Philosophiae Doctor - PhD / Non-communicable diseases (NCD) continue to be a public health concern globally and contribute to the burden of disease. The formal health system in developing countries lacks the capacity to deal with these NCD as it is overburdened by communicable diseases. Thus, community health workers (CHWs) have been suggested as a solution for alleviating the burden for primary health facilities, by extending NCD care to the community. This thesis aims to develop an integrated model of care for CHWs working with patients with non-communicable diseases by describing and exploring current CHW roles, knowledge and practices in relation to community-based NCD care. The specific objectives for this study included 1) the exploration of the NCD roles of generalist CHWs in the context of a limited resource urban setting; 2) determining the NCD-related knowledge of CHWs, and factors influencing this in a limited resource urban setting and 3) a comparison of actual and envisaged roles in the management and prevention of NCD using the integrated chronic diseases management model (ICDM) as a benchmark, and propose key competencies and systems support for NCD functions of CHWs in South Africa Mixed methods were used to achieve the objectives of this study. First, a qualitative enquiry was conducted using observations to respond to the first objective. A quantitative cross-sectional design was then used to achieve the second objective, and a questionnaire was used to interview CHWs. A comparison of findings from both the quantitative and qualitative studies with policy guidelines was undertaken to address the third objective.

Master of Public Health - MPH / Background: Obesity in South Africa is a critical public health issue. Previously considered a problem of the affluent, obesity is now reported among all populations in South Africa regardless of age, race, gender or geographical location. Although a body of literature suggests that sociocultural, environmental and behavioural factors are likely to explain the increasing levels of obesity in South Africa, few studies have examined the relationship between socioeconomic status and obesity. As such, there is dearth of evidence showing how socioeconomic status influences obesity in the country. Given the multiplicity of challenges associated with controlling obesity, understanding the link between socioeconomic status and obesity is critical for informing and developing effective prevention programmes. This study therefore examines the nexus between socioeconomic status and obesity by using Khayelitsha as a case study area. Goal and objectives: Guided by the conceptual framework of the Theory of Planned Behaviour, the overall goal of this study is to determine how education status and income level influence dietary and weight control behaviours in relation to obesity. The objectives are to 1) examine the role of social factors on food consumption behaviour; 2) investigate the influence of income levels on food consumption; 3) explore the relationship between education levels and food choices and 4) provide recommendations for policy review. Methods: This research is embedded within a larger study conducted by researchers from the Institute for Social Development on factors that influence food choices and eating habits of residents in Khayelitsha and Mitchells Plain. The epistemological position forming the basis of this research was guided by the concepts of positivist and interpretivist paradigms, as both perspectives were deemed relevant for achieving the study objectives. Moreover, the study combined both qualitative and quantitative research methodologies to analyze the gathered data. Results: The study identified cereals, bread, pasta, milk products, processed meat, fried chicken, fish and oil fat, soft drinks, fruit and vegetables as the main kinds of food consumed by residents in Khayelitsha. However, among these food groups, fruit and vegetables consumption was found to be low. In general, cost was identified as the main barrier for the frequent consumption of fruit and vegetables. The study also discovered a positive relationship between education and eating habits, with most educated individuals’ demonstrating high intentions to consume healthy foods compared to people with lower education. However, in contrast to the hypothesis of this study, the impact of education on dietary behaviour was found to be insignificant. Similarly, the impact of education on weight control behaviour was found to be insignificant although the relationship between these two variables was equally found to be positive. With regards to the association between income and food choices the study discovered an overall positive relationship between the two variables. However, the general effect of income on food choice was not statistically significant. Cost of food and low family income were found to be key barriers to the purchase and consumption of healthy foods. Conclusion and recommendations: This study has demonstrated that education and income status correlate positively with dietary lifestyle as well as weight management practices. However, contrary to the hypotheses outlined in this study, neither education nor income status was found to significantly impact on dietary and weight control behaviours. In general, other factors such as culture, price of foods, television advertisement and perception of weight status were found to also contribute to respondent’s dietary lifestyle and weight management practices. Given these findings, a multidisciplinary approach involving the promotion of proper dietary patterns as well as physical activity are recommended. Specifically, the strategies should focus on 1) the development of policy measures that regulate the high cost of healthy foods, 2) the roll-out of food voucher interventions that promote frequent consumption of fruit and vegetables and 3) the promotion of physical exercises in religious and health centers.

This thesis is concerned with the experience of aphasia in Khayelitsha, a township on the outskirts of Cape Town characterised by poverty, violence, limited resources and a culture and language that differs from the setting of most speech and language services in South Africa. It is based on three years of intermittent fieldwork that entailed participant observation of the everyday life of five adults living with aphasia and interviews with participants, kin and healthcare workers in various settings. Grounded in sociocultural theory, this thesis has aimed to provide an ethnographic account of cultural frameworks of interpretation of communication impairment following stroke and of the daily reality of life for adults living with aphasia in this setting. An exploration of causal notions in this setting provided interesting commentary on social and cultural processes and how people, caught up in these processes, search for meaning and for cure. Participants entertained plural notions of causation of aphasia and explored numerous therapeutic avenues. The wide variation in causal notions included biomedical causes, social and behavioural determinants, and the influences of supernatural powers, such as witches and ancestors. Similarly participants experienced aphasia through multiple healing systems, including traditional, biomedical and religious therapy options. All however seemed to be ambiguous sources of help. Whilst encounters with the health system presented serious challenges to participants, traditional and religious avenues for help were obscured by a burgeoning and not always ethical open market offering miracle cures. An articulation of the circumstances of this group of adults provided further commentary on the influence of the social context on aphasia. In a context where sociopolitical processes have had a disintegrating effect on social cohesion, questions of support, care and security were of primary concern. Prejudices towards the elderly and women were more acutely felt and vulnerability, isolation, insecurity and fluidity of circumstance emerged as overarching themes. The central argument in this thesis is that the genesis of these experiences can be found in contextual factors in Khayelitsha, such as poverty, inequality, urbanisation and changing cultural paradigms. These emerging themes highlight the disjunctions between the medical alignment of the discipline of speech language therapy in South Africa and the capacity for socially-engaged practice. They also highlight the socio-cultural complexity of the experience of aphasia, specifically the influences of culture and poverty. There is thus theoretical and clinical relevance in using anthropological objectives to explore the world of the adult living with aphasia and the interface between context and service provision. Interventions and healthcare communications that will make a meaningful difference to adults with aphasia in a setting such as Khayelitsha are proposed.

Introduction: Home-based care is an important part of the health care sector globally. But there is a lack of studies of the working conditions for health care workers within home-based care. Aim: The aim of the study is to illuminate the different experiences of working within home-based care for healthcare workers in economically poor communities.   Method: A qualitative research, data was collected through six semi-structured interviews and data was analysed by content analysis. Results: Three categories and eight sub-categories was identified in the data analysis: The Community; Working Conditions in the Community, Safety in the Community & Attitudes in the Community, The Family; The Family Affects the Patient & The Family Affects the Work Tasks and The Health Care Worker; Helping Beyond the Work Tasks, Emotional Involvement & Job Satisfaction. Conclusion: The study presents different challenges such as safety- and attitudes in the community but also the love for the work in the community.

Magister Artium (Medical Anthropology) - MA(Med Ant) / This research study investigates Xhosa men’s perceptions of voluntary medical male circumcision (VMMC) in Khayelitsha township (Cape Town). It explored whether the introduction of VMMC as a state HIV-prevention strategy had engendered shifts in constructions of masculinity and negative perceptions of men who had undergone VMMC. Previously traditional male circumcision (ulwaluko) was the preferred form of circumcision among amaXhosa and medical male circumcision (MMC) was viewed as alien to Xhosa culture. Xhosa-speaking men who had undergone MMC were stigmatised by peers and viewed as not being ‘real men’. VMMC has the potential to shift constructions of masculinity based on circumcision status. An ethnographic research study was carried out using qualitative research methods, including participant observation, individual interviews and focus group discussions. Data collection occurred over a 6-month period in the Mandela Park community, at Michael Maphongwana Clinic, and at a male initiation school. The study found that ulwaluko remains a definitive marker of masculine Xhosa identity and is still informed by culture and tradition. Despite VMMC, men who undergo ulwaluko continue to perceive men who choose MMC as ‘the other’ and not as ‘real men’. The study highlighted that VMMC advocates need to take cognisance of traditional notions of masculinity and address negative perceptions of men in Xhosa-speaking communities who have undergone VMMC.

<p>The ongoing development of the new post-apartheid South Africa is still dealing with its own cruel history. A socio-economic structure based on race has been built up over years of colonialization and apartheid where the black people of South Africa have been excluded from being South African citizens. The first democratic election in 1994 contributed to the “freedom in their life-time” that youth from the uprisings in Soweto urged for. But today, fourteen years after the relaxation of the apartheid the same socio-economic structures based on race are still visible, not as strict as then but still exceptionally obvious. Especially if you compare townships, like Khayelitsha in the outskirts of Cape Town, with it’s metropolitan area. Khayelitsha is predominantly black area and is also one of the poorest communities in Cape Town.</p><p>This thesis looks at one of the first generations in the ambivalence of the new post-apartheid South Africa, twelve years after the fall of apartheid. We have completed 14 qualitative interviews with adolescents in the age between 18-to-21, living in the socio-economic margin, in the township of Khayelitsha. We have examined their relations to the civil society and their participation within it. In addition also their future aspirations and how they will maintain them.</p>

The ongoing development of the new post-apartheid South Africa is still dealing with its own cruel history. A socio-economic structure based on race has been built up over years of colonialization and apartheid where the black people of South Africa have been excluded from being South African citizens. The first democratic election in 1994 contributed to the “freedom in their life-time” that youth from the uprisings in Soweto urged for. But today, fourteen years after the relaxation of the apartheid the same socio-economic structures based on race are still visible, not as strict as then but still exceptionally obvious. Especially if you compare townships, like Khayelitsha in the outskirts of Cape Town, with it’s metropolitan area. Khayelitsha is predominantly black area and is also one of the poorest communities in Cape Town. This thesis looks at one of the first generations in the ambivalence of the new post-apartheid South Africa, twelve years after the fall of apartheid. We have completed 14 qualitative interviews with adolescents in the age between 18-to-21, living in the socio-economic margin, in the township of Khayelitsha. We have examined their relations to the civil society and their participation within it. In addition also their future aspirations and how they will maintain them.

<p>This study analyses the relationship between the manner of citizens&rsquo / engagement with the state and the level of service delivery they experience in their everyday lives, as residents of Khayelitsha. The phenomena of so-called &lsquo / service delivery&rsquo / protests across South Africa have now become a fixture of South African politics. Khayelitsha is one of the sites with frequent protests in Cape Town and is inhabited by poor people, 70 percent of whom live in informal settlements. While the lack of municipal services is undoubtedly a major problem for many poor people in South Africa, thus&nbsp / far, few studies have been dedicated to investigate empirically this alleged link between service delivery and protest activity. The study utilizes mostly quantitative analysis techniques such as&nbsp / regression analysis and path analysis to discover the form and strength of linkages between the service delivery and participation forms. While residents of informal settlements and therefore&nbsp / poorer services were more prone to engage in protests and thus reinforcing the service delivery hypothesis, this relationship was relatively weak in regression analysis. What is more important than the service delivery variables such as water services was the level of cognitive awareness exemplified by the level of political engagement and awareness on the one hand and level of community engagement in terms of attendance of community meetings and membership of different organizations. In summary the study found relatively weak evidence to support the service&nbsp / delivery hypothesis and stronger evidence for the importance of cognitive awareness and resource mobilization theories in Khayelitsha as the key determinant of protest activity.</p>

<p>This study analyses the relationship between the manner of citizens&rsquo / engagement with the state and the level of service delivery they experience in their everyday lives, as residents of Khayelitsha. The phenomena of so-called &lsquo / service delivery&rsquo / protests across South Africa have now become a fixture of South African politics. Khayelitsha is one of the sites with frequent protests in Cape Town and is inhabited by poor people, 70 percent of whom live in informal settlements. While the lack of municipal services is undoubtedly a major problem for many poor people in South Africa, thus&nbsp / far, few studies have been dedicated to investigate empirically this alleged link between service delivery and protest activity. The study utilizes mostly quantitative analysis techniques such as&nbsp / regression analysis and path analysis to discover the form and strength of linkages between the service delivery and participation forms. While residents of informal settlements and therefore&nbsp / poorer services were more prone to engage in protests and thus reinforcing the service delivery hypothesis, this relationship was relatively weak in regression analysis. What is more important than the service delivery variables such as water services was the level of cognitive awareness exemplified by the level of political engagement and awareness on the one hand and level of community engagement in terms of attendance of community meetings and membership of different organizations. In summary the study found relatively weak evidence to support the service&nbsp / delivery hypothesis and stronger evidence for the importance of cognitive awareness and resource mobilization theories in Khayelitsha as the key determinant of protest activity.</p>

This research study explored the process in the development of theTeacher Support Team in assisting teachers of learners with special educational needs in the mainstream classroom. This research was conducted in the context of the restructuring of the South African Education system. The Policy Document White Paper 6 (2001) states that all learners irrespective of the barriers to learning and development have a right to be educated in the ordinary school, together with their peers.