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Background: The COVID‐19 pandemic and the lockdown experience may have not only precipitated or exacerbated mental illness but also influenced access to care and the nature and content of the psychotic symptomatology of people with psychosis. Aim: This study aimed to evaluate the association of the COVID‐19 pandemic and lockdown experience on clinical presentation and quality of life of people (QOL) with first episode psychosis (FEP). Method: Two first episode psychosis cohorts from the same epidemiological area collected prior to, and during the COVID‐19 pandemic and lockdown were compared in terms of clinical symptomatology, substance use and QOL. All adult in‐ and outpatients with FEP at five clinical units in KwaZulu‐Natal, South Africa, aged between 18 and 45 years, were assessed with the MINI interview for psychosis, Positive and Negative Symptoms Scale, WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the WHO QOL scales. Results: Eighty‐eight FEP participants were recruited between 2019 and 2020 (cohort 1) before the pandemic. Study recruitment was suspended in March 2020 due to the pandemic. On study resumption from November 2020 to November 2022, 95 new participants (cohort 2) were recruited. There were no sociodemographic differences between the two cohorts, except unemployment status (57% vs. 65%) and household income. The cohort presenting post‐COVID‐19 pandemic onset had significantly more positive psychotic symptoms (21.9 vs. 23.7), lower PANSS domain depressive score, more lifetime use of tobacco, cannabis and alcohol. However, they reported improved QOL (196 vs. 239). Conclusion: Following the pandemic and lockdown experience participants presented with more severe psychotic symptoms and concomitant substance use but improved perceived QOL. This suggests the need to explore individual and social factors that may influence the clinical presentation. [ABSTRACT FROM AUTHOR]

What were the effects of a 52 per cent increase in the minimum wage in the agricultural sector in South Africa in 2013? We estimate the short run effects of this policy change on the income, employment, and poverty rate of farmworkers, using individual-level panel data from the Quarterly Labour Force Surveys (QLFS). Before the implementation date, 90 per cent of farmworkers were paid below the new minimum wage level. We find that the wage gain of farmworkers is strongly quadratically related to pre-implementation wages, suggesting lower compliance as the gap between the minimum and the pre-implementation wage increases. We estimate that farmworkers received a median wage increase of 9 per cent as a result of the policy, and we find no evidence of job losses. Overall, farmworkers were 7 per cent less likely to have household income per person below the poverty line. One possible explanation for these outcomes is that endogenous compliance may mitigate against unemployment effects. While the minimum wage literature is large, our paper adds to the small subset of this literature on large increases, partial compliance, and poverty effects. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify characteristics and factors that assisted families in the adjustment and adaptation to the chronic illness of breast cancer. A mixed-methods convergent parallel research design was employed. Non-probability convenience sampling was utilized to recruit 104 mothers from a university hospital in the Western Cape province, South Africa. Qualitative data were collected with semi-structured interviews (n = 11), and quantitative data were obtained using seven self-report questionnaires (N = 104). Several family resilience qualities were identified by means of quantitative and qualitative analyses. Findings can be utilized in interventions aimed at strengthening families with mothers who have been diagnosed with breast cancer. [ABSTRACT FROM AUTHOR]

In this paper, I foreground the view that, as human agents initiating and participating in developmental projects that are both economically and educationally oriented, the possession of social consciousness of what development in society in the twenty-first century fully entails is an indispensable attribute. This paper, therefore, interrogates the narrower views of development, which tend to focus on identifying development with the growth of a gross national product with the rise in personal incomes, with industrialisation, or with technological advance (Sen, 1999:3). Thus, I argue that social consciousness on the part of human subjects, who are in turn agents of social developmental change, is critical since development ...requires partnerships within a framework of common values and goals (Badat, 2009:11). It is against this backdrop, therefore, that Coppedge’s (1999:465) averment to the effect that “development is more than just average wealth”. Arguably, it is rendered intelligible since “development is a process of expanding the real freedoms that people enjoy”, which ‘contrasts with the narrower views of development’ (Sen, 1999:3). Thus, societies that are bedevilled by social illsresulting from a lack of development must continue to ‘search for human agency and for the means through which inequality can be undone (Hammami, 2006). [ABSTRACT FROM AUTHOR]

Genetic diversity is crucial for crop improvement in any breeding program. Cowpea is an important indigenous grain vegetable legume crop. The crop has a significant potential to improve food and nutritional security in sub-Saharan Africa (SSA), and family income for resource poor famers. Cowpea is a source of proteins, vitamins (folate, thiamine and vitamin C), minerals (Fe, Zn, Mn and Ca) and amino acids such as lysine and tryptophan, hence, has a high potential for combating nutrient deficiencies. The SSA countries, including South Africa, have been experiencing many dry seasons, which have negatively affected agricultural production and productivity. Cowpea has a long taproot with the ability to grow in arid and semi-arid regions; however, lasting exposure to severe droughts will result in significant yield and grain quality reduction. There has been limited progress in drought tolerance research in cowpea due to the complexity of this trait, as it involves numerous genes, which in turn are affected by environmental conditions. It is therefore important to review research done on the nutritional, phenotypic and genotypic diversity of cowpea and the importance of diversity when breeding for complex quantitative traits such as drought tolerance and yield. The review will also outline the important omics tools used for drought tolerance breeding, cultivar development and as reference for future cowpea breeding. Cowpea is a highly nutrient-dense, underutilised orphan legume crop with high potential to address malnutrition and food security in the world. Cowpea crop can withstand drought and high-temperature conditions, however, lasting exposure to severe droughts will result in significant yield reduction and poor grain quality. Thus, understanding the variation present in the available cowpea accessions will assist in breeding superior cowpea varieties that can withstand the ever-changing climate. [ABSTRACT FROM AUTHOR]

Students' reasons for attending university are likely to impact their participation, academic engagement, and learning outcomes. This study aims to investigate undergraduate students' motivations for attending a South African university and its association with specific socio-demographic factors. The study used a cross-sectional survey design. Participants were undergraduate students (N = 220) who completed a socio-demographic survey and the Student Motivations for Attending University Questionnaire-Revised scale. Descriptive statistics, correlations, and analysis of variance were used to determine associations between the study variables. The reasons for attending university were significantly related to racial identity, student generational status, parental educational status, and family characteristics. Students in their first and second years of study were motivated to attend university to prove their self-worth. Students who identified as Black as well as those coming from a single- or double-parent household and students whose parents had a school-level education were more likely to attend university to help their families. The findings suggest that students are motivated beyond the immediate benefits of employment and personal earnings and that the upliftment of their families is a central reason for attending university. For universities striving to connect with their students, understanding students' motivational orientation can inform intervention efforts aimed at enhancing retention and throughput. [ABSTRACT FROM AUTHOR]

Human capital (HC) has increasingly been identified as a driver of economic development, with the potential to reduce income inequality, which, in South Africa, originates in the labour market. HC is, however, a complex concept to measure. This study uses Fields' regression-based decomposition method to analyse the relationships between income inequality and HC in South Africa. The Fields method allows for the analysis of the impact of several factors contributing to HC on the distribution of a measure of income. Data from the National Income Dynamics Study (NIDS) wave 1 (2008) and 5 (2017) are used. The findings suggest that increasing educational attainment, through improved school quality for all, would likely play a key role in reducing income inequality in South Africa. Furthermore, the large role of education attainment in explaining household income inequality supports the use of education attainment as a proxy for HC in South Africa. [ABSTRACT FROM AUTHOR]

Youth in low socioeconomic status communities experience multiple risks which disrupts their emotional, cognitive, and psychological development. In South Africa, there is a tacit acceptance of risk constructs as researched globally. This study examines risk occurrence with the aim of identifying and examining the uniqueness of risks in a community sample of youth. Data were collected from youth and their maternal caregivers through interviews and standardized instruments. Youth from grade 7 and grade 10, 9 to 18 years (M = 13.11; SD = 1.54) were recruited. Sixty-five percent were female. Thirty-five frequent risk factors were identified using a z -test for proportion of means. Five risk factors, namely, low household income, race, English not being the primary home language of the parent, low maternal self-esteem, and low dyadic satisfaction, emerged as significant risks. Other risk factors (e.g., single-parent household), which feature prominently in international studies, did not emerge as significantly present. While risk occurrence in our sample shares commonalities with international trends, our study further highlights how risk is underscored and shaped by South Africa's socioeconomic and political history. We argue that traditional concepts, like family, race, and language require conceptual review when undertaking research and developing policies and interventions that are relevant to South African communities. [ABSTRACT FROM AUTHOR]

The research analyses the precarious and non-precarious work practices within the informal sector. Labour in the informal sector and in regions without strong labour relations is not uniformly precarious but is categorised by a bimodality of incomes, citizenships and conducts. This creates opportunities for insurgent modes of counter-conduct in the interstices of regulations and social conventions, but has also resulted in exclusive local citizenships and revanchist strategies. From numerous in-depth interviews, the study found that the Covid-19 lockdown and economic recession led to a new dialectical relationship between long-term residents and a precariat in-group of non-propertied actors, recent migrants and immigrants in the informal sector. Long-term residents with local citizenship aggregated formal and informal incomes and secondary incomes within the household, elevating them out of precariousness, although primarily active in the informal sector. These included strategies of adverse incorporation and revanchist conducts to maintain incomes for non-precarious workers. Marginalised precarious workers shifted to modes of counter-conduct, hiding the true nature of the business, evading strict social conventions on local trade and pursuing new inter-ethnic citizenships based on strategic partnerships. [ABSTRACT FROM AUTHOR]

Researches have been interrogating the influence of international migration on life satisfaction but ignoring the influence of internal migration on life satisfaction. This study therefore examined the influence of inter-provincial migration on life satisfaction in South Africa. Data for the study were from the fifth and latest wave of the National Income Dynamics Survey (NIDS) conducted in South Africa in 2017. Data were analyzed by descriptive statistics, Pearson Chi-square and ordinary least-square (OLS) regression. The results showed that the migrants (mean = 5.73) had significantly (Chi = 48.8; p < 0.001) better life satisfaction than non-migrants (mean = 5.54). In addition, there existed significant variations in the level of happiness (Chi = 9.97; p < 0.002), subjective income classification (Chi = 16.8; p < 0.001) and perceived physical health (Chi = 8.65; p < 0.002). Finally, the OLS coefficients showed that respondents with average and above average subjective income classification, respondents with good perceived physical health, respondents with happier happiness level, females, married respondents, non-Blacks, respondents earning higher than R5000, household with 7 + persons and province of residence were associated with increased life satisfaction among migrants and non-migrants. [ABSTRACT FROM AUTHOR]

This paper presents a class‐analytic approach, which combines a "labour exploitation criterion" with class typologies developed for the South African context and the author's additions. The labour exploitation criterion distinguishes between rural classes based on the degree to which one employs others, works for others, or works for oneself. I combine the principal indicator of "labour exploitation" with the income contributions of social grants, ownership of farming assets and livestock, and the contribution of agricultural production to simple or expanded reproduction. Debates around class formation are explored in the context of a comparative analysis of two joint venture (JV) dairy farms, located in the Eastern Cape Province of South Africa, which involve residents as both landowners and workers. A class‐analytic approach illuminates the emerging agrarian class structure that a JV‐type intervention both reflects and in turn conditions, in dialectical fashion, with important implications for debates around agrarian change in South Africa. [ABSTRACT FROM AUTHOR]

Vitamin A deficiency (VAD) is one of the significant hidden hunger challenges in sub-Saharan Africa (SSA), and children are the most vulnerable group. Therefore, there is a need for interventions to reduce this deficiency. Provitamin A biofortified maize (PVABM) has the potential to reduce VAD for the vulnerable groups of SSA. The study investigated the possibility of incorporating provitamin A biofortified maize into smallholder farming systems and assessed the acceptability of typical PVABM meals for household consumption. Using a quantitative approach, a crosssectional study design was conducted in Bulwer local municipality of Sisonke district and Mhlathuze local municipality of uThungulu district, KwaZulu-Natal province, South Africa. A total of 233 smallholder farmers were interviewed using semi-structured interviews and focus group discussions. The sensory evaluation was done with 72 smallholder farmers assessing the sensory attributes of typical meals such as steamed mealies (ifutho) and crumbled maize meal (uphuthu) produced by PVABM and common maize. Knowledge about PVABM and the average household income highly influenced (p < 0.05) the farmers’ likeliness to accept and incorporate PVABM into their farming systems. About 82% (Bulwer) and 83% (Mhlathuze) of farmers from the areas were willing to incorporate PVABM in their farming systems, and they had positive perceptions about the success of the varieties in their systems. Farmers already growing yellow maize were more willing to integrate PVABM. Sensory evaluation showed that PVABM foods (uphuthu and ifutho) were accepted for consumption and the farmers expressed the willingness to consume PVABM in their diets for nutrient improvement. The response showed that the taste of ifutho was acceptable for both PVABM (52.8%) and white maize (52.8%). The colour of PVABM ifutho was acceptable (50%) and white maize (44.4%), and the aroma was good for PVABM (58.3%) and very good for white maize (44.4%). Overall, both maize sensory attributes were rated as acceptable. The study indicated that farmers could accept PVABM into farming systems and it can be consumed at the household level. [ABSTRACT FROM AUTHOR]

Previous studies investigating the effect of income on subjective wellbeing (SWB) have seldom accounted for the role of sub-national regional developmental context in determining the absolute and relative income effect on individual SWB. Given the varying levels of socio-economic development across regions within a country, a priori expectations point to the income and SWB relationship being contingent on the regional context. This study was conducted in the South African context using the National Income Dynamics Study datasets and municipal panel data with multilevel regression models to account for both municipal and individual level characteristics. The study finds that both absolute and relative income are significant predictors of SWB in both the developed and underdeveloped contexts. The absolute income effect is muted in low socioeconomically developed context in comparison to their more developed counterparts, explained by a non-monetized system of production and consumption in the less developed contexts. However, the relative income gradient on individual SWB, was found to be stronger in less developed municipalities and is explained by much narrower but stronger reference group formation in less developed municipalities than in more developed ones. [ABSTRACT FROM AUTHOR]

The interaction between family structure and household well-being has received considerable attention in research over the past decades. Very few studies, however, go beyond linking marital component of family structure with household income. This paper uses cross-sectional and panel analytic techniques with data from National Income Dynamic Survey (NIDS) to investigate the effects of family structure on household well-being. Findings from this study show that intact married and cohabiting households have significant positive relationship with household reported well-being, and subjective wellbeing, respectively. Furthermore, extended households, households headed by females and grandparents, have significant negative relationship with household income and consumption. Lastly, bigger household size has significant negative relationship with household reported well-being. Based on the findings, policy towards economic empowerment for poorer households, enhancing income generating, and livelihood projects are recommended. [ABSTRACT FROM AUTHOR]

Background: Understanding health-related quality of life (HRQOL) among people with HIV (PWH) can inform strategies to maintain or improve health and functioning. Most HRQOL research has focused on resource-rich settings, underrepresenting younger cohorts in lowresource settings. Objectives: To assess HRQOL and associated factors in PWH visiting two primary healthcare clinics in the Western Cape, South Africa. Method: A cross-sectional study included 48 PWH (58.3% women; mean age: 39.2 [10.3]). Health-related QOL was assessed using EQ-5D-5L descriptive domains, visual analogue scale (EQ-VAS), and index score (EQ-index). Mobility was assessed using clinical tests. Tobit regression determined associations. Results: Mean and median EQ-VAS scores were 88.14 (16.35) and 95.00. Mean and median EQ-index scores were 0.84 (0.10) and 0.90. PWH reported problems as pain/discomfort (35.4%), depression/anxiety (25.0%), mobility (22.9%), usual activities (18.7%) and self-care (12.5%) domains. Slow chair rise (p = 0.012), low income (p = 0.030), longer HIV duration (p = 0.009) and polypharmacy (p = 0.034) were associated with lower HRQOL. Antiretroviral therapy (ART) adherence was associated with higher HRQOL (p = 0.020). Conclusion: Despite high overall HRQOL, specific domains presented challenges to PWH. Health-related QOL was associated with chair rise repetitions, income, HIV duration, polypharmacy, and treatment adherence. Comprehensive care and contextualised interventions to address these through rehabilitation, including health promotion, are proposed strategies for future investigation. Clinical implications: Clinicians should be cognisant of potential physical and mental functioning problems, and factors related to drug therapy, socio-economic status and disease duration that may affect HRQOL even in seemingly unimpaired PWH. [ABSTRACT FROM AUTHOR]

Background: We use the Global Multidimensional Poverty Index (MPI) to explore how different dimensions of poverty more directly linked to young people are associated with depressive symptoms among South African youth.Methods: Data came from the 2017 wave of the nationally-representative National Income Dynamics Study (NIDS) in South Africa. We focused on a sample of 15-24-year-olds whose depressive symptoms were assessed using an adapted version of the 10-item Centre for Epidemiological Studies Depression Scale. We examine how individual dimensions and indicators of the MPI relate to depression, in comparison to more conventional measures, including household income, subjective social standing, overcrowding and personal assets. Cross-sectional analyses were adjusted for clustering to account for sampling design.Results: The MPI index was not associated with probable depression (OR = 1.02, 95 % CI 0.81-1.29). Only lack of access to the labour market emerged as a key individual dimension associated with probable depression (OR = 5.29, 95 % CI 1.70-16.47), a relationship driven by an increased odds for those not in employment, education or training. Lack of household assets, living in an informal dwelling and lower perceived social standing were also associated with increased odds for depression. No gender differences were noted.Limitations: The study is cross-sectional and not suitable to examine the causal nature of the association between multidimensional poverty and depression.Conclusions: Poverty dimensions that measure youth's access to employment or training have a strong association with depression. Further research is needed to assess whether improved access to employment or training contributes to improving mental health among young South Africans. [ABSTRACT FROM AUTHOR]

Persistent depressive disorder is under-studied in HIV settings. We recruited 500 persons seeking an HIV test in South Africa and administered the major depression and persistent depression modules of the Structured Clinical Interview for the DSM-5, the Beck Depression Inventory (BDI), Beck Anxiety Inventory, Alcohol Use and Drug Use Disorders Identification Tests and the PTSD Symptom Scale. Of the total sample, 7.2% met the criteria for persistent depression and 14.4% had major depression; 3.6% had both Major Depression and Persistent Depression; 3.6% had Persistent Depression and no Major Depression; 10.8% had Major Depression and no Persistent Depression; and 82.0% had neither Major Depression nor Persistent Depression. We found a significant relationship between major and persistent depression (X2 (1, N = 500) = 39.89; p <.00; 95% CI). Persons with PDD were over 7 times more likely to have major depression than those without PDD (OR = 7.59; 95% CI: 3.72–15.48). Income level and BDI scores were significant predictors of persistent depression (p < 0.05), but not anxiety, traumatisation, and harmful alcohol and drug use. Many people may experience diagnosable mood disturbance prior to receipt of their HIV test results, suggesting the need to integrate mental health services with HIV testing. [ABSTRACT FROM AUTHOR]

Background: The child support grant (CSG) is the largest unconditional cash transfer program in Africa and aims to alleviate poverty and improve child health and nutrition in low-income families in South Africa. Among informal working women, the CSG is an important source of income after childbirth when informal workers are unable to work, but reports suggest that women experience delays in accessing the CSG. We explore experiences and challenges of accessing the CSG among informal workers in Durban, South Africa. Methods: We undertook a longitudinal mixed-methods cohort study. Women informal workers were recruited during pregnancy and followed-up for up to one year after the baby was born. Quantitative questionnaires and semi-structured in-depth interviews were used to collect data about women's plans for applying for the CSG, the application process, use of the CSG in the household, and household food insecurity. Interviews were conducted in IsiZulu by experienced researchers. Descriptive analysis of quantitative data used SPSS v26, and framework analysis using NVIVO v12.3 was used for qualitative analysis. Results: Twenty-four informal working women were enrolled. The CSG received for older children was reported as an important and reliable source of income for mothers after childbirth. However, delays receiving the CSG for the new baby meant this support was unavailable to first-time mothers. The complex application process for the CSG required mothers to travel to various government departments to complete the required documentation, often taking the baby with them. This was costly and time-consuming for mothers who were already vulnerable, and led to delays in obtaining CSG funds. Many women experienced moderate or severe food insecurity before and after the baby was born. As a result, some mothers had to return to work earlier than planned, disrupting childcare and breastfeeding. Conclusions: Cash transfer programmes can effectively support low income households and improve outcomes for mothers and children. In South Africa there is a need for innovative approaches to streamline CSG applications, so women can access the funds immediately post-delivery to fill a resource gap and provide support at a vulnerable time for mothers and their children. [ABSTRACT FROM AUTHOR]

Late language emergence (LLE) may result from genetic and environmental factors. Little is known about environmental factors in LLE in South Africa. The study describes the nature of differences in language functioning between toddlers with LLE and without LLE, and which factors were associated with LLE in a middle-income area in South Africa. Toddlers, ages 24 to 36 months with LLE (n = 20) were matched with a control group (CG, n = 21) for household income, age, gender, maternal education, and parental employment. The research group (RG) showed moderate delays in expressive and receptive language, and play skills, while the controls exhibited no delay. Significant differences in early feeding history and multilingual exposure were found between the groups. As far as known, it is the first study utilizing a South African middle-income sample indicating that multilingual exposure may play a role in LLE. The study focuses the attention on environmental factors that are potentially modifiable in LLE. [ABSTRACT FROM AUTHOR]

In South Africa there has been relatively little consideration of the informal employment offered to domestic household workers and gardeners. Here we report on the number and profile of gardeners employed by private households and the wage and satisfaction rates in 12 towns of the Eastern Cape. Over 98% of the informal gardeners were male, middle-aged and with limited formal schooling. Approximately 58% of middle and upper income households employed a gardener, at a mean daily rate of R112.20 in 2019. This equated to 13 170 gardeners earning a total wage bill of R139 million p.a. across the 12 towns, which scales up to 0.7–1 million informal gardeners nationally earning approximately R10–14 billion per year. However, daily remuneration was insufficient to cover basic needs, and slightly more than half of the gardeners would prefer a different job, indicating the survivalist nature of the sector. [ABSTRACT FROM AUTHOR]

This study assessed the levels of knowledge of South African citizens about the fourth industrial revolution (4IR) to determine how organizations can assimilate the implications of 4IR to leapfrog the development of the country. The findings show that knowledge was higher among citizens with better socio-economic status, higher education, with in excess of R6 500 (US$464.29) household income per month, are employed full-time, and have access to uncapped internet data or could afford to spend more than R150 (US$10.72) on data per month (more than 1 GB). There were low levels of knowledge among unemployed citizens (excluding tertiary institution students and unemployed graduates) and entrepreneurs. This was concerning as these groups are the main target for the country's economic development and growth. The study recommends increasing knowledge sharing about the 4IR and related technologies and raising awareness or advocating appropriate skills for future careers. This study serves as a baseline for the policymakers and other development agencies or stakeholders to effectively set a national agenda to respond to opportunities and challenges emerging with the 4IR. [ABSTRACT FROM AUTHOR]

This study aimed to investigate waste separation at source behaviour among South African households in Abaqulusi Local Municipality in KwaZulu-Natal. Behaviour in this context refers to determining current waste separation practices, and the willingness of households to participate in waste separation in future. Awareness and attitudes towards source separation, as well as certain socio-demographic variables were determined. Door-to-door surveys, supported by structured questionnaires, were used to collect data from 757 households. Only 16% households reported current participation in waste separation practices. Less than one-third of the households indicated that they would be willing to participate in waste separation practices in the future. Gender (p = 0.02, V = 0.04) and income (p = 0.01, V = 0.15) had a statistically significant relationship with waste separation practice, but were of low practical significance, whereas household size (p = 0.06, V = 0.1) was both statistically and practically insignificant. When considering these variables and their relationship with willingness to participate in separation at source in future, gender (p = 0.003, V = 0.1), household size (p = 0.01, V = 0.3) and income (p = 0.01, V = 0.28) had a statistically significant relationship with willingness, with a low to moderate practical significance. [ABSTRACT FROM AUTHOR]

Littering has been defined as the careless and improper disposal of small amounts of waste that results in unwanted and unnatural elements remaining in the environment. People tend to blame external factors for their own littering. A person seldom refers to themselves as being the litterer but will rather place the blame on insufficient infrastructure, such as lack of bins, or on other persons. When referring to other people, they identify problematic behaviour and personal traits such as ignorance, naivety, need for convenience, laziness and inattentiveness as causes of littering. This study addressed the gap in the literature on the socially constructed perceptions people hold about reasons for littering in the South African context, as subjectively perceived reasons for littering may correspond with actual causes and could point towards options for tackling the littering problem. Five lower socio-economic areas in South Africa - particularly those that experience major infrastructural challenges - were included in the study. Qualitative semistructured interviews were held with 322 residents from the respective areas. The data were thematically analysed and the results from the areas compared with each other. The cross-case analysis confirmed that littering is contingent on contextual effects, and unique reasons for littering in the South African context were mentioned. The research reported on in this study highlights that we have only thematically 'identified' or named the socially constructed perceptions about the reasons for littering by the participants. The importance of creating platforms and processes for dialogues to deepen our understanding of people's socially constructed perceptions and subsequent behaviour, is of critical importance. [ABSTRACT FROM AUTHOR]

This article demonstrates how household solid waste (HSW) generation patterns differ in neighbourhoods of the same town by determining the composition of the residual portion of the HSW stream in 2017 in Stellenbosch. HSW was collected from 10 pre-identified suburbs out of a total of 48. These chosen suburbs and their 17 830 households were representative of all the HSW from all households in the catchment area of the Devon Valley Landfill Site. A separation at source programme was in place in nine of the suburbs. The confidence level and level of precision were set at 95% and ±8%, respectively. A total of 1543 bags of HSW were collected with a total mass of 5748.01 kg and an uncompacted volume of 84.87 m3. The samples were sorted into 7 main and 18 final fractions. The main contributor to the total waste stream was organic waste by weight (35%) and plastic wrap and packaging by uncompacted volume (32%). The average HSW generation was 0.68 kg/capita/day. Households with access to a separation at source programme tended to have lower levels of highly recyclable materials in their samples. Roll-out of a separation programme is recommended for all 48 suburbs in the study area to save landfill airspace. Correlation analysis showed that household size influenced three of the seven main waste fractions, and household income five of the seven. No statistically significant results were obtained relating to household density and waste generation. Statistically significant results were obtained through an analysis of variance for all waste fractions, excluding organics, when considering household income, indicating that both household size and income could be explanatory socio-economic factors for variations seen. Other variables, such as human behaviour, could potentially also contribute to the differences and should be further explored. [ABSTRACT FROM AUTHOR]

Background: The impact of school closures due to COVID-19 raised widespread concerns about children's health and well-being. We examine the impact on the sexual health needs of learners in the context of COVID-19 related lockdowns in rural KwaZulu-Natal, South Africa. Methods: In july-November 2020 and August-November 2021 we conducted 24 in-depth interviews and 8 group discussions with teachers and learners from 4 schools, community members and key education stakeholders. All interviews were conducted by telephone. We used a thematic analysis approach and Nvivo 12 software to manage the data. Results: Four main themes related to the COVID-19 pandemic emerged from the data: the sexual and reproductive health (SRH) of learners in the lead-up to the pandemic; the impact of COVID-19 on learners' SRH and wellbeing; the opportunities schools provided to support sexual well-being of learners during the pandemic; and the role of schools in supporting SRH for learners during the pandemic. Learners and stakeholders reported that the SRH of young people was affected by alcohol misuse, poor SRH knowledge and few pathways to link learners with services. Stakeholders working with schools reported that a lack of access to biomedical interventions (e.g., contraception) increased learner pregnancies. Gender-based violence in learners' households was reported to have increased during the COVID-19 pandemic related to loss of income. School closures disrupted the provision of a safe space to provide SRH and HIV-education through Life Orientation lessons and school nurse talks. This loss of a safe space also left learners vulnerable to sexual and physical violence. However, once schools re-opened, daily COVID-19 screening in schools provided the opportunity to identify and support vulnerable children who had other social needs (food and uniforms). Conclusion: The COVID-19 pandemic may have increased SRH needs and vulnerability of school-going children in a high HIV-burden rural setting. School shutdowns reduced the opportunity for schools to provide a vital safe space and information to enhance SRH for adolescents. Schools play a vital health promotion and social protection role. [ABSTRACT FROM AUTHOR]

The introduction of the carbon tax by South Africa was primarily aimed at reducing pollution, and possibly improving the welfare of South African households. One of the ways of reducing pollution in the construction industry is to discourage the use of building materials that are high carbon emitters or have high energy intensities. This article used the Input-Output (IO) method and sensitivity analysis to study the effects of carbon tax on welfare distribution of South African households, using the 2014-2015 Living Conditions Survey (LCS). The study also set out to determine the relative sensitivity of price changes of some building materials after application of the 2019 carbon tax. Results showed that nonferrous, ferrous, and prefabricated-based building materials had higher relative price sensitivities to carbon tax compared to other materials that were predominantly based on glass, cement, and treated metals. Increases in carbon tax may not discourage usage of relatively higher emissions-intensity materials like cement compared to wood. Operational building costs were dominated by electricity costs, with the burden being highest for lower income households. Any revenue-recycling efforts of the 2019 carbon tax for welfare purposes were marginal. However, the tax can be used to subsidize energy for lower income households. [ABSTRACT FROM AUTHOR]

Energy demand and consumption across the world are increasing, putting much pressure on current supply. The solar PV system has become one of the most promising renewable energy technologies. The potential of solar PV differs from one province and household to another depends on many attributes and variables. A household energy survey was conducted through questionnaires and interviews from September 2014 to March 2015 in order to determine perceptions on household energy consumption and solar PV's potential across household categories in South Africa. The data from the residential households were collected in nine provinces across South Africa using random sampling methods (stratified and systematic). The number of questionnaires (n = 13,007) were completed across South Africa nine provinces. This study found that 25% and 43% of the middle- and high-income residents respectively are interested in paying for electricity based on green sources. These two income groups consume 9.6 and 3 TWh/year, which means that there is a potential of 12.6 TWh/year that can be generated from solar PV technology in the residential sector. [ABSTRACT FROM AUTHOR]

Globally, overweight/obesity is rising rapidly while anaemia persists. Nevertheless, evidence on their coexistence at the household level remains limited. Using data from the Demographic and Health Surveys, we quantified the magnitude, distribution and inequalities (i.e., estimates by wealth, education level and residence) in the intra‐household double burden (DBM) of overweight/obesity and anaemia among mothers and their children living in 49 low‐ and middle‐income countries (LMICs). The pooled prevalence of total intra‐household DBM was 17.2% (95% confidence interval [CI]: 15.6, 18.8); 16.2% (95% CI: 14.6, 17.9) for mothers with overweight/obesity and children with anaemia; and 2.8% (95% CI: 2.5, 3.1) for mothers with anaemia and children with overweight/obesity. South Africa had the highest prevalence of total DBM at the household level, affecting almost one in three households. Households with mothers with overweight/obesity and children with anaemia followed an inverse social gradient, with higher estimates found in the richest quintile, highest maternal education level and in urban areas; although with some variation across regions. The opposite was observed for mothers with anaemia and children with overweight/obesity. The largest inequality gaps were found for mothers with overweight/obesity and children with anaemia in Togo by household wealth (29.3%‐points; p < 0.001), in Ghana by maternal education level (28.0%‐points; p = 0.001) and in Niger by area of residence (25.2%‐points; p < 0.001). Although double‐duty actions might help accelerate action towards reducing malnutrition in all its forms, a comprehensive assessment of the causes of anaemia is first warranted to design effective country‐specific programmes. Key messages: Using anthropometric and anaemia data from 49 low‐ and middle‐income countries, we found an overall pooled prevalence of total intra‐household double burden of malnutrition of 17.2%, with South Africa bearing the highest burden.The prevalence of mothers with overweight/obesity and children with anaemia ranged from 3.1% (Ethiopia) to 42.2% (South Africa), and was higher in the richest quintile, highest maternal education level and in urban areas.Mothers with anaemia and children with overweight/obesity was low (<9.0% in all countries). [ABSTRACT FROM AUTHOR]

Background: The factors contributing to probable postnatal depression (PND), a type of clinical depression that can affect woman after childbirth, are socially derived. Therefore, variations among groups of women necessitate studies in different communities. Aim: This study compared the prevalence of PND and associated factors among women attending postnatal services facilities. Setting: The study setting included Tshwane Municipal district in Gauteng province (GP) and Fezile Dabi District (FS) in Free State province (FSP), South Africa. Methods: A total of 477 mothers within 12 weeks of giving birth were recruited by convenient sampling in health facilities. A self-developed questionnaire was used to obtain information on socio-demographics, obstetric history, and children's characteristics. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data on depression symptoms, with a score of ≥13 used as a cut-off for probable PND. Data were analysed using STATA 14. Multivariate logistic regression was used to determine association between probable PND and various covariates. Results: The overall mean age of women was 28 ± 6 years. The overall prevalence rate of PND was 22%, slightly higher in FS (23%) than in GP (21%). Most participants living in GP were married, had tertiary education, were employed and from the households with income of more than R8000.00. A chi-square test showed that planned pregnancy was significantly higher in GP compared with FS (p &8805; 0.001). Multivariate logistic regression showed that support from a partner or husband decreased the odds of a probable PND in GP (adjusted odd ratio [AOR] 0.37; 95% confidence interval [CI] [95%CI: 0.14-0.96; p = 0.041] and in the FS [AOR = 0.14, 95%CI: 0.05-0.40; p ≥ 0.001]). Significant associations of probable PND with several factors - planned pregnancy, baby age, support in difficult times, partner or husband drinking alcohol and stressful events - were more common in the FSP than in the GP. Conclusion: The prevalence of probable PND and its associated risk factors in the GP and the FS indicates the need for routine screening and targeted interventions in both urban and rural settings. [ABSTRACT FROM AUTHOR]

Poverty is a social ill, threatening the world and developing countries in particular. Social security programmes have been proved to be one of the policies towards poverty alleviation. The aim of this study is to investigate the impact of social grants on income poverty in a South African Township. The target population was social grants beneficiaries in the Vukuzakhe Township and a sample size of 100 households was selected based on two non-probability sampling methods, namely, purposive and snowball sampling. The study used a mixed-method research approach which combines both qualitative and quantitative. Ten individuals were selected from the sample to deeply investigate ways in which social grants have impacted their lives. The study used descriptive analysis to analyse the quantitative data, and it has used the South African Lower-bound Poverty Line to determine the poor and non-poor. The study also analysed the qualitative data using thematic analysis to see recurring and different uses of social grants by beneficiaries. The findings of the study indicate the existence of high household size and low levels of education among beneficiaries. Furthermore, the results show that there is a high level of unemployment among beneficiaries compared to the rest of the country. In addition, the study found that social grants have helped in increasing income expenditure among social grant beneficiaries and especially impacted a third of the household which would go without any income if it were not for the social grants assistance. Based on the 2019 South African Lower-Bound Poverty Line, the study found that the social grants reduced poverty by almost a quarter. The participants expressed that grants increase their purchasing power. [ABSTRACT FROM AUTHOR]

This study explored the proliferation of stressors that contribute to depression in grandparents who are caregivers of an adult child with a long-term illness and their grandchildren. The data were drawn from Wave 4 of the Cape Area Panel Study in South Africa and subjected to linear regression analysis to predict depression in these older adults. We found evidence that the combination of primary and secondary care leads to a proliferation of stressors as these older adults experienced higher levels of depression, lower income, and greater food insecurity. Providing financial help to others and declining health also contributed to an increase in depression. [ABSTRACT FROM AUTHOR]

Objective: To describe the developmental risks, and its influence, in young children from a low-income South African community. Method: An exploratory, cross-sectional research study design was employed. Developmental screening was conducted during home visits with 126 caregivers and children between 0 and 42 months of age from a low-income South African community. Children who failed the rescreen were referred for diagnostic assessment. A binomial logistic regression was used to determine the effect of developmental risks on developmental outcomes. Results: Seventy-three percent of children screened were identified with a possible developmental delay (n = 59) according to caregiver-report using the PEDS tools. The regression model was statistically significant (χ2 (3) = 34.902, p < 0.001) with exposure to multiple languages (p < 0.05; odds ratio 3.810, CI 1.2–12.4) most indicative of potential developmental delay. Older children (19–42 months) were also more at risk of developmental delay (p < 0.001) than younger children (0–18 months). Conclusions for Practice: Healthcare professionals serving these vulnerable populations should create awareness amongst caregivers about the effect of developmental risks, in particularly multiple language exposure, on development. [ABSTRACT FROM AUTHOR]

Background: Families struggle to support family members with profound intellectual and multiple disabilities (PIMD), especially in low resourced settings where formal services may not be available. Method: The adapted Family Community Participation survey, measuring perceptions of community participation, was administered to 67 primary caregivers of children with PIMD in Cape Town by community‐based rehabilitation workers. Results: Families were most satisfied going to religious activities and getting together with family and friends. They were most dissatisfied with doing activities together in public and working or volunteering outside the home. Barriers to participation included negative attitudes, insufficient money and unavailability of community activities. Transportation, safety and security were additional challenges. Conclusions: Participants advocate awareness raising, community support and provision of services to address barriers to community participation. Families should be consulted on community issues to integrate their specific family needs into the overall needs of the community. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) has resulted in an enormous dislocation of society especially in South Africa. The South African government has imposed a number of measures aimed at controlling the pandemic, chief being a nationwide lockdown. This has resulted in income loss for individuals and firms, with vulnerable populations (low earners, those in informal and precarious employment, etc.) more likely to be adversely affected through job losses and the resulting income loss. Income loss will likely result in reduced ability to access healthcare and a nutritious diet, thus adversely affecting health outcomes. Given the foregoing, we hypothesize that the economic dislocation caused by the coronavirus will disproportionately affect the health of the poor. Methods: Using the fifth wave of the National Income Dynamics Study (NIDS) dataset conducted in 2017 and the first wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) dataset conducted in May/June 2020, this paper estimated income-related health inequalities in South Africa before and during the COVID-19 pandemic. Health was a dichotomized self-assessed health measure, with fair and poor health categorized as "poor" health, while excellent, very good and good health were categorized as "better" health. Household per capita income was used as the ranking variable. Concentration curves and indices were used to depict the income-related health inequalities. Furthermore, we decomposed the COVID-19 era income-related health inequality in order to ascertain the significant predictors of such inequality. Results: The results indicate that poor health was pro-poor in the pre-COVID-19 and COVID-19 periods, with the latter six times the value of the former. Being African (relative to white), per capita household income and household experience of hunger significantly predicted income-related health inequalities in the COVID-19 era (contributing 130%, 46% and 9% respectively to the inequalities), while being in paid employment had a nontrivial but statistically insignificant contribution (13%) to health inequality. Conclusions: Given the significance and magnitude of race, hunger, income and employment in determining socioeconomic inequalities in poor health, addressing racial disparities and hunger, income inequality and unemployment will likely mitigate income-related health inequalities in South Africa during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The purpose of this work was to explore and compare food choice drivers of low (LI), middle (MI) and high (HI) income urban people in an emerging economy (South Africa). Here, 13 focus group (FG) discussions [six LI, n = 36, 67% women; four MI, n = 22, 100% women and three HI, n = 17, 76% women; total n = 75) were transcribed, coded inductively and deductively and 17 food choice categories emerged. Eight of these, i.e., aspects related to: plant vs animal protein, food waste, food preparation, availability of resources, food exploration, social aspects and food spoilage, are not typically (e.g., sensory appeal, mood, health, convenience etc.) measured with established food choice questionnaires. Economic factors and Availability of food and resources were mentioned the most by LI participants compared to MI and HI. Whereas, Health; Familiarity and Food exploration were mostly mentioned by MI and HI participants. This study yielded a mixture of individual and environment based motives which add to our understanding of the "why" aspects underlying food choice in an urban and emerging economy. The fact that these aspects are compared by income group provides interesting information on the similarities and differences of how the food choice process unfolds across varying income groups. The insights from this study are useful for the development of an updated, quantitative food choice questionnaire for application in this and other emerging economies. [ABSTRACT FROM AUTHOR]

Objective To profile the prevalence of the three body mass index (BMI) categories by sociodemographic characteristics, and to calculate the percentage transitioning (or not) from one BMI category to another, to inform South African health policy for the control of obesity and noncommunicable diseases. Methods We used data from the National Income Dynamics Study, including sociodemographic characteristics and BMI measurements collected in 2008, 2010, 2012, 2014 and 2017. For each data collection wave and each population group, we calculated mean BMI and prevalence by category. We also calculated the percentage making an upwards transition (e.g. from overweight to obese), a downwards transition or remaining within a particular category. We used a multinomial logistic regression model to estimate transition likelihood. Findings Between 2008 and 2017, mean BMI increased by 2.3 kg/m². We calculated an increased prevalence of obesity from 19.7% (3686/18 679) to 23.6% (3412/14 463), with the largest increases in prevalence for those aged 19-24 years and those with at least high school education. The percentages of upwards transitions to overweight or obese categories increased sharply between the ages of 19 and 50 years. Once overweight or obese, the likelihood of transitioning to a normal BMI is low, particularly for women, those of higher age groups, and those with a higher income and a higher level of education. Conclusion In the development of national strategies to control obesity and noncommunicable diseases, our results will allow limited public health resources to be focused on the relevant population groups. [ABSTRACT FROM AUTHOR]

Despite implementation of several government policies since the dawn of democracy in South Africa, income distribution remains skewed in the country. This paper explores income distribution in the Gauteng province by addressing two important questions: first, what is the level and pattern of income distribution, and second, do the role of correlates in explaining income distribution differ across income groups? By employing quantile regression analysis, this paper's results not only show the explanatory role of various correlates, such as race, but it also confirm that the explanatory role of these correlates is heterogeneous across income groups. The paper by drilling down into the data established that there are variations across some identifiable groups (e.g. youth, pensioners, and adults) and quantiles. These results enable policy makers to tailor policies to specific income and other identifiable groups, rather than one-size-fit-all policy focus. [ABSTRACT FROM AUTHOR]

Land-based income streams, which include the consumption and selling of crops, livestock and environmental products, are inherent in rural households' livelihoods. However, the off-farm cash income stream -- primarily composed of migrant labour remittances, social grants, and savings and loans -- is increasing in importance in many regions. This case study of 590 households from Bushbuckridge, South Africa, analyses the economic value of each of these income streams at three points: what enters the household, what is used and what is sold. Two important findings emerge. First, dependence on offfarm cash incomes is far higher than previously suggested by case studies in the area and the benefits of employment accrue to those already better educated and wealthier. This suggests that shifts in offfarm opportunities will exacerbate already deep inequalities. Second, while environmental products and crops are important for direct use, they generate insignificant cash incomes from sales. This suggests a weakening of the direct links between the local ecosystem and this society, challenging traditional notions of African rurality being intrinsically land based. Significance: Off-farm incomes such as wage labour, remittances and social grants are almost the sole source of cash for households in the study area. Even when including non-monetary incomes such as harvested produce, foraged goods and livestock products, off-farm incomes still represent the overwhelmingly largest proportion of overall household income value. This highlights the fact that South African rural economies are not consistently or primarily land based, and indicates the necessity of rural development strategies that facilitate participation in local cash economies. Otherwise, such efforts will be unable to yield broad benefits and will, instead, simply enrich those who are already better off. [ABSTRACT FROM AUTHOR]

The study was carried out to examine asset ownership and income as determinants of household poverty in South Africa. The specific objectives were to determine the poverty status of the households and, investigate the influence of asset ownership and income on household poverty in South Africa. Secondary data was sourced from the National Income Dynamics Study (NIDS) 2014/2015 data. A sample size of 9619 households was selected for this study. The poverty status of the households was determined using the poverty line. The poverty line was calculated as two-third of the mean-per-capita household expenditure. Households with expenditure above the poverty line were considered to be "non-poor" and those with expenditure below the poverty line were considered "poor". For the purpose of this study, assets were divided into monetary and non-monetary assets. Binary logistic technique was further used to analyse the influence of ownership of monetary and non-monetary assets, household income, household size (as a control variable), and provincial locations on the household poverty status. An investigation into the assets owned by households indicated that real estate assets, business assets, vehicle assets, financial assets, superannuation assets, livestock assets and possessions, were assets owned by South African households. The results showed that 59.49% of South African households experience poverty, particularly in Kwazulu-Natal, Eastern Cape and Limpopo provinces. The results of the logistic regression further revealed that ownership of non-monetary assets, income and household size had a positive influence on the household poverty status. The Western Cape, Northern Cape, Free State, and Gauteng provinces had high probability for improving the household poverty status, while Kwazulu-Natal province showed a negative influence on the poverty status. It was recommended that policies should focus on income redistribution through employment generation, which will lead to enhanced income. This can, in turn, be used to acquire assets, especially in the most affected provinces like Kwazulu-Natal, Eastern Cape and Limpopo province. [ABSTRACT FROM AUTHOR]

South Africa has potential to export honey products through promoting beekeeping as an income generating opportunity amongst rural communities. Formalised beekeeping may also reduce wild fires initiated by hunters of wild bee hives. This study examined the contribution of the African Honey Bee (AHB) initiative to rural livelihoods and the incidence of forest fires using a mixed methods approach. The initiative increased incomes of newly trained and active beekeepers, although success rates and honey yields were variable. Core challenges included not catching bees, theft and vandalism of hives, insufficient bee forage, drought and pests. Most respondents also perceived an increase in crop size since AHB began, although few attributed this to pollination from the bees. The number of wild fires attributed to honey hunters more than halved after AHB began. Future steps need to reduce the challenges and integrate beekeeping into broader agriculture and forest conservation programmes. [ABSTRACT FROM AUTHOR]

Background: Mental health and poverty are strongly interlinked. There is a gap in the literature on the effects of poverty alleviation programmes on mental health. We aim to fill this gap by studying the effect of an exogenous income shock generated by the Child Support Grant, South Africa's largest Unconditional Cash Transfer (UCT) programme, on mental health.Methods: We use biennial data on 10,925 individuals from the National Income Dynamics Study between 2008 and 2014. We exploit the programme's eligibility criteria to estimate instrumental variable Fixed Effects models.Results: We find that receiving the Child Support Grant improves adult mental health by 0.822 points (on a 0-30 scale), 4.1% of the sample mean.Conclusion: Our findings show that UCT programmes have strong mental health benefits for the poor adult population. [ABSTRACT FROM AUTHOR]

Background: The full legalization of cannabis is currently being deliberated in South Africa. We aim to better understand how the market operates by investigating how cannabis consumers respond to price changes and what factors are associated with the price that consumers pay. Methods: We estimate the conditional price elasticity of demand using data on price, quantity, and quality from a cross-sectional survey of cannabis consumers across South Africa. We also investigate to what extent quality, quantity bought, income, and demographic variables influence the price paid for cannabis. Results: The price of cannabis differs greatly by quality: medium-quality is almost double the price of low quality, while the price of high-quality cannabis is nine times that of low-quality cannabis. Depending on the model specification, we estimate that a 10% increase in the price per gram of cannabis is associated with an approximate 5–6% decrease in the quantity demanded. There is some evidence that the demand for medium- and high-quality cannabis is more price elastic than low quality. The price per gram is negatively associated with the quantity purchased and positively associated with income. Conclusions: Price is a significant determinant of cannabis consumption. Increases in prices result in a decrease in quantity demanded. [ABSTRACT FROM AUTHOR]

Background: About 13.3% of the South African population use some kind of substance during their lifetime. The incidence of substance use disorders is twice the global average. The use of various substances amongst people living with human immunodeficiency virus (PLWH) has increased tremendously in recent years. The growing culture of substance use amongst PLWH is a serious threat adding to the human immunodeficiency virus (HIV) epidemic and is likely to compromise the continuity of HIV care. Methods: A cross-sectional descriptive survey recruited adult PLWH who attended primary healthcare (PHC) services in Mthatha between 15 March and 15 April 2018. The Alcohol, Smoking and Substance Involvement Screening Test questionnaire (ASSIST), a tool validated by the World Health Organization, was used for data collection. Results: Out of a total 347 participants, 53% reported lifetime substance use and 32% admitted current use of a substance. Alcohol was the most common substance reported, followed by tobacco and cannabis. The majority of participants were female (75.2%), unemployed (70.8%), had secondary school-level education (85.2%) and a per capita household income below the national food poverty line (75%). The mean age of the participants was 37.9 years (standard deviation [SD] ± 10.33); this was marginally higher for male (39.9 years; SD ± 10.92) than female (37.2 years; SD ± 10.06) participants. Conclusion: This study has shown that there is a high prevalence of lifetime and current alcohol abuse amongst PLWH who make use of PHC services in the Mthatha area of South Africa. Of particular concern are the strong pointers towards younger people and males. [ABSTRACT FROM AUTHOR]

Objectives: To establish the knowledge, attitudes and practices (KAP) regarding antibiotic use and self-medication among pregnant women.Methods: We conducted a KAP survey of 301 pregnant women hospitalized at a tertiary hospital obstetric service in Cape Town, South Africa in November and December 2017, using an interviewer-administered 12 item questionnaire. We stratified analysis of attitudes and practices by participants' mean knowledge score (K-score) group (<6 versus ≥6 out of 7 questions). Multivariate models were built to identify independent predictors of antibiotic self-medication and K-score.Results: The mean age of pregnant women was 29 (SD 6.1) years, 44/247 (17.8%) were nulliparous, 69/247 (27.9%) were HIV-infected, 228/247 (92.3%) had completed secondary school and 78/247 (31.6%) reported a monthly household income in the lowest category of ≤50-100 US dollars (USD). The mean K-score was 6.1 (SD 1.02) out of 7 questions. Sixteen percent of the cohort reported antibiotic self-medication, with higher rates among pregnant women with K-score <6 [18/48 (37.5%) versus 32/253 (12.6%); P<0.001]. The monthly household income category of >500 USD (the highest category) was the only predictor of antibiotic self-medication behaviour [adjusted OR=6.4 (95% CI 1.2-35.2), P=0.03].Conclusions: Higher antibiotic knowledge scores are associated with lower rates of antibiotic self-medication, whereas higher household income is correlated with increasing self-medication behaviours. Education of pregnant women regarding the potential dangers of antibiotic self-medication and stricter enforcement of existing South African antibiotic prescribing and dispensing regulations are needed. [ABSTRACT FROM AUTHOR]

Little is known about women who have experienced a recent rape, and how they differ from women without this exposure. Identifying factors linked to rape is important for preventing rape and developing effective responses in countries like South Africa with high levels of sexual violence. To describe the socio-demographic and health profile of women recently exposed to rape and to compare them with a non-rape-exposed group. The Rape Impact Cohort Evaluation Study (RICE) enrolled 852 women age 16–40 years exposed to rape from post-rape care centres in Durban (South Africa) and a control group of 853 women of the same age range who have never been exposed to rape recruited from public health services. Descriptive analyses include logistic regression modelling of socio-demographic characteristics associated with recent rape exposure. Women with recent rape reported poorer health and more intimate partner violence than those who were not raped. They had a lower likelihood of having completed school (Odds Ratio [OR] 0.46 95% Confidence Interval (CI): 0.24–0.87) and dependence on a government grant as a main source of income (OR 0.61: 95%CI 0.49–0.77). They were more likely to live in informal housing (OR 1.88 95%CI: 1.43–2.46) or rural areas (OR 2.24: 95%CI 1.61–3.07) than formal housing areas – however they were also more likely to report full-time employment (OR 4.24: 95%CI 2.73–6.57). The study shows that structural factors, such as lower levels of education, poverty, and living in areas of poor infrastructure are associated with women's vulnerability to rape. It also shows possible protection from rape afforded by the national financial safety net. It highlights the importance of safe transportation in commuting to work. Preventing rape is critical for enabling women's full social and economic development, and structural interventions are key for reducing women's vulnerability. [ABSTRACT FROM AUTHOR]

Introduction: As a leading global disease risk factor, cigarette smoking has declined in some developed countries, but its health consequences are not well established in sub-Saharan Africa. This is particularly evident in South Africa, where few investigations have quantified the dually neglected challenges of cigarette smoking and depression, despite decades of research from developed countries. We investigated the association between cigarette smoking and incident depression, with the hypothesis that adolescents are particularly vulnerable.Methods: Panel data from the South African National Income Dynamics Study, a nationally representative sample of households at follow-up periods (years 2008-2015), were used. Our incident cohort consists of 14 118 adult participants who were depression free at baseline. The generalized estimating equation models were fitted to assess the association between current cigarette smoking and incident depression.Results: Current cigarette smoking among individuals aged at least 15 was significantly associated with incidents of depression among men (adjusted relative risk [aRR] = 1.16, 95% CI = 1.01 to 1.34), but not women. When the analyses were restricted to a sample population of older adolescents (ages 15-19), current cigarettes smoking was significantly associated with incident depression in both men (aRR = 1.84, 95% CI = 1.18 to 2.88) and women (aRR = 2.47, 95% CI = 1.15 to 5.29).Conclusion: The results suggest an important relationship between cigarette smoking and incident depression, particularly among older adolescents, who are developmentally vulnerable and socioeconomically disadvantaged to experiencing depression. There is a considerable need to implement and prioritize culturally and developmentally appropriate prevention and cessation measures to reduce cigarette smoking and depression directed at adolescent populations.Implications: There has been little population level research into the role of smoking on depression in sub-Saharan Africa, a region classified as a tobacco epidemic in the making. Our results have major implications for the often neglected crosscutting issues of tobacco control (Sustainable Development Goal 3.9) and mental health (Sustainable Development Goal 3.4). They indicate the role of smoking on depression, with the association being particularly pronounced among adolescent who are developmentally vulnerable and socioeconomically disadvantaged, and emphasize the need to implement and prioritize prevention and cessation measures directed at this population. [ABSTRACT FROM AUTHOR]

Background: Evaluating progress towards the Sustainable Development Goal of universal access to sexual and reproductive (SRH) services requires an understanding of the health needs of individuals and what constitutes access to services. We explored women's costs of accessing SRH services in Johannesburg, South Africa and contextualized costs based on estimates of household income. Methods: We conducted an observational study of women aged 18–49 at a public HIV treatment site and two public primary health care facilities from June 2015 to August 2016. Interviews assessed women's SRH needs (for contraception, fertility problems, menstrual problems, menopause symptoms, sexually transmitted infections (STI), experiences of intimate-partner violence (IPV), and cervical and breast cancer screening) and associated costs. We calculated average and total costs (including out-of-pocket spending, lost income, and estimated value of time spent) for women who incurred costs. We also estimated the total and average costs of meeting all SRH needs in a hypothetical "full needs met" year. Finally, we contextualize SRH spending against a measure of catastrophic expenditure (> 10% of household income). Results: Among the 385 women who participated, 94.8% had at least one SRH need in the prior 12 months; 79.7% incurred costs for accessing care. On average, women spent $28.34 on SRH needs during the prior year. Excluding one HIV-negative woman who spent 112% of her annual income on infertility treatment, HIV-positive women spent more on average annually for SRH care than HIV-negative women. Sixty percent of women reported at least one unmet SRH need. If all participants sought care for all reported needs, their average annual cost would rise to $52.65 per woman. Only two women reported catastrophic expenditure – for managing infertility. Conclusions: SRH needs are constants throughout women's lives. Small annual costs can become large costs when considered cumulatively over time. As South Africa and other countries grapple with increasing access to SRH services under the rubric of universal access, it is important to remember that individuals incur costs despite free care at the point of service. Policies that address geographic proximity and service quality would be important for reducing costs and ensuring full access to SRH services. Plain English summary: Literature on women's financial and economic costs for accessing comprehensive sexual and reproductive health care in low- and middle-income countries is extremely limited, and existing literature often overlooks out-of-pocket costs associated with travel, child care, and time spent accessing services. Using data from a survey of 385 women from a public HIV treatment site and two public primary health care facilities in Johannesburg, we found nearly all women reported at least on sexual and reproductive health need and more than 75% of women incurred costs related to those needs. Furthermore, more than half of women surveyed reported not accessing services for their sexual and reproductive health needs, suggesting a total annual cost of more than $50 USD, on average, to access services for all reported needs. While few women spent more than 10% of their total household income on sexual and reproductive health services in the prior year, needs are constant and costs incur throughout a woman's life suggesting accessing services to meet these needs might still result in financial burden. As South Africa grapples with increasing access to sexual and reproductive health services under the rubric of universal access, it is important to remember that individuals incur costs despite free care at the point of service. Policies that address geographic proximity and service quality would be important for reducing costs and ensuring full access to services. [ABSTRACT FROM AUTHOR]

Relative to other low and middle-income countries, South Africa provides a generous set of cash transfers (social grants) targeted at people with disabilities. This article explores the influence of disability-related grants on family practices and configurations, care arrangements and household composition in the Western Province of South Africa. The article draws on the findings of two studies: 1) an ethnographic study of disability grant recipients and applicants in a low-income Cape Town community and; 2) a study of interactions between healthcare staff, disability grant applicants and their families. Findings show that disability grant income is shared within households and the contribution of a stable income provides opportunities for people with disabilities to exercise agency, be seen as valuable household members and secure care and support from other household members. However, conflicts may arise over how income is shared and may lead to the extortion, abuse and neglect of people with disabilities, particularly in cases of severe disablement. Given the lack of adequate social provisioning for those who are able-bodied and unemployed, disability also becomes highly valued in households and the potential suspension or cancellation of a grant can interfere with adherence to treatment. The study emphasises the influence of policy structures and economic conditions on household dynamics and care outcomes and contributes to the sparse international evidence-base on the role that disability welfare benefits play in household dynamics and care outcomes. [ABSTRACT FROM AUTHOR]