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This study investigated the psychometric properties of the Swanson, Nolan, and Pelham ADHD Rating Scale (SNAP-IV) in a sample of South African children with neurodevelopmental disorders (n = 201), primarily Autism Spectrum Disorder and Intellectual Disability. We conducted a confirmatory factor analysis to inspect the two-factor structure of the SNAP-IV. We also calculated ordinal coefficient alpha to estimate internal consistency. Fit statistics for the two-factor model approached acceptable levels. The model fit improved slightly after removing an item related to spoken language. The subscales had acceptable internal consistencies. Findings partially support the use of the SNAP-IV in this group of children. However, there are limitations to its performance in this population likely related to the presence of neurodevelopmental disorders.

Although Western biomedical treatment has dramatically increased across sub-Saharan African health systems, traditional medicine as a form of healing and beliefs in supernatural powers as explanations for disease remain prevalent. Research in this region has identified HIV in particular as a disease located within both the traditional African and Western medical paradigms, whilst mental illness is ascribed to primarily supernatural causes. Within this context, this study sought to understand and explore the perceptions of HIV and mental illness among a population of rural women in Limpopo, South Africa. 82 in-depth interviews were conducted between January and December, 2022. Interviews were transcribed and translated into English. Data were managed using NVivo 11 software and thematically analyzed. The majority of participants identified HIV as a Western illness requiring biomedical treatment with an origin largely attributed to biological mechanisms. A traditional form of HIV only cured using traditional treatments was also denoted. Unlike for HIV, the majority of respondents felt that there was no biological or behavioral cause for mental illness but rather the illness was conceptualized supernaturally thus likely impacting patient care pathways. Further research to study HIV and mental health perceptions among a larger sample in different regions of sub-Saharan Africa is warranted. [ABSTRACT FROM AUTHOR]

Background: The HIV epidemic in sub-Saharan Africa has a disproportionate gender impact, with women bearing the brunt of the epidemic. South Africa carries the largest share of the global HIV burden, with similar trends seen for women due to unequal socio-cultural and economic status. Objectives: This study aims to understand 30–49 year-old women's barriers and facilitators to accessing HIV services in order to maximize health in resource limited settings and reach women missing from HIV care. Design: Employing a convenience sampling strategy, we recruited, informed, and consented participants at clinics and public areas. Interviews were conducted in respondent's preferred languages, transcribed verbatim, translated into English if needed, and thematically analyzed using grounded theory. Methods: We conducted 81 interviews with women aged 30–49 either missing from care (n = 21), having unknown HIV status (n = 30) or linked to care (n = 30) within two sites: City of Johannesburg district, Gauteng Province and Mopani district, Limpopo Province. Results: Participants missing from care reported negative staff attitudes, queues, family rejection, medication side effects, and painful blood tests as key deterrents. Participants with an unknown status were deterred by fear of being diagnosed as HIV positive and family rejection, which was similar to women missing from care who often dropped out from care due to actual family rejection. Participants linked to care reported that long queues and staff shortages were challenges but stayed in care due to a will to live for themselves and their children, in addition to counselling and feeling emotionally supported. Interestingly, participants missing from care often accessed medication from friends but, similarly to those with unknown status, noted that they would access care if attended to by supportive nurses and by having non-clinical HIV services. Conclusions: The accounts of women in this research highlight significant improvements needed to address inequities in the fight against HIV in South Africa. Additionally, the healthcare service access preferences of women aged 30–49 need to be further explored quantitatively in order to design policy relevant interventions. Plain language summary: Understanding HIV service preferences of South African women 30–49 years old missing from or linked to care: An exploratory study of Gauteng and Limpopo provinces The HIV epidemic in sub-Saharan Africa harms women more than men. South Africa carries the largest share of the global HIV burden, with similar trends seen for women. This study aims to understand 30–49 year-old women's ability to access HIV services in order to reach women missing from HIV care. We conducted 81 interviews with women aged 30–49 either missing from care (n = 21), having unknown status (n = 30) or linked to care (n = 30) within two sites: City of Johannesburg district, Gauteng Province and Mopani district, Limpopo Province. We recruited, informed, and consented participants at clinics and public areas. Interviews were conducted in respondent's preferred languages, transcribed, and translated into English for analysis. Participants missing from care reported negative staff attitudes, queues, family rejection, medication side effects and painful blood tests as key deterrents. Participants with an unknown status were deterred by fear of being diagnosed as HIV positive and family rejection, which was similar to women missing from care who often dropped out from care due to family rejection. Participants linked to care reported that long queues and staff shortages were challenges but stayed in care due to a will to live for themselves and their children, in addition to counselling and feeling emotionally supported. Interestingly, participants missing from care often accessed medication from friends but, similarly to those with unknown status, noted that they would access care if attended to by supportive nurses and by having non-clinical HIV services. The healthcare service access preferences of women aged 30–49 needs to be further explored in order to improve interventions. [ABSTRACT FROM AUTHOR]

Religion and spirituality are powerful social forces in contemporary South Africa. Traditional Health Practitioners (THPs) are commonly consulted for both spiritual and medical ailments as a first line of care. Many studies have assessed African traditional health seeking behaviors but few have examined beliefs, practices, and behaviors of THPs themselves. This study sought to explore spiritual worldviews among South African THPs. Semi-structured in-depth interviews were conducted with 18 THPs in Johannesburg, South Africa between January and May, 2022. Interviews were transcribed and translated into English. Data were managed using NVivo 12 software and thematically analyzed. The majority of THPs interviewed indicated that initiation as a THP was almost always preceded by a sickness accompanied by dreams/visions that represented an "ancestral calling" to become a healer. Most THPs also trained as both sangomas—who healed according to traditional beliefs—and prophets—who healed according to Christian beliefs. This reflects a syncretic relationship between traditional African beliefs and Christianity. However, not all churches are accepting of traditional beliefs and subsequently these THPs are members only at non-Pentecostal AIC churches who blend both African and Christian practices. Similar to these forms of religious pluralism melding Christianity and traditional beliefs, many THPs also often practice medical pluralism, mixing Western treatments with traditional practices/medicines. THPs are able to adapt elements of Western and African beliefs into healing practices that span multiple religious and medical fields. Thus, collaborative and decentralized healthcare services may be highly acceptable among such a pluralistic community. [ABSTRACT FROM AUTHOR]

Background: A patient's pathway to care is often characterized by a sequence of actions taken to remedy ill-health. Research exploring the help-seeking behavior of individuals with mental health problems in sub-Saharan Africa is relatively limited. This study assessed the perceptions and experiences of mental illness and treatment among patients with mental illness at two psychiatric facilities in Johannesburg, South Africa. Methods: 309 interviewer administered surveys were conducted between January and July 2022. We used a logistic regression model to examine factors associated with receiving treatment for mental illnesses from traditional healers. Semi-structured interviews were conducted with 18 participants during the same period. Interviews were transcribed and translated into English. Data were managed using NVivo 11 software and thematically analyzed. Findings: Results showed that 144 (47%) patients sought mental health care from traditional healers. Higher anxiety symptoms, number of people in the household, believing that traditional medicine can cure mental illnesses, and township living were associated with seeking mental healthcare from traditional healers. Qualitative analysis indicated that participants often believed that mental illness was due to bewitchment and consulted with multiple traditional healers, thus spending large amounts of money for treatment and ultimately delaying access to biomedical care. Conclusion: Collaborative approaches between traditional healers and biomedical professionals show promise in terms of allowing for improved identification and treatment of individuals with mental disorders. [ABSTRACT FROM AUTHOR]

Background and Objectives: Rural health disparities are growing, and medical schools and residency programs need new approaches to encourage learners to enter and stay in rural practice. Top correlates of rural practice are rural upbringing and rurally located training, yet preparation for rural practice plays a role. The authors sought to explore how selected programs develop learners' competencies associated with rural placement and retention: rural life, community engagement, and community leadership.Methods: Qualitative, semistructured phone interviews (n=20) were conducted with faculty of medical schools or family medicine residencies across the United States, Canada, Australia, and South Africa in which success in training rural practitioners was identified in the literature or by leaders of the National Rural Health Association's Rural Medical Educators Group. Participants included 18 physician program directors, one nonphysician program administrator, and one PhD researcher who had studied rural preparation. Interview transcripts were read twice using an inductive process: first to identify themes, and then to identify specific strategies and quotes to exemplify each theme.Results: Participants' recommendations for rural preparation were: (1) Be intentional about strategies to prepare learners for rural practice; (2) Identify and cultivate rural interest; (3) Develop confidence and competence to meet rural community needs; (4) Teach skills in negotiating dual relationships, leading, and improving community health; and (5) Fully engage rural host communities throughout the training process.Conclusions: Medical schools and residencies may increase the likelihood of producing rural physicians by implementing these experts' strategies. Educators may select strategies that mesh with the structure and location of their training program. [ABSTRACT FROM AUTHOR]

Abstract Livestock production in South Africa is limited by frequent droughts. The South African Weather Service produces climate forecasts estimating the probability of low rainfall three and six months into the future. We used the ecosystem model SAVANNA applied to five commercial farms in the Vryburg region of the North-West Province, and five communal areas within the Province, to assess the utility of a climate forecast in refining drought coping strategies. Rainfall data from 1970 to 1994 were modified to represent a drought (225 mm of rainfall) in 1977/1978, and used in simulations. In a simulation on an example commercial farm we assumed a forecast was available in 1977 portending an upcoming drought, and that the owner sold 490 cattle and 70 sheep prior to the drought. Over the simulation period, the owner sold 31% more cattle when the forecast was used,versus when the forecast was ignored. Populations of livestock on both commercial and communal farms recovered more quickly following the drought when owners sold animals in response to the forecast. The economic benefit from sales is being explored using optimization techniques. Results and responses from South African livestock producers suggest that a real-time farm model linked with climate forecasting would be a valuable management tool. [ABSTRACT FROM AUTHOR]

Drought is a frequent occurrence in the Northwest Province of South Africa, and it appears to be strongly influenced by El Niño-Southern Oscillation events. The South African Weather Services produce long-term seasonal climate forecasts for 3 and 6 mo in advance that could allow crop and livestock farmers to plan anticipated wet or dry seasons. We describe a simple economic model linked to an ecosystem model, and we report on the results of simulation runs designed to estimate the economic value of climate forecasts in the study area. For the communal farmers of this region, forecasts may have little direct economic value in terms of modifying management decisions, but they may have little direct economic value in terms of modifying management decisions, but they may have value in terms of optimal management for asset accumulation. For commercial farmers, model results suggest that long-term average annual income could increase through utilizing forecasts associated with El Niño-Southern Oscillation events, but at the cost of increased year-to-year variability in farm income. More work is required to investigate other possible management responses to forecast information, identify more clearly the situations where climate forecasts are potentially of value, and implement mechanisms for the delivery and utilization of this information by livestock keepers in the region.. [ABSTRACT FROM AUTHOR]

Genetic association studies have made significant contributions to our understanding of the etiology of neurodevelopmental disorders (NDDs). However, these studies rarely focused on the African continent. The NeuroDev Project aims to address this diversity gap through detailed phenotypic and genetic characterization of children with NDDs from Kenya and South Africa. We present results from NeuroDev's first year of data collection, including phenotype data from 206 cases and clinical genetic analyses of 99 parent-child trios. Most cases met criteria for global developmental delay/intellectual disability (GDD/ID, 80.3%). Approximately half of the children with GDD/ID also met criteria for autism. Analysis of exome-sequencing data identified a pathogenic or likely pathogenic variant in 13 (17%) of the 75 cases from South Africa and 9 (38%) of the 24 cases from Kenya. Data from the trio pilot are publicly available, and the NeuroDev Project will continue to develop resources for the global genetics community. • First trio-based study of neurodevelopmental conditions in Kenya and South Africa • Pathogenic and likely pathogenic variants were identified in 22 of 99 trios • Families were linguistically and ancestrally diverse • Lessons learned from data collection support future NDD studies in Africa Kipkemoi et al. share the genetic and phenotypic results from the first year of NeuroDev, a study of neurodevelopmental conditions in Kenya and South Africa. They collected data from 600 participants, including 200 children with neurodevelopmental conditions. Analysis of genetic data from 99 parent-child trios found causal or likely causal variants. [ABSTRACT FROM AUTHOR]

The NeuroDev study will deeply phenotype cognition, behavior, dysmorphias, and neuromedical traits on an expected cohort of 5,600 Africans (1,800 child cases, 1,800 child controls, and 1,900 parents) and will collect whole blood for exome sequencing and biobanking., (Copyright © 2018 Elsevier Inc. All rights reserved.)