BackgroundThe disability associated with depression and its impact on maternal and child health has important implications for public health policy. While the prevalence of postnatal depression is high, there are no prevalence data on antenatal depression in South Africa. The purpose of this study was to determine the prevalence and correlates of depressed mood in pregnancy in Cape Town peri-urban settlements.MethodsThis study reports on baseline data collected from the Philani Mentor Mothers Project (PMMP), a community-based, cluster-randomized controlled trial on the outskirts of Cape Town, South Africa. The PMMP aims to evaluate the effectiveness of a home-based intervention for preventing and managing illnesses related to HIV, TB, alcohol use and malnutrition in pregnant mothers and their infants. Participants were 1062 pregnant women from Khayelitsha and Mfuleni, Cape Town. Measures included the Edinburgh Postnatal Depression Scale (EPDS), the Derived AUDIT-C, indices for social support with regards to partner and parents, and questions concerning socio-demographics, intimate partner violence, and the current pregnancy. Data were analysed using bivariate analyses followed by logistic regression.ResultsDepressed mood in pregnancy was reported by 39% of mothers. The strongest predictors of depressed mood were lack of partner support, intimate partner violence, having a household income below R2000 per month, and younger age.ConclusionsThe high prevalence of depressed mood in pregnancy necessitates early screening and intervention in primary health care and antenatal settings for depression. The effectiveness and scalability of community-based interventions for maternal depression must be developed for pregnant women in peri-urban settlements.Trial registrationClinicalTrials.gov: NCT00972699.

We describe a case study of a third-year undergraduate class in Enterprise Education. A blended learning design in the form of a flipped classroom with a duration of one semester, was explored in two cohorts. The question was to explore how students experienced the flipped class for learning and how this approach presented the different presences in the Community of Inquiry (CoI), and its revisions. The online learning components represented the individual learning space, where the main resource was bespoke videos that replaced lectures and complemented the textbook and other learning material. The classroom hosted a business school-style seminar where students in small groups engaged in solving a new business case study, going through phases of developing a concept to presenting the group solutions to the class. It aimed at fostering active learning both inside and outside the class. Students participated in the activities to apply the theory in new cases. The teacher facilitated the sessions, provided direction and correction as needed. The research used mixed methods consisting of trace data, quantitative and qualitative student feedback to explore how suitable the flipped classroom in undergraduate education was towards developing deep learning. The online individual learning space yielded highly salient Teaching Presences, accompanied by evidence of Agency Presence, characterised by independent activity and personal learning preferences. Online videos and ICT resources helped with understanding the theory ahead of class meetings. Seminars in the collaborative space fostered deep learning of the theory, and enabled students to apply the prepared theory in case studies and solve problems. Integration and particularly Resolution in Cognitive Presence of CoI featured in the seminars, while Social Presence was the weakest. Suggestions are made to implement the flipped class principles in an online class.

Innovations in health, such as the use of tablet computers, show promise in broadening the scope of work of community health workers (CHWs), and play an important role in keeping CHWs and their clients up to date with advancements in health. While the use of mobile phones and tablets is innovative, the applicability of these technologies in different contexts remains poorly understood. Furthermore, little is known about the acceptability and feasibility of the use of video teaching tools on such devices across diverse contexts. In this study, we aimed to explore the acceptability and feasibility of using tablets with teaching videos (about HIV, alcohol, nutrition and breastfeeding) to support the health promotion efforts of 24 CHWs who work with pregnant mothers and mothers of young children in an urban township in South Africa. Between November 2015 and May 2016, we conducted focus groups and identified four key themes (with several sub-themes) that demonstrated factors related to the acceptability and feasibility of these devices and their content. Focus group transcripts were analysed thematically using qualitative data analysis software. The findings indicated that while the devices contained several supportive features (such as lightening the workload, and stimulating interest in their work), they also contained several restrictive features (safety and confidentiality). CHWs considered the video content an important tool to engage not only their clients but also family members and the community at large. Issues surrounding safety, privacy and confidentiality of using these devices require careful consideration prior to implementation in large-scale studies. Furthermore, stigma associated with household visits by CHWs and the nature of their work also need to be addressed by researchers and programme implementers. Overall, CHWs deemed the devices and the video content an acceptable and feasible means with which to provide health promotion and education among their clients.

Cognitive development and child growth among children born to mothers with antenatal depressed mood can be improved by mentor mother home visitors, probably resulting from better parenting and care received early in life.

PurposeIn spite of research on entrepreneurial intentions being a mature field of enquiry, little is known about the influence of experience on entrepreneurial intentions, especially among the youth and in developing contexts. This paper aims to investigate the impact of different types of experience – entrepreneurial early childhood experiences, prior start-up experiences, work experience, education and peer influence – on the entrepreneurial intentions of South African youth.Design/methodology/approachFirst, a quantitative survey of 827 secondary students was administered, and the results were analysed by means of hierarchical logistic regression. Second, two focus groups were conducted with secondary students representing two distinct segments of South African society to shed light on some of the unique survey findings.FindingsThe results revealed that the experiences of having attempted to start a business and having previously worked in a business, as well as entrepreneurship education, have a positive influence on youth entrepreneurial intentions, while peers' entrepreneurial intentions exert a negative influence. Peer influence and contextual factors such as family and community support, which are catalytic in other parts of the world, appear to dampen youth entrepreneurial intentions because of fear of failure and fear of competition.Originality/valueThis paper examines the influence of a broader taxonomy of experience types on youth entrepreneurial intentions than found in previous studies. It highlights the unique role played by specific types of experience and points to the need to include extra-curricular entrepreneurial experiences in interventions aimed at fostering youth entrepreneurial intentions in developing nations.

The removal of trade barriers has encouraged the entry of new competitors into formerly protected markets. This situation creates pressure on many small and medium enterprises (SMEs) in emerging economies such as Tanzania. Using a survey method and cross-sectional research design, the research examines three dimensions of entrepreneurial orientation (EO), namely: pro-activeness, risk-taking and competitive aggressiveness. Understanding their relationships and variance may help to improve our ability to explain SME performance. The findings contribute to how SME performance in emerging economies can be enhanced to enable SMEs to face challenges posed by competitor influx in the context of an open market economy. The findings indicate a strong relationship between EO dimensions and performance, with risktaking and competitive aggressiveness moderating the effect of pro-activeness. The proposed model could predict 72% of the variance explained in SME performance.

Background: In South Africa, rates of exclusive breastfeeding remain low and breastfeeding promotion is a national health priority. Mobile health and narrative entertainment-education are recognized strategies for health promotion. Inhome counseling by community health workers (CHWs) is a proven breastfeeding promotion strategy. This protocol outlines a cluster-randomized controlled trial with a nested mixed-methods evaluation of the MObile Video Intervention for Exclusive breastfeeding (MOVIE) program. The evaluation will quantify the causal effect of the MOVIE program and generate a detailed understanding of the context in which the intervention took place and the mechanisms through which it enacted change. Findings from the study will inform the anticipated scale-up of mobile video health interventions in South Africa and the wider sub-Saharan region. Methods: We will conduct a stratified cluster-randomized controlled trial in urban communities of the Western Cape, to measure the effect of the MOVIE intervention on exclusive breastfeeding and other infant feeding practices. Eightyfour mentor-mothers (CHWs employed by the Philani Maternal Child Health and Nutrition Trust) will be randomized 1:1 into intervention and control arms, stratified by neighborhood type. Mentor-mothers in the control arm will provide standard of care (SoC) perinatal in-home counseling. Mentor-mothers in the intervention arm will provide SoC plus the MOVIE intervention. At least 1008 pregnant participants will be enrolled in the study and mother-child pairs will be followed until 5 months post-delivery. The primary outcomes of the study are exclusive breastfeeding at 1 and 5 months of age. Secondary outcomes are other infant feeding practices and maternal knowledge. In order to capture human-centered underpinnings of the intervention, we will conduct interviews with stakeholders engaged in the intervention design. To contextualize quantitative findings and understand the mechanisms through which the intervention enacted change, end-line focus groups with mentor-mothers will be conducted.

Introduction Pregnant South African women with histories of drinking alcohol, abuse by violent partners, depression, and living with HIV are likely to have their post-birth trajectories over 36 months significantly influenced by these risks. Design All pregnant women in 24 Cape Town neighborhoods were recruited into a cluster RCT by neighborhood to either: (1) a standard care condition (n=12 neighborhoods, n=594 mothers); or (2) a home-visiting intervention condition (n=12 neighborhoods, n=644 mothers). Setting/participants Pregnant women residing in urban, low-income neighborhoods in Cape Town, South Africa. Intervention Home visiting included prenatal and postnatal visits by community health workers (Mentor Mothers) focusing on general maternal and child health, HIV/tuberculosis, alcohol use, and nutrition. Main outcome measures Mothers were assessed in pregnancy and at 18 and 36 months post birth: 80.6% of mothers completed all assessments between 2009 and 2014 and were included in these analyses performed in 2014. Longitudinal structural equation modeling examined alcohol use, partner violence, and depression at the baseline and 18-month interviews as predictors of maternal outcomes at 36 months post birth. Results Relative to standard care, intervention mothers were significantly less likely to report depressive symptoms and more positive quality of life at 36 months. Alcohol use was significantly related to use over time, but was also related to depression and HIV status at each assessment and partner violence at 36 months. Conclusions Alcohol, partner violence, and depression are significantly related over time. A home-visiting intervention improved the emotional health of low-income mothers even when depression was not initially targeted.