Background: Antiretroviral treatment (ART) has reduced the mortality rate of HIV-positive children significantly, and is known to prevent the development and progression of HIV encephalopathy. However, even with ART, perinatal HIV infection places HIV-infected children at increased risk for encephalopathy and associated developmental delays. Research is lacking in the extent of developmental delay on children established on ART, along with evidence-based occupational therapy interventions to treat these developmental delays. A play-informed, caregiver-implemented, home-based group occupational therapy intervention (PICIHBI) presents one possible service delivery option to be explored. Aim: To determine whether children attending an experimental group (PICIHBI) versus children attending a control group (conventional, individual occupational therapy intervention) would present similar results in their total developmental quotient – on the Griffiths Mental Developmental Scales (GMDS) and Paediatric Functional Independence Measure (WeeFIM). Methods: A randomised control trial, which was pragmatic in nature and single-blinded, was used. The research population was all HIV-positive children, pre-formal school-going aged (6 months – 5 years), on ART attending the Groote Schuur Hospital paediatric HIV clinic at the time of the study. Caregiver and child dyads were randomly assigned to either the experimental or control group, and attended a monthly occupational therapy session. Differences in the GMDS and WeeFIM scores of each child after 5 and 10 months' intervention were compared. Results: Inter-rater reliability was established among the five researchers performing the GMDS before baseline assessments. Forty-two participants were recruited from a possible population of 72 participants and 39 participated in the baseline assessment. Twenty-eight participants completed mid and post assessments, 15 in the experimental PICIHBI group and 13 in the control group (90% power). Baseline averages on the GMDS showed the participants scoring at a borderline mental retardation level, with better performance in the locomotor and personal-social subscales, before interventions. Both groups had an average attendance of 5 sessions. Post-interventions, average total GMDS and WeeFIM scores between the two groups revealed similar scores within the predetermined non-inferiority margin and no significant differences at any time point. Conclusion: In conclusion, the low baseline scores confirm the need for occupational therapy intervention in pre-formal school-going HIV-positive children on ART. The PICIHBI intervention demonstrates a non-inferior impact in child development in this group compared to conventional, individual occupational therapy intervention. PICIHBI thus has potential for impacting occupational therapy practice in this field by providing an alternative equivalent treatment with increased reach.

Background: The concept of client-centred practice (CCP) was first developed and implemented by occupational therapists in Canada during the early 1980s and subsequently transferred into the Tanzanian occupational therapy curriculum by international volunteer educators. Currently, the occupational therapy curriculum at the Kilimanjaro Christian Medical University College (KCMUCo) in Moshi, Tanzania covers CCP using assessment tools and models developed by the Canadian Association of Occupational Therapy. To date, no occupational therapy research has been conducted to investigate the relevance of CCP for Tanzania, or to document the perspectives of therapists in applying the principles of CCP. This study was indicated to inform the occupational therapy curriculum at the KCMUCo and the Tanzania Occupational Therapy Association (TOTA) about occupational therapy practice realities related to the implementation of CCP in Tanzania and to guide the alignment of the occupational therapy curriculum towards a local understanding of CCP or an alternative (non-Western) perspective. This study, therefore, aimed to determine the understanding and use of CCP by occupational therapists in Tanzania. Methodology: The study used a descriptive cross-sectional design. All qualified occupational therapists working in different regions in Tanzania were approached to participate in the study (N=80). A questionnaire, the Professional Questionnaire for Assessing CCP (PQACCP) was adapted for the study. The questionnaire consisted of five sections: 1) demographic and practice information; 2) an adaptation of an existing checklist on understanding CCP (Parker, 2006); 3) potential barriers to CCP; 4) enablers of CCP; and, 5) therapist opinions on the relevance of CCP for the Tanzanian context. The checklist of potential barriers and enablers was adapted from Sumsion & Smyth, (2000). Data were analysed using the SSPS software program (version 20.0). Numerical variables were checked for normality and the appropriate measures of central tendency and dispersion calculated. Frequencies and proportions were determined for categorical items. The Chi-square test of association was done to determine whether there were any observed associations between demographic variables and barriers/enablers.

Includes bibliographical references. / This study focused on women who consumed alcohol during pregnancy. The study population was situated in the West Coast/Winelands, a rural area in the Western Cape Province of South Africa. The study was done in a community which is classified as one of the many previously disadvantaged groups in South Africa. This study was done as part of a larger three-year project on Fetal Alcohol Syndrome Prevention in the Western Cape and Gauteng Provinces of South Africa. The phenomenon of drinking during pregnancy was used as a case example of health compromising occupations in the South African context. Prenatal alcohol exposure may result in brain damage that affects behaviors of those affected. The beliefs, norms, values and perceptions of mothers regarding alcohol consumption are also an important aspect in maintaining healthy pregnancies.

This thesis explored the occupational choices of young adolescents in a southern peninsula Cape Town community of Lavender Hill in South Africa. Informed by current research and prior professional and personal experiences with young adolescents in Lavender Hill, the research question asked: 'What informs occupational choice among young adolescents in Lavender Hill?' This complemented the research aim, which was to generate insight into the nature of the occupational choices of a group of young adolescents in Lavender Hill, and the factors that influenced their occupational choices.

Background: This study is a critical description and explanation of the situated nature of the professional role transition process experienced by occupational therapists working in specialised education in post-apartheid South Africa. The study posed the research question: How do occupational therapists experience the process of professional role transition within specialised education in the Western Cape? The study was framed conceptually within critical social theory and occupational science. Aim: The study aimed to describe and analyse a single instrumental case of professional role transition experienced by five occupational therapists currently working at special school resource centres in two education districts in the Western Cape, South Africa Objectives: The objectives of the study were to: Describe and explain the process of professional role transition as experienced by occupational therapists along a trajectory from 1994 to 2013; Provide insights into the occupational therapists' perceptions, thoughts, feelings and attitudes on their professional role transition experience; Determine whether there are any role changes present and the possible impact this might have on the role and scope and development of occupational therapy practice within specialised education; and Outline the influences the socio political context has on the role of occupational therapists working in special school resource centres in the Western Cape.

Incudes bibliographical references.

BACKGROUND: Two challenging concerns prompted this research. The first was post 1994 South African society’s historically entrenched dehumanized/ing condition. And the second was the ill-positionedness and ill-preparedness of occupational science accompanied occupational therapy to do something about it. Appropriate concepts to imagine and generate potentially humanizing and healing responses to violent-divided-wounded human relations were found to be lacking in both professional and public discourses. This study therefore conceived of and applied an original conceptual depiction of being human as ‘enacting humanity affirmations’. Two questions were asked: how are affirmations of our humanity enacted in everyday post 1994 apartheid South Africa? And, how is human occupation and health implicated in enacted humanity affirmations? Consistent with the values and power rationality nature of the first research question, this study was philosophically grounded in critical contemporary interpretations of Aristotle’s intellectual virtue phronesis, and the African relational ethic Ubuntu. METHODOLOGY: Case study was heuristically employed as both a method and the object of study, along with narrative enquiry to generate storied exemplars. Maximum variation sampling aimed for heterogeneity of participants. The stories which made up the instrumental collective case were selected on the criterion of encountering likely resonance within South Africa. Situated within a dehumanized/ing context, incidents-embedded instances of enacted humanity affirmations were handled as bounded systems. Information was gathered through and from multiple methods and sources, including narrative interviews, participants’ reflective journals, multiple documents review, and researcher’s notes. Data analysis proceeded from co-constructions of nine case narratives, an across-case thematic analysis, to thesis building. Together, these informed what this study’s case is about, what it is a case of, and for. Critical reflexivity was exercised by on-going attention to power issues in research interactions, and attempts to enact reciprocal gestures and shared decision-making. FINDINGS/DISCUSSION: This study is a case about everyday enacted humanity affirmations which present as remarkable, disrupting seemingly normalized systemic oppressive power dynamics. Three main themes emerged: 'spectra of relational agency possibilities'; 'embodied-embedded radical sens-abilities'; and, 'never forget how made to feel'. Interpretations and discussion of these findings make this study a case of revealing and disrupting the violent deceptive western(ized) ontological and epistemological premise that being human is a given for all. Redressing historically inflicted harm done to our humanity necessitates that the geo- and body-political epistemic positions, from where to generate applicable understandings of human occupation and health, are delinked from ‘whiteness’. CONCLUSION: This study builds a case for advancing an understanding of being human as occupation and health. Being human was found to be radically relational, and not a given but a political potentiality which manifests on a continuum of enacted harmful negations and salutogenic affirmations of our humanity. Also, cultivation of our being human as shared identity-integrity can advance humanity-health. These insights allow for potentially humanizing and healing societal responses to violent-divided-wounded human relations. This has implications for how occupational therapy and occupational science can position and prepare for being a humanizing and healing resource through research, practice, and education.

This study examines the South African industrial training discourse and policy between 1977 and 1982. The period begins with the appointment of the Riekert and Wiehahn Commissions of Inquiry, both of which contributed materially to the restructuring of official discourse and policy affecting black industrial workers. The study ends after the first year of implementation of the Manpower Training Act of 1981. A method of ideological critique is developed and applied to the language and assumptions of the industrial training discourse and policy in order to show how the dominant industrial training ideas were formulated and given public exposure by significant reformist groups within the state and the capitalist class during a period of general ideological, economic and political change and contestation. The historical context is traced in order to situate the emergence of the reformulated and increasingly coherent dominant industrial training discourse. Prominent themes in this discourse such as the 'skills shortage crisis' are examined and related to developments in the South African social formation and economy. The agents and themes of the counter discourses in the industrial training arena are also identified and discussed. Finally, attention is given to the educational meanings which are subsumed within the industrial training formulations and it is shown how general adult education concerns are largely discarded in favour of considerations of capital accumulation in industrial training policy and rhetoric. It is argued that industrial training policy reflects the dual state strategy of incorporation of the relatively privileged sectors of the black population into a deracialized core economy in the metropolitan centres of South Africa and control of the numerically dominant poor Africans. The industrial training legislation and official guidelines for practice stress rigidly planned closed courses for worker-learners with the emphasis falling on positive attitudes towards the free enterprise system, specific and limited 'on-the-line' skills and worker-management harmony. The content of training courses is monitored through the system of training course registration and rewards for approved courses and methods are offered in the form of generous tax incentives.

Introduction: Adults with intellectual disability (ID) have a right to be included in post-school education (PSE) opportunities such as learnership programmes. They face many barriers, however, including the fact that learning facilitators do not know how to include and teach these learners with ID in a PSE context. Problem: No literature or documented evidence has been captured about inclusive educational approaches describing how learning facilitators taught adults with ID in three learnership programmes that can be used to develop training programmes that will equip learning facilitators with the necessary skills for teaching this group of learners. Rationale: Learning facilitators need to be adequately trained, equipped and supported to meet specific learning needs of adults with ID in learnerships. This study will provide a resource of practice-based educational strategies that could serve as the basis for this training. Aim: To describe how learning facilitators in learnership programmes at Organisation X provided teaching to adults with ID. Method: An indepth, moderately structured, open-ended interview method was used to collect data from six participants. Three Universal Design for Learning (UDL) principles and related guidelines were used to inform how the interview questions were structured. Findings: The main theme was “a learnership takes time, patience and many adjustments but it has to be done” that comprised three categories: namely “dealing with intellectual disability”, “streamlining learnership strategies” and “perceiving the 'just right’ learnership”. The sub-categories identified were populated into the UDL Framework. Discussion: Learnership programmes with adults with ID are time consuming and personally demanding for learning facilitators, but adults with ID have a right to access these programmes. Training programmes for learning facilitators need to include aspects of how to deal with learners with ID, what curriculum differentiation strategies need to be streamlined, and how to create the 'just right’ learnership. Conclusions: Learning facilitators believe that learners with ID have the right to access PSE and participate in learnerships. The success of post-school learnerships lies in providing the “just right” curriculum that offers support for both educator and learner.

Background: Recent studies have suggested that aside from the inhalational route, skin exposure may also play an important role in the sensitization to allergens, resulting in adverse allergic respiratory outcomes including asthma in workers exposed to these agents. This appears to be reported more commonly for low molecular weight agents such as isocyanates and some cleaning agents. This study investigated whether skin symptoms, in the presence or absence of allergic sensitization, can predict the development of allergic respiratory outcomes and asthma in bakery workers. Methods: A cohort study investigated 263 bakery workers using a modified ECRHS questionnaire; immunological tests including skin prick tests for common local aeroallergens (ALK-Abello´ A/S, Horsholm, Denmark), Phadiatop and serum-specific IgE to bakery allergens (wheat, rye and fungal α-amylase); and pulmonological tests including spirometry, non-specific bronchial hyperresponsiveness, and fractional exhaled nitric oxide (FeNO), after a 4 year period. Results: Workers’ median age was 32 years (IQR: 26-38), 50% were female, 54% were ever smokers and 32% were atopic. At baseline, 26% of workers were sensitized to bakery allergens, skin symptoms were present in 22% and 11% reported work-related skin symptoms (WRSS). 3 While the incidence of general upper (19%) and lower (22%) respiratory symptoms over the follow-up period were very similar, work-related upper (29%) respiratory symptoms were higher than lower (20%) respiratory symptoms. However, the incidence of allergic sensitization to bakery allergens was only 8% and a new asthma diagnosis present in 4% over this period. In multivariate adjusted (gender, atopy and smoking status) regression models, having a history of skin symptoms was associated with an increased risk of developing work-related lower respiratory symptoms - WRLRS (RR=2.2, 95% CI: 1.03-4.83), while having clinically significant symptoms of eczema or urticaria was associated with an increased risk of reporting general upper respiratory symptoms (RR=5.5, 95% CI: 1.30-24.20) as well as WRLRS (RR= 4.8, 95% CI: 1.60-14.40). Furthermore, WRSS was associated with an increased risk of general upper respiratory symptoms (RR=5.1, 95% CI: 1.31-19.81), WRLRS (RR=4.1, 95% CI: 1.43-11.85) and elevated FeNO levels (FeNO>25ppb: RR=2.9, 95% CI: 1.19-7.28). The association between clinically significant skin symptoms or WRSS and new onset upper or lower respiratory symptoms were modified by use of dermal personal protective equipment. Infrequent or absent glove usage was associated with a higher risk (RR=5.3, 95% CI: 1.54-18.43) of having new onset WRLRS. Conclusion: Skin symptoms, more so if work-related, appear to be associated with future development of general and work-related upper and lower respiratory symptoms and inflammatory markers suggestive of asthma in bakery workers.