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The efficacy of marine protected areas (MPAs) depends on their governance and management. We review their history in South Africa and recognise four periods. Period 1 (1964–1994) provided initial protection but was based on exclusionary, preservationist policies, was ad hoc in the absence of a national plan, and neglected social considerations. Period 2 (1994–2010) began introducing people-oriented policies, focused on ecosystems rather than species, and was strengthened by the formation of a national coordinating body. Period 3 (2010–2019) heralded improvements in design, ecosystem representation and stakeholder engagement, yet fractured governance hindered coordination and management. Period 4 (Since 2019) added challenges in managing new offshore MPAs. Progress in achieving effective MPA governance and management was assessed over these periods for 17 components of governance and management, representing key issues for which changes could be identified throughout. Fifteen components indicated overall improvements—most notably legislation and policies, MPA establishment, planning and design, and staff training and skills—whereas progress for most of the other components was weaker. Zero net gains were recorded for enforcement and compliance, and for the staff complement. Our recommendations flow principally from components assessed as faring poorly. We conclude with eight critical needs: (1) specify detailed objectives for every MPA; (2) fast-track management plans for new MPAs; (3) improve law enforcement and compliance; (4) enhance participation of adjacent communities and other stakeholders; (5) address MPA-related social impacts and injustices, and improve benefit sharing; (6) ensure financial sustainability; (7) strengthen evaluations of management effectiveness; and (8) improve cooperation between government authorities responsible for MPAs and fisheries. [ABSTRACT FROM AUTHOR]

Background: Although potentially preventable, cervical cancer is the fourth most common cancer among women globally and a leading cause of cancer-related deaths. Women living in resource-limited countries are especially at risk due to poor access to cervical cancer screening and treatment. Alternative cervical cancer screening methodologies have been investigated where cytology-based screening is not feasible. This study aimed to assess the test performance of naked eye visual inspection analysis, in addition to the comparative performance of physician/colposcopist clinical impression to Reid's colposcopic index (RCI) grading system for histopathology, in the South African setting. Methods: Women living with HIV (WLWH) and HIV-negative women aged 25 to 65 were recruited from three sites in South Africa. A cross-sectional study which assessed visual inspection with acetic acid (VIA), visual inspection with lugols iodine (VILI), colposcopic impression and RCI for the detection of histologically confirmed CIN2+ and CIN3+ was performed. Test positivity rates, sensitivity, specificity, and predictive values were calculated. Results: Three hundred and forty-four WLWH and 409 HIV-negative women, with a median age of 40 years, were included in this analysis. Histologically confirmed CIN2+ was present in 38.51% and CIN3+ in 18.99%. Overall, positive test rates for VIA were 42.76%; VILI were 45.68%, colposcopic impression were 48.26% and RCI were 46.65%. Overall sensitivities/specificities for VIA and VILI for CIN3+ were 76.92/65.25% and 75.52/61.31%, respectively. The sensitivities however increased for WLWH (VIA 82.61%; VILI 80.43%) and decreased in HIV-negative women (VIA 66.67%; VILI 66.67%). Colposcopic impression/RCI performed better in WLWH (PPV 37.96/37.74%) than in HIV-negative women (PPV 25.63/26.80%). Conclusion: The current study demonstrates that visual inspection methods perform better in WLWH than in HIV-negative women. VIA and VILI performed similarly within each sub-population, as did colposcopic impression and RCI. The use of visual inspection methods in cervical cancer screening in WLWH is warranted. [ABSTRACT FROM AUTHOR]

Research on the socio-economic aspects of marine protected areas (MPAs) in South Africa is reviewed to guide evaluation and integration. After a brief international review, we used declaration notices and management plans to determine the extent to which social and economic objectives have been included in the purpose statements of MPAs. We then reviewed the current state of knowledge about the social and economic effects of South African MPAs. While many MPAs have purposes and objectives that include some social and economic objectives, these are limited in scope. Most of the MPAs that were declared before 2019 did not include objectives directly related to people or their needs. Social or economic research has been undertaken in fewer than half of the 23 coastal MPAs. Literature is largely limited to: (i) studies on negative impacts of MPAs on adjacent rural communities; (ii) selected aspects of tourism; and (iii) various aspects related to resource use. A wide range of other tangible and intangible effects, including those experienced by a broader set of stakeholders and over differing scales of time and space, have seldom been addressed. A case study on the Tsitsikamma MPA exemplifies challenges associated with understanding the full scope of social and economic aspects of MPAs. We conclude with recommendations to address the challenges of building a better understanding of the social and economic effects of MPAs, ensuring that these are addressed in establishing or revising objectives for each MPA, and assessing the extent to which the objectives meet both human and environmental needs. [ABSTRACT FROM AUTHOR]

We reviewed 140 papers to assess the ecological effectiveness of South Africa's marine protected areas (MPAs). Evidence was assessed for coverage and representivity, protection of important biodiversity areas, other recognised elements of effectiveness, connectivity, and ecological effects—from the scale of individual MPAs to the MPA network scale. We conducted complementary novel analyses to supplement the review and to objectively determine where and how the MPA network can be improved. Evidence shows that South Africa's MPAs now provide some protection to all ecoregions and 87% of ecosystem types but to less than 50% of assessed species groups. MPAs are generally well-sited, but gaps were revealed on the west coast and in estuaries, the deep sea, and two ecologically and biologically significant areas. Enforcement emerged as a key concern, and many MPAs could be improved through expansion or by increasing no-take areas. The majority of relevant papers recorded beneficial ecological effects, detectable as increases in parameters such as the abundance, biomass, sizes or reproductive output of species. Few papers examined whether ecological benefits translate into adjacent fisheries benefits, but all those that did recorded positive effects. Full protection was more effective than partial protection, with effectiveness most clearly demonstrated for vulnerable target taxa. Further research and monitoring to achieve evaluations of effectiveness are recommended, with greater focus on neglected MPAs and species. Understanding the ecological connectivity between MPAs, an important dimension for climate-change adaptation and hence for the persistence and resilience of South Africa's marine biodiversity, is identified as a key area for future research and inclusion in MPA planning. [ABSTRACT FROM AUTHOR]

Globally, there has been a move toward 'open science' that includes the sharing of health data for research. The importance of data sharing for research is generally acknowledged, but this must only be done with legal and ethical procedures and protections in place. The use and sharing of health data for research in South Africa has changed with the coming into force of the Protection of Personal Information Act (POPIA). POPIA should ensure greater transparency and accountability in the use of personal information. POPIA, however, adopts a principle-based approach to the regulation of personal information, and there is a lack of clarity and uncertainty in the application of some of these principles to the use of health data for research. POPIA provides for sector-specific responses through the development of codes of conduct. In this article, we discuss the need for a code of conduct for health research, and an approach that could be adopted in its development. [ABSTRACT FROM AUTHOR]

Background. Health sciences students have traditionally been taught their practical skills in community health facilities. However, clinics and hospitals are not necessarily ideal settings for teaching students health-promotion skills. Objective. To explore health-promoting schools (HPSs) to teach Stellenbosch University (SU) undergraduate dietetic students health-promotion skills. Methods. In this descriptive, cross-sectional study, students completed structured reflective journals and conducted interviews with teachers. The chief professional nurse interviewed the school principals. Results. The students were positive about HPSs, but only fully understood its implementation and practice after entering the school setting. They felt that they could play a role in increasing its efficacy. The teachers were positive about the initiative and thought that they had adequate knowledge to take it further, but were open to gaining more knowledge and insight. Teachers and students had similar views on the role that students could play in HPSs, including educating learners, parents and teachers on health and nutrition, assisting with growth monitoring and promotion, developing educational tools, obtaining various resources for schools, planning menus, budgeting for meals, and growing vegetables. Resources required by the schools could best be addressed by a team of healthcare professionals in collaboration with government departments and with community support. Conclusion. HPSs offer extensive opportunities where SU undergraduate dietetic students, and possibly other healthcare profession students, could serve the needs of communities while learning and practising health-promotion skills. [ABSTRACT FROM AUTHOR]