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Revitalised agreement on the Resolution of the Conflict in South Sudan (R-ARCSS) post-2024
Get PDFHSRC Policy Brief, OctoberThis Policy Brief examines the political landscape and the consequent civic space in preparation for the first democratic general elections scheduled for December 2026. It concludes by advancing policy recommendations for revised policies conducive to the transition that is intended to take place post 2024.N/
Double burden of malnutrition among women and children in Zimbabwe: a pooled logistic regression and Oaxaca-Blinder decomposition analysis
Get PDFThe double burden of malnutrition (DBM) is a public health issue characterised by the coexistence of undernutrition and overnutrition within the same population, household, or individual. Undernutrition, manifesting as stunting, wasting, or being underweight, results from insufficient nutrient intake while overnutrition, manifesting as overweight or obesity, results from excessive caloric intake, poor diet quality, and sedentary lifestyles. This dual burden poses significant challenges for health systems due to lost productivity and increased healthcare expenditure. This study utilised data from the Demographic and Health Surveys (DHS) conducted in Zimbabwe for 2010-2011 and 2015, which provided information on women's and children's health and nutritional status, household characteristics, and socio-economic status. Pooled logistic regression was used to analyse the association between various sociodemographic factors and DBM among women and children. The Oaxaca-Blinder decomposition method explored differences in DBM between 2010-2011 and 2015. The average age of mothers was approximately 31 years, and children's ages averaged around 32 months. From 2010 to 2015, there was a notable socio-economic improvement, with a decrease in the percentage of mothers in the poorest quartile from 20 to 16% and an increase in the richest quartile from 22 to 23%. The study found a slight decrease in overall household DBM among women from 34% in 2010 to 32% in 2015, while DBM among children increased from 12 to 14%. Pooled logistic regression analysis indicated that children in rural areas had statistically significantly higher odds of experiencing DBM than their urban counterparts. The Oaxaca-Blinder decomposition showed that changes in residence status significantly impacted the increase in DBM among children. At the same time, the coefficient effect accounted for most of the unexplained differences in DBM among women. The growing DBM among women and children in Zimbabwe is significantly influenced by changes in residence status. The findings highlight the need for targeted public health interventions to address urban-rural disparities and emphasise the importance of considering socio-economic, environmental, and behavioural factors. Context-specific public health strategies, aligned with WHO's Double Duty Actions, are essential to improve the nutritional health of Zimbabwe's population.
GEMS
No full textI was born in White-City in Soweto on 15 July 1952 as Phillip Doctor. Moloto. I started writing Black-Consciousness-based poetry and plays/drama/sketch in Forms-3 & 4. I matriculated in Morris Isaacson High School in 1974. Between 1969 and1971 I studied with the Naturopathic College of South Africa and qualified as a Naturopath. In 1976 I enrolled at Ongoye University in the then Zululand. However, during the 1976 Soweto Uprising I was detained and kept as a political prisoner in a prison in eMtuba-Tuba. I broke out of prison, taking along a fellow prisoner who was in solitary confinement with me, Charles Muzi Thembekwayo. We both joined the African National Congress and its military wing, uMkhonto we Sizwe by accident. We also both ended up on death-row in the ANC's detention camp, Quatro, in Angola. I did my initial military training in MK's Novo-Catengue camp in Angola. I also completed a Commando Course in Funda near Luanda in Angola. I have lived in Lusaka, Tanzania and Harare, Zimbabwe, and spent time in the United Kingdom where I worked as an artist. I returned to South Africa in 1992 and joined the
South African National Defence Force. Presently, I am a happy pensioner who knows when not to complain.N/
Implementation of the advanced HIV disease care package with point-of-care CD4 testing during tuberculosis case finding: a mixed-methods evaluation
No full textDuring TB-case finding, we assessed the feasibility of implementing the advanced HIV disease (AHD) care package, including VISITECT CD4 Advanced Disease (VISITECT), a semiquantitative test to identify a CD4<200cells/ul. Adult participants with tuberculosis symptoms, recruited near-facility in Lesotho and South-Africa between 2021-2022, were offered HIV testing (capillary blood), Xpert MTB/RIF and Ultra, and MGIT culture (sputum). People living with HIV (PLHIV) were offered VISITECT (venous blood) and Alere tuberculosis-lipoarabinomannan (AlereLAM, urine) testing. AHD was defined as a CD4<200cells/ul on VISITECT or a positive tuberculosis test. A CD4<200cells/ul on VISITECT triggered Immy cryptococcal antigen (Immy CrAg, plasma) testing. Participants were referred with test results. To evaluate feasibility, we assessed i) acceptability and ii) intervention delivery of point-of-care diagnostics among study staff using questionnaires and group discussions, iii) process compliance, and iv) early effectiveness (12-week survival and treatment status) in PLHIV. Predictors for 12-week survival were assessed with logistic regression. Thematic content analysis and triangulation were performed. Among PLHIV (N = 676, 48.6% of 1392 participants), 7.8% were newly diagnosed, 81.8% on ART, and 10.4% knew their HIV status but were not on ART. Among 676 PLHIV, 41.7% had AHD, 29.9% a CD4<200cells/ul and 20.6% a tuberculosis diagnosis. Among 200 PLHIV tested with Immy CrAg, 4.0% were positive. The procedures were acceptable for study staff, despite intervention delivery challenges related to supply and the long procedural duration (median: 73 minutes). At 12 weeks, among 276 PLHIV with AHD and 328 without, 3.3% and 0.9% had died, 84.8% and 92.1% were alive and 12.0% and 7.0% had an unknown status, respectively. Neither AHD nor tuberculosis status were associated with survival. Implementing AHD care package diagnostics was feasible during tuberculosis-case finding. AHD was prevalent, and not associated with survival, which is likely explained by the low specificity of VISITECT. Challenges with CD4 testing and preventive treatment uptake require addressing.
South Africa's struggle for independent education: the African methodist episcopal church and the history of the Wilberforce Institute
No full textThe Struggle for African Independent Education focuses on the Wilberforce Institute, one of the first major independent African schools in segregationist South Africa.
It became the epicentre of the independent school movement in the Transvaal in the early twentieth century, demonstrating how newly urbanised mission-educated Africans, despite profound linguistic differences and regional backgrounds, shared far-reaching educational aspirations in the rapidly growing cosmopolitan, gold-driven Johannesburg after the South African War (1899-1902).
The book examines how their common histories of oppression, segregation, displacement, dispossession, as well as despair and disillusionment with the mainstream missionary education, incited the new urban dwellers to wage the struggle for African independent education, and tells the story of how their determination led to the formation of the Wilberforce Institute.N/
Community engagement for research in pandemic times: lessons for the future
No full textThe ethical imperative of community engagement for health research is based on the principle that individuals are interrelated and that decisions are made within a social context. Collaboration between researchers and communities is not only an expression of respect, but also benefits research by building trust, which contributes to the acceptability of and support for the research by the community and can improve the quality of informed and voluntary decision-making. For engagement to be meaningful, it should be authentic, effective, and ethically sound. Meaningful engagement is, however, challenging during pandemics due to the restriction, or even prohibition, of in-person activities and the urgency of developing appropriate prevention and intervention modalities. Several community engagement models and practices exist, but none seem well suited for pandemic times. This raises concerns about the relevance and fairness of the processes, especially with regard to silent and vulnerable populations. It also raises questions about the communication and engagement strategies needed to deliver evidence-based messages, the media and messengers to be used. This chapter will explore the challenges involved in effective community engagement for research during a pandemic, discuss evidence-based strategies to reach all target populations, and recommend a best practice model based on lessons learned.
A South African food security challenge: the critique of initiatives at household level
No full textThe food security challenge has affected many households in South Africa, as some households struggle to maintain a healthy diet and adequate food access. Many households in South Africa experience food hunger and starvation, in particular households in rural areas which is often characterised by large family groups. The pressing challenge encountered by policy makers is ensuring that all households in South Africa are food secure, as it stands this has not been achieved. Despite pro-active initiatives such as the Integrated food security, nutrition program, zero hunger programme and social grants, households in South Africa continue to be negatively impacted by food insecurity, especially in the awake of climate change. The paper aims to argue that food security challenges faced by households in South Africa could be addressed if strategies are formulated not only to secure the individual but the entire household. The paper analyses three literature themes namely: food security globally, accessed food security challenges in South Africa and finally critiqued food initiatives that potentially play a role in household food security. The findings of the paper conclude that food security initiative programs are available in South Africa, however they often rely on monetary terms of ensuring food security, the social grants for example are targeted to some household members not everyone in the household. The paper suggests that targeting certain household members is not a comprehensive approach in addressing food security at household level. Lessons drawn from literature, provide a way forward towards policy effective and efficient interventions that seek to foster household food security interventions while observing nature-based agro-forestry initiatives that are community-led.
Associations of HIV and prevalent type 2 diabetes mellitus in the context of obesity in South Africa
No full textIt is unclear how rising obesity among people with HIV (PWH) impacts their risk of type 2 diabetes mellitus (diabetes). We examined associations between HIV, prevalent diabetes and adiposity among South African PWH and their peers without HIV (PWOH). HIV status was ascertained by antibody testing. Diabetes was defined as current use of oral hypoglycemics, insulin, and/or HbA1c ≥6.5%. Adiposity was measured by body mass index (BMI), waist circumference and waist-to-height ratio. Their associations were examined using sex-stratified multivariable fractional polynomial generalized linear models, reporting adjusted prevalence and prevalence ratios (adjPR). The mean age among 1,254 PWH and 4,381 PWOH was 41 years (95%CI 28, 56). The prevalence of diabetes among males was similar between PWH [11.3% (7.1, 15.5)] and PWOH [9.8% (8.5, 11.1); p=0.740]. By contrast, diabetes prevalence was higher among female PWOH [15.7% (14.4, 17.0)] than female PWH [10.5 (8.3, 12.8)%; adjPR: 0.67 (0.51, 0.82); p<0.001]. This difference was accentuated with obesity but reversed with leanness. At BMI ≥25 kg/m2, female PWH had lower diabetes prevalence [adjPR: 0.58 (0.41, 0.76); p<0.001] than female PHIV. In contrast, at BMI <18 kg/m2, female PWH had higher prevalence [adjPR: 1.72 (−1.53, 4.96); p=0.756] than female PWOH. We found sex-specific differences in the relationship between adiposity and diabetes prevalence by HIV serostatus in South Africa. Notably, females living with obesity and HIV had lower prevalence of diabetes than females living with obesity and without HIV, which may have particular implications for diabetes prevention programs in the region.
Towards strengthening electoral democracy in Africa: a review of trends, challenges, and future prospects
No full textThis article reviews the current trends in electoral democracy in Africa and assesses the electoral integrity and governance challenges, to make recommendations for improved electoral integrity and democratic governance in the future. Democracy has been touted as an inclusive system of electoral process and governance that respects universal suffrage. Western nations and post-colonial countries, especially in Africa, have adopted and encouraged democracy as the system of national governance, citing as its advantages inclusivity and respect for the voting rights of citizens in choosing political leaders. Democratic elections are an integral aspect of democracy, but this seems to be declining globally, especially in Africa. Several studies have been conducted on democracy and electoral integrity, without reviewing the trends in electoral democracy to assess the electoral integrity and governance challenges of democracy on the continent. By learning from these experiences, fostering international collaboration, and empowering citizens, Africa can strive towards a future in which electoral integrity is a cornerstone of democracy. The forecasted ratios for 2030 provide insight into the potential trajectories of electoral integrity or governance challenges in select countries and serve as valuable indicators for policymakers and stability in Africa. The article clarifies the broader significance of its findings and recommendations. Improving electoral integrity and governance in Africa is not just about ensuring fair elections; rather, it is about creating a foundation for sustainable development, social cohesion, and long-term political stability in Africa.