This PhD thesis addresses southern African archaeology, emphasizing the importance of considering geoarchaeological context when using archaeological remains to support hypotheses. It focuses on... Show moreThis PhD thesis addresses southern African archaeology, emphasizing the importance of considering geoarchaeological context when using archaeological remains to support hypotheses. It focuses on Umhlatuzana and Umbeli Belli rockshelters, conducting a comprehensive stratigraphic analysis for a deep understanding of their depositional history and archaeological context.Umhlatuzana's stratigraphic sequence reveals primary, unaltered depositional micro-layering throughout, challenging assumptions of sediment movement. Bioturbation features are present but do not significantly impact lithic assemblages.Umbeli Belli rockshelter shows intense percolating water activity, causing poor preservation of organic remains. Different geogenic processes and pulsed occupations form varying artifact densities and sterile zones, but overall, the archaeological context remains secure with minimal bioturbation.This research highlights the need for taphonomic studies to understand the visibility, invisibility, or absence of specific proxies in the archaeological record. In-depth geoarchaeological analysis contributes to assessing archaeological record completeness and revealing remnants affected by post-depositional processes.In conclusion, this study underscores the importance of geoarchaeological research in elucidating site formation processes and archaeological visibility, especially in challenging preservation conditions, like Umhlatuzana and Umbeli Belli rockshelters, providing valuable insights into southern African archaeology. Show less
Heitkamp, A.; Sandberg, E.; Moodley, A.; Burke, J.; Roosmalen, J. van; Gebhardt, S.; ... ; Theron, G. 2023
Objectives: To describe the incidence and outcomes of pulmonary oedema in women with severe maternal outcome during childbirth and identify possible modifiable factors through audit.Methods: All... Show moreObjectives: To describe the incidence and outcomes of pulmonary oedema in women with severe maternal outcome during childbirth and identify possible modifiable factors through audit.Methods: All women with severe maternal outcome (maternal deaths or near misses) who were referred to Tygerberg referral hospital from health facilities in Metro East district, South Africa, during 2014-2015 were included. Women with severe maternal outcome and pulmonary oedema during pregnancy or childbirth were evaluated using three types of critical incident audit: criterion-based case review by one consultant gynaecologist, monodisciplinary critical incident audit by a team of gynaecologists, multidisciplinary audit with expert review from anaesthesiologists and cardiologists.Results: Of 32,161 pregnant women who gave birth in the study period, 399 (1.2%) women had severe maternal outcome and 72/399 (18.1%) had pulmonary oedema with a case fatality rate of 5.6% (4/72). Critical incident audit demonstrated that pre-eclampsia/HELLP-syndrome and chronic hypertension were the main conditions underlying pulmonary oedema (44/72, 61.1%). Administration of volumes of intravenous fluids in already sick women, undiagnosed underlying cardiac illness, administration of magnesium sulphate as part of pre-eclampsia management and oxytocin for augmentation of labour were identified as possible contributors to the pathophysiology of pulmonary oedema. Women-related factors (improved antenatal care attendance) and health care-related factors (earlier diagnosis and management) would potentially have improved maternal outcome.Conclusions: Although pulmonary oedema in pregnancy is rare, among women with severe maternal outcome a considerable proportion had pulmonary oedema (18.1%). Audit identified options for prevention of pulmonary oedema and improved outcome. These included early detection and management of preeclampsia with close monitoring of fluid intake and cardiac evaluation in case of suspected pulmonary oedema. Therefore, a multidisciplinary clinical approach is recommended. Show less
With advancements in assisted reproductive technologies (ART), more and more individuals across the globe want access to these medical miracles, not only to realise their desire for offspring but... Show moreWith advancements in assisted reproductive technologies (ART), more and more individuals across the globe want access to these medical miracles, not only to realise their desire for offspring but also to realise their desires for specific offspring and/or healthy offspring. South Africans are no exception. The challenge posed by this situation is that there is no specific right to reproduce with assistance in this country. Instead, there are certain general constitutional rights which may be interpreted as affording recognition to this right. Moreover, while the current legislative framework permits certain forms of ART, it expressly prohibits others, or it fails to make provision for newer and emerging technologies entirely. As a result, prospective parents are uncertain about the reproductive options available to them. Increasingly individuals are approaching the courts for clarity regarding their rights. The results have however been conflicting. Additionally, divergent views on the applicability of children's rights to prospective offspring is a complicating factor, which has yet to be resolved in South Africa (SA).This thesis, therefore, attempts to contribute to the existing knowledge on the legal rights of prospective parents to make use of ART in SA. It does so, by firstly exploring the current legal framework for assisted reproduction (AR). It additionally explores the legal implications of AR for the various parties concerned, in particular the prospective parents and the future child; and how their interests are balanced, if at all. What emerges from this investigation is that tension exists between the interests of these parties.The study further considers the existence of a right to reproduce from a global perspective. Given that there is no such express right, the thesis considers how the right has been given effect to by applying other rights. In this regard five primary rights have been identified, namely the rights to reproductive autonomy, reproductive health care, dignity, equality and privacy. The thesis then examines how the rights identified above have been interpreted to recognise reproductive rights and whether these interpretations would be useful in recognising the right to reproduce with assistance in SA.The thesis concludes that while the right to reproductive autonomy offers the most recognition to prospective parents’ rights to make use of certain forms of ART, it too is inadequate. To address this shortcoming, the study calls for legislative reform as well as wider interpretations of rights to accommodate various family forms. The need to adopt an interconnected approach that considers both the rights of the prospective parents and the potential offspring is also proposed. This however requires a consistent approach to be applied in respect of the interests of prospective offspring, which is currently lacking. These recommendations would go a long way towards realising the right to reproduce with assistance in SA and it would undoubtedly provide clarity on the existence of this right. Show less
At-risk families and caregivers from low-and middle-income countries have been shown to benefit from parenting interventions. But there is limited evidence on the impact of interventions on... Show moreAt-risk families and caregivers from low-and middle-income countries have been shown to benefit from parenting interventions. But there is limited evidence on the impact of interventions on adolescent parents. This paper considers the effects of a parenting programme targeting adolescent parents in South Africa, emphasising parenting and adolescent well-being outcomes. Secondly, it explores whether such an intervention can influence adolescent depression and parenting behaviours. Using a quasi-experimental, longitudinal design, data was collected over 2015-2017 from 113 adolescent parents (aged 12-22 years) who attended three secondary schools in Cape Town. Adolescents (biological and non-biological parents) were assigned to intervention (parenting programme participation) and control groups. They completed assessments on parenting, adolescent well-being, and social context at three time-points. Inter-group, and time-period differences were examined, and analyses on whether depression moderates programme effects on outcomes were conducted. At the ten-month follow-up, positive parenting and resilience improved for biological and non-biological parents and in both study groups. For the non-biological intervention group parents, depression rates increased over time. Intervention adolescents with high depression risk showed smaller improvements in supportive parenting than their control group counterparts. Although adolescents increased in positive parenting and resilience, it is unclear whether and how the intervention contributed to these results. As the intervention group included more adolescents at high risk of depression at follow-up, this study highlights the importance of including mental health support in interventions targeting adolescents in LMIC contexts. The study is limited by a small sample size and reliance on self-reported data. Show less
Is it ethical to freely redistribute photographs taken in colonial contexts, historically and today? Showing the complexities behind this question, this study looks at how a vast media network... Show moreIs it ethical to freely redistribute photographs taken in colonial contexts, historically and today? Showing the complexities behind this question, this study looks at how a vast media network evolved around the commercial photographic studio at Mariannhill Monastery and the mission station Centocow in South Africa from the 1880s until today. Taking a grass-roots perspective, it argues that photographs produced by missionaries, like all colonial photographs, must be studied by considering their interconnectedness: first, their alliances with other media, like paintings, theatre plays, tableaux vivants, maps, films, exhibitions, and “ethnographic” objects; second, the exhibitionary complex they depend on, involving museums, libraries, archives, and printing presses; and finally the lobbies, journals, printed instructions, discourses, and interpretive communities that produced, used, and consumed them. Eventually, the study turns to the crucial question how photographs act on and as subjects. Few colonial photographs have left sufficient traces that allow to write their biographies. Mariannhill’s photographs, however, due to their aesthetic aspiration and the congregation’s unique setup, have successfully taken root in many places, moments, and discourses. To show the photographs’ ongoing relevance for stakeholders in both South Africa and Europe, and possible ways of dealing with them today, this study follows their intermediary role over time and in between other images, spaces, objects, and subjects. Show less
Heitkamp, A.; Vollmer, L.; Akker, T. van den; Gebhardt, G.S.; Sandberg, E.M.; Roosmalen, J. van; ... ; Theron, G. 2021
Objective To assess the incidence of severe maternal outcome (SMO), comprising maternal mortality (MM) and maternal near miss (MNM), in Metro East health district, Western Cape Province, South... Show moreObjective To assess the incidence of severe maternal outcome (SMO), comprising maternal mortality (MM) and maternal near miss (MNM), in Metro East health district, Western Cape Province, South Africa between November 2014 and November 2015 and to identify associated determinants leading to SMO with the aim to improve maternity care.Methods Region-wide population-based case-control study. Women were included in the study, if they were maternal deaths or met MNM criteria, both as defined by WHO. Characteristics of women with SMO were compared with those of a sample of women without SMO, matched for age and parity, taken from midwifery-led obstetrical units from two residential areas in Metro East, using multivariate regression analysis.Results Incidence of SMO was 9.1 per 1000 live births, and incidence of MNM was 8.6 per 1000 live births. Main causes of SMO were obstetrical hemorrhage and hypertensive disorders. Factors associated with SMO were HIV (adjusted odds ratio [aOR] 24.8; 95% confidence interval [CI] 10.0-61.6), pre-eclampsia (aOR 17.5; 95% CI 7.9-38.7), birth by cesarean section (aOR 8.4; 95% CI 5.8-12.3), and chronic hypertension (aOR 2.4; 95% CI 1.1-5.1).Conclusion Evaluation of SMO incidence and associated determinants supports optimizing tailored guidelines in Metro-East health district to improve maternal health. Show less
A little-known feature of the vast migrant labour system that supplied South Africa’s gold-mining industry was the Deferred Pay Interest Fund. For much of the 20th century, a portion of the wages... Show moreA little-known feature of the vast migrant labour system that supplied South Africa’s gold-mining industry was the Deferred Pay Interest Fund. For much of the 20th century, a portion of the wages owed to African mine workers was deferred and remitted to them only at the end of their contracts. This is well-known, but what happened to the interest that accumulated on these deferred wages remains virtually unknown. Mine workers did not receive this interest; it was, instead, deposited into a fund controlled by the mining industry. This article examines the operations of this fund in the Transkei in the context of the crisis in the migrant labour system precipitated by newly independent states refusing to supply further migrant labour to South Africa. This prompted the Chamber of Mines to reorient labour recruitment towards the South African bantustans, and the Transkei quickly became the most important source of labour for the mines in the 1970s and 1980s. Although the fund had a mandate to spend on welfare projects in labour-sending regions, we argue that patterns of spending clearly show how it was used to support the reproduction of the migrant labour system. Payments were used as patronage for local elites, upon whom recruitment depended, and for distributing propaganda for the mining industry. In contrast, payments were consistently directed away from education for able-bodied students, because education would reduce the pool of unskilled labour on which the gold industry relied. Money that, arguably, rightfully belonged to mine workers from the Transkei was used to perpetuate their dependence upon migrant labour to the mines. Show less
This dissertation investigates the changing healing practice of Zulu sangomas in KwaZulu Natal, South Africa. Indigenous healing in South Africa is currently at a crossroads. While the latest... Show moreThis dissertation investigates the changing healing practice of Zulu sangomas in KwaZulu Natal, South Africa. Indigenous healing in South Africa is currently at a crossroads. While the latest healthcare legislation accepts the traditional healthcare system as equal to cosmopolitan healthcare, the accompanying institutional developments present obligations and challenges for indigenous healers. While the legalisation is important for sangomas, certain valued characteristics of their much-frequented healing practices are now under pressure. This research seeks to detect where transformations in indigenous healing practices originate and it seeks to understand to what purpose adaptations in healing processes serve. Show less
Colonial misconceptions about the absence of depression and the lack of a psychologization of distress among Africans have long been refuted. However, cultural variation in depression in terms of... Show moreColonial misconceptions about the absence of depression and the lack of a psychologization of distress among Africans have long been refuted. However, cultural variation in depression in terms of symptomatic expression, conceptualization, explanatory models, and social responses is widely acknowledged. Insight into the cultural variation of depression is useful for providing appropriate care; however, few studies have explored cultural understandings of depression in African settings. In a depression vignette study of two displaced and marginalized San communities in South Africa, we conducted 20 semistructured interviews to explore causal interpretations and strategies for coping. Causal interpretations consisted of several dimensions, including life struggles and physical, psychological, and spiritual interpretations. Respondents primarily focused on life struggles in terms of socioeconomic and interpersonal problems. They described coping strategies as primarily addressing negative emotional and psychological affect through social support for relief, comfort, distraction, or advice on coping with the situation and emotions. In addition, religious coping and professional support from a social worker, psychologist, support group, or medications were mentioned. Findings illustrate that depression should be understood beyond individual suffering and be situated in its immediate social environment and larger sociopolitical setting. Interventions for depression therefore may benefit from a multilevel approach that addresses socioeconomic conditions, strengthens local resources, and fosters collaboration among locally appropriate informal and formal support structures. Show less
