The psychological experience of being in hiding against the background of political repression in South Africa during the 1986 general State of Emergency: a phenomenological explication

This is a study in Critical Psychology which examines the psychological costs of one of the direct outcomes of political repression - the experience of being in hiding. The aims of the study can be depicted on two levels: it is first and foremost an attempt to provide a true account of the phenomenon of being in hiding. On a second level of equal importance it is an implicit and overt critique of the social order in which this phenomenon takes place. The psychological experience of being in hiding is examined and discussed in its proper socio-political context. Therefore, the theoretical part of the mini-thesis has a strong political bearing, focusing on the State, and extra-parliamentary opposition in South Africa. repression The empirical part of the mini-thesis explicates the psychological experience of being in hiding with the aid of the phenomenological method of investigation. Due to the lack of research on this or similar topics, it is discussed within the framework of the experience of a stressful life event. For the five subjects being in hiding was an extreme intervention which was imposed upon their existences and which brought about a qualitative transformation in the individual subjects mode of being-in-the-world - not only in terms of practicalities, but also on a deep experiential level. It was a phenomenon which touched on fundamental parts of their experience of themselves and their individual worlds and the way in which they actualized themselves. For them it essentially entailed a loss of relationships and roles which resulted in an experience of a measure of encapsulation or separation from the world of others . It was a profound, multi - dimensional disruption of the structure of the subject ' s existence which infused a rich emotional experience

Risk factors for domestic physical violence: national cross-sectional household surveys in eight southern African countries

<p>Abstract</p> <p>Background</p> <p>The baseline to assess impact of a mass education-entertainment programme offered an opportunity to identify risk factors for domestic physical violence.</p> <p>Methods</p> <p>In 2002, cross-sectional household surveys in a stratified urban/rural last-stage random sample of enumeration areas, based on latest national census in Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia and Zimbabwe. Working door to door, interviewers contacted all adults aged 16–60 years present on the day of the visit, without sub-sampling. 20,639 adults were interviewed. The questionnaire in 29 languages measured domestic physical violence by the question "In the last year, have you and your partner had violent arguments where your partner beat, kicked or slapped you?" There was no measure of severity or frequency of physical violence.</p> <p>Results</p> <p>14% of men (weighted based on 1,294/8,113) and 18% of women (weighted based on 2,032/11,063) reported being a victim of partner physical violence in the last year. There was no convincing association with age, income, education, household size and remunerated occupation. Having multiple partners was strongly associated with partner physical violence. Other associations included the income gap within households, negative attitudes about sexuality (for example, men have the right to sex with their girlfriends if they buy them gifts) and negative attitudes about sexual violence (for example, forcing your partner to have sex is not rape). Particularly among men, experience of partner physical violence was associated with potentially dangerous attitudes to HIV infection.</p> <p>Conclusion</p> <p>Having multiple partners was the most consistent risk factor for domestic physical violence across all countries. This could be relevant to domestic violence prevention strategies.</p

Engaging community health workers in maternal and infant death identification in Khayelitsha, South Africa : a pilot study

CITATION: Igumbor, J., et al. 2020. Engaging community health workers in maternal and infant death identification in Khayelitsha, South Africa : a pilot study. Pregnancy and Childbirth, 20:736, doi:10.1186/s12884-020-03419-4.Background: Engaging community health workers in a formalised death review process through verbal and social autopsy has been utilised in different settings to estimate the burden and causes of mortality, where civil registration and vital statistics systems are weak. This method has not been widely adopted. We piloted the use of trained community health workers (CHW) to investigate the extent of unreported maternal and infant deaths in Khayelitsha and explored requirements of such a programme and the role of CHWs in bridging gaps. Methods: This was a mixed methods study, incorporating both qualitative and quantitative methods. Case identification and data collection were done by ten trained CHWs. Quantitative data were collected using a structured questionnaire. Qualitative data were collected using semi-structured interview guides for key informant interviews, focus group discussions and informal conversations. Qualitative data were analysed thematically using a content analysis approach. Results: Although more than half of the infant deaths occurred in hospitals (n = 11/17), about a quarter that occurred at home (n = 4/17) were unreported. Main causes of deaths as perceived by family members of the deceased were related to uncertainty about the quality of care in the facilities, socio-cultural and economic contexts where people lived and individual factors. Most unreported deaths were further attributed to weak facilitycommunity links and socio-cultural practices. Fragmented death reporting systems were perceived to influence the quality of the data and this impacted on the number of unreported deaths. Only two maternal deaths were identified in this pilot study. Conclusions: CHWs can conduct verbal and social autopsy for maternal and infant deaths to complement formal vital registration systems. Capacity development, stakeholder’s engagement, supervision, and support are essential for a community-linked death review system. Policymakers and implementers should establish a functional relationship between community-linked reporting systems and the existing system as a starting point. There is a need for more studies to confirm or build on our pilot findings.https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03419-4Publisher's versio

The psychological experience of being in hiding against the background of political repression in South Africa during the 1986 general State of Emergency: a phenomenological explication

This is a study in Critical Psychology which examines the psychological costs of one of the direct outcomes of political repression - the experience of being in hiding. The aims of the study can be depicted on two levels: it is first and foremost an attempt to provide a true account of the phenomenon of being in hiding. On a second level of equal importance it is an implicit and overt critique of the social order in which this phenomenon takes place. The psychological experience of being in hiding is examined and discussed in its proper socio-political context. Therefore, the theoretical part of the mini-thesis has a strong political bearing, focusing on the State, and extra-parliamentary opposition in South Africa. repression The empirical part of the mini-thesis explicates the psychological experience of being in hiding with the aid of the phenomenological method of investigation. Due to the lack of research on this or similar topics, it is discussed within the framework of the experience of a stressful life event. For the five subjects being in hiding was an extreme intervention which was imposed upon their existences and which brought about a qualitative transformation in the individual subjects mode of being-in-the-world - not only in terms of practicalities, but also on a deep experiential level. It was a phenomenon which touched on fundamental parts of their experience of themselves and their individual worlds and the way in which they actualized themselves. For them it essentially entailed a loss of relationships and roles which resulted in an experience of a measure of encapsulation or separation from the world of others . It was a profound, multi - dimensional disruption of the structure of the subject ' s existence which infused a rich emotional experience

Engaging community health workers in maternal and infant death identification in Khayelitsha, South Africa: a pilot study

Abstract Background Engaging community health workers in a formalised death review process through verbal and social autopsy has been utilised in different settings to estimate the burden and causes of mortality, where civil registration and vital statistics systems are weak. This method has not been widely adopted. We piloted the use of trained community health workers (CHW) to investigate the extent of unreported maternal and infant deaths in Khayelitsha and explored requirements of such a programme and the role of CHWs in bridging gaps. Methods This was a mixed methods study, incorporating both qualitative and quantitative methods. Case identification and data collection were done by ten trained CHWs. Quantitative data were collected using a structured questionnaire. Qualitative data were collected using semi-structured interview guides for key informant interviews, focus group discussions and informal conversations. Qualitative data were analysed thematically using a content analysis approach. Results Although more than half of the infant deaths occurred in hospitals (n = 11/17), about a quarter that occurred at home (n = 4/17) were unreported. Main causes of deaths as perceived by family members of the deceased were related to uncertainty about the quality of care in the facilities, socio-cultural and economic contexts where people lived and individual factors. Most unreported deaths were further attributed to weak facility-community links and socio-cultural practices. Fragmented death reporting systems were perceived to influence the quality of the data and this impacted on the number of unreported deaths. Only two maternal deaths were identified in this pilot study. Conclusions CHWs can conduct verbal and social autopsy for maternal and infant deaths to complement formal vital registration systems. Capacity development, stakeholder’s engagement, supervision, and support are essential for a community-linked death review system. Policymakers and implementers should establish a functional relationship between community-linked reporting systems and the existing system as a starting point. There is a need for more studies to confirm or build on our pilot findings. </jats:sec

Community surveillance and response to maternal and child deaths in low- and middleincome countries: A scoping review

Background Civil registration and vital statistics (CRVS) systems do not produce comprehensive data on maternal and child deaths in most low- and middle-income countries (LMICs), with most births and deaths which occur outside the formal health system going unreported. Community-based death reporting, investigation and review processes are being used in these settings to augment official registration of maternal and child deaths and to identify deathspecific factors and associated barriers to maternal and childcare. This study aims to review how community-based maternal and child death reporting, investigation and review processes are carried out in LMICs. Methods We conducted a scoping review of the literature published in English from January 2013 to November 2020, searching PubMed, EMBASE, PsycINFO, Joanna Briggs, The Cochrane Library, EBM reviews, Scopus, and Web of Science databases. We used descriptive analysis to outline the scope, design, and distribution of literature included in the study and to present the content extracted from each article. The scoping review is reported following the PRISMA reporting guideline for systematic reviews. Results Of 3162 screened articles, 43 articles that described community-based maternal and child death review processes across ten countries in Africa and Asia were included. A variety of approaches were used to report and investigate deaths in the community, including identification of deaths by community health workers (CHWs) and other community informants, reproductive age mortality surveys, verbal autopsy, and social autopsy. Community notification of deaths by CHWs complements registration of maternal and child deaths missed by routinely collected sources of information, including the CRVS systems which mostly capture deaths occurring in health facilities. However, the accuracy and completeness of data reported by CHWs are sub-optimal. Conclusions Community-based death reporting complements formal registration of maternal and child deaths in LMICs. While research shows that community-based maternal and child death reporting was feasible, the accuracy and completeness of data reported by CHWs are suboptimal but amenable to targeted support and supervision. Studies to further improve the process of engaging communities in the review, as well as collection and investigation of deaths in LMICs, could empower communities to respond more effectively and have a greater impact on reducing maternal and child mortality.PM202

Impact of lay health worker programmes on the health outcomes of mother-child pairs of HIV exposed children in Africa: A scoping review.

BACKGROUND:Increased demand for healthcare services in countries experiencing high HIV disease burden and often coupled with a shortage of health workers, has necessitated task shifting from professional health workers to Lay Health Workers (LHWs) in order to improve healthcare delivery. Maternal and Child Health (MCH) services particularly benefit from task-shifting to LHWs or similar cadres. However, evidence on the roles and usefulness of LHWs in MCH service delivery in Sub-Saharan Africa (SSA) is not fully known. OBJECTIVES:To examine evidence of the roles and impact of lay health worker programmes focusing on Women Living with HIV (WLH) and their HIV-exposed infants (HEIs). METHODS:A scoping review approach based on Arksey and O'Malley's guiding principles was used to retrieve, review and analyse existing literature. We searched for articles published between January 2008 and July 2018 in seven (7) databases, including: MEDLINE, Embase, PsycINFO, Joanna Briggs, The Cochrane Library, EBM reviews and Web of Science. The critical constructs used for the literature search were "lay health worker", "community health worker", "peer mentor", "mentor mother," "Maternal and Child health worker", "HIV positive mothers", "HIV exposed infants" and PMTCT. RESULTS:Thirty-three (33) full-text articles meeting the eligibility criteria were identified and included in the final analysis. Most (n = 13, 39.4%) of the included studies were conducted in South Africa and used a cluster RCT design (n = 13, 39.4%). The most commonly performed roles of LHWs in HIV specific MCH programmes included: community engagement and sensitisation, psychosocial support, linkage to care, encouraging women to bring their infants back for HIV testing and supporting default tracing. Community awareness on Mother to Child Transmission of HIV (MTCT), proper and consistent use of condoms, clinic attendance and timely HIV testing of HEIs, as well as retention in care for infected persons, have all improved because of LHW programmes. CONCLUSION:LHWs play significant roles in the management of WLH and their HEIs, improving MCH outcomes in the process. LHW interventions are beneficial in increasing access to PMTCT services and reducing MTCT of HIV, though their impact on improving adherence to ART remains scanty. Further research is needed to evaluate ART adherence in LHW interventions targeted at WLH. LHW programmes can be enhanced by increasing supportive supervision and remuneration of LHWs