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    Undergraduate research- a tale of three African institutions
    (Makerere University, Faculty of Medicine, 2023-06) Delport, Rhena; Dreyer, Abigail; Maart, Ronel; MohamedSharif, Asma; Rebecca Nekaka,; Nekaka, Rebecca; Turner, Astrid; Wolvaardt, Jacqueline
    Background: The inclusion of research in undergraduate medical curricula benefits students as well as the scientific community. Multiple studies report the presence of one or more barriers to research training in these curricula. Objectives: This paper presents and compares three studies done regarding the teaching of research in undergraduate medical curricula in South Africa, Sudan and Uganda. Methods: Two cross-sectional study designs (South Africa and Sudan) and one interventional study design (Uganda) were conducted. Both cross-sectional studies used mixed methods while the Ugandan study used a quantitative method. A total of 41 faculty members and 554 students participated. The studies used a combination of surveys, focus group discussions, key informant interviews and document analysis. Results: Participants from all three studies valued research and considered it useful and relevant to their studies. The findings from the South African and Sudanese studies align with the ‘Four I’s’ framework that summarise the barriers to research training as lack of initiative, impulse, incentive and idols. The Ugandan study demonstrated improved self-reported knowledge and atti- tude (specifically anxiety) among participants after completion of a short course on research.
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    Protective factors for adolescent sexual risk behaviours and experiences linked to HIV infection in South Africa: a three-wave longitudinal analysis of caregiving, education, food security, and social protection
    (Springer Nature, 2023) Rudgard, W.E.; Saminathen, M.G.; Orkin, M.
    Background: Structural interventions are endorsed to enhance biomedical and behavioural HIV prevention programmes for adolescents. Aiming to inform future interventions, we evaluated longitudinal associations between six protective factors that link closely to existing structural HIV prevention interventions, and five sexual risk behaviours for HIV transmission in a cohort of adolescents in South Africa. Methods: We used three rounds of data between 2014–2018 on 1046 adolescents living with HIV and 473 agematched community peers in South Africa’s Eastern Cape (Observations=4402). We estimated sex-specific associations between six time-varying protective factors−number of social grants, education enrolment, days with enough food, caregiver supervision, positive caregiving, and adolescent-caregiver communication; and five HIV risk behaviours−multiple sexual partners, transactional sex, age-disparate sex, condomless sex, and sex on substances. HIV risk behaviours were analysed separately in multivariable random effects within-between logistic regression models that accounted for correlation of repeated observations on the same individual. We calculated prevalence ratios (PR), contrasting adjusted probabilities of HIV risk behaviours at‘No’ and‘Yes’ for education enrolment, and average and maximum values for the other five protective factors. Results: The sample mean age was 15.29 (SD: 3.23) years and 58% were girls. Among girls, within-individuals, increases from mean to maximum scores in positive caregiving were associated with lower probability of transactional sex (PR=0.79; 95%CI=0.67–0.91); in caregiver supervision were associated with lower probability of transactional sex (PR=0.75; 95%CI=0.66–0.84), and age-disparate sex (PR=0.84; 95%CI=0.73–0.95); in adolescentcaregiver communication were associated with higher probability of transactional sex (PR=1.70; 95%CI=1.08–2.32); and in days with enough food at home were associated with lower probability of multiple sexual partners (PR=0.89; 95%CI=0.81–0.97), and transactional sex (PR=0.82; 95%CI=0.72–0.92). Change from non-enrolment in education to enrolment was associated with lower probability of age-disparate sex (PR=0.49; 95%CI=0.26–0.73). Betweenindividuals, relative to mean caregiver supervision scores, maximum scores were associated with lower probability of multiple sexual partners (PR=0.59; 95%CI=0.46–0.72), condomless sex (PR=0.80; 95%CI=0.69–0.91), and sex on substances (PR=0.42; 95%CI=0.26–0.59); and relative to non-enrolment, education enrolment was associated with lower probability of condomless sex (PR=0.59; 95%CI=0.39–0.78). Among boys, within-individuals, increases from mean to maximum scores in positive caregiving were associated with lower probability of transactional sex (PR=0.77; 95%CI=0.59–0.96), and higher probability of condomless sex (PR=1.26; 95%CI=1.08–1.43); in caregiver supervision were associated with lower probability of multiple sexual partners (PR=0.73; 95%CI=0.64–0.82), transactional sex (PR=0.63; 95%CI=0.50–0.76), age-disparate sex (PR=0.67; 95%CI=0.49–0.85), and sex on substances (PR=0.61; 95%CI=0.45–0.78), and in days with enough food at home were associated with lower probability of transactional sex (PR=0.91; 95%CI=0.84–0.98). Conclusion: Effective structural interventions to improve food security and education enrolment among adolescent girls, and positive and supervisory caregiving among adolescent girls and boys are likely to translate into crucial reductions in sexual risk behaviours linked to HIV transmission in this population.
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    The use of yoga as a treatment modality by South African Occupational Therapists
    (University of the Witwatersrand, Johannesburg, 2025) Evangelidis, Dimitra; Jackson, Faye
    Introduction: Yoga is increasingly recognized as a complementary treatment modality in healthcare, providing holistic benefits for physical, emotional, and sensory challenges. This study aimed to explore how South African occupational therapists use yoga as a treatment modality in practice to enhance therapeutic outcomes and support client-centered care. Objectives: This study aimed to explore how occupational therapists in South Africa use yoga as a treatment modality, specifically the extent to which they use yoga, the demographics of clients that they use yoga with, and the treatment goals they aim to reach. Method: An exploratory qualitative research design was used in this study with 6 South African occupational therapists taking part in semi-structured interviews. Qualitative content analysis was used to analyse the data. Manual coding was done in this study, making use of a coding manual. MAXQDA was also used to assist with the development of the codes. Findings: Three key themes emerged from the data analysis: (1) ‘Harnessing Yoga’ which encompasses how SA OTs find yoga is a versatile and holistic therapeutic approach; (2) ‘Mindful Movements’ which highlights how yoga can play a role in enhancing sensory integration and emotional regulation; (3) ‘Increasing the OT Toolbox’ which shows how OTs adapt yoga to the SA context and gain professional growth through yoga training. Conclusion: Yoga is a valuable treatment modality used by South African OTs. Addressing barriers through expanded training, greater inclusivity, and further research into long-term impacts can enhance its integration. This study contributes to growing evidence supporting yoga as a complementary approach in occupational therapy.
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    Cognitive impairment in moderate to severe stroke: Is the MoCA an appropriate tool for South African stroke survivors?
    (University of the Witwatersrand, Johannesburg, 2025) Harris, Christey Llara
    Background The Montreal Cognitive Assessment (MoCA) is widely used to screen for Post Stroke Cognitive Impairment. However, its clinical utility for the stroke survivor population and populations outside of Western, English-speaking cultures has been extensively critiqued. Cognitive impairments in stroke are common, affecting between 20 to 80% of stroke survivors. Attention, information processing, memory, and executive functioning are cognitive skills frequently affected in Post Stroke Cognitive Impairment. These impairments occur at varying severity levels and can significantly affect performance in multiple areas of daily functioning. An appropriate cognitive screening tool needs to accurately identify areas of dysfunction in Post Stroke Cognitive Impairment (PSCI) allow these impairments to be adequately managed through the therapy process. 2.1.1. Aims The aim of this study was to determine whether the MoCA is a valid screening tool for post-stroke cognitive impairment in moderate-to-severely impaired stroke survivors in South Africa. 2.1.2. Methods A quantitative, cross-sectional design was employed. A small, expert consensus group was used to gain information around cognitive skills from the Comprehensive ICF Core Set for Stroke which could be assessed using the MoCA. Nominal Group Technique processes were utilised to conduct the group and gather data. Responses from the consensus group were analysed from the transcription and recording, to confirm the cognitive skills from the ICF Core Set for Stroke agreed upon by all experts for each section of the MoCA. Thereafter, a self-administered, online survey was used to collect data on perceptions of occupational therapists who work with stroke survivors in South Africa on the utility of the MoCA for assessing Post-Stroke Cognitive Impairment in moderate to severely impaired stroke survivors in South Africa. 21 iv completed responses were analysed using the Content Validity Index Method and descriptive statistics. 2.1.3. Conclusion This study was completed following ethical approval by the Wits Human Research Ethics Committee. A total of 21 responses were collected (n=21) with 17 and 4 participants from the private and public sectors respectively. This study found the MoCA to be largely a valid tool for screening cognition in stroke survivors living in South Africa. However, this was not without critique. Low simplicity scores and poor item-level validity of the executive function were areas of concern for participants considering diverse demographics of stroke survivors in South Africa, as well as the confounding effects of other stroke-related impairments. Moreover, participants felt that the MoCA does not adequately screen for PSCI, nor does it screen the most commonly affected cognitive skills following stroke. Despite these concerns, the MoCA remains widely used. This is due to a lack of other screening tools which are recommended for use with stroke survivors and have some adaptation to account for demographics (specifically language). Future research should focus on adding to the body of information around the MoCA and its clinical utility for stroke survivors in South Africa to develop a set of normative data, build a foundation of empirical data on the validity of the MoCA in both the private and public sectors, and develop a body of information which could help with the development of a diagnostic and contextually relevant cognitive screening tool. Clinicians using the MoCA with stroke survivors in South Africa should be critical of the interpretation of scores considering demographic and other stroke-related factors. Furthermore, other resources and tools such as the Comprehensive ICF Core Set for Stroke, the Cognitive Assessment for Stroke Patients, the Oxford Cognitive Screen and the MMSE should be utilised to supplement the MoCA administration to triangulate data on test performance; and provide a guide/checklist for commonly affected cognitive skills to be adequately assessed and observed during the evaluation phase of rehabilitation
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    Predictors of TB disease in HIV-exposed children from Southern Africa
    (International Union Against Tuberculosis and Lung Disease, 2023-08) Maritz, E. R.; Montepiedra, G.; Mitchell, C. D.; Madhi, S. A.; Bobat, R.; Violari, A.; Hesseling, A. C.; Cotton, M. F.
    BACKGROUND: P1041 was a randomised, placebocontrolled isoniazid prophylaxis trial in South Africa. We studied predictors for TB in HIV-exposed children participating in the P1041 trial. METHODS: We included data from entry until Week 108. Predictors considered were type of housing, overcrowding, age, sex, ethnicity, tobacco exposure, weightfor-age percentile Z-score (WAZ), CD4%, viral load (VL), antiretroviral therapy (ART) and number of household smokers. RESULTS: Of 543 HIV-positive (HIV1) and 808 HIVexposed uninfected (HEU) infants at entry, median age was 96 days (interquartile range: 92–105). Of 1,351 caregivers, 125 (9%) had a smoking history, and 62/1,351 reported current smoking. In 594/1,351 (44%) households, there was at least one smoker. Smoking caregivers consumed 1–5 cigarettes daily. In the HIV1 cohort, significant baseline TB predictors after adjusting covariates were as follows: WAZ (adjusted hazard ratio [aHR] 0.76, P 5 0.002) and log10 HIV RNA copies/ml (aHR 1.50, P 5 0.009). Higher CD4% (aHR 0.88, P 5 0.002) and ART (aHR 0.50, P 5 0.006) were protective. In the HEU cohort, smoking exposure was associated with reduced TB-free survival on univariate analysis, but not after adjustment in the multivariate model. CONCLUSION: Low WAZ and high VL were strong predictors of TB disease or death. Rising CD4 percentage and being on ART were protective in the HIV1 cohort