A Qualitative Study of Contextual Factors’ Impact on the Adaptation of a Caregiver-mediated Early Autism Intervention in South Africa

Background: Autism Spectrum Disorder (ASD) is a major global health challenge as the majority of individuals with ASD live in low- and middle-income countries (LMICs) and receive little to no services or support from health or social care systems. Despite this global crisis, the development and validation of ASD interventions has almost exclusively occurred in high-income countries, leaving many unanswered questions regarding what contextual factors would need to be considered to ensure the effectiveness of interventions in LMICs. This study sought to conduct explorative research on the contextual adaptation of a caregiver-mediated early ASD intervention for use in a low-resource setting in South Africa.

Methods: Participants included 22 caregivers of children with autism, including mothers (n=16), fathers (n=4), and grandmothers (n=2). Four focus groups discussions were conducted in Cape Town, South Africa with caregivers and lasted between 1.5-3.5 hours in length. Data was recorded, translated, and transcribed by research personnel. Data was then coded for emerging themes and analyzed using the NVivo qualitative data analysis software package.

Results: Nine contextual factors were reported to be important for the adaptation process including culture, language, location of treatment, cost of treatment, type of service provider, familial needs, length of treatment, support, and parenting practices. One contextual factor, evidence-based treatment, was reported to be both important and not important for adaptation by caregivers. The contextual factor of stigma was identified as an emerging theme and a specifically relevant challenge when developing an ASD intervention for use in a South African context.

Conclusions: Eleven contextual factors were discussed in detail by caregivers and examples were given regarding the challenges, sources, and preferences related to the contextual adaptation of a parent-mediated early ASD intervention in South Africa. Caregivers reported a preference for an affordable, in-home, individualized early ASD intervention, where they have an active voice in shaping treatment goals. Distrust of community-based nurses and health workers to deliver an early ASD intervention and challenges associated with ASD-based stigma were two unanticipated findings from this data set. Implications for practice and further research are discussed.

The Relationship Between Support Systems and Disease Burden for Families Coping with Sickle Cell Disease in South Africa and Cameroon

Background: Sickle cell disease (SCD) is a debilitating genetic blood disorder that seriously impacts the quality of life of affected individuals and their families. With 85% of cases occurring in sub-Saharan Africa, it is essential to identify the barriers and facilitators of optimal outcomes for people with SCD in this setting. This study focuses on understanding the relationship between support systems and disease outcomes for SCD patients and their families in Cameroon and South Africa.

Methods: This mixed-methods study utilizes surveys and semi-structured interviews to assess the experiences of 29 SCD patients and 28 caregivers of people with SCD across three cities in two African countries: Cape Town, South Africa; Yaoundé, Cameroon; and Limbe, Cameroon.

Results: Patients in Cameroon had less treatment options, a higher frequency of pain crises, and a higher incidence of malaria than patients in South Africa. Social support networks in Cameroon consisted of both family and friends and provided emotional, financial, and physical assistance during pain crises and hospital admissions. In South Africa, patients relied on a strong medical support system and social support primarily from close family members; they were also diagnosed later in life than those in Cameroon.

Conclusions: The strength of medical support systems influences the reliance of SCD patients and their caregivers on social support systems. In Cameroon the health care system does not adequately address all factors of SCD treatment and social networks of family and friends are used to complement the care received. In South Africa, strong medical and social support systems positively affect SCD disease burden for patients and their caregivers. SCD awareness campaigns are necessary to reduce the incidence of SCD and create stronger social support networks through increased community understanding and decreased stigma.

Pollen analysis of sediment core GIK16415-2 in the eastern tropical Atlantic

Palynological data of the marine core M 16415-2 show latitudinal shifts of the northern fringe of the tropical rain forest in north-west Africa during the last 700 ka. Savanna and dry open forest expanded southwards and tropical rain forest expanded northwards during dry and humid periods, respectively. Until 220 ka B.P., the tropical rain forest probably kept its zonal character in West Africa during glacials and interglacials. It is only during the last two glacial periods that the rain forest possibly fragmented into refugia. Throughout the Brunhes chron, pollen and spore transport was mainly by trade winds.

Surface mass balance along the K-transect in West Greenland

A 21-year record is presented of surface mass balance measurements along the K-transect. The series covers the period 1990-2011. Data are available at 8 sites along a transect over an altitude range of 390 - 1850 m at approximately 67° N in West Greenland. The surface mass balance gradient is on average 3.8 x 10**-3 m w.e./m, and the mean equilibrium line altitude is 1553 m a.s.l. Only the lower 3 sites within 10 km of the margin experience a significant increasing trend in the ablation over the entire period.

Struggles for Citizenship in South Africa

South Africa’s first democratic constitution of 1996, which defines the content and scope of citizenship, emerged out of what the country’s Constitutional Court accurately described as ‘a deeply divided society characterized by strife, conflict, untold suffering and injustice which generated gross violations of human rights, the transgression of humanitarian principles in violent conflicts and a legacy of hatred, fear, guilt and revenge’ (cited in Jagwanth, 2003: 7). The constitution was internationally noteworthy for its expressed protection of women’s and sexual minority rights and its extension of rights of citizenship to socio-economic rights, such as rights of adequate healthcare, housing and education (SAGI, 1996). During South Africa’s first two decades of democracy, the Constitutional Court has proven its independence by advancing citizenship rights on a number of occasions (O’Regan, 2012). The struggle for citizenship was at the heart of the liberation struggle against the apartheid regime and within the complex dynamics of the anti-apartheid movement, increasingly sophisticated and intersectional demands for citizenship were made. South Africa’s constitutional rights for citizenship are not always matched in practice. The country’s high rates of sexual violence, ongoing poverty and inequality and public attitudes towards the rights of sexual minorities and immigrants lag well behind the spirit and letter of the constitution. Nevertheless, the achievement of formal citizenship rights in South Africa was the result of a prolonged and complex liberation struggle and analysis of South Africa demonstrates Werbner’s claim that ‘struggles over citizenship are thus struggles over the very meaning of politics and membership in a community’ (1999: 221). This chapter will begin with a contextual and historical overview before moving onto analyzing the development of non-racialism as a basis for citizenship, non-sexism and gendered citizenship, contestations of white, militarized citizenship and the achievement of sexual citizenship by the Lesbian, Gay, Bisexual and Transgender (LGBT) rights movement. As shall be made clear, all these citizenship demands emerged during the decades of the country’s liberation struggle.

An overview of top-down vs. bottom-up models for informal settlement upgrading in South Africa

The paper explores informal settlement upgrading approaches in South Africa and presents a review of top-down vs. bottom-up models, using experience and lessons learned from the Durban metropolitan area. Reflections on past upgrading efforts suggest that top-down policies in South Africa have not been successful to date. By contrast, participatory techniques, such as planning activism, can be used to enhance community empowerment and a sense of local ownership. This paper reveals that although the notion of ‘bottom-up’, participatory methods for community improvement is often discussed in international development discourses, the tools, processes and new knowledge needed to ensure a successful upgrade are under-utilised. Participation and collaboration can mean various things for informal housing upgrading and often the involvement of local communities is limited to providing feedback in already agreed development decisions from local authorities and construction companies. The paper concludes by suggesting directions for ‘co-producing’ knowledge with communities through participatory, action-research methods and integrating these insights into upgrading mechanisms and policies for housing and infrastructure provision. The cumulative impacts emerging from these approaches could aggregate into local, regional, and national environmental, social and economic benefits able to successfully transform urban areas and ensure self-reliance for local populations.

Community-led upgrading for self-reliance in informal settlements in South Africa: a review

Around the world, informal and low-income settlements (so-called “slums”) have been a major issue in city management and environmental sustainability in developing countries. Overall, African cities have an agenda for slum management and response. For example, the South African government introduced the Upgrade of Informal Settlements Program (UISP), as a comprehensive plan for upgrading slum settlements. Nevertheless, upgrading informal settlements from the bottom-up is key to inform broad protocols and strategies for sustainable communities and `adaptive cities´. Community-scale schemes can drive sustainability from the bottom-up and offer opportunities to share lessons learnt at the local level. Key success factors in their roll-out are: systems thinking; empowered local authorities that support decentralised solutions and multidisciplinary collaboration between the involved actors, including the affected local population. This research lies under the umbrella of sustainable bottom-up urban regeneration. As part of a larger project of collaboration between UK and SA research institutions, this paper presents an overview of in-situ participatory upgrade as an incremental strategy for upgrading informal settlements in the context of sustainable and resilient city. The motivation for this research is rooted in identifying the underpinning barriers and enabling drivers for up-scaling community-led, participatory upgrading approaches in informal settlements in the metropolitan area. This review paper seeks to provide some preliminary guidelines and recommendations for an integrated collaborative environmental and construction management framework to enhance community self-reliance. A theoretical approach based on the review of previous studies was combined with a pilot study conducted in Durban (South Africa) to investigate the feasibility of community-led upgrading processes.

Musically Consonant, Socially Dissonant: Orange Walks and Catholic Interpretation in West-Central Scotland

This article examines the music used by the Orange Order, in its public parades, more commonly referred to as “Orange Walks.” The Orange Order is an exclusively Protestant fraternal organization, which traces its roots to 1690 and the victory of the Protestant Prince William of Orange over the Catholic King James. Yet, as in Northern Ireland, many consider the group to be sectarian and view its public celebrations as a display of ethno-religious triumphalism. This article explores the extra-musical factors associated with Orangeism’s most iconic song, “The Sash My Father Wore,” how other groups have misappropriated the song, and how this has distorted its meaning and subsequent interpretation.

Recent statistics have shown that Glasgow hosts more Orange parades each year than in Belfast and Derry/Londonderry combined, yet while there have been many anthropological and ethnomusicological studies of Northern Ireland’s Orange parades, very little research has focused on similar traditions in Scotland. This article seeks to address that gap in the literature and is intended as a preparatory study, laying the groundwork for further analysis.

The politics of establishing catchment management agencies in South Africa: the case of the Breede-Overberg Catchment Management Agency

We reflect on the politics of establishing catchment management agencies in South Africa with a specific focus on the Breede-Overberg Catchment Management Agency (BOCMA), which was recently replaced by the Breede-Gouritz Catchment Management Agency (BGCMA). We do so by applying the framework of adaptive comanagement and its institutional prescriptions: collaboration, experimentation, and a bioregional approach. We start by introducing the history of this catchment management agency (CMA) and then describe the establishment of CMAs in South Africa in general and that of BOCMA in particular. We follow the framework for rule types and types of river basin organizations set out by the editors of this special feature with reference to adaptive comanagement where applicable. We then discuss the politics and strategies involved in the introduction of the CMA concept to the National Water Act and the latest developments around these institutions in South Africa. This is followed by reflections on what can be surmised about BOCMA’s democratic functioning and performance to date. We conclude by reflecting on the future of operations of the new BGCMA and CMAs in South Africa in general. While our research shows that BOCMA’s establishment process has featured several elements of adaptive comanagement and its institutional prescriptions, it remains to be seen to what extent it is possible to continue implementing this concept when further developing and operationalizing the BGCMA and the country’s other CMAs.

Developmental TVET rhetoric in-action: the White Paper for post-school education and training in South Africa

This paper explores the extent to which latest developments in the Technical and Vocational Education and Training System in South Africa respond to key principles espoused for a developmental, democratic and inclusionary ideal. The White Paper for post school education and training approved by Cabinet in November, 2013 is referred to by the Minister as the “definitive statement of the governments vision for the post school system” and as such represents a crucial strategy document intended to chart the TVET direction to 2030. Using key theoretical constructs from development theory, this paper provides an assessment of the TVET strategy contained is the paper and explores the extent to which it does respond to the agenda defined by the promise. It is argued that the challenges outlined are not yet able to provide the blueprint for a TVET transformative vision. It is concluded that while the development rhetoric contained in the paper is plausible, the creative tinkering of the system is unlikely to lead to the radical revisioning necessary for a truly transformative TVET system. The underlying assumptions regarding purpose, impact and outcome will need to be carefully reconsidered if the system is to be responsive to the promises of the democratic developmental ideal to which the government is committed. (DIPF/Orig.)

Climate Change or Urbanization? Impacts on a Traditional Coffee Production System in East Africa over the Last 80 Years

Global environmental changes (GEC) such as climate change (CC) and climate variability have serious impacts in the tropics, particularly in Africa. These are compounded by changes in land use/land cover, which in turn are driven mainly by economic and population growth, and urbanization. These factors create a feedback loop, which affects ecosystems and particularly ecosystem services, for example plant-insect interactions, and by consequence agricultural productivity. We studied effects of GEC at a local level, using a traditional coffee production area in greater Nairobi, Kenya. We chose coffee, the most valuable agricultural commodity worldwide, as it generates income for 100 million people, mainly in the developing world. Using the coffee berry borer, the most serious biotic threat to global coffee production, we show how environmental changes and different production systems (shaded and sun-grown coffee) can affect the crop. We combined detailed entomological assessments with historic climate records (from 1929-2011), and spatial and demographic data, to assess GEC's impact on coffee at a local scale. Additionally, we tested the utility of an adaptation strategy that is simple and easy to implement. Our results show that while interactions between CC and migration/urbanization, with its resultant landscape modifications, create a feedback loop whereby agroecosystems such as coffee are adversely affected, bio-diverse shaded coffee proved far more resilient and productive than coffee grown in monoculture, and was significantly less harmed by its insect pest. Thus, a relatively simple strategy such as shading coffee can tremendously improve resilience of agro-ecosystems, providing small-scale farmers in Africa with an easily implemented tool to safeguard their livelihoods in a changing climate.

Some Like It Hot: The Influence and Implications of Climate Change on Coffee Berry Borer (Hypothenemus hampei) and Coffee Production in East Africa

The negative effects of climate change are already evident for many of the 25 million coffee farmers across the tropics and the 90 billion dollar (US) coffee industry. The coffee berry borer (Hypothenemus hampei), the most important pest of coffee worldwide, has already benefited from the temperature rise in East Africa: increased damage to coffee crops and expansion in its distribution range have been reported. In order to anticipate threats and prioritize management actions for H. hampei we present here, maps on future distributions of H. hampei in coffee producing areas of East Africa. Using the CLIMEX model we relate present-day insect distributions to current climate and then project the fitted climatic envelopes under future scenarios A2A and B2B (for HADCM3 model). In both scenarios, the situation with H. hampei is forecasted to worsen in the current Coffea arabica producing areas of Ethiopia, the Ugandan part of the Lake Victoria and Mt. Elgon regions, Mt. Kenya and the Kenyan side of Mt. Elgon, and most of Rwanda and Burundi. The calculated hypothetical number of generations per year of H. hampei is predicted to increase in all C. arabica-producing areas from five to ten. These outcomes will have serious implications for C. arabica production and livelihoods in East Africa. We suggest that the best way to adapt to a rise of temperatures in coffee plantations could be via the introduction of shade trees in sun grown plantations. The aims of this study are to fill knowledge gaps existing in the coffee industry, and to draft an outline for the development of an adaptation strategy package for climate change on coffee production. An abstract in Spanish is provided as Abstract S1.