Mohamed Seedat

Violence and injuries in South Africa: prioritising an agenda for prevention

Violence and injuries are the second leading cause of death and lost disability-adjusted life years in South Africa. The overall injury death rate of 157.8 per 100,000 population is nearly twice the global average, and the rate of homicide of women by intimate partners is six times the global average. With a focus on homicide, and violence against women and children, we review the magnitude, contexts of occurrence, and patterns of violence, and refer to traffic-related and other unintentional injuries. The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking, and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement. Although there have been advances in development of services for victims of violence, innovation from non-governmental organisations, and evidence from research, there has been a conspicuous absence of government stewardship and leadership. Successful prevention of violence and injury is contingent on identification by the government of violence as a strategic priority and development of an intersectoral plan based on empirically driven programmes and policies.

Discerning Community Resilience in Disadvantaged Communities in the Context of Violence and Injury Prevention

The study of community resilience is a relatively under-explored area. Accordingly, in an attempt to further our understanding of community resilience, we present a study focused on the development of a questionnaire to assess and delineate the nature of community resilience across three low socio-economic neighbourhoods in the Western Cape. The study embraced a participatory framework that incorporated several phases. Data indicated significant associations between some of the dimensions of community resilience, namely, neighbourhood cohesion and community hope (p<0.001, Fisher-Exact); community structures and leadership and social supports (p<0.05, Fisher-Exact); the ownership of a business and physical security (p<0.001, Chi-squared); and the ownership of a business and social supports (p<0.05, Chi-squared). However, some of the community resilience measures, such as the knowledge of treatment of injuries yielded no associations with any of the other measures. Using the Chi-squared test, it was found that there were significant differences between the three communities on three of the resiliency measures: neighbourhood cohesion (p<0.001), knowledge of treatment of injuries (p<0.001), and community structures and leadership (p<0.001). The results suggested that communities may have the capacity to develop resilient responses and that these responses differ across neighbourhoods. By way of conclusion, we discuss the findings and review the implications for the further conceptualisation and operationalisation of the notion of community resilience.

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion

BackgroundThe development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources.MethodsA case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation.ResultsThe study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support.ConclusionsThis evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention.

Magnitude and categories of pedestrian fatalities in South Africa

Road traffic injuries, a major global public health burden, are concentrated in low-income and middle-income countries.(1) In contrast to high-income countries, pedestrians make up the largest group of road traffic injuries and fatalities in low- and middle-income countries. This article presents an analysis of pedestrian fatalities (2001-2004) in four South African cities. The article describes the magnitude, demographic, and temporal factors associated with pedestrian fatalities and presents a typological analysis to identify particular groups of at risk pedestrians. The analysis can serve to inform the development of prevention programmes tailored to the needs of specific at risk pedestrian groups. Data were obtained from the National Injury Mortality Surveillance System (NIMSS). The results indicated that there were a total of 7433 pedestrian deaths (2001-2004) for the four cities and the majority occurred over weekends. Most (56.7%) were between ages 20 and 44 years. Overall, there were 3.3 male pedestrian deaths for every female pedestrian death, and over half (58%) of the 4004 cases tested were positive for alcohol. A typological analysis identified three categories of pedestrian fatalities: (1) male pedestrian fatalities that showed high levels of alcohol concentrations, (2) female and elderly pedestrian deaths that occurred between 6 AM and midday, and (3) children, adolescents, and young adult pedestrian fatalities that typically occurred during weekday afternoons and evenings. The findings call for multiple strategies for combating pedestrian fatalities.

Paraprofessional home visitation program to prevent childhood unintentional injuries in low-income communities: a cluster randomized controlled trial

Objective: To investigate the effectiveness of a paraprofessional home visitation program (HVP) to improve home safety and prevent injuries among children living in low-income settings. Methods: The HVP was implemented in two low-income communities in South Africa. In each community, approximately 200 households were randomly selected for the trial. Eligible households were those with children aged ⩽10 years. Intervention households received four visits, one every two weeks, by trained paraprofessionals that focused on a specific injury topic and consisted of: information dissemination about specific injury prevention practices; home inspection accompanied by information about home hazards; and the supply of safety devices. The key outcomes to measure the presence of home hazards were scores for burns (safety practices, paraffin, and electrical), poisoning, and falls. Results: Significant reductions were found for injury risks related to burn safety practices. For injury risks related to electrical burns, paraffin burns, and poisoning, a decline was also noted although this was not statistically significant. No decline was noted for fall-related risks. Conclusions: Subject to further replication and evaluation, home visits by paraprofessionals providing safety education, home inspection, and safety devices be considered for integration into a comprehensive child injury prevention strategy in low-income communities.

Trends and redress in community psychology during 10 years of democracy (1994-2003) : a journal-based perspective

Drawing on a content analysis of selected articles from the South African Journal of Psychology (SAJP) and Psychology in Society (PINS), the authors reflect on the extent to which South African community psychologys early vision resonates in publications in post-1994 South African psychology. Concerned about the Euro-American, patriarchal, classist, and individualised orientation in clinical, counselling, and social psychology, community psychologys vision arose as a response to this crisis of ‘relevance’ in the 1980s in South Africa. It placed the accent on accessible psychosocial services, re-defining the roles of psychologists, democratising psychological practice, prevention, competencies, empowerment of under-represented groups, collaboration, and inclusive modes of knowledge production. Our content analysis suggests that South African community psychology tends to operate within a porous disciplinary boundary, sharing academic concerns with a larger group of critical psychologists. Authorship characteristics show that for the 1994 to 2003 period male and females were more or less equally represented as authors, the majority of whom were affiliated to academic institutions. In contrast, co-authorship as an expression of collaboration did not feature strongly and the community voice was unrepresented at authorship level. Most of the articles tended to assume an empirical or theoretical slant and examined themes consistent with community psychologys early vision and focus. Similarly, research in community psychology seemed to have attended to selected priority psychosocial issues and drawn on historically neglected groups, including black adolescents and adults, to serve as participants. By way of conclusion, we surmise that community psychology, albeit an under-represented branch of psychology, may be one of many areas of engagement for those aligned to the quest for emancipatory psychological practice and theory in South Africa.

Rape Surveillance through District Surgeon Offices in Johannesburg, 1996–1998: Findings, Evaluation and Prevention Implications

Rape prevention efforts are hampered by a chronic lack of adequate epidemiological and surveillance data. Information on identifying factors such as the who, when, where and how of rape is needed to inform the design of effective intervention programmes. Results from a demonstration Rape Surveillance Project show that records of rape cases presenting at three medico-legal clinics provide a valuable source for the epidemiological surveillance of rape. From January 1996 to December 1998 a surveillance questionnaire was completed for rape victims presenting at the Hillbrow, Lenasia South, and Chris Hani Baragwanath Medico-Legal Clinics in Gauteng. Analysis of the data suggests which women are most at risk for being raped, by whom they are raped, the areas where attacks most often occur, and the day and time when rapes are mostly committed. Despite the limited database and difficulties with generalizing findings beyond the three clinics, it is apparent that surveillance procedures have enormous import for sexual violence prevention and intervention. Implications for prevention strategies, aftercare, policy formulation, and future research are discussed. Methodological issues and institutional constraints are also discussed with a view to strengthening and developing such information management systems.

The Quest for Liberatory Psychology

Despite scepticism about the viability, scope and nature of liberatory psychology, a nuanced study of anti-apartheid and international progressive scholarship within psychology reveals otherwise. Accordingly, in this paper I seek to describe the distinctive processes, phases and epistemological challenges integral to the quest for a liberatory psychology. Specific attention is also accorded to a liberatory agenda which may be distilled from the progressive psychological literature.

A critical review of instruments assessing characteristics of community

Community development is critical in South African and other low- to middle-income contexts characterised by unemployment, violence, poverty and poor infrastructure. The current asset-based trend in community research emphasises constructive community development and change through the mobilisation of existing and unrecognised community resources and skills. Following this trend we critically examine the conceptual soundness and logic of asset-based community assessment instruments. We give particular attention to measures of social capital, social cohesion, community resilience, and sense of community. Our review reveals that while the asset-based approaches embody an important shift away from the deficits orientation, their associated instruments, which bring discursive impositions, are marked by conceptual and operational ambiguities, troubling assumptions about community and uneasy power dynamics in their implementation. We suggest that such challenges may be addressed through the employment of measures that draw on both quantitative and qualitative paradigms, and that assume participatory strategies to implementation.

Authoritarianism and Autonomy. 1. Conflicting Value Systems in the Introduction of Psychological Services in a South African Primary Health Care System

Psychology functions within the context of South Africas ruling ideology, resistance discourse and national health care philosophy. Using a psychological skills training programme in the Soweto Community Health Centre System in Johannesburg as a case study, the authors examine how the introduction of psychological services in primary health care is both enabled and constrained by state ideology, medical hegemony, professional interests and personal perceptions. Nuances underlying the subversion of an empowering concept such as primary health care, and some general rules about the perception of psychology that are likely to apply in South Africa and other developing countries, are discussed. In Part 2 (this issue) this etic perspective is extended into an emic exploration of how these factors impact upon the interpersonal processes and practices of nursing staff in the health care system.