftercare services for persons with substance use disorders (PWSUD) within a rural context is typically met with various intersecting challenges, including unclear policy implications and lack of resources. In the South African context, service providers are expected to provide aftercare services that should achieve successful reintegration of persons with PWSUD into society, the workforce, family and community life as mandated by Act No. 70 of 2008, despite population diversity. Little has been established on the provision of aftercare services in South Africa and specifically within a rural context. This article explores the perspectives of service providers in aftercare service provision for PWSUD in a rural district.Methods: A qualitative exploratory study design was conducted in a rural district in South Africa using semi-structured interviews and focus group discussions with forty-six service providers from governmental and non-governmental institutions, ranging from implementation to policy level of service provision. Data were analyzed thematically using a deductive approach. Codes were predetermined from the questions and the aims and objectives of the study used Beer’s Viable Systems Model as a theoretical framework. NVivo Pro 12 qualitative data analysis software guided the organization and further analysis of the data.Results: Four themes emanated from the data sets. Theme 1 on reflections of the interactional state of aftercare services and program content identified the successes and inadequacies of aftercare interventions including relevant recommendations for aftercare services. Themes 2, 3, and 4 demonstrate reflections of service provision from implementation to policy level, namely, identifying existing barriers to aftercare service provision, situating systemic enablers to aftercare service provision, and associated aftercare system recommendations. Conclusions: The intersecting systemic complexities of providing aftercare services in a rural context in South Africa was evident. There existed minimal enablers for service provision in this rural district. Service providers are confronted with numerous systemic barriers at all levels of service provision. To strengthen the aftercare system, policies with enforcement of aftercare services are required. Moreover, a model of aftercare that is integrated into the existing services, family centered, sensitive to the rural context and one that encourages the collaboration of stakeholders could also strengthen and sustain the aftercare system and service provision.