Research Articles (Psychology)

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Access to education in Africa : responding to the United Nations Convention on the rights of persons with disabilities
(Taylor & Francis Routledge, 2012-05) Chataika, Tsitsi; Mckenzie, Judith Anne; Swart, Estelle; Lyner- Cleophas, Marcia
Article 24 of the United Nations Convention on the Rights of Persons with Disabilities mandates that disabled people should have full rights to education in inclusive settings. However, to ensure that educational polices and settings are designed to meet this criterion seems challenging to African countries that have ratified this Convention. This article arises from the 2nd African Network of Evidence-to-Action on Disability Symposium. This fluid network was established to address the gap between research and practice in the region. The article reports proceedings and the emerging themes from the Education, Training and Work Commission; one of the six commissions of this Symposium, focusing specifically on the education aspect. It also challenges various stakeholders to move from evidence to action to ensure the educational rights of disabled people in inclusive settings.
Access to health care for persons with disabilities in rural South Africa
(BioMed Central, 2017-11-17) Vergunst, R.; Swartz, L.; Hem, K.-G.; Eide, A. H.; Mannan, H.; MacLachlan, M.; Mji, G.; Braathen, S. H.; Schneider, M.
Background: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at “triple vulnerability” – poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. Methods: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. Results: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. Conclusions: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
Access to healthcare for people with disabilities in South Africa : bad at any time, worse during COVID-19?
(AOSIS, 2021-07) McKinney, Emma L.; McKinney, Victor; Swartz, Leslie
People with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.
Accessing community health services : challenges faced by poor people with disabilities in a rural community in South Africa
(AOSIS Publishing, 2012-10) Grut, Lisbet; Mij, Gubela; Hellum Braathen, Stine; Ingstad, Benedicte
Poor people with disabilities who live in poor rural societies experience unique problems in accessing health services. Their situation is influenced by multiple factors which unfold and interplay throughout the person’s life course. The difficulties do not only affect the person with a disability and his or her family, but also impact on the relevant care unit. The barriers are rooted in a life in poverty, upheld and maintained by poverty-reinforcing social forces of the past and the present, and reinforced by the lack of the person’s perspective of the health services. This article explores how difficulties may interact and influence access to and utilisation of health services, and how this may render health services out of reach even when they are available. The study reveals that non-compliance is not necessarily about neglect but could as well be a matter of lived poverty. The study was based on in-depth interviews with people with disabilities and family members, and semi-structured interviews with health personnel. The data analysis is contextual and interpretive. When offering health services to people with disabilities living in resourcepoor settings, services should take into consideration the person’s history, the needs, and the resources and abilities of the family group. Rethinking access to health services should transcend a narrow medical institutionalisation of health professional’s training, and include a patient’s perspective and a social vision in understanding and practice. Such rethinking requires health service models that integrate the skills of health professionals with the skills of disabled people and their family members. Such skills lie dormant at community level, and need to be recognised and utilised.
Alcohol consumption among HIV-positive pregnant women in KwaZulu-Natal, South Africa : prevalence and correlates
(Elsevier, 2012) Desmond, Katherine; Milburn, Norweeta; Richter, Linda; Tomlinson, Mark; Greco, Erin; Van Heerden, Alastair; Van Rooyen, Heidi; Comulada, W. Scott; Rotheram-Borus, Mary Jane
Background: HIV-positive pregnant women who drink put their children at risk of both HIV and fetal alcohol spectrum disorders. The province of KwaZulu-Natal (KZN) has the highest prevalence of HIV in South Africa, but has not before been considered an area of high alcohol consumption among women. This paper analyzes a large sample of HIV+ pregnant women in KZN to examine alcohol consumption in that population. Methods: Data came from assessments of women enrolled in Prevention of Mother-To-Child Transmission programs at 8 clinics in KZN. Descriptive statistics and logistic regressions were used to examine the prevalence and correlates of alcohol consumption and binge drinking. Results: Of 1201 women assessed, 18% reported drinking during pregnancy, and 67% of drinkers usually binged when drinking (had 3+ drinks in one sitting). Over one-third of drinkers binged twice a month or more. Women living in urban and peri-urban locations were more likely to drink, as were those with indicators of higher economic status and greater social engagement. Married women were less likely to drink, while women who had poorer mental health, used tobacco, or had a greater history of sexual risk-taking were more likely to drink. Conclusion: Health care workers in KZN should be aware that pregnant women who drink are likely to do so at a level that is dangerous for their babies. Some factors associated with drinking indicate social/environmental influences that need to be counteracted by greater dissemination of information about the dangers of drinking, and greater support for abstinence or moderation.
Alcohol use in South Sudan in relation to social factors, mental distress and traumatic events
(BioMed Central, 2016-09-06) Lien, Lars; Hauff, Edvard; Martinez, Priscilla; Eide, Arne H; Swartz, Leslie; Ayazi, Touraj
ENGLISH SUMMARY : Background: Alcohol use is a major public health problem with vast implications for poor, war-torn countries. The objective of this study was to describe prevalence of alcohol use and risky drinking across socio-demographic factors in South Sudan, and to determine the association between risky drinking, traumatic events and mental distress. Methods: This is a randomized, population based, cross-sectional study from the north-western part of South Sudan with nearly 500 participants. We used the Alcohol Use Disorders Identification Test (AUDIT) as main outcome variable, the General Health Questionnaire (GHQ-28) for mental distress and five questions to assess traumatic events. Results: the mean AUDIT score was 2.7 (SD 0.3) with 14,2 % in the high risk problem drinking category. Being male, lack of a regular income and psychological distress were significantly associated with higher AUDIT score. Traumatic events, however, was not associated with higher score on AUDIT. Conclusion: Despite decades of civil war and great poverty the alcohol use in this population was at the same level as other countries in Southern Africa. Traumatic events were not related to risk of problem drinking.
Anxiety in children with selective mutism: a meta-analysis
(Springer, 2019) Driessen, Jim; Blom, Jan Dirk; Muris, Peter; Blashfield, Roger K.; Molendijk, Marc L.
This study evaluates the current conceptualization of selective mutism (SM) as an anxiety disorder in the DSM-5 using a meta-analytic approach. In the absence of any systematic assessment of anxiety in the field of SM, we pooled prevalence data of comorbid anxiety disorders in a random-effects meta-analysis. On the basis of 22 eligible studies (N = 837), we found that 80% of the children with SM were diagnosed with an additional anxiety disorder, notably social phobia (69%). However, considerable heterogeneity was present, which remained unexplained by a priori specified moderators. The finding that SM is often diagnosed in combination with anxiety disorders, indicates that these disorders are not discrete, separable categories. Moreover, this finding does not help to elucidate the relation between SM and anxiety as an etiological mechanism or symptomatic feature. Broadening our research strategies regarding the assessment of anxiety is paramount to clarify the role of anxiety in SM, and allow for proper classification.
Assessment of the uptake of neonatal and young infant referrals by community health workers to public health facilities in an urban informal settlement, KwaZulu-Natal, South Africa
(BioMed Central, 2013-02) Nsibande, Duduzile; Doherty, Tanya; Ijumba, Petrida; Tomlinson, Mark; Jackson, Debra; Sanders, David; Lawn, Joy
Abstract Background Globally, 40% of the 7.6 million deaths of children under five every year occur in the neonatal period (first 28 days after birth). Increased and earlier recognition of illness facilitated by community health workers (CHWs), coupled with effective referral systems can result in better child health outcomes. This model has not been tested in a peri-urban poor setting in Africa, or in a high HIV context. Methods The Good Start Saving Newborn Lives (SNL) study (ISRCTN41046462) conducted in Umlazi, KwaZulu-Natal, was a community randomized trial to assess the effect of an integrated home visit package delivered to mothers by CHWs during pregnancy and post-delivery on uptake of PMTCT interventions and appropriate newborn care practices. CHWs were trained to refer babies with illnesses or identified danger signs. The aim of this sub-study was to assess the effectiveness of this referral system by describing CHW referral completion rates as well as mothers’ health-care seeking practices. Interviews were conducted using a structured questionnaire with all mothers whose babies had been referred by a CHW since the start of the SNL trial. Descriptive analysis was conducted to describe referral completion and health seeking behaviour of mothers. Results Of the 2423 women enrolled in the SNL study, 148 sick infants were referred between June 2008 and June 2010. 62% of referrals occurred during the first 4 weeks of life and 22% between birth and 2 weeks of age. Almost all mothers (95%) completed the referral as advised by CHWs. Difficulty breathing, rash and redness/discharge around the cord accounted for the highest number of referrals (26%, 19% and 17% respectively). Only16% of health workers gave written feedback on the outcome of the referral to the referring CHW. Conclusions We found high compliance with CHW referral of sick babies in an urban South African township. This suggests that CHWs can play a significant role, within community outreach teams, to improve newborn health and reduce child mortality. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health which involves the establishment of family health worker teams including CHWs. Trial registration number ISRCTN41046462
Association between exposure to traumatic events and anxiety disorders in a post-conflict setting : a cross-sectional community study in South Sudan
(BioMed Central, 2014-01) Ayazi, Touraj; Lien, Lars; Eide, Arne; Swartz, Leslie; Hauff, Edvard
Abstract Background The negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables. Methods In this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors. Results The participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD. Conclusion In individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms.
Attitudes toward condom education amongst educators for deaf and hard-of-hearing adolescents in South Africa
(AOSIS Publishing, 2014-08) Mall, Sumaya; Swartz, Leslie
Background: Disabled adolescents are at a critical time in their psychosocial and sexual development. Aim: This study explores the attitudes of educators working in schools for Deaf and hard-ofhearing pupils in South Africa toward condom education for their pupils. Methods: We conducted a combination of individual in-depth and joint interviews with a total of 27 participants. The sample comprised educators, school psychologists, school nurses and teaching assistants. Results: Results showed that educators were aware of the HIV risk for their pupils and reported the risk of sexual abuse or premature sexual activity as being risk factors for HIV infection. None of the schools had a written condom education policy. Whilst some schools were integrating condom education in existing school curricula, others faced moral or religious dilemmas in doing so. There were differences in attitudes, both amongst schools and amongst educators in the same schools. Conclusions: Given the context of a burgeoning HIV epidemic, it is vital to address adequate condom education in schools.
Barriers to the participation of people with psychosocial disability in mental health policy development in South Africa : a qualitative study of perspectives of policy makers, professionals, religious leaders and academics
(BioMed Central, 2013-03) Kleintjes, Sharon; Lund, Crick; Swartz, Leslie
Abstract Background This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa. Method Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people’s organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. Results Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. Conclusion A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development.
The Benefits of Early Book Sharing (BEBS) for child cognitive and socio-emotional development in South Africa: study protocol for a randomised controlled trial
(BioMed Central, 2017-03-09) Dowdall, Nicholas; Cooper, Peter J.; Tomlinson, Mark; Skeen, Sarah; Gardner, Frances; Murray, Lynne
Background: Children in low and middle-income countries (LMICs) are at risk for problems in their cognitive, social and behavioural development. Factors such as a lack of cognitive stimulation, harsh parenting practices, and severe and persistent aggression in early childhood are central to the genesis of these problems. Interventions that target the intersection between early childhood development, parenting, and early violence prevention are required in order to meaningfully address these problems. Methods: We are conducting a randomised controlled trial to evaluate a parenting intervention for caregivers of children aged between 23 and 27 months, designed to promote child cognitive and socioemotional development in Khayelitsha, a low-income peri-urban township in South Africa. Families are randomly allocated to a book-sharing intervention group or to a wait-list control group. In the intervention, we train caregivers in supportive book-sharing with young children. Training is carried out in small groups over a period of 8 weeks. Data are collected at baseline, post intervention and at 6 months post intervention. In addition to targeting child cognitive development, the intervention aims to improve child socioemotional functioning. Discussion: The Benefits of Early Book Sharing (BEBS) trial aims to evaluate the impact of an early parenting intervention on several key risk factors for the development of violence, including aspects of parenting and child cognition, prosocial behaviour, aggression, and socioemotional functioning. The study is being carried out in a LMIC where violence constitutes a major social and health burden. Since the intervention is brief and, with modest levels of training, readily deliverable in LMIC contexts, a demonstration that it is of benefit to both child cognitive and socioemotional development would be of significance. Trial registration: The BEBS trial is registered on the International Standard Randomised Controlled Trial Number database, registration number ISRCTN71109104. Registered on 9 February 2016. This is version 1 of the protocol for the BEBS trial.
Beyond the checklist : understanding rural health vulnerability in a South African context
(Taylor & Francis Open, 2016) Vergunst, Richard; Swartz, Leslie; Mji, Gubela; Kritzinge, Janis; Braathen, Stine Hellum
Background: Vulnerability in the past has sometimes been measured and understood in terms of checklists or common understanding. It is argued here that vulnerability is a more complex issue than this. Although checklists of vulnerable groups are important, they do not capture the essence and dynamics of vulnerability. Objective : The case of rural health vulnerability in South Africa is discussed to show that classifying people into vulnerable groups does not portray the complexity and intricacies of what it means to have vulnerability. We also wish to show that there are different kinds of vulnerabilities, and the difference between access vulnerability and illness vulnerability is highlighted. Methods : As part of a larger study, this case study is presented to show how vulnerability in a poor rural community in South Africa has to be understood in a contextual and dynamic manner as opposed to a static manner. Results : Family and social dynamics can influence health. For example, fractured families were seen as a vulnerable issue within the community, while being a person with a disability can lead to isolation and callous attitudes towards them. It is these family and social dynamics that lead proximally to vulnerability to ill health. Conclusions : A contextual approach can assist in giving a more layered understanding of vulnerability than a checklist approach can do. Interventions to change health cannot be addressed simply by medical means. Social conditions need to be changed, and part of changing social conditions is the process of assisting those who are isolated or experience themselves as vulnerable to reconnect with others in the community. Poverty leads to social exclusion; social and family inclusion may be key to well-being.
Bongani’s story
(Palgrave Macmillan, Cham, 2021) Mapumulo, Bongani
In this chapter, Bongani writes about growing up with a disability in a Zulu family, as well as in the context of a school for children with disabilities. He reflects on what physical disability has meant for his developing sense of himself as a young man, his sexuality and relationships, and his wishes for the future.
Boring family routines reduce non-communicable diseases : a commentary and call for action
(BioMed Central, 2015-07) Rotheram-Borus, Mary Jane; Tomlinson, Mark; Davis, Emily
As global donors shift their efforts from infectious diseases to non-communicable diseases (NCD), it is critical to capitalize on our prior mistakes and successes. Policy makers and public health administrators are often looking for magic bullets: drugs or treatments to eradicate disease. Yet, each potential magic bullet requires consistent, daily implementation and adherence to a new set of habits to actually work. Families’ and communities’ daily, interlocking routines will be the battlefield on which scientific and technological breakthroughs will be implemented and succeed or not. Currently, there are many evidence-based interventions (EBI) which have been demonstrated to shift specific habits which account for most NCD (eating, drinking, moving, and smoking). Yet, securing sustained uptake of these programs is rare – suggesting different intervention strategies are needed. Structural changes, policy nudges, and partnerships with private enterprise may be able to shift the health behaviors of more citizens faster and at a lower cost than existing EBI. Addressing concurrent risk and protective factors at the community level and intervening to shape new cultural routines may be useful to reduce NCD.
Bruin gesinne se belewenisse van die negatiewe uitwerking van ouerlike alkoholmisbruik
(LitNet, 2016-11-09) Van den Berg, Estelle; Greeff, Abraham P.
Die doel van hierdie verkennende, kwalitatiewe ondersoek was om vas te stel hoe gesinne deur die probleem van ouerlike alkoholmisbruik geraak word. Die teoretiese raamwerk vir hierdie ondersoek is gesinsisteemteorie, waarvolgens gesinne oop, deurlopende, doelsoekende, selfregulerende sosiale sisteme is wat op hulle beste verstaan kan word in die konteks van interaksies en sisteemverhoudings. Die studiepopulasie was bruin gesinne waarvan ’n ouer alkohol misbruik wat in die Wes-Kaap woon. Hierdie populasie is geteiken aangesien die Wes-Kaap die provinsie met die hoogste voorkoms van alkoholmisbruik in Suid-Afrika is. Om hierdie hoë voorkoms te verstaan, behoort die agtergrond en oorsprong, met spesifieke verwysing na Suid-Afrika se verlede en die sogenaamde dopstelsel, in ag geneem te word. Alhoewel daar reeds kwantitatiewe ondersoeke in verband met alkoholmisbruik in Suid-Afrika gedoen is, is hierdie ondersoek daarop gemik om die persoonlike lewenservarings van gesinne wat elke dag met die probleem van ouerlike alkoholmisbruik saamleef, vas te vang. Dit is verkry deur middel van ’n kwalitatiewe-ondersoek-ontwerp. Verteenwoordigers van 18 gesinne waarvan een of albei ouers vir ses maande of langer alkohol misbruik het, het aan die ondersoek deelgeneem. Inligting is deur middel van semigestruktureerde onderhoude ingesamel en tematies ontleed. Resultate toon dat ouerlike alkoholmisbruik ’n negatiewe uitwerking het op finansies (byvoorbeeld deur geld wat vir die huisgesin bedoel was, op drank te spandeer), die gemeenskap (byvoorbeeld kinderverwaarlosing wat in die gemeenskap voorkom), die gesin in sy geheel (byvoorbeeld gesinslede wat met mekaar baklei), gesondheid (byvoorbeeld ander gesinslede wat spanning ervaar), die huwelik (byvoorbeeld huweliksmaats wat liefdeloosheid in die huwelik ervaar), kinders (byvoorbeeld ’n negatiewe uitwerking op kinders se skoolwerk) en loopbane (byvoorbeeld ’n ouer wat sy/haar werk verloor). Die bevindinge van hierdie ondersoek vul ’n leemte in die literatuur en kan sinvol aangewend word in die ontwikkeling van alkoholmisbruikvoorkomings- en ingrypingsprogramme.
Burnout and its correlates in South African clinical and counselling psychologists
(SUN MeDIA Bloemfontein, 2007) Jordaan, Ilse; Spangenberg, Judora; Watson, Mark; Fouche, Paul
This article explores burnout and its correlates among South African psychologists. A random sample of 238 clinical and counselling psychologists completed internet surveys that included a biographical questionnaire, the Maslach Burnout Inventory, and the Brief Coping Orientations to Problems Experienced. Results indicated that approximately half of the participants showed moderate to high levels of burnout. Different combinations of coping strategies predicted the three components of burnout. The biographical variables of age, gender, weekly client hours, years in practice, and medical aid payment difficulties were significant predictors of burnout. Recommendations are made to improve the emotional well-being of South African psychologists.
Can cash break the cycle of educational risks for young children in high HIV–affected communities? A cross–sectional study in South Africa and Malawi
(Edinburgh University Global Health Society, 2017-06) Sherr, Lorraine; Tomlinson, Mark; Macedo, Ana; Skeen, Sarah; Hensels, Imca Sifra; Cluver, Lucie Dale
Background: Household cash grants are associated with beneficial outcomes; enhanced if provided in combination with care. Objectives: This study describes the impact of cash grants and parenting quality on 854 children aged 5–15 (South African and Malawi) on educational outcomes including enrolment, regular attendance, correct class for age and school progress (controlling for cognitive performance). Consecutive attenders at randomly selected Community based organisations were recruited. The effects of cash plus good parenting, HIV status and gender were examined. Results: Overall 73.1% received a grant – significantly less children with HIV (57.3% vs 75.6% (χ2 = 17.21, P < 0.001). Controlling for cognitive ability, grant receipt was associated with higher odds of being in the correct grade (odds ratio (OR) = 2.00; 95% confidence interval (CI) = 1.36, 2.95), higher odds of attending school regularly (OR = 3.62; 95% CI = 1.77, 7.40), and much higher odds of having missed less than a week of school recently (OR = 8.95; 95% CI = 2.27, 35.23). Grant receipt was not associated with how well children performed in school compared to their classmates or with school enrolment. Linear regression revealed that grant receipt was associated with a significant reduction in educational risk (B = –0.32, t(420) = 2.84, P = 0.005) for girls. Conclusion: Cash plus good parenting affected some educational outcomes in a stepwise manner, but did not provide additive protection.
Cannabis and other drug use among trauma patients in three South African cities, 1999-2001
(Health & Medical Publishing Group, 2005) Parry, Charles D. H.; Pluddemann, Andreas; Donson, Hilton; Sukhai, Anesh; Marais, Sandra; Lombard, Carl
Objective. To assess the extent of cannabis and other drug use among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001. Design. Cross-sectional surveys were conducted during a 4-week period at each of the above sites in 1999, 2000 and 2001. The concept of an idealised week was used to render representative samples. Outcome measures. Cause of injury and biological markers to assess use of cannabis, methaqualone (Mandrax), opiates, cocaine, amphetamine, and methamphetamine. Results. Over half of all patients tested experienced violent injuries. Excluding opiates, across sites and over time between 33% and 62% of patients tested positive for at least one drug (N = 1 565). In most cases the drugs were cannabis and/or methaqualone. While no inter-city differences were found, male patients were typically more likely to test positive for drugs in general and specific drugs such as cannabis and the cannabis/methaqualone ('white pipe') combination than female patients. Drug positivity was higher in 2001 than in the previous 2 years in Cape Town, and patients injured as a result of violence in Cape Town and Durban were more likely to test positive for drugs than patients with certain other types of injuries. Conclusions. Drug use among trauma patients has remained consistently high for each of the 3 study periods. Efforts to combat the abuse of drugs such as cannabis and methaqualone would appear to be paramount in reducing the burden of injuries on health care services. The study has raised numerous issues requiring further research.
Caregiver experiences of public services following child trauma exposure : a qualitative study
(BioMed Central, 2018-04-10) Williamson, Victoria; Halligan, Sarah L.; Coetzee, Bronwyne; Butler, Ian; Tomlinson, Mark; Skeen, Sarah; Stewart, Jackie
Background: Many children in low and middle income countries (LMIC) are exposed to trauma. Contact with public services are a potential influence on parent–child reactions and coping post-trauma. Little is known about how caregivers perceive these interactions. Methods: The aim of this study was to explore caregivers’ experiences of accessing and interacting with public services post-trauma and perceptions of needed improvements to public services in a LMIC context. Qualitative interviews were conducted with 20 female caregivers from a high-risk settlement in South Africa after child trauma exposure. Results: Three themes and seven sub-themes were identified regarding caregivers’ perceptions of interactions with public services post-trauma. The key themes identified related to (1) communication and exchanges with law enforcement, (2) consequences of an under-resourced justice system and (3) importance of communication and empathy in the healthcare system. Interactions with police were often positive. However, caregivers explained that police-family communication post-trauma could be improved and may help to lessen caregiver anxiety and concerns for the child’s safety post-trauma. Caregivers perceived the judicial system to be under-resourced as contact with the judicial system was often protracted and caused child anxiety and distress. Medical treatment was reportedly rushed, with extensive waiting times and little information provided to caregivers regarding the child’s injuries or treatment. Some medical staff were perceived as unsympathetic during the child’s treatment which was found to exacerbate caregiver and child distress post-trauma. Conclusions: This study provides insight into caregiver experiences of accessing public services following child trauma exposure in a high-risk LMIC context. Public services were perceived as oversubscribed and under-resourced and negative interactions often influenced caregiver responses and appraisals of child safety. Given the impact of poor interactions with public services on families post-trauma, additional research is needed to investigate feasible improvements to public services in LMIC.

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