In spite of high levels of poverty in low and middle income countries (LMIC), and the high burden posed by common mental disorders (CMD), it is only in the last two decades that research has emerged ...that empirically addresses the relationship between poverty and CMD in these countries. We conducted a systematic review of the epidemiological literature in LMIC, with the aim of examining this relationship. Of 115 studies that were reviewed, most reported positive associations between a range of poverty indicators and CMD. In community-based studies, 73% and 79% of studies reported positive associations between a variety of poverty measures and CMD, 19% and 15% reported null associations and 8% and 6% reported negative associations, using bivariate and multivariate analyses respectively. However, closer examination of specific poverty dimensions revealed a complex picture, in which there was substantial variation between these dimensions. While variables such as education, food insecurity, housing, social class, socio-economic status and financial stress exhibit a relatively consistent and strong association with CMD, others such as income, employment and particularly consumption are more equivocal. There are several measurement and population factors that may explain variation in the strength of the relationship between poverty and CMD. By presenting a systematic review of the literature, this paper attempts to shift the debate from questions about whether poverty is associated with CMD in LMIC, to questions about which particular dimensions of poverty carry the strongest (or weakest) association. The relatively consistent association between CMD and a variety of poverty dimensions in LMIC serves to strengthen the case for the inclusion of mental health on the agenda of development agencies and in international targets such as the millenium development goals.
Disability and International Development Towards Inclusive Global Health Edited by Malcolm MacLachlan Leslie Swartz One of the greatest challenges facing modern global health is how to include the ...most marginalized and impoverished people in international efforts to promote social and economic development. In Disability and International Development disability rights are situated within the broader context of global health and the need for much greater inter-sector collaboration. Reports from a broad cross-section of low- and middle-income countries—locales as diverse as Zimbabwe, Bolivia, Kyrgyzstan, and Papua New Guinea—move beyond surface discussions of 'what is working' and 'what shows promise' to discuss political and governance contexts, the roles of people with disabilities in research by outsiders, concurrent struggles (e.g., women’s or children’s rights), and instructive inroads made by community activists and national Disabled People’s Organizations. The results are provocative, and offer new lenses for viewing both the issues and the populations they affect. Each of the book’s chapters spotlights a topic as representative of the enormity and immediacy of challenges to inclusive global health, including:The impact of international human rights law on domestic law and local traditions.The effect of failed states on the lives of people with disabilities.Empowerment and advocacy: disability organizations and movements.HIV/AIDS interventions with disabled persons.Assistive technologies in low-income countries.Strategies for improving the lives of children with disabilities.
Research into the mistreatment of women during childbirth has increased over recent years. Overt violence is an important focus of research, but recently there has been increasing recognition that ...there are other ways in which women in labour may be uncared for or even hurt. As part of a larger study focussing on staff responses to stillbirths, we wanted to gain contextual information on how high risk pregnancies are handled in general in Khayelitsha Hospital, a district hospital in an impoverished urban setting in the Western Cape Province of South Africa. This health care system experiences an immense patient load, the poverty of the community it serves, and the numerous traumas affecting both patients and staff.
In order to obtain rich exploratory data, a qualitative research methodology was used. The primary data source was observations in the labour ward, interviewing labour ward staff (doctors, nurse, and cleaners). The secondary data source was the analysis of hospital documents, specifically those related to labour ward policy.
From our numerous observations and discussions, it is clear that no one is being overtly mistreated in this hospital and patients are medically well attended to. Although we saw no physical abuse, we noted the silence in the ward. Beside medical related interactions, we also noted that there were limited interactions between the women and the health care providers.
Silence can be a form of neglect as it leaves the women feeling uncared for and not seen. In an overburdened health care system where both staff and patients are often overwhelmed or traumatised, silence can be a way in which a system defends itself against what it knows it cannot provide.
Inclusion through writing Swartz, L.; Fick, L.
South African Journal of Science,
11/2022, Letnik:
118, Številka:
11-12
Journal Article
Recenzirano
Odprti dostop
On 5 December 2022, the Academy of Science of South Africa (ASSAf) will be hosting a session entitled ‘Promoting social justice through accessibility of language in science’ at the World Science ...Forum. Our journal is proud to be chairing this event, which coincides with the launch of our revamped language and style guide – what we term our Inclusive Language Policy.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Literature shows that in South Africa there are insufficient resources to meet mental healthcare needs. At general or district hospital level, the non-specialist doctor is often responsible for the ...holistic assessment and management of mental health service users. Such situations inevitably increase doctors' care load as they are required to treat across disciplines. We highlight the particular challenges faced by a community service (CS) doctor in this context.
The presented case study formed part of a larger project that investigated public mental healthcare provision in the Eastern Cape province. Data were collected through a once-off semi-structured interview with the participant. The interview was transcribed and data analysed by utilising thematic analysis to yield results.
The study suggests that the CS doctor experiences being overloaded with duties, and feels overwhelmed in a healthcare context that lacks resources needed for service provision, which may lead to inadequate mental healthcare provision to public health service users.
Healthcare facilities in rural parts of the Eastern Cape province are in need of assistance. This in-depth account highlighted the consequences of working on the front line of a disadvantaged and under-resourced health system. The presented account can be interpreted as a cry for help by CS doctors for relevant authorities to improve access and provision of mental healthcare in the area.Contribution: The paper provides an exploration of the circumstances wherein mental healthcare is provided in rural parts of South Africa.
South Africa is a very diverse middle-income country, still deeply divided by the legacy of its colonial and apartheid past. As part of a larger study, this article explored the experiences and views ...of representatives of hospices in the Western Cape province of South Africa on the provision of appropriate spiritual care, given local issues and constraints.
Two sets of focus group discussions, with 23 hospice participants, were conducted with 11 of the 12 Hospice Palliative Care Association registered hospices in the Western Cape, South Africa, to understand what spiritual care practices existed in their hospices against the backdrop of multifaceted diversities. The discussions were analysed using thematic analysis.
Two prominent themes emerged: the challenges of providing relevant spiritual care services in a religiously, culturally, linguistically and racially diverse setting, and the organisational context impacting such a spiritual care service. Participants agreed that spiritual care is an important service and that it plays a significant role within the inter-disciplinary team. Participants recognised the need for spiritual care training and skills development, alongside the financial costs of employing dedicated spiritual care workers. In spite of the diversities and resource constraints, the approach of individual hospices to providing spiritual care remained robust.
Given the diversities that are largely unique to South Africa, shaped essentially by past injustices, the hospices have to navigate considerable hurdles such as cultural differences, religious diversity, and language barriers to provide spiritual care services, within significant resource constraints.
While each of the hospices have established spiritual care services to varying degrees, there was an expressed need for training in spiritual care to develop a baseline guide that was bespoke to the complexities of the South African context. Part of this training needs to focus on the complexity of providing culturally appropriate services.
Disability research in contemporary sub-Saharan Africa is developing rapidly, and this is something to be celebrated. This article reviews some contemporary developments and suggests that there are ...five central, and interrelated, challenges for the field. These challenges - experience, expertise, enumeration, evidence, and expectations - go to the heart of thinking about disability research in sub-Saharan Africa. An optimistic but appropriately critical approach to addressing these issues is suggested.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Spiritual care is a key component of palliative care, but it has been overlooked and understudied in low- and middle-income country contexts, especially in Africa. In this study we sought to ...establish what the current spiritual care practices are in hospice palliative care settings in South Africa with a focused view on what spiritual care training is currently offered and what training needs still remain unmet.
We explored spiritual care practices, and training needs, through a national quantitative online study of palliative care organisations in South Africa registered with the Hospice Palliative Care Association of South Africa. A survey was sent to representatives of all member organisations listed on the national database of Hospice Palliative Care Association of South Africa. Viable data from 41% (n = 40) member organisations were analysed through the use of simple statistics.
An expressed need (75%; n = 30) was recorded for the development of a national spiritual care curriculum. Although 48% (n = 20) of the member organisations were willing to participate in the development of a spiritual care curriculum, 37% (n = 14) could not participate, citing financial (n = 27), time (n = 31) and expertise constraints (n = 22). A set of hard and soft skills were suggested to suit the diverse South African context.
Spiritual care was seen by participants as a key component of palliative care. International curricula in spiritual care, while useful, do not offer easy adaptation to the diversities of South Africa. A bespoke spiritual care curriculum was called for, for diverse South Africa.
In South Africa adoption as a form of alternative care had decreased despite a supportive legal and policy environment. This qualitative exploratory study explored adoption policy implementation. ...Semi-structured interviews were conducted with four social workers and two magistrates implementing adoption in the Western Cape. Data were thematically analysed using Lipsky’s theory of street-level bureaucracy. Results indicate significant problems in implementation, including lack of adoption services by the Department of Social Development (DSD) social workers; overuse of foster care; and difficulties in registration of the birth of abandoned babies and babies assumed to be foreign. Recommendations for practice are provided. Keywords: adoption, alternative care, legal and policy framework, legal policy framework, policy implementation, practitioners, street-level bureaucracy
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