Catherine L. Ward

Violence, violence prevention, and safety: A research agenda for South Africa

Violence is a serious problem in South Africa with many effects on health services; it presents complex research problems and requires interdisciplinary collaboration. Two key meta-questions emerge: (i) violence must be understood better to develop effective interventions; and (ii) intervention research (evaluating interventions, assessing efficacy and effectiveness, how best to scale up interventions in resource-poor settings) is necessary. A research agenda to address violence is proposed.

South African street children: A survey and recommendations for services

This paper describes a sub-study of children within the Human Sciences Research Council study of street people in South Africa. It used both quantitative and qualitative methods (a survey and census, and focus group discussions and in-depth interviews) to gather information from street children, their service providers, and five women who had grown up on the street but subsequently made a success of their lives. The paper reviews the origins of homelessness among children, the dynamics of life on the streets, and care requirements. It recommends a continuum of care for those already on the streets, but points also to the need for preventive services. It suggests that truancy from school could provide early warning of children at risk, and recommends a range of family support services that may be needed to prevent children from taking to the streets.

Injury-related behaviour among South African high-school students at six sites

OBJECTIVES To document and compare prevalence rates of adolescent injury-related risk behaviours at six sites in South Africa. DESIGN The identical self-administered instrument was used at all sites. Prevalence rates (with 95% confidence intervals) were calculated taking the multistage cluster sampling strategy into account. SETTING AND SUBJECTS In Cape Town, Durban, Port Elizabeth and Mankweng participants were drawn from either grades 8 or 9, and grade 11, while in Queenstown and Umtata they were drawn from grade 11 only. We selected 39 schools in Cape Town and Durban, 33 in Port Elizabeth and 20 in each of the rural areas. OUTCOME MEASURES Road-related risk behaviour, violence, and suicide attempts. RESULTS Across the sites there were high rates of risk behaviour in all domains. For example, in the 12 months preceding the survey an estimated 52.8% of grade 11 males in Cape Town had travelled in the front seat of a motor vehicle without a seatbelt, 33.0% of grade 8 males in Mankweng had bullied others, while 44.5% of the same group had been bullied, and 18.6% of females in Port Elizabeth had attempted suicide. Rates were lower in rural areas for behaviour involving motor vehicles, but there were no consistent urban-rural findings for violence-related behaviour. Females were at higher risk of suicidal behaviour and males were at higher risk of other injury-related behaviour. CONCLUSIONS There is a need for effective interventions to reduce the extent of injury-related risk behaviour in adolescents in urban and rural settings.

Skeletons at the feast: A review of street homelessness in South Africa and other world regions

Homelessness on the streets has been of concern to governments and civil society for hundreds of years, and the number of homeless tends to rise when economic conditions take an adverse turn. Laying stress on questions of access to housing, livelihoods and services, this paper compares the historical causes of homelessness in Britain and Europe, India, the US and South Africa, in order to approach a better understanding of South Africas own homelessness situation. Internationally, the key debate is whether homelessness is due to simple lack of affordable housing, or to a range of complex factors involving poverty and unemployment. The paper argues that spatial access to street livelihoods and access to the metro core zones are critical factors linking housing access to poverty economics, and it questions whether in South Africas situation street homelessness can be eliminated in the foreseeable future.

Development of a parenting support program to prevent abuse of adolescents in South Africa: findings from a pilot pre-post study

Purpose: Violence against children increases in adolescence, but there is a research and practice gap in research-supported child abuse prevention for the adolescent years. A pilot program for low-resource settings was developed in collaboration with nongovernmental organizations, government, and academics in South Africa, using research-supported principles. Method: This study used a pre-post design to test initial effects of a 10-session parenting program with 60 participants (30 caregiver–adolescent dyads) in high-poverty rural South Africa. Areas requiring further testing and adaptation were also identified. Results: Pre-post findings show medium to large program effects in reducing child abuse and adolescent problem behavior, as well as large effects in improvements of positive parenting, and perceived parent and adolescent social support. Discussion: There is potential to reduce child abuse, improve parenting, and reduce adolescent problem behavior in rural South Africa through parenting programs. Further development, testing and longer term follow-up are required to ascertain potential for scale-up.

Effectiveness of Nurse-Practitioner-Delivered Brief Motivational Intervention for Young Adult Alcohol and Drug Use in Primary Care in South Africa: A Randomized Clinical Trial

AIMS To assess the effectiveness of brief motivational intervention for alcohol and drug use in young adult primary care patients in a low-income population and country. METHODS A randomized controlled trial in a public-sector clinic in Delft, a township in the Western Cape, South Africa recruited 403 patients who were randomized to either single-session, nurse practitioner-delivered Brief Motivational Intervention plus referral list or usual care plus referral list, and followed up at 3 months. RESULTS Although rates of at-risk alcohol use and drug use did not differ by treatment arm at follow-up, patients assigned to the Brief Motivational Intervention had significantly reduced scores on ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) for alcohol-the most prevalent substance. CONCLUSION Brief Motivational Intervention may be effective at reducing at-risk alcohol use in the short term among low-income young adult primary care patients; additional research is needed to examine long-term outcomes.

Adapting a blended motivational interviewing and problem-solving intervention to address risky substance use amongst South Africans

Abstract The purpose of this study was to examine the acceptability and initial substance use outcomes of a blended motivational interviewing (MI) and problem-solving therapy (PST) intervention, delivered by peer counsellors. Twenty people who scored at risk for substance use according to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) received a five session blended MI-PST intervention and were assessed at baseline and at three months. An open-ended semi-structured interview, designed to identify possible factors that may hinder or promote the acceptability of the intervention was also conducted. Fifteen participants completed the intervention and the three-month follow-up. According to ASSIST scores, participants significantly reduced their substance use (p > 0.001) at the three-month follow-up. Randomized controlled trials are needed to evaluate the effect of this intervention more rigorously.

A parenting programme to prevent abuse of adolescents in South Africa: study protocol for a randomised controlled trial

BackgroundAn estimated one billion children experience child abuse each year, with the highest rates in low- and middle-income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence-prevention programmes for implementation in low-resource contexts. The objectives of this parenting support programme are to prevent the abuse of adolescents, improve parenting and reduce adolescent behavioural problems. This trial aims to evaluate the effectiveness of Sinovuyo Teen compared to an attention-control group of a water hygiene programme.Methods/DesignThis is a pragmatic cluster randomised controlled trial, with stratified randomisation of 37 settlements (rural and peri-urban) with 40 study clusters in the Eastern Cape of South Africa. Settlements receive either a 14-session parenting support programme or a 1-day water hygiene programme. The primary outcomes are child abuse and parenting practices, and secondary outcomes include adolescent behavioural problems, mental health and social support. Concurrent process evaluation and qualitative research are conducted. Outcomes are reported by both primary caregivers and adolescents. Brief follow-up measures are collected immediately after the intervention, and full follow-up measures collected at 3–8 months post-intervention. A 15–24-month follow-up is planned, but this will depend on the financial and practical feasibility given delays related to high levels of ongoing civil and political violence in the research sites.DiscussionThis is the first known trial of a parenting programme to prevent abuse of adolescents in a low- or middle-income country. The study will also examine potential mediating pathways and moderating factors.Trial registrationPan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. It can be found by searching for the key word ‘Sinovuyo’ on their website or via the following link: http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1119

Screening and brief interventions for substance use in emergency departments in the Western Cape province of South Africa: views of health care professionals

As part of the formative phase of screening and brief interventions (SBIs) for substance use amongst patients presenting for emergency services in South Africa, the present study explored health care providers’ attitudes and perceptions towards SBI. Twenty-four health care providers working in two 24-hour emergency departments (EDs) were interviewed using an open-ended semi-structured interview schedule designed to identify factors that may hinder or promote the implementation of SBI for substance use in these settings. All respondents felt that screening patients for substance use in EDs is possible; however, they emphasised the need for an additional staff member dedicated to these activities. Secondly, they felt this dedicated individual should meet certain educational criteria and be from a specific socio-demographic background in order to increase the likelihood of intervention uptake. Thirdly, a number of patient- and clinic-level barriers were revealed that could potentially hinder the successful implementation of SBIs in EDs.

Medical Conditions of Hazardous Drinkers and Drug Users in Primary Care Clinics in Cape Town, South Africa

Research has identified a wide range of health conditions related to alcohol and drug use in studies conducted primarily in developed countries and in populations with severe alcohol and drug problems. Little is known about medical conditions in those with less severe alcohol and drug use in developing countries. We used WHO AUDIT and ASSIST screeners to identify hazardous drinking or drug use in public health clinics in Cape Town, South Africa, and included questions about doctor-diagnosed medical conditions. Using logistic regression we examined the relationship of medical conditions to hazardous alcohol, drug and tobacco use. Those with hazardous substance use had higher prevalence of many health conditions including tuberculosis, Hepatitis B, migraine, chronic bronchitis, and liver cirrhosis. Optimal treatment for some medical conditions may include treatment of underlying hazardous substance use, particularly use of drugs other than alcohol. In these populations, access to substance use treatment is limited and even brief interventions or advice may be useful.