Stellenbosch Institute for Advanced Studies (STIAS)

Permanent URI for this community

https://scholar.sun.ac.za/handle/10019.1/14997

Browse

Now showing 1 - 20 of 25

An approach to reduce the blindness burden in sub-Saharan Africa : special focus on childhood blindness
(African Sun Media, 2020) Marmamula, Srinivas; Bharadwaj, Shrikant R.; Keeffe, Jill; Balasubramanian, Dorairajan
Sub-Saharan Africa is afflicted with high levels of blindness burden, affecting the quality of life and productivity of its people. While cataracts account for over 40 per cent of blindness, uncorrected refractive error leading to vision loss is over 50 per cent. The number of ophthalmologists and optometrists in the region, who can restore vision by surgery, and provide corrective eyeglasses for uncorrected refractive error, respectively, is woefully inadequate. However, most of these countries have primary health care centres. Workers in these centres have played remarkably successful roles in working with professionals in helping to reduce the burden of blindness due to onchocerciasis and trachoma.
Celebrity health promotion messaging : novel opportunities to engage youth in the developmental origins of health and disease
(African Sun Media, 2020) Macnab, Andrew J.; Mukisa, Ronald
This chapter is a personal view seen from disparate viewpoints of age and culture. Two proponents of health promotion, one a Ugandan youth with firsthand experience of the burden of illness among African children and the other a Canadian academic with a lifetime spent treating sick children, speak to the place and potential of celebrity in the promotion of health among youth. Since 2011, school-based health promotion programmes conceived at the Stellenbosch Institute for Advanced Study (STIAS) have been introduced into many communities in Uganda. These initiatives are seen as an example of innovative health promotion with the potential to give the next generation health knowledge and skills that will translate into an important measure of ‘health independence’ for them in their future lives. A regular component of these programmes enables schools to introduce new topics through teacher-guided in-class discussions about health; in this way, pupils were introduced to elements of the developmental origins of health and disease (DOHaD) agenda, and then asked to discuss which ‘messages’ they saw as most relevant to them, and which ‘messengers’ could deliver these messages with the greatest impact. Amongst the messengers, celebrities were identified as particularly influential; young people said they would listen to what a celebrity said about health, lifestyle and behaviour. Expanding on these discussions, pupils quoted health and lifestyle messaging that they already knew from listening to celebrity-recorded music videos. Here we describe examples, from a Ugandan perspective, of this form of celebrityendorsed health messaging contained in music videos; these are the songs young people told us they listened to and knew the promotional messages they contain. National music celebrities, whom these young people identify with, have recorded a variety of videos with content advocating specific health behaviours, endorsing physical, emotional or spiritual health and calling for individual and collective action to address challenges such as maternal deaths related to childbirth and infant mortality. Some artists even raise awareness of difficult but very important social issues such as gender inequity, sexual harassment and domestic violence through their music. Music videos resonate with youth, and celebrity recordings appeal as they combine young people’s love of music with their fascination of the aura of celebrity. We review the production concepts, content and messaging that make these celebrity music videos particularly powerful, and also suggest future directions where the engagement of celebrity messengers could offer a conduit for innovative delivery of DOHaD-related messages, and an effective way to impart knowledge and impact health behaviours among youth.
The challenges of breastfeeeding in poor urban areas in sub-Saharan Africa
(African Sun Media, 2020) Kimani-Murage, Elizabeth Wambui; Wekesah, Frederick Murunga; Wanjohi, Milka; Nyamasege, Carolyn Kemunto; Mutoni, Sandrine; Macharia, Teresia
Optimal breastfeeding has the potential to prevent more than 800 000 deaths in children younger than five years; 500 000 neonatal deaths; and 20 000 deaths in women every year. Despite these benefits, evidence from Sub-Saharan Africa shows that breastfeeding practices remain sub-optimal with only 25 per cent of children exclusively breastfed for the first six months, while six per cent of infants in these countries are never breastfed. For example, although the proportion of children who were exclusively breastfed in Kenya improved from 32 per cent in 2008 to 61 per cent in 2014, pockets of suboptimal breastfeeding practices are documented in urban slums. Exclusive breastfeeding in some of the urban slums in Kenya is as low as two per cent, with the age of introducing complementary foods being onemonth post-delivery, while about a third of children are not breastfed within one hour of delivery as recommended by the World Health Organization (WHO). Urban slums are faced by unique social and structural factors that hinder optimal breastfeeding including poverty and non-conducive livelihood opportunities, poor living conditions, food insecurity, poor professional and social support to breastfeeding mothers and knowledge deficit coupled with negative cultural beliefs and misconceptions about breastfeeding. This situation calls for macrolevel policies and interventions that consider the ecological setting. Promising interventions may include global initiatives such as the Baby-Friendly Hospital Initiative, the Baby-Friendly Community Initiative, Human Milk Banking and the Baby-Friendly Workplace Initiative. However, innovations in their implementation need to take consideration for the contextual complexities. This chapter explores breastfeeding practices, associated challenges and interventions that could promote breastfeeding in urban slums.
China in a global world
(African Sun Media, 2020) Liebenberg, Ian; Van der Merwe, Justin
This chapter provides an overview of the growth of China as a political, military and economic power since its emergence as an independent communist state in 1949. China became a notable political force during the era of decolonisation (1950‑1980) and one of the leading states within the Non‑Aligned Movement (NAM). Due to its relative economic development and substantial population, China became well-known for posing alternatives to Western domination. During the era of decolonisation, China’s external involvement increased through its use of soft power and as a result of its support for liberation movements in Africa. The end of the Cold War saw the demise of the bipolar world and resulted in unipolarity. More recently, however, multipolarity has taken root through the rise or resurgence of non‑Western emerging powers. Since 1990, and especially since 2000, China has moved from being a regional hegemon to a global power. This chapter describes the rise of China and its current status as an aspiring global hegemon. Although the chapter is mainly descriptive, it also provides some reflective and analytical notes on China’s current and conceivable future role on the international stage.
Cuba's defence diplomacy : hard and soft power, 1959‑2018
(African Sun Media, 2020) Kruijt, Dirk
Cuba, a country with eleven million people, played a significant military and development role from the 1960s to the late 1980s, and is still an influential donor country. Its reputation was built on support to revolutionary and national liberation movements in Latin America and in Africa. Additionally, Cuba also was a provider of medical and humanitarian assistance to the global South. Cuba’s military were involved in training and advising Latin American revolutionaries and provided assistance in several African colonial and postcolonial wars. During the ‘special relation’ with the Soviet Union and the COMECON countries, Cuba had a redoubtable military and intelligence apparatus, at the same time procuring explicit defence against a potential invasion by the United States (US) and supporting multiple revolutionary and resistance movements in Africa, Latin America and the Caribbean. After the disintegration of the Soviet Union and the COMECON, Cuba restructured its economy, strongly supported by its Armed Forces as a management instrument and as a food and security provider. In the 1990s, when its strong military position was weakened, Cuba still preserved and even expanded its medical and literacy assistance to many countries. During the period of the Latin American Pink Tide governments (2000‑2015), Cuba was again a high-profile player in Latin American and Caribbean politics.
Diabetes in pregnancy : lessons for developing countries
(African Sun Media, 2020) Yajnik, Chittaranjan; Wagle, Sonali S.; Kumaran, Kalyanaraman; Krishnaveni, Ghattu V.
Pregnancy diabetes is fast becoming a common condition across the world with developing countries particularly affected. In the short term, maternal hyperglycaemia worsens pregnancy outcomes, but in the long run, it appears to be a precursor to diabetes and cardiovascular disease in the mother and obesity and diabetes in the child. Thus, pregnancy diabetes is thought to contribute to the escalating epidemic of obesity and diabetes. Classic thinking is that pregnancy diabetes consists of pre-gestational diabetes and gestational diabetes. There are considerable confusion and controversy about the diagnosis and management of gestational diabetes. There is increasing evidence that risk factors and metabolic disturbances of gestational diabetes patients are present long before pregnancy, implicating peri-conceptional fetal programming of future obesity and diabetes. This chapter reviews what developing countries need to consider as a public health challenge in the context of gestational diabetes and how to contribute to research that will improve the understanding of the condition: biology, diagnosis, costeffective treatment, and long-term contribution to the health and economy of the nation. A lot can be learned from the experience of the developed world that will help to avoid the pitfalls plaguing this field. Forming a multinational consortium may improve the efficiency of such research.
Ensuring healthier trajectories that start in early life to assist non-communicable disease prevention in Africa : a life-course approach
(African Sun Media, 2020) Norris, Shane A.
Non-communicable diseases are increasing globally, particularly in low- and middle-income countries. For countries on the African continent, this is of particular concern as the combination of a persisting burden of infectious disease coupled with a burgeoning of non-communicable diseases could cripple already strained health care systems. The current paradigm subscribes heavily on detection, treatment and management of patients with non-communicable diseases. This perspective is important, but a more balanced approach that strengthens prevention efforts is also needed.
Epilogue
(African Sun Media, 2020) Liebenberg, Ian; Kruijt, Dirk; Paranjpe, Shrikant
An astute observer of international politics, in following global events unfolding over the past 50 years, remarked not so much tongue-in-cheek that the fallacy of a unipolar world was evident for decades including during the Cold War, and the phenomenon is becoming more evident day by day. He suggests that ‘the process of globalisation to the extent that it exists … has been proven to be far from linear. Some general trends may be observed by some, but there are visible signs of deglobalisation in various areas such as politicalmilitary and economic spheres’.1 His statement reminds one of an argument once posed by the sociologist, Anthony Giddens, cautioning theorists that the globalisation of (social) life also implies fragmentation and alienation on various socio- and political levels, which is likely to invite conflict rather than peaceful existence. This collected volume through various contributions touches on how the post-1945, post-decolonisation and post-Cold War era transformed power, diplomatic and strategic relations and defence diplomacy in the “Global South”. As the assassination of an Iranian general in Iraq by a US drone attack in January 2020 illustrates, the space of global politics remains tense, if not explosive. If not for Iranian restraint, this thoughtless act of aggression outside the parameters of international law could have led to some conflict of magnitude. One may argue that the then Cold War divide made conflict more containable and perhaps predictable. The consequences of the Cold War conflicts in the “Third World”, however, were enormous in human and material terms be it through so‑called proxy wars or direct intervention by powers that perceived themselves as Gladiator-World Saviours (for example, the US involvement in Vietnam and US involvement in enforced regime changes in Latin- America). Despite a brief moment of (perhaps delusional) optimism following the end of the Cold War, the present context remains one of tension, increasing fragmentation and fragile relations that can change in a moment through one single un‑reflected-upon military act.
The fundamental importance of breastfeeding for health and development
(African Sun Media, 2020) Martin, Robert D.
How an infant is nourished in early life is central to the DOHaD hypothesis regarding the later onset of chronic non-communicable diseases, especially where feeding practices result in either stunting of growth or excessive weight gain. This chapter reviews the evolutionary history of the origins of breastfeeding and summarises studies evaluating its benefits. Mammals take their name from the Latin word mamma for the teat. This root also gave rise to the term mammary gland, which, along with the associated behaviour of suckling offspring, is a universal feature of all mammals alive today. Human cultural practices over the past 5 000 years or so, notably including the exploitation of milk from other mammals and eventual development of milk formulae, have exerted a major impact on breastfeeding. The greatest effects have occurred in industrialised nations, where many mothers breastfeed for only a few months, if at all, and breastfeeding beyond a year is rare. Because of pervasive cultural influences, it is difficult to establish a ‘natural’ period for human breastfeeding that would include an initial period of exclusive breastfeeding, followed by a phase of supplementary feeding. Information from modern hunting-and-gathering populations and other non-industrialised societies indicate an average total duration of at least two-and-ahalf years, with a wide range of variation extending up to around five years. Whenever tested, the benefits of breastfeeding for infants have been found to show a dose-response relationship, with the greatest benefits shown with breastfeeding for two to three years. Breastfeeding is also beneficial for mothers. There have been recent claims that over-enthusiastic promotion of breastfeeding, given the label ‘activism’ is both unkind and unwarranted. While it is true that women who, for whatever reason, are unable to breastfeed, need support and not bullying, it is both unjustifiable and irresponsible to dismiss the very substantial scientific evidence that now exists for the undoubted benefits of breastfeeding.
Graduate School formats and functions
(SUN MeDIA, 2016) Groenewald, Johann; Steenekamp, Cindy
INTRODUCTION: This chapter explores the reasons for the success, in the area of doctoral studies, of the recently established Graduate School in the Faculty of Arts and Social Sciences (FASS) at Stellenbosch University (SUN), South Africa. First we provide a brief history of the establishment of the FASS Graduate School which includes a description of the institutional developments leading to the release of funding for this HOPE project initiative. (We use the term ‘graduate school’ in referring exclusively to doctoral programmes.) We also look at recent national policy developments that catapulted doctoral education to the position of a strategic enabler in the South African science and research system, as well as some of the recommendations for increasing doctoral production in South Africa. The greater part of the chapter is devoted to a description of the structure and functions of the Graduate School. The discussion explores the meaning of fulltime study as a key component of successful PhD programmes. Next, the recently developed notion of graduate enrolment management (GEM) is introduced as a heuristic device to describe the operations of the Graduate School. The provision of continuous programmatic support is unpacked as a specific form of support of which the content as well as the timing is determined by the stage of study. In the last section, the outcomes of the FASS Graduate School are presented and evaluated, concluding with a summary of the reasons for the success of the Graduate School and an attempt to articulate some general lessons that could be learnt from this enterprise.
How environmental exposures early in life might influence phenotypes of non-cummunicable diseases in Africa
(African Sun Media, 2020) Mandy, Mirembe; Lule, Swaib A.; Nyirenda, Moffat J.
Chronic non-communicable diseases, such as diabetes, cancer, cardiovascular and chronic respiratory diseases are leading causes of death and disability in the world – accounting for over 60 per cent of the nearly 60 million deaths in 2008.4 Importantly, 80 per cent of non-communicable disease deaths occur in low- and middle-income countries.5 Although Africa still has a high burden of infectious diseases, the non-communicable disease epidemic is rising rapidly; it is projected that, by 2030, non-communicable diseases will account for 46 per cent of all deaths in the region.6 For example, although diabetes was considered a rare disease in Africa until about a century ago, it now affects up to a third of the population in some countries; the prevalence of diabetes and hypertension will have increased by nearly 80 per cent, and deaths from ischemic heart disease doubled between 2008 and 2030. This chapter discusses how environmental exposures early in life might influence phenotypes of non-communicable diseases in Africa.
Hyperglycaemia in pregnancy
(African Sun Media, 2020) Sobngwi, Eugene
According to the International Diabetes Federation, the burden of diabetes is progressively rising worldwide with an expected doubling of prevalence in most low- and middle-income settings within twenty-five years. The projected surge in diabetes prevalence to epidemic proportions reflects the ongoing so-called epidemiological transition experienced across most of the fastestgrowing economies. The concept of epidemiological transition is characterised by the reduction in infectious disease burden and a quasi-parallel rise in chronic non-communicable disease burden as the result of better health care, reduced fertility, lifestyle changes, increased life expectancy and changing age structure of populations. The specificity of epidemiological transition in most African nations is its accelerated character compared to most Western countries where the transition took place over two to three centuries. As a result, chronic non-communicable diseases frequently occur at a lower age than previously reported, including in women of childbearing age. This chapter reviews key knowledge about the pathophysiology and consequences of hyperglycaemia in pregnancy, and their implication for screening, diagnosis and management strategy in high risk but resource-limited populations, with special emphasis on Africa.
The implications of developmentel origins of health and disease for Africa : what can be learnt from available data?
(African Sun Media, 2020) Byass, Peter
There is a broad spectrum of knowledge globally that shows that specific exposures in early life – during pregnancy and early childhood – might affect what happens at various later stages of life. The scientific field behind this has become known as the developmental origins of health and disease (DOHaD). The underlying mechanisms may be complex, and understanding and analysing the epidemiology of the causes and effects are complicated. Long-term individual data, often across generations, are the best way into understanding the precise nature of such effects. Therefore, much of the research that has been done in this area has happened where detailed, individual data on health and welfare are a routine part of social structures – for example, in Scandinavian countries. Nevertheless, it is reasonable to suppose similar exposures and effects might apply within African populations – the difference being that relevant details are much less likely to be documented. Since there is no quick fix for implementing data collection that spans generations, the only indirect clues as to how DOHaD may be affecting Africans is to consider how available data sources might be used in derivative analyses. In this chapter, an example is presented of taking a relationship established elsewhere between breastfeeding and obesity, applied to publicdomain estimates on breastfeeding and childhood obesity in Africa, and analysed to estimate the magnitude of the likely consequences of non-breastfeeding on childhood obesity in Africa. This approach is much less rigorous than the ideal situation where specific individuals’ breastfeeding histories could be related to their later individual obesity, but it offers some clues as to the likely magnitude of this particular issue in Africa, and offers a proof-of-principle for this general approach.
International Society for Developmental Origins of Health and Disease's work at the Stellenbosch Institute for Advanced Study
(African Sun Media, 2020) Daar, Abdallah; Pauw, Christoff; Macnab, Andrew J.
This chapter describes the core group at the Stellenbosch Institute for Advanced Study (STIAS) who have contributed to the long-term theme project, ‘Health in Transition’. It also describes what this book is about, why it is crucial, and the different strands and topics that are covered.
Intersectoral approaches to health and non-communicable disease prevention in Africa
(African Sun Media, 2020) Oni, Tolu
This chapter grounds efforts to achieve optimal population health in Africa, within the context of global and regional aspirations for health as part of the sustainable development agenda. The author highlights the important role that the rapidly growing urban centres in Africa are playing in the ongoing epidemiological transition, with an emerging non-communicable disease epidemic alongside a high burden of infectious disease. Far from seeing this only as a challenge, the author of this chapter explores the opportunity to harness this changing environment for health creation, propose a re-thinking of accountability for health towards a more inclusive definition of health services, and the role that adolescents can and should play both as important targets for non-communicable disease prevention and as agents of change, advocating for an all of government, all of society’s approach to health.
Mapping of developmental origins of health and disease to 'Sustainable Development Goals' and implications for public health in Africa
(African Sun Media, 2020) Kajee, Nabeela; Daar, Abdallah; Macnab, Andrew J.; Sobngwi, Eugene
A call for new approaches and knowledge systems has emerged, to map the way forward for the ‘Sustainable Development Goals’ in Africa.6 Public health on the continent, calls for an approach to effect changes to reach the goals proposed by the World Health Organization.7 It is against this backdrop that the developmental origins of health and disease (DOHaD) are proposed as a framework of implementation for specific Sustainable Development Goals.8 The DOHaD concept identifies the origins of health and disease, and also elucidates early mechanisms for achieving these goals. Numerous Sustainable Development Goals are specifically applicable to the DOHaD concept, and DOHaD and Sustainable Development Goals have immense synergistic potential. The chapter identifies gaps in which DOHaD may offer direct, informed solutions to the hurdles encountered in Sustainable Development Goals achievement strategies, and these have direct public health implications for the continent.
National security in complex times : the South African military dimension
(African Sun Media, 2020) Ramokgadi, Shadrack; Beukes, Tobie; Liebenberg, Ian
Having returned to the international gallery of nations in 1996 after its apartheid pariah status was lifted, South Africa had to adjust its defence posture, defence diplomacy, and general national security framework to new conditions. The Cold War was over, interstate wars in the region were unlikely, and if undertaken at all, military deployment was to participate in peacekeeping operations. With the apartheid garrison state mentality a thing of the past, a new national security strategy became a necessity. This chapter discusses the need and guidelines for a national security strategy suited to a democracy and a developmental state aware of current and future socio-economic challenges, and its role in the region and on the African continent.
Photo-essays : a creative format for effective communication
(African Sun Media, 2020) Stothers, Lynn; Mukisa, Ronald; Macnab, Andrew J.
Scientists and educators regularly face the challenge of effectively, concisely and interestingly communicating their ideas and findings, and the need to engage readers unfamiliar with the concepts or issues they want to describe. In the context of advancing the developmental origins of health and disease (DOHaD) agenda, effective communication is essential, particularly when aiming to engage government agencies, inform leaders in the health care professions, and motivate organisations able to drive change in the community. Hence, it is important to consider approaches that might make key DOHaD concepts and health promotion strategies more readily accessible to any target population. In this chapter, we share our experience from a collaboration between the Peter Wall Institute for Advanced Studies (PWIAS) at the University of British Columbia, and STIAS at Stellenbosch University to explore ways to make research and global public health issues accessible and meaningful to a broad readership; we identified the genre of photo-essay as an established and valid format, and describe its origins and principles. A photo-essay effectively presents a broad range of facts and data to varied audiences because the format principally relies on the impact visual images have. When well-chosen images are combined with appropriate captions and a concise explanatory text, the resulting composition can engage and inform a wide range of readers, and in a way likely to allow even those unfamiliar with the topic to rapidly gain an overall understanding of the information and recommendations presented. Photographs are a powerful way to furnish evidence because they expand the scope of the information provided and uniquely engage individual readers. The reader cannot be made to look at the images in the presented order, nor can the time spent on each image be indicated. So, we suggest that a photo-essay offers a very individual, informative yet flexible format for sharing ‘what works and why”, and how, and under what circumstances it works in the context of DOHaD.
Reconciliation in Burundi crisis : a practical theological approach
(African Sun Media, 2020) Niyukuri, Benaya
Situated in east-central Africa, Burundi is a small landlocked country of 10,750 square miles (27,830km2) that accommodates a population of around 10 million people belonging to three ethnic groups, namely: Hutus (85%), Tutsis (14%), and Twas (1%) (Lemarchand, 1995). Its neighbouring countries are Rwanda, Tanzania, and the Democratic Republic of the Congo. Although these three ethnic groups share the same culture and mother tongue, Burundi has experienced a sequence of ethnic conflicts (Lemarchand, 1995). Various attempts to deal with the ethnic conflicts have been put in place but these have failed to achieve sustainable peace. The current situation has raised concern. This chapter looks at the history of conflicts in Burundi and suggests the role of practical theology in bringing about reconciliation to the nation.
The reconciliation of lepers in Luke 5:12-15 and its implications for human dignity : an African perspective
(African Sun Media, 2020) Etukumana, Godwin
Reconciliation is an important topic in contemporary political, social, economic and religious spheres since it has the ability to redefine human relationships therein. Without the possibility of reconciliation it would be impossible for humanity to live together in the modern world. The same was true of the ancient world in which the New Testament was written. The focus of this chapter2 is on the various ways in which the Gospel according to Luke describes the reconciliation of those who had become estranged from their communities with special reference to the case of lepers3 in Luke 5:11-16. Based on Luke’s account, this estrangement directly deprived the sufferer from having contact with the community of people and thereby denied him or her, in a violent manner, the right to liberty and human dignity. By using a socio-historical hermeneutics this chapter will investigate whether the metaphors used in Luke are similar to those used in African4 society’s engagement with lepers.

Browse

Browsing Stellenbosch Institute for Advanced Studies (STIAS) by browse.metadata.type "Chapters in Books"

Results Per Page

Sort Options