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Charged Vector Boson (W ±) production in simulated proton-proton collisions at √s = 5.36 TeV.
No full textIn this work, the focus is on the charged vector boson (W ±) production in the forward rapidity region of simulated relativistic proton-proton collisions, where the POWHEG and Pythia Monte Carlo (MC) event generators are used to simulate the events of interest for the analysis. The W ± boson production is studied via the muonic decay channel as W ± → μ±+νμ (–). It is theoretically motivated in the work that this process can serve as a probe of the initial state of the collision, since the W ± boson is produced in the hardest partonic interaction and neither the W ± boson nor the μ± have a colour charge. The muonic decay of heavy-flavour (HF) mesons in the same forward rapidity region is also investigated, where it is shown that these processes serve as the dominant background for the muon production from W ± boson decays. The primary charged-particle multiplicity is also introduced as an observable of interest, where the self-normalised W ± boson production as a function of the normalised multiplicity is defined and studied specifically. For this observable, it is shown that a linear trend is obtained when estimating the multiplicity in the central rapidity region and using the default Monash Tune. The choice of the central region for the multiplicity estimation is clearly motivated by looking at auto-correlation effects - which are shown to effect the slope of the multiplicity observable. In addition, it is shown that the slope of the multiplicity observable is also sensitive to the multi-parton interaction (MPI) and colour reconnection (CR) models - which motivates the use of the observable to probe the initial-state of the collision. Finally, a feasibility study is also performed to investigate whether the same study can be done with the ALICE Run 3 proton-proton reference data at the same centre-of-mass energy - where an estimation of the available statistics for the W ± → μ±+νμ (–) process is presented. Through the work, it is also argued that the study in proton-proton collisions can serve as a meaningful baseline measurements for other collision systems - such as proton-lead and lead-lead
HIV self testing uptake and associated factors in Cape Town: a contextual framework
No full textSouth Africa bears one of the highest HIV burdens globally, with nearly 8 million people living with the virus. Despite hosting the world's largest antiretroviral therapy (ART) program, HIV-related deaths remain significant, accounting for over 23% of all deaths in 2019. Early detection and timely initiation of ART are essential to prevent transmission, improve quality of life, and reduce HIV-related morbidity and mortality. However, insufficient testing coverage among males and younger individuals remains a concern. HIV self-testing (HIVST) has emerged as a promising strategy to bridge these gaps, offering a private and convenient option for individuals hesitant to access healthcare facilities. The World Health Organization (WHO) endorses HIVST as a complementary approach to enhance access, particularly for populations underserved by traditional testing methods. While research has examined HIVST uptake in various settings, little is known about the specific factors influencing its adoption in Cape Town. Given South Africa's unique socio-economic landscape and the disparities between urban and rural areas, understanding the factors shaping HIVST uptake is crucial for developing tailored interventions. This thesis seeks to address this gap by investigating and analyzing the demographic, socio-economic, and community-level factors associated with HIVST uptake in Cape Town. Methods: This study utilized a cross-sectional design to examine HIV testing uptake and associated factors in Cape Town, South Africa, between January and December 2022. The analysis leveraged routine HIV Testing Services (HTS) programmatic data collected by the Anova Health Institute. The dataset included a total of 266,284 observations: 30,785 for HIV self-testing (HIVST) and 235,499 for conventional HIV testing. Data were drawn from individuals aged 18 years and older across the eight subdistricts of the Cape Town metropolitan area: Eastern, Northern, Southern, Western, Khayelitsha, Klipfontein, Mitchells Plain, and Tygerberg. The data, comprising sociodemographic details and testing information, were deidentified with formal permission from Anova Health Institute and the Department of Health. Individual-level data was recorded through consent forms and HTS registers and subsequently transferred to Red Cap and Power BI for quality checks and analysis. Community-level data, including the number of healthcare facilities, new and registered ART patients, and child acute malnutrition rates, were sourced from City of Cape Town health profiles (2021). Predictors were selected based on a socio-ecological framework, capturing both individual- and community-level factors. Individual-level variables included age, gender, and HIV testing history. Community-level factors encompassed healthcare access (number of healthcare facilities), HIV burden (number of registered and new ART patients), and socioeconomic status (child acute malnutrition rate). Descriptive statistics summarize the frequencies of HIVST, and conventional testing variables stratified by subdistrict, alongside community-level factors. A bivariate logistic regression model was conducted to assess associations between individual predictors and HIV testing options. Subsequently, a multivariate logistic regression model was employed to evaluate the influence of both individual- and community-level predictors on HIV testing choices (conventional vs. HIVST). Odds ratios were calculated with 95% confidence intervals to quantify these associations. This methodology integrates diverse data sources and robust statistical approaches, enabling a comprehensive examination of the factors influencing the uptake of HIV self-testing in Cape Town. Results: The study had a sample size of 265,063 of which 234,853 (88.60%) had utilized conventional HIV testing method and 30,210 (11.40%) opting for self-testing. Majority of individuals undergoing conventional testing are adults aged 25- 49 (63.16%), followed by older adults aged 50+ (17.16%). Similarly, for self-testing, most users are also within the 25-49 age group (63.84%), but there is a higher proportion of young adults aged 20-24 choosing self-testing (23.72%) compared to conventional testing (15.59%). Additionally, adolescents aged 18-19 are more likely to opt for self-testing (7.75%) than conventional testing (4.08%). Regarding gender, females constitute a larger share of those undergoing conventional testing (65.62%) compared to males (34.38%). The trend is similar for self-testing, where females account for 65.32%, and males make up 34.68%. In terms of the last HIV test, self-testing is more prevalent among individuals who were tested within the past 12 months (63.51%), while conventional testing is more common among those whose last test was over a year ago. Subdistrict analysis shows that conventional testing is most frequent in Tygerberg (20.06%) and Khayelitsha (16.87%), followed by Western (13.24%) and Eastern (12.45%). In contrast, self-testing is more widely utilized in Western (19.38%), Southern (15.33%), and Mitchell's Plain (16.97%). The bivariate logistic regression indicated that age was a significant factor influencing self-testing preferences, with the likelihood of using HIVST decreasing with age. Individuals aged 20‐24 had 20% lower odds of using self‐testing compared to adolescents aged 18‐19 (OR = 0.80, 95% CI: 0.76–0.85, p < 0.005). Those aged 25‐49 had 47% lower odds compared to the adolescent group (OR = 0.53, 95% CI: 0.51–0.56, p < 0.005), and adults aged 50 and above had 86% lower odds (OR = 0.14, 95% CI: 0.13–0.15, p < 0.005). Additionally, for facility testing those who had tested for HIV within the last 12 months were more inclined towards self‐testing. In contrast, individuals who last tested more than 12 months ago were 77% less likely to choose self‐testing (OR = 0.23, 95% CI: 0.22–0.25, p < 0.005), and those who had never been tested were 40% less likely (OR = 0.60, 95% CI: 0.54–0.67, p < 0.005) to use self‐testing. HIVST was more popular among people living in areas with a high concentration of registered ART patients. Specifically, the odds of choosing self‐testing increased by 32% in high-density areas (≥30,001 registered ART patients) (OR = 1.32, 95% CI: 1.28–1.37, p < 0.005) and by 53% in medium-density areas (20,001–30,000 registered ART patients) (OR = 1.53, 95% CI: 1.49–1.58, p < 0.005), compared to areas with fewer than 20,000 registered ART patients. On the other hand, people living in areas with a higher number of healthcare facilities were more likely to choose conventional HIV testing. The odds of self‐testing decreased by 15% in subdistricts with a medium number of healthcare facilities (15–25 facilities) (OR = 0.85, 95% CI: 0.82–0.87, p < 0.005) and by 27% in areas with a high number of facilities (26 or more) (OR = 0.73, 95% CI: 0.71–0.76, p < 0.005), relative to areas with fewer than 15 facilities. Additionally, communities with a high number of newly enrolled ART patients (≥2,901) showed a 31% lower likelihood of opting for self-testing (OR = 0.69, 95% CI: 0.67–0.72, p < 0.005). Subdistrict variations were evident, with Southern (OR = 2.04, 95% CI: 1.94–2.13, p < 0.005) and Mitchell's Plain (OR = 2.12, 95% CI: 2.03–2.23, p < 0.005) showing more than twice the odds of self‐testing compared to the Eastern subdistrict. Other subdistricts with significantly higher odds of self-testing included Western (OR = 1.63, 95% CI: 1.56–1.71, p < 0.005) and Klipfontein (OR = 1.12, 95% CI: 1.06–1.18, p < 0.005). Conversely, Northern (OR = 0.52, 95% CI: 0.48–0.55, p < 0.005), Tygerberg (OR = 0.55, 95% CI: 0.52–0.57, p < 0.005), and Khayelitsha (OR = 0.97, 95% CI: 0.83–0.91, p < 0.005) had significantly lower odds. Finally, testing preferences assessed through the multivariate logistic regression model highlighted the influence of both individual- and community-level factors. Consistent with the bivariate analysis findings, age remained a strong predictor of HIVST. Individuals aged 20–24 had 23% lower odds of using self-testing compared to those aged 18–19 (OR = 0.77, 95% CI: 0.73–0.82, p < 0.005), while those aged 25–49 had 49% lower odds (OR = 0.51, 95% CI: 0.48–0.53, p < 0.005). The oldest age group (50 years and above) had 86% lower odds of choosing self-testing compared to the youngest group (OR = 0.14, 95% CI: 0.13–0.15, p < 0.005). 5 Individuals residing in communities with a medium (20,001–30,000) and high (≥30,001) number of registered ART patients had 240% (OR = 3.40, 95% CI: 3.18–3.65) and 182% (OR = 2.82, 95% CI: 2.70– 2.96, p < 0.005) higher odds of using self-testing, respectively, compared to those in areas with low ART caseloads (<20,000). Additionally, living in areas with more newly enrolled ART patients was negatively associated with self- testing. Residing in communities with a medium number of new ART patients (1,800–2,900) was associated with 68% lower odds of self-testing (OR = 0.32, 95% CI: 0.29–0.34, p < 0.001), while living in areas with a high number of new ART initiations (≥2,901) was associated with 81% lower odds (OR = 0.19, 95% CI: 0.18–0.21, p < 0.001), compared to areas with a low number of new ART patients (<1,800). Unlike in the bivariate analysis, gender also played a significant role in the multivariate model, with females having 8% lower odds of choosing self-testing compared to males (OR = 0.92, 95% CI: 0.90– 0.94, p < 0.005). Additionally, individuals who received a positive HIV test result had 9% lower odds of having used self-testing compared to those who tested negative (OR = 0.91, 95% CI: 0.84–0.98, p = 0.005). The number of healthcare facilities was also positively associated with self-testing uptake. Living in areas with a medium (15–25) or high (≥26) number of healthcare facilities increased the odds of self-testing by 13% and 34%, respectively (OR = 1.13, 95% CI: 1.09–1.17, p < 0.005; and OR = 1.34, 95% CI: 1.26–1.43, p < 0.005), compared to areas with a low number of facilities (0–14). Conclusion: In conclusion, the study underscores the complex interplay of individual and community-level factors influencing HIV testing preferences in Cape Town. Younger age, recent HIV testing history, male gender, and residence in areas with higher number of registered ART patient and more healthcare facilities were associated with increased likelihood of HIV self-testing (HIVST). Conversely, older age, female gender, living in communities with more newly initiated ART clients, and receiving a positive HIV diagnosis were linked to a lower likelihood of using HIVST. Geographic disparities across subdistricts further highlight the need for targeted, context-specific strategies to enhance HIV testing uptake, particularly among underrepresented groups, and to optimize the reach and impact of self-testing interventions
A Multi-Scale analysis of organochlorine pesticide contamination in raptor populations: research effort, historical trends, and current concentrations
No full textPesticide contamination and the associated impacts on biodiversity, have been the focus of intense research and tremendous concern for environmental and conservation scientists over many decades. The environmental consequences of organochlorine pesticides, particularly Dichlorodiphenyltrichloroethane's (DDT) were made famous by Rachel Carson's book, Silent Spring in the early 1960s. Their impacts on environmental and human health were subsequently widely recognised and led to their bans and/or restricted use. DDT and dieldrin are two of the most infamous pesticide compounds ever manufactured, being included on a list of organochlorine pesticides (OCP) of global concern by the Stockholm Convention on Persistent Organic Pollutants (POPs). Their effectiveness in controlling pest species has come with a considerable negative impact on the global environment. These OCPs have consequently been strictly controlled and managed globally by various legislation, treaties, and conventions, some of which have been in place for many decades. These bans and restrictions have led to a decline in the production and use of DDT and dieldrin throughout most parts of the world. However, despite their bans, or in the case of DDT, strict restrictions on use, have their levels fallen or are they still present in the environment at elevated levels because of their persistent nature? The biomagnification of DDT and dieldrin in the environment, at higher trophic levels is well documented in the literature. These pesticides are ingested by potential prey species at lower trophic levels, which consume contaminated vegetation, water, or invertebrates. These prey species are then subsequently consumed by species at higher trophic guilds and then ultimately by apex predators. The concentrations of these pesticides consequently increase in tissues of organisms at successively higher levels of the food chain. This process of bioaccumulation and biomagnification means that species at higher trophic levels, like raptors, can act as valuable indicators of environmental pollutants. Raptors are quintessential apex predators, occupying top levels of the food chain in various ecosystems globally. Due to the well-known negative impacts of these pesticides on global raptor populations, this group of predatory birds have played an invaluable role as sentinel species in the monitoring of DDT and dieldrin contamination in both aquatic and terrestrial ecosystems. Consequently, raptors may be a prime candidate to undertake a comprehensive global-scale assessment to evaluate the extent of DDT and dieldrin monitoring and to assess whether the implementation of worldwide bans has led to a decline in these pesticide levels. Chapter 1 of this thesis introduces pesticides and the pivotal role they played in the success of humankind over centuries. I discuss the various natural, benign pesticides developed throughout history and how these pesticides gradually advanced into more powerful, synthetic chemicals such as DDT and dieldrin. I demonstrate that while these chemicals did offer an undeniable benefit to humankind, compelling evidence began to surface uncovering the more harmful effects of these chemicals on both environmental and human health. I outline the history of these chemicals and delve into how these pesticides were used in different contexts. Chapter 1 concludes by demonstrating how, over time, raptors became an invaluable group of sentinel species for monitoring these pesticides in various ecosystems. In Chapter 2, I explore DDT and dieldrin monitoring in raptors globally over time and space. Through reviewing the multitude of published studies assessing DDT and dieldrin in raptors, I describe the patterns in global research effort focused on the evaluation of these pesticides in raptors. This monitoring spans from the widespread use of these pesticides in the 1950s to the period following the implementation of worldwide restrictions. I then contrast these patterns of monitoring between regions, species, and time, describing how the biases uncovered in this thesis are yet another example of the inequality in scientific knowledge production between the Global North and Global South. In Chapter 3, I assess the efficacy of local legislation and international agreements to manage environmental contamination by DDT. I once again used the abundance of published literature to describe the spatial and temporal patterns in DDT concentrations in raptors across the globe, specifically looking at contamination levels in the most commonly sampled tissues following local bans and restrictions in DDT use across the globe. I not only describe how concentrations of this pesticide have changed over time but also how these levels and changes differ amongst environments. I demonstrate a clear decline in DDT in the Global North, while demonstrating how the lack of monitoring in the Global South has led to insufficient data to assess whether declines are globally representative. I also found that rates of decline depend on variables such as precipitation, and dietary guild. The declines in the Global North, provide hope that legislation and mitigation efforts, in concert with increased monitoring in the Global South, may benefit this region. Thus, the key finding from this chapter, is the welcome demonstration that local legislation and international agreements, when implemented correctly can efficiently halt environmental contamination. The Montreal Protocol is another such example that helped reduce the depletion of the ozone layer, curbing harmful solar ultra-violet radiation by banning chemicals such as CFCs (chlorofluorocarbons). These success stories provide hope that other global crises such as climate change and biodiversity loss can benefit from well planned and implemented local and global agreements. Furthermore, the benefits of using raptors as biomonitors of pesticides and other dangerous contaminants has been well documented, particularly in the Global North. Decades of using raptors as sentinels have played a crucial role in shaping international conventions like the Stockholm Convention by providing essential information on the harmful effects of contaminants on the environment and humans. Given the reduced concern about these contaminants, especially in the Global North, and limited data from the Global South, Chapter 4 examined contemporary DDT and dieldrin levels in a single raptor species. Various tissues were sampled from multiple migratory Amur Falcons (Falco amurensis), collected during a mass mortality event at two roost sites in the KwaZulu-Natal Province of South Africa. The analysis of these migratory falcons was only the second study conducted in a country of the Global South, allowing restricted use of DDT, post the 2006 reintroduction of this pesticide. It, therefore, actively addresses some of the knowledge gaps identified in Chapter 2 (namely the lack of data on DDT and dieldrin concentrations from the Global South). The concentrations of DDT detected in these falcons were generally low, echoing the downward trend in Global North DDT contamination described in Chapter 3. However, two fat samples exhibiting the highest DDT concentrations in the last two decades suggest cause for caution in the face of limited Global South data. This work also directly contributes to the limited toxicological data available for Amur Falcons in particular, representing the first samples of DDT and dieldrin concentrations in this species to my knowledge. While this study found low DDT concentrations in these migratory raptors, the dieldrin concentrations were indicative of a potential worrying, recent exposure to a pesticide that has been completely banned globally since the late 1980s. Chapter 5 of this thesis ties together all the chapters and synthesises the key findings from each of them. It provides a global perspective on the decline in DDT and dieldrin in raptors, taking into consideration the considerable geographic bias in research on this topic towards the Global North. It also highlights the efficacy of international agreements and local legislation and implementation in addressing and curbing global issues such as OCP contamination of the environment. This final chapter also discusses that, while contemporary DDT levels generally echo historical measurements, they may not necessarily confirm a global decline in this pesticide. I conclude this chapter by exploring potential future research opportunities that have emerged as a result of this thesis. This thesis provides the first global-scale review of how DDT and dieldrin has been studied and assessed in raptors, providing direct evidence that DDT concentrations in the Global North are declining. This suggests that legislation in this region has been largely successful in mitigating environmental contamination by this pesticide. However, insufficient data from the Global South post the 2006 DDT reintroduction affirms the bias in monitoring and research to the Global North. Furthermore, it highlights an urgency to generate sufficient data from countries still using DDT in order to assess whether the decline in DDT can be regarded as globally representative. It is tempting to suggest that low contemporary concentrations of DDT in a raptor wintering in a country with restricted DDT use supports the notion that DDT may also be declining in the Global South. However, the record high concentrations in fat from two individuals may indicate the contrary, that declines in the Global North do not necessarily translate to declines in the Global South. The dieldrin concentrations found in Amur Falcons in South Africa, also raises concern that there may be illegal and illicit use of a banned pesticide in South Africa. This result necessitates an urgent need to monitor dieldrin in KwaZulu-Natal, South Africa. By combining my findings across the chapters, I provide robust evidence that local findings further indicate an urgent need to improve monitoring of DDT and dieldrin in the Global South in order to determine whether declines in these pesticides from the Global North can be considered globally representative
A conceptual model for digital forensic readiness in security operation centres: a South African study
No full textThe increase in the adoption of technology has resulted in the number of cyber-attacks and security breaches also rising. These cyber-attacks and breaches have become advanced and can go undetected for months. With the rise in cyber-attacks, the need for organizations to tighten cybersecurity measures and be ready to investigate the breaches speedily has become crucial. These measures include the adoption of Security Operations Centres (SOC) that integrate digital forensic capabilities with various cybersecurity tools. The reviewed literature shows that having a well-defined digital forensic readiness (DFR) strategy in place is important to ensure quick and efficient investigations that do not have a huge impact on the organization. In addition, conducting internal investigations helps an organization reduce costs. While there are proposed frameworks that aim to help an organization become forensically ready, none have a specific focus on a SOC. SOCs are complex, making conducting a digital forensic investigation challenging. The objective of this study was to develop a conceptual model for DFR that focused on SOCs in South Africa. To achieve this, the study first analysed existing DFR frameworks and drew key factors that were common in all frameworks. Management support, policies, processes and procedures, forensic technologies, legal frameworks, technical skills, and training were identified as the key factors that have a potential influence on the forensic readiness of a SOC. The study was conducted using a quantitative research approach and a survey questionnaire. Data were collected from professionals who work in organizations running a SOC in South Africa through a survey. The data were analysed using statistical methods and the results of the study indicate that the digital forensic readiness of a SOC is dependent on management support, organizational policies, processes and procedures, the integration of forensic and cybersecurity technologies, understanding various legal requirements, technical skills, and continuous training. All participants had at least one form of formal qualification and one industry-related certificate. The proposed DFR conceptual model examined various factors that SOCs can use to assess their forensic readiness. The findings also highlight the importance of having a holistic approach to forensic readiness which also include continuous investment in both technology and technical skills to keep up with evolving technology. Furthermore, the findings can be used by SOCs to identify areas in their DFR plan they need to focus on to enhance their cyber-resilience
Factors associated with partial health insurance coverage among households in Malawi
Full text linkHealth insurance has proven ideal for curbing the increase in household contribution towards health expenditure. However, despite efforts to expand health insurance in Sub-Saharan Africa, coverage has remained low and favouring higher-income groups. Malawi is among the countries that face this low uptake, with only 3% of the total population insured. Moreover, within insured households, coverage is often incomplete, leaving some members without protection. This partial insurance coverage increasingly contributes to a reliance on out-of-pocket expenditure (OOPE), a regressive and inequitable financing mechanism that disproportionately affects vulnerable households. However, there is dearth of evidence on factors associated with this phenomenon among households in Malawi, thus, understanding the dynamics of partially insured households is crucial to addressing these gaps, reducing financial barriers to healthcare, and promoting Universal Health Coverage (UHC). Methodology: This study aimed to examine the determinants associated with partially insured households in Malawi. The thesis is divided into three parts: a structured literature review, a journal manuscript and a policy brief. The literature review revealed that most studies in Africa and elsewhere have focused on individual health insurance coverage determinants and not intrahousehold health insurance coverage status determinants. In Malawi, this is coupled with a low health insurance uptake. There is also limited information on factors influencing households to insure some but not all members. This study therefore aimed to fill this gap in literature and inform health financing policies. This quantitative study used cross-sectional secondary Data from the 2019-2020 Multiple Indicator Cluster Survey (MICS). The individual health insurance status; insured and uninsured, was defined as coverage by any health insurance. Using unique identifiers (cluster number, household number and line number), every individual was grouped into their respective households. Consequently, household size was used to determine a household's health insurance coverage status where a household with all members as insured was categorized as fully insured, a household with at least one but not all members insured as partially insured and a household with no member covered as completely uninsured. A two-stage analysis approach was then utilized in this study. Firstly, descriptive statistics were used to analyse and compare fully insured households, partially insured households and completely uninsured households. Zoning into partially insured households, the second stage applied multivariate binary logistic regression to identify factors associated with health insurance coverage. Analysis was done using STATA statistical package version 18. Results: This study had 64,615 unique individuals from 22,886 households. Only 0.6% of individuals had health insurance. A higher proportion of the households were completely uninsured (22,649; 98.96%) with 228 households (1%) being partially insured and the remaining 9 households (0.04%) were fully insured. Household sizes differed significantly among fully, partially insured, and completely uninsured households (median of 1, 5, & 4 respectively; p-value=<0.001). Higher education levels of household heads were strongly associated with full and partial insurance coverage and in contrast, lower education levels, such as no education or primary education, were linked to a lack of insurance coverage (89% vs 50% vs 72%; p-value=<0.001). All fully insured households were from the richest quintile. Age of household head [AOR 1.025 (1.000-1.050);p-value=0.045], higher education level of an individual [ AOR 4.470 (1.519-13.154); p-value=0.007], an individual's access to media [AOR 2.276 (1.050-4.931); p-value=0.037] and a higher dependency ratio [AOR 1.655 (1.111-2.466);p-value=0.014] were positively associated with being an insured individual from a partially insured household with household size [AOR 0.813 (0.682-0.969); p-value=0.022] being negatively associated with the outcome. On the other hand, residential area, sex of an individual and region were not associated with health insurance ownership in partially insured households. Households, therefore, were partially insured mainly because of being with large household members (median size of 5), higher dependency ratio, media access, individuals having no or primary education and being from the poorest quintile. Conclusion: Socioeconomics and household dynamics influence health insurance coverage. This study highlights education, household size, wealth, dependency ratio, and media exposure as significant determinants influencing partial household health insurance enrolment. Partially insured households remain particularly vulnerable as they continue to face financial risks due to uninsured members, highlighting the need for targeted interventions to facilitate their transition to full coverage. The findings emphasize socioeconomic and informational disparities. Therefore, efforts to enhance health insurance enrolment should focus on improving education access, supporting larger and economically disadvantaged households, and leveraging media channels to raise awareness about the benefits of comprehensive health insurance coverage. Implementing policies that enhance affordability, and accessibility will also be essential in achieving universal coverage and reducing financial vulnerability among households. Moreover, these findings are timely given Malawi's commitment to UHC, Sustainable Development Goal 3, and regional targets such as the Abuja Declaration, reinforcing the need for equitable health financing policies that address partial household insurance coverage
A theory and outcome evaluation of the Allan Gray Orbis Foundation's (AGOF's) scholarship programme
Full text linkThis report presents the results of the formative (theory and outcome) evaluation of the Allan Gray Orbus Foundation (AGOF) scholarship programme. The programme offers scholarships to academically excellent grade 6 learners of 11 to 12 years of age, who demonstrate financial need and attain a minimum score of 70% in English and Mathematics and are from poor family backgrounds to attend secondary school. The programme provides financial support, coaching, and extracurricular activities (a development camp, breakthrough sessions, jamborees and an online curriculum) to help needy students access high-quality secondary education and develop an entrepreneurial mindset. The financial support covers tuition, boarding, allowances, uniforms, stationery and extracurricular expenses. Scholars receive academic support through tutoring and remedial lessons, particularly in mathematics, science, and English. Further, the students attend extracurricular activities that comprise of camps, breakthrough sessions and jamborees, gaining networking and entrepreneurial exposure. Graduates meeting this academic criterion can apply for the fellowship programme and contribute to society and the economy
Determining caregiver priorities for musculoskeletal interventions in children with Cerebral Palsy
Full text linkIntroduction: Cerebral palsy is caused by an insult to the developing brain and typically results in the development of musculoskeletal deformity and resultant physical disability. These deformities are frequently addressed by non-invasive measures such as physiotherapy and splinting, but also by orthopaedic surgery. The musculoskeletal system is affected to varying degrees based on the severity of the cerebral insult and the goals of musculoskeletal interventions will vary accordingly. Little is known about what caregivers' expectations are following non-surgical or surgical interventions for musculoskeletal deformities and treatment is usually based on the expectations of the therapists or surgeons.. The aim of this study is to determine the treatment priorities of caregivers of children with cerebral palsy for musculoskeletal intervention. Methods: Participants were selected from the Red Cross Children's Hospital cerebral palsy clinic. They were divided into two groups of parents/guardians of children with cerebral palsy who were ambulatory and those who were non-ambulatory. There were 20 participants in each group who filled out a questionnaire regarding their expectations from interventions for their child. A Delphi consensus study design was used to prioritise responses given by participants in the questionnaire. There were two follow up iterative rounds to prioritise the list of responses given by asking participants to choose the top four responses relevant to them in the first iterative and the top 2 responses in the final round. A final percentage agreement of 50% or higher was chosen to denote a consensus. Results: In the ambulatory group 60% of caregivers were concerned that their children walked on their toes, 40% agreed that more physio therapy in the community, 45 % concurred that they had difficulty with shoe wear and 35 % agreed that their children had difficulty running and playing sport. The results of the non-ambulatory group were more varied. 20% of parents concurred to have difficulty when trying to open their child's legs to bathe or clean them. 20% agreed that their children were treated differently to other children. 20 % of the parents felt that caring their child became difficult as they got heavier was a major issue they faced and 20 % agreed that their child's muscles being tight was a priority that needed to be addressed. Conclusions: A consensus was reached in the ambulatory group with correction of a child's toe walking being the most frequently reported concern. This should be seen as one of the main treatment priorities when assessing treatment options in an ambulatory child. In the non-ambulatory group, no definitive consensus was reached. This may be due to the fact that children with higher grades of cerebral palsy have many medical complications that have to be addressed and a child's home circumstances and resources may greatly affect what caregivers prioritise as most important to improve the child's quality of life
A critical analysis of the impact of the MLI in the determination of corporate residency in South Africa: a synthesis of a hierarchy of factors to used for resolving dual residency under map
Full text linkSouth Africa was a signatory to the Multilateral Instrument (“MLI”) on 7 June 2021. South Africa has deposited its ratified, accepted, and approved MLI and list of reservations and notification with the OECD on 30 September 2022. The MLI applies from 1 January 2023 in South Africa. In alignment with the OECD/G20 Inclusive Framework on Base Erosion and Profit Shifting (“BEPS”) Action 6, South Africa has elected to include Article 4(1) of the MLI. Article 4(1) deals with the determination of corporate residency and modifies the existing tie-breaker rule in South Africa's Double Taxation Agreements (“DTAs”) to solving cases of dual residency through a Mutual Agreement Procedure (“MAP”). The MLI's approach of using MAP as a tie-breaker includes a non-exhaustive list of criteria that tax authorities may consider as relevant. This approach lacks clear criteria of factors to resolve dual residency, which may lead to delays, uncertainty, and the risk of double taxation where tax authorities do not reach agreement. This research considers South Africa's domestic tax legislation concerning corporate residency and the application of Article 4(1) of the MLI on its treaty network. The study overlays the South African considerations with the United Kingdom and Mauritius domestic legislation and case law in determining corporate tax residency and how this interacts with the application Article 4(1) of the MLI. The result of this study is a proposed hierarchy of factors for taxpayers and tax authorities to consider when determining corporate residency for MAP purposes in instances of corporate dual residency. The study concludes that while Article 4(1) of the MLI acts as an anti-abuse measure, it imposes challenges that should be managed by tax authorities to maintain the fairness and certainty for taxpayers. Thus, suggesting that tax authorities adopt a structured sequence of criteria to provide certainty for corporate dual residency cases
The diagnostic pathway to a surgical lymph node excision biopsy service in a HIV and TB endemic region in a Western Cape Tertiary Institution
Full text linkIn the HIV/TB endemic public care setting of the Western Cape, diagnostic consideration of patients with persistent lymphadenopathy is focused towards extra- pulmonary tuberculosis (EPTB), more than other infectious or malignant causes of lymphadenopathy. We investigated patients consecutively referred for lymph node excision at Groote Schuur Hospital for selection of, and results of, laboratory tests performed during the diagnostic pathway and possible impact on diagnostic delay. Eighty-six patients were included, 61 patients (71%) had no previous diagnosis to explain the lymphadenopathy, while 25 patients had a previous diagnosis of a haematological malignancy, cancer or tuberculosis. In the new patient group, EPTB was the commonest diagnostic outcome (24.6%, 15/61), followed by lymphoma (21.3%, 13/61) and cancer (14.8%, 9/61). HIV positive patients constituted 41% (n=25). Median time from presentation with lymphadenopathy to first excision biopsy was 55 days (IQR 22-106). Fine needle aspiration (FNA) cytology of lymphadenopathy was performed in 30/61 (49%) of patients and repeated in a third of these, while smear for AFBs and culture for M. tuberculosis were infrequently performed and GeneXpert MTB/RIF assay on FNA never performed. Furthermore, in the seven patients with a final diagnosis of lymphoma in whom FNA cytology was performed, cytology was not diagnostic of lymphoma. In patients with persistent lymphadenopathy, this study demonstrates how poorly structured diagnostic pathways contribute to unnecessary health care utilisation and diagnostic delay in readily treatable conditions. We need to implement accurate diagnostic pathways for patients with lymphadenopathy in South Africa's healthcare system, thus improving early diagnosis of both EPTB and lymphoma, potentially improving patient outcomes
“Rape and GBV is part of the TRC's unfinished business!”: Illuminating a culture of impunity through tracing the legacy and collective memory of sexual violence in contemporary South Africa
Full text linkThe proliferation of sexual and gender-based violence (SGBV) in South Africa has ranked it as one of the countries with the highest rates of violence against women in the world – with interventions to address SGBV failing dismally to do so. A cursory glance at this issue may reveal that South Africa is in crisis, however, what underpins this crisis is the broader historical project of colonial and apartheid era crime and the culture of impunity that has surrounded this for decades. While the transition from apartheid saw substantial changes being brought about in the country, as part of the process of addressing past harms with a view of securing a peaceful and democratic future, the issue of gendered harm, particularly sexual violence, was depoliticised and deprioritised as an issue that needed to be acknowledged and accounted for in the historical record. Addressing the long-standing issue of sexual violence in South Africa, with a particular lens of understanding how sexual violence is political in the colonial and apartheid era, explores how a lack of accountability for this harm, fosters a culture of accountability and a dislocation of sexual violence in the collective memory