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
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
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
We explore if taxonomic analysis of archaeological mollusc assemblages can be used to reconstruct Late Pleistocene (MIS 5–3) coastal environments at Klasies River in South Africa. To obtain a... Show moreWe explore if taxonomic analysis of archaeological mollusc assemblages can be used to reconstruct Late Pleistocene (MIS 5–3) coastal environments at Klasies River in South Africa. To obtain a balanced reconstruction, we analyse the large molluscs separately from the so-called incidentals, the small mollusc species. Based on modern mollusc habitat preferences and tolerances we identify four different eco-profiles to help characterise sea surface temperatures and the character of the shore: temperature profile; geographical distribution; substrate; wave interaction. We hypothesise that changes in the Klasies River mollusc community/eco-profiles can be linked to global glacial and interglacial events and we define several testable assumptions. We found that in response to global warming and cooling events, the Klasies River mollusc communities change slightly, yet significantly. Other sources of marine environmental data confirm that average sea surface temperatures gradually decreased, but probably remained within the modern southern east coast range of variation. It appears that coastal sea surface temperatures of the warm Agulhas current were not particularly depressed during the occupation sequence. The character of the coastal topography does change more apparently during the occupation sequence of the sites and with it the mollusc assemblages: from an interglacial rocky shore in the Klasies and two Mossel Bay phases to a more glacial sandy environment during the Howiesons Poort and the MSA III. In conclusion, the temperature tolerance levels of many Klasies River mollusc species are too broad to reflect small changes in sea surface temperatures. However, in conjunction with other eco-profiles and environmental proxies, such as substrate requirements and oxygen isotopes, the temperature approximations are useful, particularly when evaluating large scale sea surface temperature fluctuations. For the characterisation of the shore and substrate we found the eco-profile approach very useful. Show less
Marriage used to be widespread and common throughout Southern Africa. However, over the past decades marriage rates have substantially declined in the whole region. Marriage has changed from a... Show moreMarriage used to be widespread and common throughout Southern Africa. However, over the past decades marriage rates have substantially declined in the whole region. Marriage has changed from a universal rite of passage into a conspicuous celebration of middle class lifestyles. Bridewealth or lobola remains important and is supplemented by a plethora of new rituals and expenditures. Yet, despite marriage's recent turn towards exclusivity, the institution nevertheless continues to be an important frame of reference for most people. The contributions in this special issue explore reconfigurations of marriages and weddings in South Africa, Botswana and Namibia through the last decades. While there are numerous anthropological studies on marriage in Southern Africa for the period up to the 1980s, a remarkable paucity of studies has to be noted for the time since then. The ethnographic and comparative findings on Southern African weddings and marriages compiled in this special issue pick up an important anthropological legacy and stimulate future research and theorising. Show less
Current political negotiations in South Africa which explore the possibility of pre-1913 land claims and the recognition of Khoisan traditional authorities have spurred the growth of the "Khoisan... Show moreCurrent political negotiations in South Africa which explore the possibility of pre-1913 land claims and the recognition of Khoisan traditional authorities have spurred the growth of the "Khoisan revival": the phenomenon of people identifying as Khoisan and asserting indigenous rights. Based on fieldwork conducted in Cape Town in 2014 and 2015, this paper discusses the motivations and strategies of several Khoisan activists. After outlining the political context of the Khoisan revival, I show how activists make claims and demands through the use of popular imagery and a global indigenous rights discourse. While producing valuable insights, this "strategic essentialist" approach inadequately addresses motivations for claiming land. Based on a discussion of several case studies, I argue that claiming land functions not so much as a means of procuring physical or economic spaces, but as a way for activists to express grievances regarding coloured identity, history and healing. This symbolic interpretation prompts the reconceptualisation of land claims within the restitution paradigm and policy negotiations. Show less
The article explores theoretically the juxtaposition of local stories about landscape with institutional arrangements and exclusionary practices around a conservation area in South Africa. The... Show moreThe article explores theoretically the juxtaposition of local stories about landscape with institutional arrangements and exclusionary practices around a conservation area in South Africa. The Masebe Nature Reserve is used as a case study. The article argues that the institutional arrangements in which the nature reserve is currently positioned are too static, and consequently exclusionary, in their demarcation of boundaries. This stifles local communities’ sense of belonging to these landscapes. Hence, they strongly resent and feel alienated by the nature reserve. Their opposition and alienation often manifests in poaching. The empirical material is based on how local people living adjacent to the Masebe Nature Reserve have historically named and interpreted the area’s impressive sandstone mountains, in the process creating a sense of belonging. Juxtaposing this mostly tranquil cultural reading of the landscape to the institutional practices of boundary demarcation gives the analysis an immediate critical edge regarding issues of social justice Show less
In this farewell lecture on the occasion of his departure as Professor of Development in sub-Saharan Africa at Leiden University and Director of the African Studies Centre (ASC), Leiden, the... Show moreIn this farewell lecture on the occasion of his departure as Professor of Development in sub-Saharan Africa at Leiden University and Director of the African Studies Centre (ASC), Leiden, the author starts with the vuvuzela issue as an illustration of the lack of confidence the world has in South Africa organizing and running the World Cup smoothly. He takes that as a sign that there still exists a stereotype of African incompetence, despite the social and economic progress Africa has witnessed in the last decade. He does not want to argue that African Studies have not been able to offset such a stereotype. What he tries to show is that it is not clear from the wealth of actor-oriented research in African Studies what the main social, political and economic trends in Africa are. He argues that actor-oriented research in African Studies should try to increase its relevance by contributing- through meta-analyses and comparative research-to the discussion on social, political and economic trends in Africa. Special attention should be paid to the possible rise of the developmental state in Africa. In doing so, African Studies may also substantiate its claim that it is able to challenge the universal pretensions of mainstream social science. Show less
Over the last twenty years independent Islamic schools have emerged in many countries where Muslims are a minority, among them South Africa. Although these schools differ in religious and... Show moreOver the last twenty years independent Islamic schools have emerged in many countries where Muslims are a minority, among them South Africa. Although these schools differ in religious and pedagogical orientation, they all aim to offer an excellent education and a space where the Islamic identity of Muslim children can develop. While the curricula of some of these schools hardly differ from those of public schools, other schools are Islamizing their teaching materials and methods. Show less
Secularism is often seen as anathema to Islamic traditions. The findings from research on the responses of Muslims in Cape Town to state secularism and societal secularization in postapartheid... Show moreSecularism is often seen as anathema to Islamic traditions. The findings from research on the responses of Muslims in Cape Town to state secularism and societal secularization in postapartheid South Africa indicate the emergence of an ambiguous accommodation between Muslims and the secular state, and thus challenge reductionist assumptions about the relation of Islamic traditions to secularism. Show less
The Sufi tradition in South Africa—with roots going back to the seventeenth century— regained momentum in the 1990s. Capitalizing on the reduced authority of the ulama, the new Sufi leaders could... Show moreThe Sufi tradition in South Africa—with roots going back to the seventeenth century— regained momentum in the 1990s. Capitalizing on the reduced authority of the ulama, the new Sufi leaders could claim to represent a normative South African version of Islam. Moreover, their focus on the grassroots has increased their visibility in many townships and allowed them to provide spiritual solutions to everyday social issues. Show less
The Indian Muslim community experienced double minority status, first in India, then in South Africa, a factor that contributed to this group’s later modes of mobilization in the early decades of... Show moreThe Indian Muslim community experienced double minority status, first in India, then in South Africa, a factor that contributed to this group’s later modes of mobilization in the early decades of the twentieth century. From the 1930’s, as the education system modernized, the cultural heritage of Indian Islam began to play a role in the specific context of South Africa characterized by modes of integration of the Indian Muslim minority in South Africa. Show less
Islam in South Africa is characterized by an exceptional diversity that might be compared to that of the Muslim world in general. Despite the relatively low number of Muslims in South Africa ... Show moreIslam in South Africa is characterized by an exceptional diversity that might be compared to that of the Muslim world in general. Despite the relatively low number of Muslims in South Africa (approximately 550000 Muslim inhabitants, or 1.36 per cent of the entire population -one of the smallest minorities in the country- they form an integral and visible part of the society. This is especially true in the urban areas of the Western Cape, Natal, and Transvaal regions. Show less
